The P Wave P waves are caused by atrial depolarization. In normal sinus rhythm, the SA node acts as the pacemaker. The electrical impulse from the SA node spreads over the right and left atria to cause atrial depolarization. The P wave contour is usually smooth, entirely positive and of uniform size. The P wave duration is normally less than 0.12 sec and the amplitude is normally less than 0.25 mV. A negative P-wave can indicate depolarization arising from the AV node.
Note that the P wave corresponds to electrical impulses not mechanical atria contraction. Atrial contraction begins at about the middle of the P wave and continues during the PR segment. The PR Segment PR segment is the portion on the ECG wave from the end of the P wave to the beginning of the QRS complex, lasting about 0.1 seconds. The PR segment corresponds to the time between the end of atrial depolarization to the onset of ventricular depolarization. The PR segment is an isoelectric segment, that is, no wave or deflection is recorded. During the PR segment, the impulse travels from the AV node through the conducting tissue (bundle branches, and Purkinje fibers) towards the ventricles. Most of the delay in the PR segment occurs in the AV node. Although the PR segment is isoelectric, the atrial are actually contracting, filling the ventricles before ventricular systole.
The QRS Complex In normal sinus rhythm, each P wave is followed by a QRS complex. The QRS complex represents the time it takes for depolarization of the ventricles. The Q wave is not always present. The R wave is the point when half of the ventricular myocardium has been depolarized. The normal QRS duration range is from 0.04 sec to 0.12 sec measured from the initial deflection of the QRS from the isoelectric line to the end of the QRS complex.
Normal ventricular depolarization requires normal function of the right and left bundle branches. A block in either the right or left bundle branch delays depolarization of the ventricles, resulting in a prolonged QRS duration.
The ST Segment The ST segment represents the period from the end of ventricular depolarization to the beginning of ventricular repolarization. The ST segment lies between the end of the QRS complex and the initial deflection of the T-wave and is normally isoelectric. Although the ST segment is isoelectric, the ventricules are actually contracting.
The T Wave The T wave corresponds to the rapid ventricular repolarization. The wave is normally rounded and positive.
Top 10 actions
Earth Day Canada president Jed Goldberg has identified his top 10 actions to make every day Earth Day.
1. Think before you act. Shopping has become a form of entertainment. While it can be difficult to avoid the seduction of advertising, Goldberg advises to think about what you need, not what you want, before you buy.
2. It’s all about conservation. Goldberg says we need to make the shift from being “consumers” to “prosumers” – producing consumers – to conserve energy and resources. Planting a garden is a great way to start.
3. Go vegetarian one day a week. Meat production has a huge environmental impact. Eating lower on the food chain just one day a week helps to conserve water, reduce greenhouse gas emissions and preserve valuable farmland.
4. Rethink convenience. Goldberg says people do things because they perceive that it’s easier, but easy isn’t always what’s best. Doing things in an environmentally responsible way can ultimately end up being more convenient and much cheaper, too! One example, stop buying bottled water and use tap water instead.
5. Eat and shop locally. Most of our food travels thousands of kilometres to get to our dinner plates. Ditto for our clothing and other consumers goods. Supporting local businesses also helps to build strong local communities.
6. Vote with your dollar. Advertisers and producers are conscious of what consumers want says Goldberg. Take the time to express your opinion to store owners with your wallet and your voice.
7. Use active transportation. Whether it’s walking, cycling or rollerblading, when you use your body to get from A to B instead of a motorized vehicle, you not only get the benefit of improved fitness while reducing your environmental impact, but you get to experience your community.
8. Borrow, don’t buy. Consider renting, borrowing or sharing what you need.
9. Refashion your yard. Instead of trying to achieve the perfect, lawn, why not get rid of the lawn altogether. Plant native shrubs, wildflowers or a vegetable garden. You’ll use fewer resources and free yourself from the lawnmower, too!
10. Use your sphere of influence. Collectively we have a great influence over our politicians, says Goldberg. Engage your family, friends, coworkers and community.
Our pancreas is affected by diabetes – specifically, Type 2.Our body contains glucose found in the blood stream, which it gets from the sugar in food. Our body uses the glucose, but only when it goes into our blood cells and the insulin released by our pancreas converts it. Insulin production and utilization is difficult for someone who lives with Type 2 diabetes .There is a lot of glucose in the body, but your cells cannot locate them.
The American Diabetes Association has the duty of looking for information regarding this important medical condition. 23.6 million individuals living in America currently have diabetes, and because of this the country is seen as very unhealthy. Ninety percent of this figure has been diagnosed with Type 2 diabetes. Diabetes and the tendency to be overweight usually run in the family. If there is too much glucose in your body, it could result in serious internal organ damage and affect one’s nervous system.
Living with Diabetes
A life with Type 2 diabetes is best lived in a healthy way. Diabetics will find that healthy practices will have a huge effect on them. Simple actions like eating healthy food and exercising are considered as healthy practices. Keeping the levels of your glucose within the appropriate range ensures you stay away from health complications.
To check the levels of blood glucose in your body, you can do the common finger prick test. Physicians say that such a test is comparable to the HbA1c test when tracking the glucose fluctuations in your body. This HbA1c test works by determining how high your glucose levels are and by identifying the blood’s exact glycated hemoglobin percentage. According to results of the A1c tests, people who have diabetes maintain their levels at seven percent. A seven percent maintaining level of a1c, according to the CDC, can dramatically reduce the risks of this disease by around forty percent.
Too-Tight Controls
Many studies in the medical field show that if your a1c levels are below seven percent it could mean a bad thing. People who use insulin and people who have median a1c levels have a higher death risk, according to the Seattle Lancet and Swedish Medical Center’s studies. Other tests maintain that keeping your a1c level at seven percent is still on the healthy side. Accredited endocrinologist Matt Davies shares that seven percent is healthy but it is still important for physicians to consider a patient’s medical history before implementing treatment.
About the Author – Kristina Ridley writes for the bloodless glucose meter blog , her personal hobby blog focused on healthy eating and tips to measure blood glucose levels at home to help people understand early diabetes symptoms.
SmartOne ECG is a self-service consumer portable heart monitor for checking abnormal heart rhythms.
The device can safely measure electrical activities of the heart using one’s finger tips without the need for any trained technician.Upon placing thumbs on the sensor panel of the portable ecg machine,a digital output of the heart rhythm is displayed.If the reading displays any abnormal heart rhythm,it indicates the user the type of abnormal heart rhythm.Atrial fibrillation is an important risk factor for stroke.
According to the WHO,15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on family and community.
The FDA advised patients currently taking Invirase that they should not stop taking the drug, but to discuss any questions or concerns they have about Invirase with their doctors.
As well, the FDA said patients should review their cardiovascular medical history and current medications with their doctors to determine if they should continue using Invirase, and report any side-effects.
FDA’s preliminary analysis of clinical trial data from Invirase’s manufacturer, Roche, suggests the drug combination can lead to irregular heart rhythms that can cause lightheadedness, fainting and in some cases death.
The heart rhythm problem occurred in healthy patients aged 18 to 55 who were taking 1,000 mg of Invirase boosted with 100 mg of Norvir. The side-effects depended on the dose, FDA said.
The FDA is still reviewing the magnitude of the effects and their clinical implications.
What are arrhythmias?
Arrhythmias (or dysrhythmias) are problems that affect the electrical system of the heart muscle, producing abnormal heart rhythms. They can cause the heart to pump less effectively.
The heart has four chambers. The top two are the atria, and the lower two are the ventricles. Normally the heartbeat starts in the right atrium when a special group of cells sends an electrical signal. (These cells are called the sinoatrial or SA node, the sinus node or the heart’s “pacemaker.”) This signal spreads throughout the atria and to the atrioventricular (A-V) node. The A-V node connects to a group of fibers in the ventricles that conduct the electrical signal. The impulse travels down these specialized fibers (the His-Purkinje system) to all parts of the ventricles. The electrical signal must follow this exact route for the heart to pump properly.
Under some conditions almost all heart tissue can start a heartbeat. In other words, another part of the heart can become the pacemaker. An arrhythmia occurs…
Did you know that most of the diagnostic tests are often taken for granted by most of physicians and patients?And most of the Diagnostic information is imperfect!!
When any test or an diagnostic evaluation is ordered by the physician,it is most often taken as a true representation of what is really going on with the patient,when in reality it is an error.These tests may not reflect on truly what is going on with the patient.When any test is performed on the patient,two important concerns are safety and efficacy.The other important criteria is cost of the investigation.In the current era of rising costs,combing the two factors is critical for effective patient management.
The efficacy of a diagnostic test should be measured in terms of the test’s safety, its technical quality, its accuracy, its therapeutic impact, and its impact on the health of the patient (Fineberg et al. 1977).
The second stage of an efficacy assessment is to define the test’s diagnostic accuracy. In this regard, three commonly used expressions are true-positive rate, truenegative rate, and accuracy. The true-positive rate, or sensitivity, is a measure of the test’s ability to detect disease correctly when it is present. The true-negative rate, or specificity, measures the test’s ability to exclude disease in those patients who do not have it. Accuracy is the proportion of test results that are correct (true-positive results plus truenegative results divided by the total number of test results) when the test is used in a specified population. Thus, it is a reflection of both the sensitivity and the specificity of the test.To call a test result a true positive or a true negative, one must determine the true state of the patient. This is usually accomplished by doing another test, called the “gold standard,” which is considered sufficiently reliable to reveal the true state of the patient, and either confirm or refute the study test result. For example, coronary angiography has been used to verify the presence of coronary artery disease in patients participating in an efficacy study of the stress electrocardiogram. For an ideal test, there should be little disagreement between its result and the result of the “gold standard”: the test should have both high sensitivity and high specificity.
Although quantitative measures of test performance are important, a study of efficacy should not focus solely on its technical aspects (that is, on the machine). Rather, an assessment should include data on diagnostic impact and on therapeutic impact, including outcomes that are relevant to the patient. These are the third and fourth levels of an efficacy assessment.
The following questions needs to be asked by the patient to their health care provider before any diagnostic tests are performed on them:
1.Does the result of the technique change the diagnosis?
2.Does the technique add clinically significant information?
3.Is the diagnostic impact one that changes my management?
Do you have any experience with diagnostic tests?Share your experience !!
Assessment of diagnostic technology in health care: rationale, methods & Directions-Monograph By Harold C. Sox
The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying Your Customers column, titled Engaging Staff with Social Media. In the article I describe how successful leaders will prepare for the shifts occurring in the healthcare workplace; including the push for efficiency and new generations. I also include a few examples of where social media is contributing to a more effective workplace in hospitals.
Social media technologies are tools that can help increase customer, physician and employee satisfaction. I hope you will take the time to read the article and share your thoughts.
Another blog post that includes a few great workplace examples is list of 20 hospitals with inspiring social media strategies.
I was interviewed for a recent article in Becker's Hospital Review that explores the common belief that older adults have more difficulty accepting and using technology. It includes some great comments about "digital natives" and "digital immigrants" by the other interviewees.
Speaking for myself, as a late Boomer, I can say that I certainly am a digital immigrant who has embraced technologies as I have found value to my work and life. And, I believe that this applies to older adults in general. There are differences in the generations and the oldest may need the most convincing and support, but it isn't that they can't incorporate technology into their daily life.
I remember older adults thinking it was a bit silly for people to carry around a cell phone. But, once they began to realize value - they feel safer because they can call for help -- then older adults start using the technology just as anyone else. If I'm correct, I also I believe this is how telephone adoption went. It took a long time for it to catch on and for people to find value in the technology.
Health IT is just one more advancement that needs to progress through the adoption cycle.
I've posted on the subject of volunteers, young people working in hospitals and those considering a career in healthcare administration, previously. However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.
Candy Stripers at Doctors Memorial Hospital, FL
I'd love to here your thoughts or stories about the youngest of our hospital workforce! If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com
I'm thinking I should also start researching the Pink Ladies, too!
The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism. I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.
All Changes to the Manual since the 2005 (fifth) edition
Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH). This means anyone can see the nosocomial infection rates of their local hospital by unit. But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital. Hospitals may be interested in using this data to benchmark themselves against other hospitals.
Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.
HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:
Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.
I participated in this morning's Gartner Worldwide IT Spending Forecast. Gartner, the technology research giant, brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially at this moment in time. The issues will have major revenue implications for vendors (perhaps leading to service changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.
The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to meeting demand. There is some uncertainty about this timeline.
This means:
One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of components to help prevent business disasters like this one. In this case all of our (the world's) eggs (hard drives) are manufactured in one basket (Thailand).
PC and software spending is down due to the downturn in the economy. But, there was one bit of good news that I pulled from the discussion on software. Spending on software (tools) for collaboration is increasing. Companies are investing in technologies that will help them stay competitive and this means tools that will help their employees collaborate will reduce the need to bring on additional people.
Now, I've been seeing this in other industries and have started to see it trickle into healthcare. With health reform upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.
The American College of Physicians has a YouTube video that demonstrates the impact of low health literacy on the healthcare delivery system and costs. Healthcare administrators and clinicians should view this video to see the challenges for themselves. Notice the potential for medication errors alone!
It reminds me of Louise, the discharge advocate!
This video hits a little close to home since LSU Shreveport seems to have been involved and a few of the accents were familiar. However, this is an issue across the US.
A look ahead at healthcare data points to increased risks, regulatory expectations and reputational fallout. So it was a pleasure that I could contribute to a list of the top 10 trends for 2012 in healthcare data. And, I really do appreciate so may news organizations carrying the story.
My hope is that by increasing awareness of the risk among both healthcare providers and consumers, the necessary safeguards will get implemented. The top 2012 predictions in healthcare data are:
See PR Newswire for the complete release.
The NIMS objectives for hospitals have been reduced from 14 to 11 and there is some new clarification and guidance. The changes, effective July 1, 2012, include:
Combining Object s 8 & 10: Promote and ensure that hospital processes, equipment, communication and data interoperability facilitate the collection and distribution of consistent and accurate information with local and state partners during an incident or event
Combining Objectives 11 & 12: Manage all emergency incidents, exercises, and preplanned (recurring/special) events with consistent application of ICS organizational strucutres, doctrine, processes and procedures.
Combining Objectives 13 & 14: Adopt the principle of Public Information, facilitated by the use of the Joint Information System (JIS) and Joint Information Center (JIC) ensuring that Public Information procedures and processes gather, verify, coordinate and disseminate information during an incident or event.
Revised guidance for personnel requiring NIMS related training (reduced emphasis on IS 800 for hosptial staff and clarification of staff needing IS 100, 200 and 700) Note: From reading the Implemention Guidance I'm not reallying seeing a reduced emphasis on IS800. I'll follow-up on this one and report back.
Each of the 11 objectives are important, because compliance is a condition to receive Federal Preparedness Assistance, such as receipt of funds from the Hospital Preparedness Program. These funds are to be used to maintain, refine and enhance healthcare organization capabilities, as well as, exercising and improving preparedness plans for all hazards.
In addition, compliance with NIMS is also required for receipt of some FEMA funds after a declared disaster has impacted a healthcare organization.
I'm preparing to audit several hospitals in 2012 for compliance with the NIMS Objectives and welcome you to contact me if I can do the same for you. Write to Christina {at} cthielst {dot} com.
When will our employees learn not to identify patients on Facebook or any other social media site. This recent example goes beyond a simple error in judgment to a complete disregard for patient privacy and respect by the employee of a staffing agency working at a hospital in Southern California.
The patient involved sought treatment for an STD and the employee took a picture of her medical record and posted it on his Facebook page with the comment: "Funny, but this patient came in to cure her VD and get birth control."
I've read the article a couple of times and discussed it with other healthcare leaders. The following come to mind:
1. First, there is the policy and staff training/education that must occur by all providers on social media in the healthcare setting.
2. Beyond the policy and training, we need to consider the character of the person we are hiring or bringing into our environment of care. They may be the best ER nurse in the world, but if they have a complete disregard for patient privacy and respect, you may not want them working with your patients.
3. Clues may come from looking at what it is like to work with someone. This agency employee's response to the post is that he would leave the post up and he writes:
"People, it's just Facebook... Not reality. Hello? Again...It's just a name out of millions and millions of names. If some people can't appreciate my humor than tough. And if you don't like it too bad because it's my wall and I'll post what I want to. Cheers!"
Is this his attitude with co-workers about other disagreements? Is this really someone we want working in healthcare or any other caring profession?
4. Contracts with vendors, including staffing agencies, should already address their employee use of social media ... in line with your organization's policy. And, their staff should be trained before they are allowed to begin working with your patients and in your healthcare environment.
5. The younger generations of healthcare workers are using social media, especially on mobile devices, on a daily and hourly basis. As healthcare leaders, we need to educate and guide them in understanding the boundaries between their personal and professional lives.
6. As Thomas Friedman states in his book, The World is Flat, "we {as healthcare leaders} really do have to find ways to affect the imagination of those who would use the tools of collaboration to destroy the world that has invented those tools."
7. Disbarment: The Feds have a list of disbarred individuals who have inappropriately used federal funds. I think it is time that they create a new list of individuals who are disbared from ever caring, treating or working around Federal beneficiaries. This guy should be first on the list!
Ed Bennet has a really cool map displaying social media use by hospitals. If you haven't already, you should visit his blog Found in Cache, which includes some great hospital social media resources.
Thanks for sharing your list and the map, Ed!
Here is a new example of where having a comprehensive social media policy will come in handy for minimizing risks and associated legal costs. It involves an employee who left an Internet company and took a Twitter account being used for business purposes. This includes all of the followers that had been built-up over his tenure -- who are now receiving tweets from a competitor business. So now, there is a lawsuit over ownership and value of the followers.
Having a policy that clearly stated that the account was the property of the business and implementing appropriate steps to secure the account at the time of the employee's departure would have saved much grief for both parties. For those who have authority to engage on the healthcare organization's social media channels, changing passwords to secure the account should occur at the same time you are collecting ID badges, keys and other property.
I've been hearing a push for have simple one page social media policies and I agree that a concise policy is best. However, I fear some healthcare organizations will eliminate important details in an effort to keep the policy short. It all comes down to negotiating the language with risk management and legal advisers.
My guest blog post for Health IT Exchange made it onto their list of top 7 community blogs of 2011. Telehealth, the cloud and BI — oh my! includes my post on the importance of connecting health IT with disaster planning and others addressing some of my favorite topics - telehealth, meaningful use, health information exchange, the cloud and medical devices.
Their list of top 2011 blogs also also includes something new for me - voice commands on mobile devices. I've been watching my teenage daughter, who has a form of dyslexia, speak into her new phone (Christmas present) to text her friends. It has gotten me thinking...
To all of my readers, I wish you a very happy and healthy new year!
Thousands of earthquakes occur in the United States each year; most are too small to significantly affect businesses and communities. However, large and very damaging earthquakes have occurred in the past and could happen again at anytime. In general, many businesses (and healthcare providers) have invested in emergency management and continuity of operations planning. However, most businesses have not conducted earthquake mitigation measures to protect their assets, staff, and business operations. During an earthquake, buildings—or their components or contents—can be collapsed, toppled, broken apart, tossed around, or rendered inoperable or unusable.
Therefore, as part of addressing all-hazards emergency management, it is critical for businesses (and healthcare providers) to also incorporate actionable earthquake mitigation solutions into their planning and business decisions. By doing so, businesses protect the organization’s assets (people, property, operations); sustain the capability to provide goods and/or services to the community; maintain cash flow; preserve competitive advantage and reputation; and provide the ability to meet legal, regulatory, financial and contractual obligations.
To help businesses (and even healthcare providers), the Federal Emergency Management Agency (FEMA) National Earthquake Hazards Reduction Program (NEHRP) has released FEMA P-811 CD: Earthquake Publications for Businesses (QuakeSmart Toolkit).
This QuakeSmart Toolkit (FEMA P-811CD) provides business owners, managers, and employees with basic guidance and ready-to-use tools that can be tailored to the specific needs and requirements of the user. The guidance and tools focus on the importance of earthquake mitigation and the simple things they can do to reduce the potential of earthquake damages, injuries, and financial losses at work…AND also at home and within their communities.
The toolkit walks you through the following 3-step QuakeSmart process:
These resources are especially timely for California, because the 2012 Statewide Medical and Health Training and Exercise will be an earthquake scenario. View or download the QuakeSmart Toolkit (FEMA P-811CD) or order CD copies of the QuakeSmart Toolkit from the FEMA Publications Warehouse by calling (800) 480-2520. Or fax your request to (240) 699-0525. All orders will be shipped in January 2012.
Other FEMA materials and earthquake guidance are also available.
My latest article for HIT Exchange Magazine, titled EHR Pitfalls, is drawn from a lively HIMSS LinkedIn Group discussion (via social media) that has lasted for over two years.
It all started with a fairly straight-forward question -- "what are the top ten reasons why EMR/EHR implementations are failing?" Since then, there has been a great deal of technical discussion, a couple of disagreements and even one or two heated debates. But, the body of work that continues to grow is truly amazing.
The EHR Pitfalls article pulls some of the pearls of wisdom together and blends key themes to present an overview. As always, I welcome your comments and feedback on this article.
Hew (hyū) v.
“In every block of marble I see a statue as plain as though it stood before me, shaped and perfect in attitude and action. I have only to hew away the rough walls that imprison the lovely apparition to reveal it to the other eyes as mine see it.” – Michaelangelo
An unfinished Michealangelo sculpture.
I just re-read this quote – I think it is a powerful metaphor for any innovator that is out there trying to change the world.They are the ones that can see the fully defined, fully articulated, and fully functional end product within the building blocks that others pass off as mere landscape material. I think this gift of vision – this ability to “see” what others cannot – and the doggedness to stick to the mindless chipping away until others can see it enough to give you the tools you need to finish it off.
We are privileged to be working on a HUGE project right now with a highly innovative company that sees the value of what we are doing and wants to be a part of changing health care. It has been fun to work with them to begin the process of “hewing” away and to literally see the game changing product we have always seen begin to take shape from the dust, the chipped stone, the dirty hands, and the bleeding fingers. The process of discovery and refinement is almost as fun as seeing how the end product will move people.
I am on an email list of Bill DeMarco’s, a reputable industry insider who has written and consulted extensively in the physician group and medical management space. He recently sent me a note about several physician aggregation events in New Jersey.
For some reason it struck a nerve with me . . . which led me to fire off the response below:
Bill,
I thought we already saw this movie?
My question for you . . . besides banding together in some megagroup – what are these physicians doing to actual change the delivery of medicine? ACO is just the latest buzzword excuse to aggregate physicians under a new moniker and a supposed new model.
I am highly suspect that these physicians are doing anything to change the relationship with their patients, to use enabling technology to create team based care, or actually be accountable for the outcomes they produce. What systems are they using to tie themselves together? What financial alignment do they have? What measures are they using to demonstrate superior outcomes? What about the patient experience – 7 minute visits that push pills as the “treatment” won’t get it done in the future.
I think your closing statement, “Representatives from Summit and Optimus were unavailable for comment” says it all.
Am I seeing this the wrong way? Is there anything new about this model this time around? Am I getting old enough to see these things cycle through?
PS – and no, I don’t mean a wolf. The sheep get nervous and band together waiting to get pounced on by wolves.
I don’t even think there is anything to say about this picture:
This is why our health care system as current constructed is a massive #FAIL. Obamacare does NOTHING to change this.
Relevant (rĕl’ə-vənt)
1. Having to do with the matter at hand; to the point
I read with amusement Susanna Fox’s redux review about the relevance of Health 2.0 in general and in changing patient’s behavior specifically. Here questions reveals her bias in a very limited definition of Health 2.0 that I attempted to abolish originally in some of my bantering with Matthew Holt. I always saw Health 2.0 as a “movement” that would not be defined so much by its technology but rather enabled by it. As an “enabler”, the technology can help people do new things in new ways but I never believed technology in and of itself had the power to truly change health, health behaviors, or health care delivery in and of itself.
That is why my definition of health 2.0 was always more expansive and contemplated an entire “movement” to the next generation health care “system”. This new system must include new delivery models, new financing mechanism, and the new tools and technology that bring all of this together in a simple, efficient, and affordable way. Clearly this next generation of care would include technology, the new tools, but until we had a new delivery system that is financed in a new way we are going to continue to have the same behaviors across the patient, physician, provider, and payor continuum.
So Susanna, I don’t think your version of Health 2.0 (Tools and Technology) do much to get us to the behavior change you seek. In fact, getting to the root of behavior change requires almost a religious experience. Interestingly enough, the health care industry provides plenty of “religious” experiences including passing close to death, unbelievably poor customer experiences that invoke deep passions (ie, the birth of ePatient Dave), and promise of a far better world than we currently enjoy. So while the tools and technology show us what is possible, health care delivery and health finance are the catechismal doctrines we must reform first that actually incent the behavioral change we all seek.
So is Health 2.0 Relevant? I think it depends on your definition!
Extirpating (ĕk’stər-pāt’) v.
I recently took a great road trip with my two boys. We rented one of the new Kia Soul’s which my boys recognized from a very funny commercial developed to highlight its hipster (hamster?) vibe. The commercial reminded me of the old Hamburger A or Hamburger B commercials from Wendys back in the late 80′s wherein this ludicrous contrast is set up to demarcate the dichotomy between two distinct choices.
This modern reinvention of that age old contrast struck me because it is something that I deal with everyday in explaining Crossover Health to people. It all stems from a pervasive misconception about the term “Health Insurance”
Understanding the components parts of our modern conception of "Health Insurance" is the our first step toward meaningful reform.
The challenge is that “Health Insurance” is a confused term which most people equate with both Health Care (care delivery) and Health Finance (how you pay for it). Our current employer based system (wherein your employer provides and in most cases pays for your insurance) as well as a third party insurance payment system (we have the insurance pay for us) creates all kinds of weird incentives but also results in no accountability in terms of cost, quality, or outcome. It is currently imploding before our eyes.
Our reaction, both opportunistic as well as obligatory, is to do something totally different by blowing up the current Health Insurance model and separating out Health Care from how you pay for it (Health Financing). We say that there is a better way to do BOTH – pay your physician directly for the care you need and then get smart about how you pay for it with the right insurance product. In fact, you should “self insure” with the highest deductible plan you can find and then take responsibility for your health for all the small stuff or hire someone to do that for you (like Crossover Personal Health Advisory Service). There is no reason to intermediate with a parasitic organizations that are taking your premium dollars and wasting it on overhead, fancy offices, mindless phone trees, and my all time favorite “this is not a bill” disinformation pamphlets.
As people begin to take this in (they always get how the practice model is a radically improvement), they immediately revert back to the combined “Health Insurance” concept. Does Crossover Health want to replace my current “Health Insurance”? The answer is slightly nuanced, but a resounding YES! I want to replace what you call “Health Insurance” with a direct “Health Care” product (Crossover Health) and a smarter Health Finance product (highest deductible you can get).
We believe there are large and significant opportunities to roll this into a single product that can be purchased by employers, families, and other organizations seeking fresh alternatives that can demonstrate not only trend bending improvements but trend busting outcomes.
Piquant (pē-känt’) adj.
One of the great promises of technology is to make things simpler, easier, and more affordable for end users. In the medical practice, we have so much complexity, difficulty, and cost in most of our processes that when we find something that actually works as advertised we fall in love.
I had one such “appealingly provocative” experience this weekend. While attending a high school football game in support of one of my member patients (leading passer in Orange County by the way!), the player was injured. I initially thought it was a concussive injury but the reason he remained down was the he knew he had severely rolled his ankle. His father called me from the field (I was in the stands) and I followed along by text messaging as he was treated initially by the trainer and later by the team orthopedic surgeon. He was unable to continue playing due to the injury and it was iced and wrapped overnight.
The next morning I met him at our clinic, fired up our new TRX GP-5 machine (all digital x-ray machine), and took some beautiful images. These were captured on our PC based OmniView rendering software (proprietary and expensive) and fed to our OsiriX viewing software (open source and free!). I was able to manipulate the image at will, contrast and enlarge as needed to highlight all the structures, and automatically send the image to a remote radiologist for reading. No films to carry, no chemicals to purchase, and no storage required – ever. Simple, Efficient, and Affordable.
But I was just warming up.
The process we are using at Crossover Health to acquire an x-ray image to the iPad
The piquant was my ability to wirelessly transmit the image from my MacBook (serving as a server) to the iPad. This process is made possible by the fact that I have can move the standards based DICOM image from a PC to a MAC (using OsiriX), and then push it out to my iPad. While I thoroughly enjoy technology, I often get frustrated because I lack the technical expertise and patients to work out all the kinks. I was pleased to see that I was able to point and direct all the connections where they needed to go and the images appeared neatly onto my iPad without any problems.
From the patient experience, all they knew was that the image was shot, its being read by a board certified radiologist, and they are seeing, touching, and experience the iPad as a new device in our patient-physician relationship. The patient was intrigued, impressed, and engaged (entertained?) by the whole process. I dare say it was a “fun” visit (why does the typical health care experience have to be so lame anyway?) for them to participate in this process, see their physician pushing the technology barriers, and engaging in the diagnostic process in a way they never have before.
The piquant experience certainly piqued the interest of their family who had the family.
Insouciant (ĭn-sū’sē-ənt) adj.
Its a funny thing to start a brand new medical practice completely from scratch. To be completely unfettered, unbound, and perhaps a little unhinged to do things every way that you thought they can be done. It is actually quite a rare opportunity at Crossover Health for us to completely reinvent, redefine, and reimagine health care delivery, finance, and experience. Its an awesome endeavor – one that we enter into with humility realizing the challenges ahead, some confidence given our unique approach, and some swagger because what we are doing has very little precedent.
It reminds me of these guys:
Going down the rapids raw – despite the years of preparation, the preliminary surveying, and all the other typical preparations for any great adventure, at some point you just have to push off into the unknown and figure it out on the way down. Crossover Health has been in the works ever since I got my medical degree and finally having the opportunity to fully control the delivery system and to have free reign, nay, a mandate to innovate as much as possible, I look forward to the unknown possibilities with great anticipation.
As part of that discovery process, I always wondered who would be the very first patient at Crossover Health. I wondered who would be the person, what would be setting, the diagnosis, and how would this great journey begin. Well, I am pleased to report that we had two back to back visits by young patients who wanted to get their picture taken, sign our new patient poster, and show off their “sit-chi-ations”:
Some of our first few patients. All photographs used with permission by parents.
Two down, two decades to go!
FOR IMMEDIATE RELEASE
Crossover Health Launches New Model of Primary Care in South Orange County
Innovative membership service delivers Urgent, Primary, and Online Care
Aliso Viejo, CA (PRWEB) October 1, 2010
Crossover Health Medical Group announced today the launch of their flagship membership-based, primary care practice in Aliso Viejo, California. The new clinic will offer urgent, primary, and online care services directly to individual members, families, and employer groups. Membership based health care is a new health care finance and delivery innovation that has gained widespread popularity as the cost of health insurance and ongoing service deficiencies have plagued the current health care delivery system. The Crossover membership model decouples health care from health insurance, and allows individuals and organizations to purchase primary care directly from health care providers who offer increased access, enhanced services, and an exceptional service experience.
“The membership-based practice model allows Crossover Health to fundamentally change the way health care is practiced, delivered, and experienced,” according to Chief Executive Officer Scott Shreeve, MD. “Crossover has been specifically designed to restore and enhance the patient-physician relationship, increase access and convenience, reduce the cost of health care, and deliver an unprecedented patient experience.” The membership fee pays for access to the technology enabled practice and wellness services, as well as affordable prices for office visits, specialty consultations, and ongoing health management followups. A health concierge is assigned to each member to assist in overseeing follow-ups, proactive health maintenance, and care coordination. Crossover also provides health advisory services to guide patients in financial decisions related to the management of their health.
Crossover Health introduces two key innovations to the membership model. First, Crossover members have direct access to their physician via Crossover’s unique online, anytime, from anywhere technology platform that includes options for email, text, and video chat consultations. Second, the technology also enables a direct financial, administrative, and clinical relationship between the patient and their personal physician and the extended Crossover care team of medical specialists, diagnostic testing centers, and other licensed professionals. This inherent connectivity enables the creation of the Crossover Health Network™, a network of specialist providers who commit to deliver to a specific service level, make their prices transparent to members, and communicate on a common platform. The result is a simple, efficient, and affordable care experience.
“Many people, including employers, are surprised to find out how affordable exceptional health care can be when purchased directly from the physician,” said Chief Medical Officer Richard Patragnoni, MD. “Members can typically save a significant amount of money while enjoying a broader range and higher quality of personalized service to meet individual, family, or corporate health needs.” Crossover offers a variety of individual and corporate memberships that provide essential primary and preventive care services as well as targeted wellness programs like medical weight loss, executive health programs, health portfolio management, and virtual clinics.
Crossover Health memberships appeal to individuals looking to establish a personal relationship with a physician, families whose care requires a higher service level, and busy professionals who need flexible access to their physician. Membership care is particularly attractive to employers facing annual double digit health care cost increases. Employers using this model have consistently shown significant reduction in inappropriate utilization, dramatic improvements in satisfaction, and cost savings of up to 50% when bundled with lower premium insurance plans. Crossover Health is currently accepting new members throughout the Orange County area.
Blur (blûr) v.
As those who follow this blog know, we have been counting down from the 90 day mark toward our grand opening. The actual countdown has been expanded by the time-space continuum in that as you approach the speed of light time actually slows down.
Crossover Health Showroom feature wall and self check in area.
Crossover is all about a simple, affordable, and efficient health care experience.
However, the last 35 days have zoomed by without me providing the regular updates so here you go:
The good news is alot of it was captured on video or time lapse and I will be making some pointed comments in future posts regarding several aspects of our buildout and preparations for launch. Needless to say, it was a fabulous experience and we worked with an amazing high end retail builder – Display It – to create a space that is equal to the opportunity that we are pursuing. So take a long look . . . its all a blur to me.
By Sheldon Needle
The real problem of an established medical practice moving into the realm of EHR is not the cost of the medical software package; it is not the training necessary for staff; and it is not security and backups.
The real problem of moving into EMR/EHR is the problem of unstructured medical data.
If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious search to compare medical software vendors who are available to answer your questions honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient’s blood pressure or lab test values. You can get used to that.
Neither is it difficult to take notes on a notebook that upload to the EHR system.
The real problem is taking your notes and dictation on a patient that go back 15 years and finding a way to get his possible symptoms, his worry about IBS, his headache history, and his worries over his children into a metrically available rendition that that does not take you or a member of your practices days to decipher. These notes are usually on dictation, hand written notes, and referral letters.
The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear symptoms may not translate easily into metrics but may be critically important in future diagnoses.
There are two critical questions here:
In the long run, it doesn’t even matter if it is worth it. It will happen. Medicine as well as the rest of our cultural world, is becoming electronically-based whether we like it or not. But in the long run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself, and having all his data available to the admitting doctor in an instant: blood type, history, etc.
Think of a patient being referred to you, the specialist, and having all his patient history available in less than a minute. What a time saver! What insight!
Medical informatics has a number of methodologies it is using to translate unstructured data into useful and structured data.
Three basic methodologies exist to accomplish this:
These methods will be refined, utilized, and integrated in some way into most decent medical vendor software packages over the next few years. For you the physician or practice manager, this may start to pay off in a while, but you still have to get from hand written records into the database.
The obvious way to proceed makes use of our culture idea of, “going forward”:
The real message to practitioners moving to electronic health records is, don’t look at the top of the mountain when you start climbing, just put one foot in front of the other. Delaying the climb will not get you anywhere, but starting the march will move faster than you think!
Source:
Having recently spent time as an observer in a hospital setting, I was struck by the lack of intelligent planning and forethought made for doctors trying to move into an EMR / EHR environment.
Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR being used to record certain patient data, doctors were taking their notes in long-hand. Later on the same day I saw the same doctors transcribing their notes onto their computers. The doctors, doing double duty on note taking were not available to their patients because they were acting as secretaries.
When a large clinical environment is incorporating an EHR it has to be done in a modular way that does not impact productivity any more than it has to. The task is hard enough. If you are using an EHR to record point of care patient information, give your doctors a Notebook so they can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change with some forethought to peoples’ time and effort.
This real-life observation just underscores the need to plan for transition to an EMR rather than throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper Paratus! Always be ready and prepared.
Most good EMR / EHR systems can offer medical clients some guidance as to best practices in incorporating EMR / EHR systems within their practices.
By Sheldon Needle
The prospects for EHR in the coming year are exciting but more than a little daunting. The issue is really how to find an EMR/EHR system that will organize and centralize the functions of your practice, without bankrupting you and throwing your staff and yourself into turmoil.
If you look at the websites for EMR vendors today, you can see that the functions they describe within their system –the integration of clinical records with practice management data, e-prescription, patient portals — could conceptually do wonderful things for you and for your patients in the way you handle their individual cases, but many of the details are still not working smoothly.
Here are some of the things to be aware of:
Remember, always read the fine print and ask every question you need to. Know that EMR software decisions is a very competitive business. The vendors need you just as much as you need them!
By Sheldon Needle
5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.
The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.
This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:
About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.
Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.
If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!
By Sheldon Needle
November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the adoption and use of health IT in the form of meaningful-use qualified EHR in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.
The new administrative actions announced today, which will be made possible by provisions of the HITECH Act, will loosen requirements for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.
“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”
The press release continues to state: “HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”“ (The italics are ours.)
We need to understand what acting quickly means: buying in 2011? Incorporating EHR within the next month, so that meaningful use occurs in 2011? This is not yet clear.
HHS is redoubling its effort to reach out with information, education, and the possibility of incentive payments to doctors and hospitals and vendors about stepping up the pace of transitioning practices and HER software to meet standards of Meaningful Use. What Meaningful use means to the individual practice depends on size, degree of implementation of the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for instance, figures into the formula of Meaningful Use.
The Obama Administration is working to create a nationwide network of 62 Regional Extension Centers, comprised of local nonprofits, to help eligible health care providers learn how to participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.
See the HHS press release, at: http://www.hhs.gov/news/press/2011pres/11/20111130a.html to learn more.
Keep your eyes on the newspapers, government announcements and on this blog to learn about EMR and EHR news and updates.
By Sheldon Needle
You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?
Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:
1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?
Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?
Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!
2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company’s own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support
3. Do we have to set up all the hardware and maintain the software? I don’t think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.
4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.
The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.
Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.
Many EMR experts — both on the user side and the training side – agree that comprehensive training in the specifics of EMR software — or the absence of it, can be one of the most costly aspects of the transition from a paper based medical practice to an EMR /EHR.
Making the move to an EMR, and failing to train your staff adequately, can sour your entire staff, top to bottom, on the use of the EMR. You certainly need to avoid such a situation.
Here are some considerations and precautions to keep in mind and to discuss with your EMR vendor when evaluation the purchase or leasing of an EMR / EHR: Some of them will surprise you:
By Sheldon Needle
No one can promise you that Implementing an EMR, however good, can be easy and without false starts and problems. The changes you are planning to make – both in the way your practice does business, the workflow, and the change from paper trail to electronic documentation – are so major. Finding the right intersect between the needs of your medical practice and the features and strengths of a particular EMR/EHR will make this implementation go more smoothly. But it helps to know which EMR implementation problems you can surely anticipate, and which you can hope to avoid .
Here are some ideas to help avoid major disasters within your implementation:
There are so many critical planning and training factors to keep in mind in planning for your EMR/EHR, but these are critical ones. Look at the CTS Demos Scorecard to help you compare EMR/EHR software and find the right fit for your practice. Your practice – and your patients – stand to gain the most from a good EMR/HER fit and a semi-calm implementation.
Come back to this blog for additional EMR implementation and integration ideas and planning issues
By Sheldon Needle
Should you consider integrating your current Medical Practice Management System with a new EMR, or must you shift to an EMR that includes medical practice management functions?
Practices which are relatively new to software as a management tool sometimes do not realize the very different functions that a PMS (medical practice management system) and an EMR system offer:
A PMS is used for managing administrative, billing, scheduling, and budget related (financial) information, and an EMR is used for managing clinical, patient related information How feasible is it to integrate these two functions to produce reliable information for your practice, and to fulfill government reporting requirements.
Let us assume that you are a practice ahead of the wave, and you transitioned long ago to a medical billing software and medical scheduling system. You are very happy with it. It works for you and for your patients. Now the world, and the government, are at your door, and is pushing for a more total solution: an EMR / EHR.
Do you have to ditch the practice management system that you worked so hard to install and to customize to your needs and replace it with a total solution – an EMR that incorporates financial and billing capabilities? Or is there a way to keep you medical Practice Management System and integrate it safely with an EMR minus its billing and scheduling capabilities?
Here are some issues you must consider before you can answer this question:
Read the complete article at CTSGuides.com.
By Sheldon Needle
EMR’s come loaded with options, medical practice modules, streamlining techniques. But, unless your employees – physicians included –learn to harness (if not master) most of the modules of the EMR and tailor them to the work-flow of your practice, you will lose the advantages the EMR can bring.
Thus, training in the use and management of the EMR is almost as crucial as your choice of EMR. In fact, when you compare EMR software be sure to investigate the training options the EMR manufacturer, and the consultants who install it offer to a practice like yours. The training and support offered by an EMR vendor is as important as the quality of your EMR software. If you can’t use it correctly, and it doesn’t save you time and effort, it will make your whole practice miserable.
Here are some critical tips to keep in mind regarding training:
1. Understand the workflow of your practice. Chart it out on paper, for starters: who does what? Who follows up on a task. Just charting the progress of a medical prescription from the doctor’s pen to the patient’ pharmacy is a multi-person task. See what tasks may be eliminated or cut short by the use of your prescription module, for instance.
2. Understand who needs to be trained in what: Unless you are a 1-physician doctor’s office, different people generally perform different functions within the practice. Everyone doesn’t do everything, and doesn’t have to be trained in the use of all modules.
If you are dealing with a reputable vendor, the people who are installing your EMR will talk to you first about your workflow and your needs, and tailor and help customize the EMR to meet those needs. They and you will recognize the need to train different people in the use of different modules.
For instance, the people who handle medical practice management and medical insurance claims processing do not need to be expert in the Prescription Drug Tracking Modules. They may need to know how to access the module for reporting purposes, but they do not need to know all of its ins and outs as the doctors and nurses do.
3. Don’t try to implement the whole EMR at once. Virtually all EMR’s are modular, and handle different functions discretely. Since functions are often pretty complex, allow your employees to master a number of critical modules before they move on to others.
Read the complete article at CTSGuides.com.
It seems like everyone I talk to or interact with in the Health IT world is in full on HIMSS 12 preparation mode. I only attended my first HIMSS 2 years ago in Atlanta. So, I’m mostly a newbie at HIMSS. I sometimes long for the days when I just went to HIMSS with little real planning. I just went and enjoyed myself.
As you can imagine, HIMSS is a perfect place for me and my business. I’ve often told people that the core of my business is great content and advertisers. Turns out that every booth and every person at HIMSS is possibly both. For me, it’s like being a kid in a candy store. So, many exciting things to try (and you might even say you get sick after “eating” too many as the flavors all run together). To be quite honest, I love the entire experience. I was meant for the system overload that happens at HIMSS. I love large crowds of people and being overstimulated. I guess that’s why I love living in Las Vegas (which is also convenient for this year’s HIMSS).
HIMSS Attendee and Exhibitor Count
Enough about me. What can we expect at this fantastic affair called HIMSS 2012? Last year there were 30,000 attendees and I wouldn’t be surprised if this year it’s somewhere in the neighborhood of 35,000 people attending HIMSS. During an #HITsm twitter chat about HIMSS, I said that there would be at least 1000 vendors exhibiting at HIMSS. If I remember right (I can’t find the tweet), one of the HIMSS staff corrected me and said there would be 1100 companies exhibiting at HIMSS this year.
What does all this mean? Well, as my mother always told me: You can’t do everything. I’d always look at her shaking my head saying, “You’re right….but I’m sure going to try.” I think this describes my approach to HIMSS as well. Although, each year I am getting more selective on what I spend my time doing.
Press at HIMSS
I’m sure that many reading this are wondering how they can get some coverage on the Healthcare Scene blog network at HIMSS. Considering the 40 or so emails from PR people that I have filed away already, I’m going to have to apply a pretty strict filter.
What then are my filters?
First, if you’re an EHR company, then I’m probably interested in connecting with you in some form. Although, if you’re an EHR company that’s just seen me and has nothing new to say, then I’ll probably pass at this HIMSS. To be honest, I could probably fill my entire schedule with just EHR companies considering how many EHR companies there are out there. Plus, I think I’m going to bring around my flip video and do an EHR series called “5 Questions with EHR Companies.” I’ll see how many EHR companies I can get to answer the same 5 questions.
However, an entire week of just EHR talk would be a little rough. Plus, I asked on Twitter if I should look at things outside of EHR and they all said I should. I’m a man for the people, so I must listen. How then could another healthcare IT company get me interested in meeting with them at HIMSS?
The best way to get me interested in talking with your company is to provide something that will be interesting, unique and insightful to my readers. Remember that my main goals are great content and advertising. If you provide me with great content that my readers will love, then I’ll love you and likely write about that content.
I didn’t realize this when I started blogging, but I’m not like a lot of journalists. I don’t go to any conference with stories in mind. I’m not digging around HIMSS to try and find an ACO story for example. Instead, every person that I talk to I’m trying to discover what stories are being told at HIMSS that are worth telling. I’m always happy when people help me find interesting stories.
Social Media at HIMSS 12
Speaking of finding stories. One of the most interesting ways I use to find stories and connect with people is through social media and in particular Twitter (see this post I did on EMR and HIPAA about Twitter). I guarantee you that Twitter usage at HIMSS 12 is going to be off the charts. There is going to literally be no way to keep up. I love the idea that Cari McLean had of the HIMSS Social Media Center summarizing the most important tweets during HIMSS. Granted, that’s an almost impossible task to ask anyone to do.
Of course, the HIMSS related hashtags will be another great way to filter through the various HIMSS related tweets that are happening. Here are some of the ones I’m sure I’ll be using:
#HIMSS12 — official hashtag for the event
#HSMC — HIMSS Social Media Center
#HITX0 — HIT X.0: Beyond the Edge specialty program
#LFTF12 — Leading from the Future specialty program
#eCollab12 — eCollaborative Forum
Here’s a bunch more HIMSS related social media hashtags you might want to consider:
HIMSS Social Media Center
If you love social media like I do, then you’re also going to love the HIMSS Social Media Center. They’re doing a number of Meet the Bloggers sessions again and I’ve been invited to participate in the Health IT Edition of Meet the Bloggers at HIMSS. I’m on the panel along with: Brian Ahier (Moderator) Health IT Evangelist, Mid-Columbia Medical Center, Jennifer Dennard, Social Marketing Director at Billian’s HealthDATA/Porter Research/HITR.com, Neil Versel, Freelance Journalist and Blogger, Carissa Caramanis O’Brien, Social Media Community and Content Director, Aetna. Should make for a pretty interesting conversation. Plus, you know I always like to mix it up a bit.
New Media Meetup at HIMSS
More details coming soon. We’ll have to work on Neil Versel’s idea of starting a Twitter storm to get Biz Stone to come to the HIMSS meetup.
Dates of HIMSS
Be sure to check the dates of HIMSS. As Neil Versel noted, it’s a little different days than it’s been in the past. I personally like these dates better than the other ones.
There you have it. I thought I’d do a short post on HIMSS and I guess I had a lot more to say. I’d love to hear if you’re going to HIMSS. If you know of any events, sessions, parties, announcements, technologies etc. that I should know about at HIMSS, let me know.
And the most exciting part of HIMSS…seeing old friends and making new friends. I can’t wait.
No related posts.
One thing that I love about this industry is its willingness to collaborate, and I’m not just talking about collaborative care. I’m talking about healthcare IT’s propensity to brainstorm new ideas as the drop of a hat. Put two HIT folks – be they physician, vendor or blogger – in a room, and 20 minutes later you’re going to have a new idea related to care delivery, product development or possible partnership on your hands. It gets even more prolific when editorially minded marketing folks like me are added to the mix.
I’ve been pleasantly surprised at how even blogs can foster this sort of collaboration. Last month in “Finding an EMR Job Champion,” I chatted with Rich Wicker, HIMS Director at Shore Memorial Hospital in New Jersey, about how this industry can best align recent graduates of HIT certification programs with training and jobs. Some of you may have noticed several comments left on that post by Sean McPhillips, a man of many hats. He is currently an adjunct instructor at Cincinnati State – a community college in the HITECH College Consortia; project manager at the Kentucky Regional Extension Center; and creator of the HITECHWorkforce.com, a free resource to help students enter the HIT work environment.
In his comments, he advocates for a mentor-protégé program: “Students still need some more help finding jobs. What I think needs to happen is a “Mentor/Protégé” model. That is, pairing students with industry professionals who can mentor them into the industry. I’ve passively done that…to success. I think that will work.” He later followed up with the news that he hopes to work with HIMSS, which is developing a similar program, to get this model off the ground.
I recently had the opportunity to speak with McPhillips a bit more about his idea. I was eager to find out just how he plans to jumpstart it:
It seems as if you’ve been kicking this idea around for a while. How did it come about?
Being with the extension center, I’ve mentored a handful of people along the way, and I think there needs to be a more structured process so that students coming out of these [HITECH College Consortia] programs who want to be mentored have a place to go, they know how to get and stay engaged in the process. I think that there is with HIMSS, but I don’t think it’s really been tightly coupled with the workforce development program.
When I spoke with Helen Figge, Senior Director of Career Services at HIMSS, she was really excited to talk with me, and pointed me to HIMSS’ career development page to look around and see what they have out there. I’m thinking of how we can connect [what they’re already doing] into the workforce development program within the overall HITECH project structure, so that we can connect students who come out of these programs with their local HIMSS chapter, which could then pair them up with a mentor that’s in their region. That’s what’s really missing. That’s what’s really necessary to get people plugged into this profession – especially if they’re coming from outside of this profession.
HIMSS does not already have some sort of relationship with the college consortia?
They kind of do, but I don’t think it’s really tightly coupled. I think HIMSS recognizes this, so they’ve been developing their career development program. They’re near completion of a new, entry-level certification called the CSHIMS certification. That is something where you don’t need to have a whole lot of experience in health information technology, but you need to demonstrate some degree of knowledge in subject matter to obtain that certification. That might be a good way to help these students take the next step into the profession, when they’re looking to get a job. That could be part of the whole mentorship program concept.
Isn’t there a double-edged sword to it financially? Wouldn’t students have to become paying members of HIMSS, and then would they have to pay for certification? If they’re looking for jobs, finances might be tighter than usual.
That’s a great point. The question is, what are the costs associated with certification and becoming a member. There is a student membership discount. There’s a cost to certification, obviously, so these are things that are to be considered. That has not escaped me, so that’s going to be part of my brainstorming session. I’m going to meet up with them in Vegas when I go out to HIMSS.
One of the things I want to be able to do is make this attractive for people, particularly students, and if they have to lay out $500 or $1,000, and they’re already unemployed or they’re financially strapped, it becomes not just a double-edged sword, it becomes a disincentive.
I wonder if the vendors couldn’t get involved and offer scholarships.
It’s funny that you mention scholarships because that might be something the local HIMSS chapters can do. I know the Ohio HIMSS chapter used to do a $1,000 scholarship every year for students. So this might be something that the boards or the individual chapters could subsidize.
If you’re in the HITECH workforce development program, maybe HIMSS would be willing to waive membership for one year. That might be something they may be interested in doing.
This is part of the whole brainstorming session that I’m going to try to have over the next month or so. I’ll vet this through HIMSS over the next couple of weeks and hopefully we’ll come up with a good strategy by the end of February. And then we’ll start piloting it in the March timeframe.
I hope to run into McPhillips in Vegas to see how his chat with the HIMSS career development folks is coming along. It’s nice to know that one industry insider’s idea, and subsequent blog comments, might actually create job opportunity in the industry.
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I recently saw a tweet to the National Conference of State Legislatures (NCLS) list of “Top 12 Legislative Issues of 2012.” It’s an interesting look into issues that state legislatures will be dealing with in 2012. Plus, it makes an interesting observation at the outset that state budgets have been cut so much in past years that lawmakers won’t have to focus all of their initial energy on budget shortfalls.
Most of the list is not surprising with managing the state budget and jobs are at the top of the list. However, there are a couple healthcare and health IT related sections in their list of top government issues as well.
One of the issues is Medicaid: Efficiencies and quality. It talks about how the tough economy is making the Medicaid budgets in states a real challenge and many are looking for cost containing actions. Plus, it points to ACO type reimbursement based on patients’ health outcomes, medical homes and streamlining services. The ACO part was quite interesting to me. I wonder how much of an effect lack of Medicaid budget will push forward a new model of healthcare.
The disturbing part of the report comes in the “Health: Reform in the states, health care exchanges, technology and benefits. Here’s the section on health IT, the EHR incentive money and HIEs.
HEALTH INFORMATION EXCHANGE: One focus for state legislatures in 2012 will be how to move health care providers, especially those participating in the Medicaid program, toward the adoption of certified electronic health records (EHRs). Essentially, instead of having a different health record at each doctor or provider you visit, an EHR will serve as one file that all of your doctors can see. EHRs, once fully implemented, are expected to provide doctors and health professionals with easier access to patient histories and data, resulting in cost-savings and better health outcomes by removing costly errors and duplications in services.
I love how this basically assumes that by having widespread adoption of EHR software, that we’ll then have one patient record that each doctor you visit can see instead of having a different health record at every doctor. Of course, those of us in the EHR world know that this is a far cry from the reality of EHR software today. In most cases you can’t even share a patient record with someone using the same EHR software as you let alone sharing a patient record with a doctor who is using a different EHR.
The sad part is that whoever wrote these legislative issues must have realized that there was some issue with EHR software exchanging information, because then they wrote the following about the state HIE initiatives.
In addition, states are responsible for building and implementing health information exchanges (HIEs) where those EHRs can be accessed by health care providers. HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit. By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements.
So, wait. If EHR software has created one file where any doctor can access our patient record, then why do we need “an online file cabinet” for our medical records? We know the answer is that we need the online filing cabinet because EHR software isn’t connected and there isn’t one patient record. Each doctor maintains their own patient record and that’s not going to change any time soon.
The above quote also implies that every state is working towards an HIE program per the federal program. I must admit that I haven’t gone through every state, but is every state working on an HIE? I certainly know there are a lot of states working on some sort of HIE project, but I didn’t think that every state had funding for HIE. I guess maybe the question is whether there is any state that doesn’t have some sort of HIE program in the works.
Reading issues described like this, you can understand how government passes legislation with limited understanding. Based on this resource, EHR software creates one patient record. Wouldn’t that be nice if it were the case?
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EMR and EHR Readers, have you already started breaking your New Year Resolutions? I know I have. My New Year resolution was a very unambitious I will exercise at least every other day, and I couldn’t hold on to that for a week. However, all is not lost. Even if you’re falling short on fulfilling your resolutions, you can still make a compelling video on some kinds of health IT related resolutions and maybe walk away with a decent cash prize. Don’t know what I’m talking about?
The Office of National Coordinator on Health IT is hosting a health IT challenge. Participants need to create a short (upto 2 mins) in length video that covers:
a) what your health resolution for 2012 is
b) how you will use IT to fulfill your resolution and
c) how you maintain your resolution using health IT tools.
Here are some examples listed on the ONCHIT website:
I will set up an online personal health record for myself (or another family member) so I can have all of my health information conveniently stored in one place.
I will ask my doctor for a copy of my own health records — electronically if available — and help him or her to identify any important information that may be missing or need to be corrected.
I will find an online community that helps me figure out the best ways to manage my health condition (depression, cancer, diabetes, etc.)
I will use an electronic pedometer to help me track my physical activity and will try to take 10,000 steps per day.
I will find an app on my smartphone to help me track my food intake so I can lose 10 pounds by my high school reunion.
I will sign up for a text reminder program on my cell phone to help me stop smoking or remind me to take my medications on time.
Please note that these are just suggestions, not listed topics. In fact ONCHIT encourages you to get creative and create your own HIT resolutions.
Of course, being as it is 2012, and well into Web 2.0fication of our lives, it’s not enough to make resolutions about improving our health. If you want to participate in the ONCHIT challenege, you’ll have to find ways to incorporate health IT into your resolution. I’ve worked pretty much my whole adult life, barring some exceptions, in the IT industry. But even so, I believe that IT can only solve some classes of problems, so I’m a bit wary when developers and programmers bring their hey-I-can-create-an-app-for-that attitudes whenever they’re confronted with any problems. That said, I do think some aspects of health IT can be useful. And I’m excited to see what creative things people will come up with.
No related posts.
Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well. This is the second to last post in the series of EMR tips
10. Build performance dashboards, not just quality dashboards
Yes, Dashboards can work well for clinicians, but for support people as well. If you start measuring something and displaying the results of that measurement, then the measurement improves. Study after study has shown this.
9. Flexibility with physician devices is important, but you still need to standardize
I think this is a little bit of an evolving issue. However, it’s unreasonable to expect your IT staff to support every platform, every version, and every type of device out there. Tech innovation is moving way too fast and an attempt to go this route will lead to failure. Create some standards so you don’t have your IT staff spinning their wheels and cursing your name for a bad policy.
8. Do time studies
My gut reaction to this one is two fold. First, get the data. Don’t assume you know the data. Get as much data as possible and focusing on the time it takes to do things is one of the best places to get data since this is incredibly important for users. Second, don’t shy away from the truth. If your EHR software has doubled the time it takes to do something, don’t be afraid to find that out. It’s better to know that there’s a problem and try to fix it than to let the problem fester because you didn’t want to know the truth.
7. Make sure IT shadows the clinicians
I’d probably take this one step further. If your IT doesn’t want to shadow the clinician, then you might want to find other IT. There’s no way that IT can help to design the proper system for the clinicians if they don’t understand the daily processes that the clinician has to do. Clinicians need to be willing to let IT in on what they do as well. It takes two to Tango and this is certainly true when you’re talking about implementing an EHR. It’s not nearly as pretty if they aren’t dancing together.
6. Use predicative analytics
I’m definitely not an expert on predicative analytics and its application, so I’ll just give you Shawn’s summary:
Predictive analytics are old hat in most industries. However, health care hasn’t put PA in a real forefront of the clinical practice. If you want your physicians (especially in a ED / UC) to be able to prepare for trends due to environment or time, make sure to have PA built into your EMR and easily available for all providers.
If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.
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As most of you know, I’m attending the Digital Health Summit at CES this year. As happens at most conferences, it’s hard to blog about the happenings at the conference while attending the conference. Particularly with all the CES traffic issues (it’s a literal zoo) and the packed CES Press Room. Although, I must admit that I haven’t found too many things all that impressive. More on that later.
For today, I thought I’d give you a little picture view of what I call the Garden of Eden booth that United Health Group has at CES (click twice to see full size image):
They seriously have grass on the ground and a wood path through their booth. Plus, they have some of the only benches at CES (many really enjoyed those including myself). They’re also doing the pedometer promotion they did last year at CES and that they did at mHealth Summit, but this time you record your findings through the OptumizeMe app. I better win the iPad for all the walking I’m doing at CES. At least this time we’re not up against the exercise demo lady in the booth across from United Health Group. That was totally unfair (No, I’m not bitter).
Also, I’m surprised how few people know about SOPA. So I thought I’d do my small part to get the word out to more people. SOPA is an abomination that they’re trying to push through Congress. Here’s the tweet I sent out recently about it:
Join me & change your profile picture to protest SOPA: BlackoutSOPA.org #BlackoutSOPA #vegastech #HITsm
— John Lynn (@techguy) January 12, 2012
As you can see I’ve put the STOP SOPA badge on my Twitter icon and will be doing it on some other places, likely including the blog logo above. I’m good with legislation that actually works to stop copyright infringement, but SOPA does nothing to stop it and does a lot to really screw up the internet as we know it today. I hope others will join me in helping to stop SOPA. This weekend I’ll see if I can do a full post on why SOPA is bad if people are interested.
No related posts.
I’m not a big fan of reality shows, especially those that involve contestants singing, telling jokes, dancing, or anything else that could potentially result in public humiliation. I’m in the minority, of course, as this style of television programming shows no sign of abating anytime soon. It’s a worldwide epidemic, in my opinion.
I am a fan of creative marketing – applying concepts traditionally associated with one particular medium (like television) to something entirely different (like healthcare). Needless to say, the Big Break job recruitment program – you could also call them auditions – intrigued me.
In a nutshell, pre-screened candidates take part in a one-day audition process put on by recruitment firm Intellect Resources and participating hospitals. Candidates then compete to become trainers and instruct staff on the use of the sponsoring hospital’s electronic medical record system or related healthcare IT system.
Seems like a slam-dunk concept, in my opinion. Those who are unemployed get a job within their community, and also get a taste of what that popular 15 minutes of fame is like. Did I mention that candidates go through video interviews and public presentations during the daylong process?
I recently chatted with Tiffany Crenshaw, President and CEO of sponsoring organization Intellect Resources, about how the program came about and the impact it has had on its participants’ lives (and go-lives).
How did the Big Break come about?
Tiffany Crenshaw: The Big Break spawned out of a project we were working on at Mt. Sinai Hospital last year. Last fall, they were getting ready for their Epic training and called me in a panic. They were expecting to get 90 to 100 trainers, and were going to use nurses, but realized at the last minute that wasn’t a viable idea. So they called us and said, “We have to do something now – we have no budget and we have no time. And we want to do some sort of done-in-a-day type audition. What can you do?”
So we said this is right up our alley. We created a really cool event – it was at the big Marriott Marquis in Times Square. We had around 500 contestants, and they all went through a timed audition process – stressful for them, but it was still fun.
They had to go through seed interviews and get in front of cameras. They had to get in front of a boardroom of judges and do presentations. At the end of the day, we ended up with 100 trainers that worked at Mt. Sinai to help roll out the hospital’s Epic training and go-live.
So that’s really the model of Big Break. We created it as a solution for Mt. Sinai, and now other folks are getting the word about it. Ochsner Health System is our next one. We’ve got the Big Break event for them in just a couple of weeks (January 21).
Did they reach out to you?
A consultant and dear friend of mine that was actually helping them with their system selection and project planning for their Epic implementation recommended this business model, and brought us in as the vendor to run this product for them. So yes, they did reach out to us, but it was really a consultant that made it happen.
Are you an all-Epic recruiting firm?
At the moment, that’s just about all we’re doing. Through the years, we’ve worked with many other products – with McKesson, Cerner, Siemens. The demand right now is Epic, so by default we’re doing all Epic. That’s just where the demand is, and so that’s where we’re spending our time.
How have you seen this type of program impact sponsoring hospitals and surrounding communities?
We think it’s a business model that works very well for hospitals. It’s a very low-cost way to get good resources. It’s also a good marketing opportunity for them to promote the fact they’re installing an electronic health record to the benefit of their patients, and it’s a great way for them to reinvest in their own community.
At Ochsner, the idea is that this is really for the New Orleans community. They don’t like to hire outside consultants. They really want to empower and revitalize their own community.
Many of the folks that we worked with at Mt. Sinai have gone on to work at other places. Big Break was really their footprint in the door. The end result is that the consultants that come through with really good experiences. Over 50 percent of them are now working in the industry. Mt. Sinai actually hired four full-time employees. There was a big project up in Rochester, N.Y., that a lot of the people went to after that first project. We redeployed probably 20 of them on several go-lives.
Is there an opportunity for this to work in other cities?
At our very first meeting with Ochsner’s project executive, we talked about the fact that there are several area hospitals in and around New Orleans gearing up for Epic implementations. Our original thought was, let’s do this together, but the go-live timeframes didn’t work.
It would make perfect sense if there were multiple hospitals that could do the event together, do the credentialing together, and then take people from a generic credentialing and deploy them to the individual hospitals to learn the individual builds. I think it’s a model that could be a really good collaboration.
I think one of the neatest things about Big Break is that this industry is so thin on the amount of really good resources that are out there. It’s a great way to breed new talent
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#AHIMA11 these people talking about a genomics-based #EHR are blowing my mind…storage vendors must love the concept…lawyers, too
— Don Fluckinger (@DonFluckinger) October 4, 2011
This is a pretty old tweet that I’d stored away, but I’m completely interested in the idea of a Genomics based EHR. I meant to reach out to Don Fluckinger to see what he was talking about. I don’t think that there is any EHR that is based on Genomics. Although, if there is I’d love to know about it. Instead, I’m pretty sure that Don is just talking about integrating Genomics into EHR software.
I’ve made this prediction for a number of years now: Genomics will be part of the EHR software of the future. Genomics is one of the core elements that I think a “Smart EMR” will be required to have in the future. I really feel that the future of patient care will require some sort of interaction with genomic data and that will only be able to be done with a computer and likely an EHR. I love some of the quotes by Shahid Shah in this eWeek article about Digital Biology and Digital Chemistry.
As I think about genomics interacting with EHR data and the benefits that could provide healthcare going forward, I realize that at some point doctors won’t have any choice but to adopt an EHR software. It will eventually be like a doctor saying they don’t want to use a blood pressure cuff since they don’t like technology.
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So the first round of the HIPAA compliance audit program is underway. Howard Anderson, writing in HealthcareInfoSecurity.com, has a great post on what’s going on:
- 20 organizations will be hosting auditors from KPMG in the next few weeks, followed by another 130 organizations in the second phase of the audits later this year.
- The focus this year is on covered entities, not on their business associates.
- OCR is not just going after the big fish. OCR is auditing “eight health plans, two claims clearinghouses plus 10 provider organizations, including three hospitals, three physicians’ offices, and a laboratory, a dental office, a nursing/custodial facility and a pharmacy.”
- Adam Greene, the blogger who broke this news first on his blog has some interesting details about the organizations. It seems as if 6 of the 20 organizations chosen for the first audit are Level 4 entities, meaning “Small providers and community pharmacies with less than $50 million in revenue and/or assets.” This translates to 30% of the initial list.
- Notifications were sent to organizations on the 1st of December. Auditors are going out for field visits expected to last between 3-10 business days.
Having been in charge of Sarbanes Oxley audits at my last place of work, I know first hand what a flurry external audits can cause in any organization. I can only empathize with the first few organizations chosen. However, I also find OCR’s approach to the audit process to be quite wise – the post at HealthcareInfoSecurity quotes Leon Rodriguez, OCR head honcho as saying “Our first objective is not to go out there and start banging [organizations] with penalties; it’s really to take a good look at them, find out where their opportunities for improvement are and help them improve… Having said that, I think we know that there are cases where we’re going to find some significant vulnerabilities and weaknesses. And in those cases, we may be pursuing significant corrective action. And in some of those cases, we may be actually pursuing civil monetary penalties. But that’s really not the primary goal of the audit program.”
Which probably is some solace for the organizations that are currently being audited. Hopefully at the end of this exercise, OCR will have a good idea of where the major weaknesses are, where it wants organizations to be at, and help them get there.
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I’d been meaning to do a post about Emdeon‘s EHR lite (that’s their term for their EHR) since I first heard about it at MGMA. While I think that EHR Lite might be some good branding, I’m not sure you can really classify Emdeon’s EHR as lite. I’m sure they’re just trying to differentiate themselves from the 300+ EHR companies out there. The idea of a lite EHR is great since it gives the impression that the EHR is easy to use and implement. Not a bad strategy at all.
As most of you know by now, instead of doing full reviews of EHR software I like to try and dig into the EHR software to try and find points of differentiation. When I talked to the people at Emdeon about their EHR lite, I wanted to do the same.
I think I found the thing that most differentiates Emdeon from many other EMR companies. it’s their network. Here’s a summary they sent me of their network:
Emdeon’s network encompasses:
340,000 providers
1,200 government and commercial payers
5,000 hospitals
81,000 dentists
60,000 pharmacies
600 vendor partners
I think if you asked most people what Emdeon the company did, you’d say claims processing. The title of their website for search engine rankings (at least that’s usually the intent) is Revenue Cycle Management. However, I won’t be surprise if they reinvent themselves a little bit and become a connection company.
I strongly believe that healthcare will be a very heterogeneous environment. Some might argue that 3-4 EHR vendors will dominate the market (which I don’t believe), but even if this is the case EHR software is still going to have to connect with hospitals, pharmacies, labs, payers, government entities etc. An EHR is going to be key to integrating with these other heterogeneous software as I do believe the EHR will be the “Operating System of Healthcare.”
Today a silo’d version of an EHR is not an issue at all. However, the writing on the tea leaves that I read is that healthcare providers that have a well connected EHR are going to be at an advantage. We’ll see if Emdeon can use their current connections as an advantage in this way.
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“The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.
National Consortium of Breast Centers, Inc.
Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)
The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.
The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the “harms” vs. “benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.
In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.
The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.
We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40’s, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.
The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.
Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women’s healthcare screening policy.
# # # #
About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.
References:
1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.
2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.
3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.
4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.
All content and design © 2009 by the National Consortium of Breast Centers, Inc.”
2. Know who you are selling to
3. Sell through the Gatekeeper
Finally, when it comes to choosing an EMR solution make sure it is one that will fit your practice. This goes for price and for functionality. ARRA is giving away 44k to adopt a system. Most large vendors cost much more than 44k so where is the incentive? It's like someone giving me 1 million to put down on a G5, where is the other 58 million coming from?
I know all small companies are not the same, but I have to go off of what I know. (And no, this is not a plug for my company). Most smaller vendors are practically giving their applications away. We are cheaper because we have less overhead....simple stuff. Our company has no marketing dept...we have developers, physicians, surgeons, customer support and sales.
From what I have heard from other physicians who have already implemented a branded EMR, they hate it. There is no customer support, or at least what I have heard is "too little, too late". I'm not knocking the large vendors here, but why would they get back to a 2 physician practice when they have large hospitals to keep happy.
I believe large vendors are perfect for larger organizations. They have the support and can be afforded. In my opinion, smaller vendors have the advantage on large vendors when it comes to smaller practices. There is less red tape and quicker results. Speaking for myself, if a customer calls in and wants a special report done that's not already in our system, it typically takes only a day and costs our customers nothing.
I have heard of implementations taking months, ours takes about 10 days.
In these tight times, people have to do their homework. Ask your vendor the hard questions and be secure in your final decision because once you implement a system, there is almost no turning back.
Recently I found some written instructions I had prepared several years ago to help my parents program their VCR. It took me three pages to write out the steps to record a program. Where applicable each step included a hand drawn representation of the button the VCR (and/or the remote) to ensure clarity and understanding.
The first page explained how to bring up the menu to record a program in the future. The second provided further details and discussed potential troubleshooting strategies. The third included the final steps and introduced the steps for recording a program currently being viewed. Even with these detailed instructions mistakes were made and recordings were missed. We will never know if the error was occurred in the programming stage or if show never actually aired.
I believe I also wrote out similar instructions for my grandmother. As she was even less inclined to adapt she opted to use her own technique. My grandmother would start recording a program hours in advance of its airing before leaving her home by putting the television on the desired channel and pressing the record button on the VCR. It may have required hours of rewinding but it worked for her. Since this time technology has evolved and we now “one touch” programming through the use of on-screen guides that list program dates and times. However, I’m pretty sure if my grandmother were alive today she would use her old system – start recording on the PVR when she went out rather than using the on-screen guide.
In 1988 Donald Norman wrote about this issue in “The Psychology of Everyday Design“. He made reference to digital watches and microwave ovens as well as VCRs as examples of devices that were difficult to operate. Yet they were supposed to be for an average person to use on a daily basis. Why were they so difficult to use? One theory suggests that the skill set required to design such devices doesn’t necessarily translate in a way that is evident to someone who does not have a similar background or training. What is apparent to one is not necessarily so to others. A lack of applying design principles (human-computer interaction) or examining how the device works in real use (e.g. usability testing) were provided as possible reasons. One resolution was to utilize technical writers, those skilled in interpreting complex electronic interfaces using plain language written material Some things are made to be obvious or intuitive – you use the sharp edge of the knife to cut. Others have developed over time with common usage – it is universally understood that turning the knob is a necessary step in opening a door.
Human behaviour is like running water. It always finds the path of least resistance. But can we ‘afford’ this type of affordance in health care?
In a previous post I presented an analysis of the tweets from the Health Care Social Media Canada (#hcsmca) Twitter community. By using a network analysis tool (NodeXL) I was able to determine that two Twitter identities (@infoway and @jasonboies) were participating but perhaps not in a connected way. When community members are “off to the side” it may be an indication of lurking behaviour (reading messages but not posting). However, since tweets were present from these Twitter accounts this label may not be applicable. A similar concept, labeled “legitimate peripheral participation” (described more thoroughly here) in which novices engage in a community of learners in limited fashion may be a more accurate descriptor of the phenomenon captured in the data set. In order to understand the findings from this network analysis a more thoroughly examination of the tweets containing referenced to the two outliers was required. To facilitate this process I used a tool called ITCA (Internet Community Text Analyzer) developed by Dr.Anatoliy Gruzd at Dalhousie University.
Using the Excel spreadsheet created by NodeXL from the network analysis I exported it into .cvs format, which was then imported into the ITCA tool. The dates of the tweets included Thursday November 24th, Friday November 25th and Saturday November 26th. There were 953 unique messages and 243 posters in this sample. The top ten posters (Image 1) is essentially in alignment with the network analysis, which was ordered by eigenvector centrality. In other words importance is, in part, reflected by the number of tweets.
Image 1: Top Ten Posters in #hcsmca Twitter community
The ‘local concepts’ (characters, words, terms and concepts) were extracted by looking for patterns frequently used in the data set. The ITCA tool revealed that there were 9812 unique terms. Image 2 shows the thirty most frequent terms and the number of times the term appear in the data set. The tag cloud formation shown in Image 2 also provides a visual representation of frequency (the larger the word the more times it appears). An individual term can be removed by clicking on the red X or explored further by clicking on its hypertext link, which reveals all instances by which has been tweeted.
Image 2: Top 30 Results of Local Concept Extractor (click to enlarge)
Using this tool I was able to search for the tweets associated with @Infoway. The results indicated that the two tweets were related to an upcoming HL7 (health level seven, a concept related to standardization in health information technology) certification. A hand search of the .cvs file indicated that one tweet on Friday November 25th, 2011 was directly from @infoway. The other was a re-tweet of this tweet by @alexanderberler on the same day. The second tweet was also recorded because @mentions were included in the data set obtained using NodeXL. Image 3 shows the @alexanderberler RT.
Image 3: @alexanderberler Re-tweet of @infoway tweet (click to enlarge)
A search of jasonboies revealed twelve tweets. Image 4 shows the total number of times in which tweets contained this Twitter identity in this data set.
Image 4: Incidents of jasonboies
Tweets with jasonboies appear to have taken place from Friday November 25th (four in early evening UTC) to Saturday November 26th (eight in late evening UTC). This time frame is outside the weekly hcsmca tweet chat, which took place in the evening on Thursday November 24th (the weekly tweet chat is held every Wednesday at 1:00 pm EST except for the last week of the month in which it is held on Thursday evenings).
Based on this preliminary analysis it would appear as though connecting with other members of the hcsmca community is a phenomenon beyond just using the hashtag in your tweet. These findings may indicate that being engaged means participating with others in the real time chat.
Perhaps more importantly this analysis demonstrates the need to examine not only the pattern of tweets as yielded using network analysis tools but also to examine the content. In addition, these findings should be interpreted with the aid of survey data and interview findings obtained directly from members of hcsmca community. For example, a survey could determine which participants are tweeting as part of their work, which may affect which time of the day they use Twitter. Interviews would provide even richer detail allowing us to understand what exactly prompts someone to both tweet and re-tweet material in the hcsmca community.
Recommended reading
Daniel, B. K. (2010). Handbook of research on methods and techniques for studying virtual communities: paradigms and phenomena. Hershey, PA: Information Science Reference.
Feldman, R., & Sanger, J. (2007). The text mining handbook: advanced approaches in analyzing unstructured data. Cambridge ; New York: Cambridge University Press.
In the ethnography, “Situated Learning” (Lave & Wenger, 1991) it was observed that learning a trade or profession such as a tailor or midwifery was best supported by engaging in this activity within the actual community in which it was taking place. In this context the learner, as an apprentice, can be exposed to others with varied skill levels within that particular job or trade from which they can learn. Initially they may engage in some limited tasks such as maintaining inventories of equipment or tools and ordering supplies. Over time and with more exposure to the task their role will evolve and increase in responsibility. For this to take place they must learn from others with more experience. Some members of this particular community may have expert status whereas others may be at more of an intermediary level. At the beginning those new to the community participate only on a peripheral level. As novices they have yet to learn the terms, concepts and practices that would allow them to engage in the profession in a meaningful way. For example, someone new to programming may subscribe to a mailing list or follow a newsgroup that discusses the computer language they want to learn. These groups are often composed of individuals with varying levels (novices, intermediaries, experts) of skill level forming what has been termed “communities of practice”. This legitimate peripheral participation or “lurking” is an acceptable and supported behaviour amongst many well established online communities. After reading the messages for a period of time novices may feel more comfortable and post questions of their own. This may lead to some form of debate amongst other participants in which new knowledge is co-created. Novices may contribute in other ways by sharing information related to issues they have already encountered. For example, the novice programmer may have been advised before participating in the message forum that using an integrated development environment (IDE) will aid their learning of how to program. Over time the community shares their experiences and members of all levels engage and learn from and with each other. This phenomena has been documented amongst mailing lists and newsgroups.
But what about the newer forms of social media such as Twitter?
Founded by social media expert and plain language writer Colleen Young (@colleen_young) the Health Care Social Media in Canada (hcsmca) Twitter-based community was designed as a means by which Canadians with an interest in social media within a health care context could exchange information. By posting tweets using the acronym, “hcsmca” those wanting to share and learn more about this topic area can follow the posts. Each week the community meets for a live tweet-up in which messages are exchanged in real time providing for a more conversational tone to the exchange. I have participated in this community almost since its inception. Over this time I have wondered about the types of connections that were being formed, what information is being shared and learned and how effective Twitter is as forms of information dissemination in this context.
To explore this further I examined the network relationships in the hcsmca community with NodeXL (http://nodexl.codeplex.com/). Using the import tool I limited the results to 100 people for this initial exploration. I requested edges (or connections) for each of these Twitter scenarios: “follows” relationship (an individual and their followers), “replies-to relationship in tweet” (a reply to an individual tweet), “mentions relationship in tweet” (a tweet that mentions a user) and a “tweet that is not a reply-to or mention” (a posted message or tweet). NodeXL calculates a variety of statistics related to network analysis. By using filters you can refine the resulting graph in form that provides meaning.
Image I provides one static representation of a many possible layouts of the results. The NodeXL tool allows for more dynamic views (e.g. colour coded relationships between users such as “follows”, “replies-to relationship in tweet” and depictions of the other metrics mentioned above). It also provides for the ability to re-position the location of each user. Image I (below) demonstrates one instance of these options.
Image I: Network analysis of #hcsmca community – November 26th, 2011
To better view the relationships I limited the out degree (people with the most connections) to seven. I then arranged the display from left to right by eigenvector centrality (a measure of importance in the network). Community leader Colleen Young, who often moderates the weekly tweet chats is positioned at the far left as she has the highest eigenvector centrality in this group. @DoctorFullerton is next, @nursefriendly and @ehealthmusings follow and so on. What may be of most interest are the two outliers positioned on the far right: @infoway and @jasonboies. They were represented in the graph because they had an out degree value greater than seven. However, I am curious as to why they had no connections to the remaining members in this particular snapshot of the #hcsmca community tweets. Does this indicate some form of lurking? How can this behaviour be explained?
In order to understand this further a content analysis of the tweets will be conducted. In the next installment I will explore the contents of these tweets using Netlytic (http://netlytic.org/), an Internet Community Text Analyzer.
Reference
Lave, J., & Wenger, E. (1991). Situated learning: legitimate peripheral participation. Cambridge [England] ; New York: Cambridge University Press.
Recommended Reading
Hansen, D. L., Schneiderman, B., & Smith, M. A. (2010). Analyzing social media networks with NodeXL: insights from a connected world. Burlington, MA: Morgan Kaufmann.
Valente, T. W. (2010). Social networks and health: models, methods, and applications. Oxford ; New York: Oxford University Press.
Thanks to @marc_smith for his assistance.
Accidents happen. Often when we are tired, overwhelmed with too much information and too much to do we make mistakes. Many of us work long hours, interacting with complex machinery and in noisy environments. Few of us, however, are required to work 36 or more hours in a row, with little or no sleep. Physicians do this on a regular basis and patient safety is at risk as a result.
Why does this happen? Many years ago I asked a senior staff physician who worked in a large metropolitan hospital this question. He told me there were three reasons: (1). A physician needs to learn how to make decisions no matter how they feel physically (2). We are short-staffed and (3). It was done to us before therefore it will also be done to those who come after us. I’ve since heard another reason: the more hours you work the more opportunity you have to learn new things. I don’t know how effective this latter strategy is for physicians-in-training. Or whether it is used as a fear tactic. For example, someone might be told: “if you don’t treat enough cases of X you will not have enough knowledge to pass the board exam in your specialty”.
This clip (1:23 minutes) from the television show “ER” in which Dr. Elizabeth Corday explains at a weekly M&M (Morbidity and Mortality) meeting reasons why and ways in which the system could be changed.
Her concluding marks are quite poignant. I don’t think the situation is much different now then it was when this show aired in 1998. Or when I asked a physician ten years previous to that. But I do think her point is valid. Who would want to fly in a plane in which an air traffic controller co-coordinating its take-off and landing had worked 36 hours in a row without sleep?
But I think the real question is whether you would want to fly in plane with a pilot who had worked 36 hours without sleep. However that would never happen. Pilots (and the airline industry) know that if they had people flying jets for many hours in a row they would likely make a mistake. The plane could crash and many lives would be lost. Including the pilot. Not quite the same scenario for a physician. Maybe the rules regarding work hours would change if their lives and not just those of the patient were also in danger. For this to be achieved we need more collaboration between everyone involved in providing care.
A couple of great posts from other bloggers on the peer review process, journal publishing and the open access movement:
I’m excited that others are sharing their thoughts on this issue. I’ve written about this before (see “Access to peer reviewed journals“ ). Petermr’s piece specifically advocates for patients (among other groups) to have access to this information and uses the Human Rights code as a foundation to make the argument. Brilliant work!
It should be noted that JMIR has adopted two unique methods for open access publishing. The fast track fee provides the option of paying a fee for a three week turnaround. I believe the money is used to compensate the reviewers for their time. There is also an Open Peer Review Articles process, which allows JMIR users to review articles who have yet to undergo peer review. Abstracts for these articles are posted at the site so please take a look if you are interested in engaging in this process.
Update: Monday October 3rd, 2011
I recently found out about a repository, arXiv that has been used for pre-publication papers in the sciences since 1991. It was started in physics and later expanded to include other fields such as computer science, mathematics and astronomy. Although the papers posted are not peer reviewed moderators do review the submissions to ensure they are relevant topic-wise. We should consider this unique model to disseminate information when considering changes to the current system.
Deb Matthews, Minister of Health and Long–Term Care Webchat Transcript: Ontario Liberal Party plan for health care
Tuesday September 20, 2011 8:00 pm
Note: This transcript is also available on Facebook. Each comment or question is followed by a time stamp indicating when it was posted. Inclusion of this transcript is for informational purposes only. No endorsement intended.
Ontario Liberal Party: Hello everyone and thank you for joining us tonight on Facebook. Tonight we’re joined by Deb Matthews, Minister of Health and Long–Term Care, to talk about the Ontario Liberal plan to keep building the healthiest province to grow up in and grow old in. 8:01
Deb Matthews: Welcome to tonight’s webchat! So glad you could all join us. Please start submitting your questions – we’ll try to get to as many as possible tonight but it probably won’t be possible to get them all. Looking forward to the conversation! 8:02
Comment From Guest: Good evening Ms. Matthews, thank you for providing a forum to ask questions and open discussions for all Ontarians. 8:02
Comment From Philip: Can you confirm that, if re-elected, the Liberals will continue to support the First Link program and roll it out across the province? 8:03
Deb Matthews: Thanks for the First Link question. I can tell you that we enthusiastically support First Link! It’s making a real difference for people with Alzheimer’s and their families — and will continue to do so! 8:04
Comment From Jacquie Micallef: Good Evening – The 8-week unpaid caregiver leave is a step in the right direction, however we (Alzheimer Societies in Ontario) hear from caregivers that flexible respite is critical to their health and wellbeing. If re-elected, how will Liberals give caregivers the break from caregiving that they need? 8:05
Deb Matthews: The 8-week job guarantee for caregivers is an important part of our strategy to keep people home, where they want to be, as long as possible. i’m glad you support it, and i look forward to working with you to find other ways to support caregivers.8:06
Deb Matthews: As you know, tomorrow is World Alzheimer’s Day. I want to take this opportunity to say “thank you” to everyone committed to improving the lives of people with Alzheimer’s Disease. 8:07
Comment From Natrice Rese: Thank you for this chance to ask questions, can you elaborate more on the coming PSW Registry and how it will protect our elderly and vulnerable please, as their protection is paramount. 8:07
Comment From OntarioPSWAssoc: We would like to know what you plan on doing about the PSW issue in this province? 8:07
Comment From OntarioPSWAssoc: Minister Matthews; Societies most vulnerable are dependent upon PSWs everyday. How do you plan to standardize the PSW profession? 8:08
Deb Matthews: I’m very excited about the PSW registry, and I know PSWs are too! I’m also excited that we’re committed to 3 Million more hours of PSW homecare – three times the number of hours the NDP is committed to! 8:10
Comment From Paula Schuck: How will the McGuinty government meet the needs of the coming demographic shift. The sheer number of seniors that will be diagnosed with dementia and alzheimers as well as other health issues in the coming decades is staggering. What are we doing to meet this co 8:10
Comment From Paula Schuck: Families like ours have been sitting on a waitlist for special services at home for three years. What will be dine to clear up the wait-list?. No respite money right now for far too many struggling families. 8:11
Deb Matthews: Thanks for joining us, Paula! Embracing the demographic shift is exactly what we’re doing. There are many parts to our strategy, outlined to some degree in our Party platform, but the foundation is building community supports to allow people to stay home as long as possible, instead of moving to LTC before they need to. 8:13
Comment From Jacquie Micallef: Thank you so much for the recognition of World Alzheimer Day. This chat is very timely! 8:13
Deb Matthews: Another piece is that we’ll refocus a portion of our province’s research investments to support the prevention, treatment and possible cure of conditions such as Alzheimer’s and related dementias. 8:14
Comment From Patricia: I keep hearing about what the Conservatives will cut — and I am growing tired of this talk. Instead, I want to hear what you and the Liberals will build. 8:15
Deb Matthews: Our plan is to strengthen local decision making through the LHINs. We have seen great examples of how communities are working together to get better results for patients and better value for health care dollars. 8:16
Deb Matthews: No matter how good the bureaucrats in Toronto are, they’ll just never be able to pull communities together the way local decision-makers are. People in Thunder Bay will make better decisions about health care in Thunder Bay than people in Toronto can! 8:17
Comment From Guest: What is the Liberal plan for Local Health Integration Networks, as compared to the Conservative plan to eliminate them, to reduce administrative health care costs and increase funds for direct care? 8:17
Comment From Patricia: LHINs? I’m not familiar with that. 8:18
Ontario Liberal Party: “Local Health Integration Networks”: http://www.health.gov.on.ca/transformation/lhin/lhin_mn.html 8:19
Deb Matthews: Patricia, I urge you to take a look at our platform. We set out a challenge to make Ontario the healthiest place in North America to grow up and grow old. Part of that is a goal to reduce child obesity by 20% in 5 years, and to develop an Active Aging Strategy. It’s time to focus on wellness!! 8:20
Ontario Liberal Party: The Ontario Liberal plan: http://www.ontarioliberal.ca/OurPlan/Platform.aspx 8:20
Comment From Ritika Goel: Hello Ms. Matthews. I’m representing an organization of young health providers concerned with the state of publicly-funded healthcare in Canada called Students for Medicare. We are interested in hearing how the Liberal party would put a stop to and prevent the further emergence of for-profit facilities in Ontario. 8:21
Comment From StudentsforMedicare: Hello Ms. Mathews, Our organization is interested in knowing how the Liberal party will do to prevent and curb the proliferation of private, for-profit clinics in Ontario to uphold the Canada Health Act. 8:21
Comment From Dan Raza: A few months ago, the government passed a law prohibiting extra, out-of-pocket billing as a measure to prevent creeping privatization. On behalf of physicians that want to continue to practice in a pro-medicare system, thank you! What plans to do you have to enforce it? 8:23
Deb Matthews: Protecting universal health care in Ontario is a sacred trust, as far as I’m concerned. We’ve passed The Commitment to the Future of Medicare Act, and we’re enforcing it. Last year, we collected over $600,000 for patients who had paid illegal fees. Sad to say, both the NDP and PCs voted against the CFMA 8:24
Deb Matthews: Thanks Dan, Ritika and The Students for Medicare, for standing up for universal health care! 8:25
Ontario Liberal Party: Thank you everyone for your questions. We are trying to get to as many of them as possible before 9:00. 8:27
Comment From Guest: Tim Hudak has promised to shut down eHealth Ontario. What are your plans for eHealth Ontario? 8:28
Deb Matthews: Anyone who works in health care knows that we need to continue to transform it unless we want to move to two-tier health care, which Ontario Libs certainly don’t!! A vital part of that transformation is moving forward with eHealth. We’ve now got about half of Ontarians with EHRs – shutting down eHealth would be just dumb! 8:29
Ontario Liberal Party: “EHRs”: electronic health records 8:31
Comment From Laura O’Grady: Then why do we rely on population-based research for decision making? (i.e. one study in Windsor, for example, informs the policy around screening for the whole province because it is considered “evidence-based”) 8:32
Deb Matthews: Sustainability of universal health care requires reliance on evidence. The Excellent Care for All Act reinforces that principle. Of course, there will always be debates about how strong that evidence is, so we need to keep investing in better research. 8:33
Deb Matthews: I urge you all to participate in the Ontario Health Study! It will give us extraordinary data!!8:33
Ontario Liberal Party: https://ontariohealthstudy.ca 8:34
Comment From Don Seymour: Deb, can you talk about how your will improve services for persons with mental illness? 8:35
Deb Matthews: Thanks for joining us, Don! Our Mental Health and Addictions Strategy is already being implemented. It’s a 10 year strategy, starts with kids, and backed up by a $257M commitment in our last budget. 8:36
Deb Matthews: I was very disappointed that neither the PCs nor the NDP even mention mental health in their platforms. For us, it’s a high priority. 8:37
Comment From Natrice Rese: Can you tell us more about in home dr. visits? Many elderly and infirm, special needs in our population do not get seen by professionals when they have crisis 8:39
Deb Matthews: Bringing back House Calls is part of our strategy to help people stay home longer. It’s proving to be very popular with seniors and the families that support them. It’s more than just doctors, it will include nurses, OTs and other health care professionals. Also telemedicine and on-line support! 8:41
Deb Matthews: The Libs are the only party that is facing the demographic challenge seriously. Our health care system wasn’t designed for the demographic reality of tomorrow — we need to fix that! 8:43
Comment From Nicole: What about support for Community Health Centres? They service vulnerable and marginalized populations and provide great interdisciplinary service for the community….and are often undersupported in funding. 8:44
Deb Matthews: We are thrilled to have supported the greatest expansion of CHCs ever! We’re in the middle of doubling sites from 53 to 101. Delighted with the announcement of new CHCs just a few weeks ago! Also, increased funding for CHCs by 108% — that’s $152M! 8:45
Comment From Nicole: That’s fantastic news! 8:48
Comment From J: Will you support OHIP to fund IVF procedures?8:49
Comment From Josee L: 1 in six couples suffer with infertility. My husband and I being included in that statistic. If elected, will you support IVF funding for Ontario families struggling with infertility?8:50
Comment From J: We also suffer from infertility. 8:50
Deb Matthews: I know how important it is that we support Ontarians as they build their families. That’s why we established the Expert Panel on Adoption and Infertility. We’re moving on their recommendation re: educating both public and providers. And we’re watching the Quebec experience very carefully and doing the research in Ontario to be better able to make the decision here. At this time, we’re not moving with OHIP funding of IVF, but we’re not closing the door, either. 8:53
Comment From Zach: What role does preventative care play in the Liberal health care plan? 8:55
Deb Matthews: Now that we’ve come such a long way in rebuilding our health care system – cut wait times in half, got 94% of Ontarians with primary care, and rebuilding infrastructure – it’s possible to focus on prevention. We know that 1/4 of our health care spending is spent on preventable illness. So making Ontario the healthiest place in North America is our next goal!!8:59
Comment From Laura O’Grady: The system was designed for acute care. Now we have chronic complex disease. This should be part of focus for change. 9:00
Deb Matthews: You are so right! People with chronic, complex needs deserve special care.That’s why we’ll provide a Health Care Coordinator to facilitate care between specialists and family doctors, hospitals, and the community to assist seniors who’ve been hospitalized within the previous 12 months. 9:02
Deb Matthews: Thank you so much for all your questions and comments! I wish we had more time to get through everything. Please make health care an issue in this election and ask your local candidates to support better health care for all! Hope you’ll all vote Liberal so we can do this again!! 9:03
Ontario Liberal Party: Thank you for joining us Deb.
If you don’t yet, make sure you follow her on twitter: @Deb_Matthews
We hope we’ll see you on Facebook again for our next webchat. Stay tuned for details in the next coming days.
We need not look far for examples of the massive change the Internet has brought upon us. Take the music industry for example. Like water finding the path of least resistance people started to find ways to create and exchange copies of songs for free. There has been much speculation as to why this occurred. Some say it is because no one wanted to buy a whole album when they only wanted one song. It became simple to share music, one song at a time, online. Peer to peer file sharing ensured no one would be required to store songs on their server and risk getting caught providing copyright material for free.
Why wouldn’t the record companies sell new material online? Did they just not “get it”? Some bands began to sell their songs online or provide them for free. Others found innovate, “pay what you think it is worth” business models. Music fans will always buy music. Just make it available in a convenient and fairly priced format. Same goes for the film industry. People didn’t even wait for the film to be released in a digitized format before they were recording it in the theatre and distributing these versions online (in some ways this is similar to bootleg concert recordings). Now this industry is suffering. But it has learned from the mistakes of others and now offers other channels of delivery. Soon films released in the theatre will also be available for viewing online at the same time.
Another medium experiencing great threat from the Internet is journalism. They also ignored the signs. People wanted their news in an online format. They wanted to be able to provide comments instantly by posted their opinion at the web page below the story. Who would write a letter to the editor using paper, an envelope and stamp when you can instantly post online? Print subscriptions to newspapers have plummeted. Some say this is because the news is outdated once it arrives. Others prefer to save on costs and view it for free online. Other threats also arose. Bloggers, some of whom write about events experienced in person and others who share their own opinions have become a serious threat to credentialed journalists from well respected newspapers and magazines. Suddenly the monopoly these industries had on what, when, how and by whom news was reported became threatened.
Then HIN1 happened and some very smart journalists at The Guardian UK learned it was much better to create the story then just sit back and report it. They found data about the reported incident rates at the Center for Disease (CDC) web site. They took that information and put it into a Google Docs spreadsheet. Using the Google Maps API they did a bit of programming to connect the location from the outbreak data to the map. This created an interactive rendering of where the current outbreaks of the pandemic were in real time. This incredibly useful and informative tool goes beyond writing a story that H1N1 is spreading. It provided us with up to date information professionals and laypersons could use in an easy to access format with complete transparency of how the information was developed. This field is now called data journalism.
In the future all workers will need to adapt and change their job on the fly in this fashion. It is no longer about learning how to do a task or set of tasks – it is about learning to identify what the task is then adapt, acquire or even create the skills to complete task. This is the knowledge economy.
Many of those already in the work force won’t have the skills to work in this type of environment. They want to stick with what they know, what they were taught and have been doing for years. They don’t want to learn anything new. In part the academic system in which they were schooled is to blame. The emphasis on memorization and testing of rote knowledge is out of date. What can we do now to change this for the next generation?
The first think we need to acknowledge is that it is no longer about memorizing. Information is freely available online. What is the point having the student memorize the periodic table when they can just look it up online? I know what you’re thinking, “I had to long how to add, subtract, multiple and divide and there’s no way my kid is going to get away with using a calculator”. Yes, it is important to understand the theoretical underpinnings of a concept. But we need to shift our emphasis. We need to focus more on creating academic environments that foster ways to combine collective knowledge into new forms of intelligence. And we need to do this at a younger age. It is about the co-creation of new knowledge not the memorization of old. And the sooner we make these adjustments the better off we will be. In a global economy our future depends on it.
Another way to obtain data for use in research studies is to find sources in which it has already been collected. There are many organizations that record data either for their own purposes or as their mandate. Obtaining data in the former circumstance may be difficult due to privacy issues. However, Statistics Canada as an example of the latter provides many data sets for free. Compilations that require specific variables can also be obtained but there is often a fee associated with this type of request. The advantage of using pre-existing data include not eliminating the need to obtain approval to collect the data but also obtain permission from a research ethics board, both of which can add a year or more to the process.
The two main health-related data sets provided by Statistics Canada are the Canadian Health Measures Survey (CHMS) and the Canadian Community Health Survey – Annual Component (CCHS). Both collect information on a number of clinical indicators such as chronic conditions, medication use, medical history, nutrition, chemistry panel, disease screening as well as social support and some socio-demographic information.
Unfortunately this kind of data is not of much use to me. Questions about patient engagement, empowerment, use of social media and other technologies in diagnosis and self management are more of interest to my research. Some of this information I can get by collaborating with organizations that provide web-based forums or resources for patients. I can also scrape it directly from online sources (e.g. mining the Twitter feed). However, there are also obstacles in this process. Partnering with an organization may involve an ethical review and involve other institutional barriers. Data scraping involves hiring someone with technical and programming skills or doing this on my own.
I think the larger issue here is how this data will be used. My intentions are to demonstrate how patients (and providers) can collaboration using technology to improve health. However, I am concerned that some technology-based patient initiatives that rely on funding will be at risk if they are unable to “prove their worth”. Some progress has been made in developing metrics for social media. But is it specific enough to health care? Patient-driven efforts like those who informally share information on message forums, through social networking and using Twitter will likely continue to thrive as they are not dependent on these funding sources. Some promising work on how patient collected data can be used is being conducted by the organization Patients Like Me. However, what is still lacking is patients’ ability to collectively use data on their health to influence change in procedures, prioritization and policy in health care. Of particular concern to me is what is being collected in electronic health records. Will patients have control over this information? Will they be able to export it for their own use? Will they be able to combine it with other patients in order to conduct in-depth analysis? In Canada we are paying for this system. Mining data is one way to have a say in its development, design and delivery. It is therefore imperative that patients maintain control over their data or it may not be used to best serve their interests. I look forward to the day when my job involves teaching courses how to mine patient-generated data to aid decision making and the class is filled with empowered, engaged people who want to be part of this change.
Healthcare social media (hcsm) can be defined as the interactive engagement through use of electronic platform(s) for the multi-directional exchange of user-generated information, knowledge, data and wisdom including anecdotal experiences amongst patients, their families, healthcare professionals, health researchers and healthcare administrators.
1 answer on Quora
What is the definition of social media within a healthcare context?
An important component of my work involves publishing papers in academic journals. There are a variety of different formats but most are either original research or theoretical pieces. Original research papers result from conducting a study or experiment. This format may be easier to publish, at least in biomedical journals as many accept submissions in this format only. In addition, with the aid of powerful statistical analyses original research may be viewed as more solid form of “proof” that new knowledge has been generated and therefore be considered to be of more merit. Qualitative research yields what is commonly referred to as ‘findings’, which can also lead to new information or knowledge. Journals are ranked based on their “impact factor”, which is calculated based on the number of times a paper is cited and other variables. It is more desirable to have your paper published in a high ranking journal as it an indication of your value as a researcher.
There are various steps associated with conducting original research. The first is generally to conduct a literature review. This is done in order to ensure that your research idea has not been previously published. Over the past ten years the literature review has evolved from simply searching a variety of relevant indexed databases to the much more rigorous “systematic review”. The way in which you conduct your literature search can impact the ability for your research to be published in the higher ranked journals. The more rigorous standards you apply in your literature search increases the chances you did not overlook publications that may presents similar results as your study. There are specialists trained to conduct literature reviews. If possible you should consult such an expert during this stage of the research.
Once you have determined that your research question is viable you may need to obtain funding in order to conduct the study. This will allow you to hire research assistants, biostaticians and others to help execute the study. To obtain funding you will need to complete a grant application, which may require anywhere from ten to twenty pages of written information. Within these documents you make the case for your study, articulate why it is worthy of funding and back this up with citations from the research you obtained in the literature review. You must then wait until a funding organization announces a call for applications that fits with your research idea, apply for funding and wait again to find out whether your project has been selected.
If you are lucky (success rates vary from ten to thirty percent) enough to be granted funding you must then apply for permission to conduct the study from an ethical review board (also known as a Research Ethics Board or REB). These boards consist of volunteers who may have specialized knowledge in research, ethics or specific topic areas (e.g. expertise in clinical trials, research with specialized populations, etc.). Universities and hospitals generally have one or more REB in order to review research conducted by or within these institutions. This application process can also take many months and may involve a series of revisions.
When approved you must now find participants for the study, which can also take months, especially if you are looking for a niche population (e.g. diabetics who use social media). When the data has been collected it must coded, analyzed and the results written up. This process can also take weeks or months, depending on how much time you have available and the schedule of others assisting in this process. In some situations you may chose to present preliminary findings at a conference in order to gain feedback on your study.
After the paper has been written you must submit it for publication. This process involves a peer review in which others with expertise in this particular area read over your work to ensure it is worthy of publication. This is also conducted by volunteers and the process can take months or longer. Your article may be accepted but require several amendments. You may need to consult your colleagues who were involved in the study in order to complete these revisions. This process may go on for two or three rounds of edits before your paper is ready to be published. All of this may take months. In addition there is often a backlog of other papers that are waiting to be published so it may take a year or more before your paper actually appears in print.
To illustrate a real world example I share the following steps and time line for a research study I recently collaborated on with other researchers:
Almost four years has passed since this study was started and we still have no idea of when the results will be published.
Update: This paper was accepted for publication in the International Journal of Medical Informatics on Monday October 3rd, 2011.
Have you taken the challenge yet? “What challenge?”, you ask. The Health 2.0 Developer Challenge or those on Challenge Post. These sites take advantage of the recent US initiative to make health databases available to the public.
Since 2010, both sites have hosted challenges sponsored by organizations, corporations, and the government. Some have monetary prizes, some just offer recognition. The goal is to bring software programmers, designers, and health care experts together for rapid application development. There are two types of developer projects: 1) challenges, which overseas team collaboration to build specific requested tech solutions, and 2) code-a-thons. Code-a-thons are typically one day or weekend events that spur teams to rapidly create new applications and tools to improve health care.
Health 2.0 and Challenge Post make it easy to form teams with their community boards and resources. Check out the wide array of challenges posted on their sites. Compare goals, deadlines and prizes. Make new contacts, enjoy the thrill of creativity, and the pride of helping find real solutions to health care issues. Several have December 31, 2011 deadlines, so check out the fun and competition, and register today!
containers that ring, play music and send emails to remind people to take sixteen different medications when loaded only once in two or three months. Another medication lid glows when it is time to take a pill and then records the time the bottle is opened and the pill was taken.
Multiple pedometers and sensors track steps, galvanic skin response, brain waves, and pulse and are easily synched with smartphone apps that forward reports to your doctor. Sensors can be placed in carpets, slippers, kitchen drawers and refrigerators to track movement of elders living alone. Reports can be sent to specified caregivers. One sensor tracks sleep patterns when placed in an arm band and then placed under your smartphone in the morning to sync and download and email the report. Airstrip Tech links doctors with EMTs in ambulances to follow monitors as the patient travels to the hospital. Two 5 minute Rapid Fire product demo sessions reviewed over 25 new products.
Several websites help patients track their medical information. Patients determine what they want to share and with whom. Some are open source; some are created by private companies. Patient groups like ePatient Dave and Patients Like Me encourage sharing collective medical information to foster a faster learning curve to how to best treat patients and diseases in the US and abroad.
I had the distinct honor of speaking on a panel about game play.
My expertise comes from creating and consulting on multiple smartphone apps related to food and nutrition. Gamification was a hot topic in multiple sessions, mentioned frequently as a terrific means to engage and educate patients. Interesting to me was the fact that some telemedicine products and apps already include game play. This is mostly in the form of Q&A or true/false questions. To celebrate Breast Cancer Month in October, a colleague, Nadine Fisher, MS RD LD, and I created the Apple app Breast Cancer Care. We included five true/false games and one food photo match game.
Many of the products I saw at Connected Health are first generation this year. One company rep said there were only a handful of tech vendors exhibiting last year. This year there were five exhibitor rows lining a hotel ballroom. This business is exploding. I have seen the future of medicine, and it is exciting and often fun. Games are a great hope to advance the health of the world for patients, caregivers, and professionals.
Here’s a link to a blog post about the panel on which I spoke. I was the only RD on the program.
http://mobihealthnews.com/13977/add-health-to-games-or-games-to-health
Games for Health Project originated in the United States in 2004.
Ben Sawyer was instrumental in its foundation and development into the force that it is today. It’s annual meeting draws hundreds of global participants each year in Boston.
So it was exciting news this year when Games for Health announced a European partner. It’s first meeting will be held in Amsterdam on October 24 and 25. The central theme is: How games and simulations can improve health(care) and make it affordable. The program is dynamic includes topics on five core tracks:
Cognitive and emotional health
Participatory health
Exergaming, active gaming and fitness
Rehabilitation games
Medical/Education and training
So if you are looking for an excuse to visit Amsterdam, the Games for Health Europe conference is a must do. It will be exciting to watch this innovative group develop and deliver fresh ideas and research on health games for the European health community.
Register today!
www.GamesforHealthEurope.org
Nick Yee, PhD, a research scientist at the PARC (the Palo Alto Research Center) has published studies that show how people’s behaviors change when they use avatars. One study notes how players engage when offered tall, attractive avatars, versus shorter, less attractive ones. He suggests that people will exercise longer and better when offered fit looking avatars.
James Watt, PhD is a serious games researcher at the University of Connecticut. He explains that social interaction is relative to masked identity. Group communication is best when there is also social interaction. So how about creating an avatar-likeness with body movements that still provides anonymity? Microsoft Xbox recently released Avatar Kinect that scans participants and then creates a general look-alike avatar of themselves – including body movements.
Players might not mind sharing personal attributes with friends, but would players feel comfortable revealing their size, hair color, and mannerisms to strangers, too? This remains to be seen, as medical professionals brainstorm about health applications. Consider in-home avatar group therapy sessions, patient education classes, addiction support groups, or parent clubs. Now layer on a health gaming twist. How about a virtually engaging game of Nutrition Jeopardy? The possibilities are tremendous! What kind of avatar health games do you envision? This field is wide-open for development. Game on!
Strong research is the foundation of the health professions, and health game development is no different. When a person’s health is being manipulated, then people expect the method or product to be well researched before being recommended. After all, the physician’s oath is, “First, do no harm …”
From the start, early thought-leaders recognized that progress in this emerging industry needed to rely on health professional collaboration based on sound, scientific research to prove efficacy. This is what researchers call, “the scientific method.” Developers, designers, funders, and players want to see supportive data. Multiple colleges and universities have stepped up to take the task, and many privately funded developers eagerly share their methods and results to further the cause. Unfortunately, researchers publishing their results has been a problem. Traditional scholarly journals do not target video games for health — until now.
Mary Ann Liebert, Inc, publishers of scores of well-respected peer-reviewed scientific journals have announced plans to publish Games for Health: Research, Development, and Clinical Applications this fall. Games for Health will be a peer-reviewed journal and has a stellar editorial board line-up. The Liebert press release stated the journal would be published bi-monthly and would be “dedicated to the development, use, and applications of game technology for improving physical and mental health and well-being. The Journal breaks new ground as the first to address this emerging, widely-recognized, and increasingly adopted area of healthcare.”
The Games for Health journal and it’s accompanying online presence is a welcome home for the health video games community. For more information check out www.liebertpub.com
Organized by the the IU School of Informatics at Indiana University–Purdue University Indianapolis (IUPUI), the 2nd annual Midwestern Conference on Health Games conference will be held in Indianapolis on October 28, 2011. Abstracts are being accepted now. The submission deadline is June 1. 2011. For more information please contact Vicki Daugherty at vdaugher@iupui.edu or 317-278-4123.
Back in 2010 we were introduced to the “Wii-killer,” aka the Kinect for Xbox 360. Microsoft’s initial lineup of exergames revealed great health gaming potential. Others, such as Dr. Bill Crounse who writes for the Microsoft Health blog, speculated that the Kinect could be used in healthcare for even bigger purposes due to its set of special characteristics. This includes:
Innovators in the medical community have been able to take these special characteristics and far surpass initial expectations for the ways the Kinect can be used in healthcare. I doubt that Microsoft expected their new controller-free gaming device to have such an impact in such a variety of ways. Here are just some of the many examples:
I’m sure there are many other ways the Xbox 360 Kinect is being used in medicine today, whether in testing or in practice. Feel free to share your knowledge with the group by leaving a comment.
One of the health game products I’ve been watching very closely is Zamzee. Not a whole lot has been written about this innovative new company yet, especially when one compares it to previous HopeLab products like Re-Mission. However, they have really geared up for an impressive product, and it will be very interesting to see how well it does in clinical testing and in the market.
Zamzee is an online rewards program for teens based on their recorded physical activity. Users wear a three-axis accelerometer specially calibrated to record short bursts of movement and vigorous activity. Increased movement increases website status which can then be converted into spendable Zamz, a virtual currency used to purchase virtual and tangible rewards.
Zamzee was established in 2010 with an initial investment of $1M from the HopeLab Foundation. The creators of Zamzee hope to make it into a profitable business with the added benefit of getting teens more physically active.
Although Zamzee has some characteristics that make it completely unique, some of its features do remind me of other products, many of which haven’t done so well in the market.
I have to say that one benefit Zamzee has over probably many of these others is the strong team they’re building. Back in February, Zamzee announced that they finally established a solid executive team including Jonathan Attwood as CEO and Lance Henderson as COO.
However, not all of the available positions have been filled. This is excellent news for all of you job hunters out there as it is very rare for health game positions to be available. Take a look at their careers page to see if you might be a good fit for one of these openings. Good luck out there!
It’s that time of year again where the best and brightest in the games for health field gather together for the Games for Health Conference. The 2011 conference will be held at the Hyatt Harborside Hotel in Boston, MA from May 18-19 with a pre-conference May 17.
This year, the chosen keynote is an interesting one for Games for Health. Ben Sawyer announced that the founding father of Positive Psychology, Dr. Martin Seligman, will be taking the stage. You can read Dr. Seligman’s full bio on the U Penn Positive Psychology Center page.
Dr. Seligman will help Games for Health attendees understand the opportunities that positive psychology presents for games. His opening talk “Positive Psychology>Positive Computing>Positive Videogames” is one of over 60 talks planned for the three day event will provide the basis for a conference long discussion about how video game developers and researchers can create “PERMA Power Ups” forged by a collaboration between the documented interventions of positive psychology and interactive entertainment.
I’m actually very excited about this keynote. Several years ago I did a little series on healthGAMERS called “What Makes a Great Health Game Great.” One of the many things required for a good game is the ability to help players reach that feeling of flow or losing oneself through enjoyment. Perhaps Dr. Seligman will be able to expand upon this.
Additional speakers and presentations are available on the full schedule block page for the conference. This is constantly being updated so if you don’t see something here for you just yet, keep checking back. There are over 60 talks planned this year.
To register, visit the Games Beyond Entertainment Week registration page. Prices range from $199 to $999 depending on how early you sign up and how many events you choose to attend. Us the code BOST11 to receive 10% off registration!!
I received a very nice note from Dr. Sylvester Arnab of the Serious Games Institute requesting leads on researchers and practitioners interested in helping contribute to a new book called Serious Games for Healthcare: Applications and Implications. Hopefully you healthgamers can be of assistance!
Similar to the DIVERSE Conference call for eHealth papers, this is a great opportunity for those of you with experience in games for health research to step up to the plate and get your knowledge in print.
Below is a summary of the general needs:
Researchers and practitioners are invited to submit on or before April 15, 2011, a 1-2 page chapter proposal clearly explaining the mission and concerns of his or her proposed chapter. Visit the Serious Games for Healthcare: Applications and Implications for full details about the requirements. Inquiries and submissions can be forwarded electronically (Word document):
Dr. Sylvester Arnab
Serious Games Institute
Coventry University
CV1 2TL, UK
Tel.: +44(0)24 7615 8205
E-mail: s.arnab[at]coventry.ac.uk
President Obama speaks to the nation about healthcare reform (AP photo)
Tonight, President Obama spoke to the nation about his plans for healthcare reform. He outlined how he plans to reform the current system and how he plans to pay for it including cutting over $100 billion worth of subsidies to insurance companies as part of Medicare.
Few key points:
He also touched upon the need to increase health IT and move way a fee for service system to a team-based approach to deliver healthcare.
Full Video:
Full Text: Obama’s Remarks on Health Care
(without question/answer session)
Following is a text of the prepared remarks by President Obama before his White House news conference on Wednesday, as released by the White House.
Good evening. Before I take your questions, I want to talk for a few minutes about the progress we’re making on health insurance reform and where it fits into our broader economic strategy.
Six months ago, I took office amid the worst recession in half a century. We were losing an average of 700,000 jobs per month and our financial system was on the verge of collapse.
As a result of the action we took in those first weeks, we have been able to pull our economy back from the brink. We took steps to stabilize our financial institutions and our housing market. And we passed a Recovery Act that has already saved jobs and created new ones; delivered billions in tax relief to families and small businesses; and extended unemployment insurance and health insurance to those who have been laid off.
Of course, we still have a long way to go. And the Recovery Act will continue to save and create more jobs over the next two years – just like it was designed to do. I realize this is little comfort to those Americans who are currently out of work, and I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.
And the fact is, even before this crisis hit, we had an economy that was creating a good deal of wealth for folks at the very top, but not a lot of good-paying jobs for the rest of America. It’s an economy that simply wasn’t ready to compete in the 21st century – one where we’ve been slow to invest in the clean energy technologies that have created new jobs and industries in other countries; where we’ve watched our graduation rates lag behind too much of the world; and where we spend much more on health care than any other nation but aren’t any healthier for it.
That is why I’ve said that even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before. And health insurance reform is central to that effort.
This is not just about the 47 million Americans who have no health insurance. Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job, or change their job. It’s about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive. And it’s about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.
So let me be clear: if we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction. These are the stakes of the debate we’re having right now.
I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, “What’s in this for me? How does my family stand to benefit from health insurance reform?”
Tonight I want to answer those questions. Because even though Congress is still working through a few key issues, we already have agreement on the following areas:
If you already have health insurance, the reform we’re proposing will provide you with more security and more stability. It will keep government out of health care decisions, giving you the option to keep your insurance if you’re happy with it. It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money.
If you don’t have health insurance, or are a small business looking to cover your employees, you’ll be able to choose a quality, affordable health plan through a health insurance exchange – a marketplace that promotes choice and competition Finally, no insurance company will be allowed to deny you coverage because of a pre-existing medical condition.
I have also pledged that health insurance reform will not add to our deficit over the next decade – and I mean it. In the past eight years, we saw the enactment of two tax cuts, primarily for the wealthiest Americans, and a Medicare prescription program, none of which were paid for. This is partly why I inherited a $1.3 trillion deficit.
That will not happen with health insurance reform. It will be paid for. Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over one hundred billion dollars in unwarranted subsidies that go to insurance companies as part of Medicare – subsidies that do nothing to improve care for our seniors. And I’m pleased that Congress has already embraced these proposals. While they are currently working through proposals to finance the remaining costs, I continue to insist that health reform not be paid for on the backs of middle-class families.
In addition to making sure that this plan doesn’t add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run. Our proposals would change incentives so that doctors and nurses are free to give patients the best care, not just the most expensive care. That’s why the nation’s largest organizations representing doctors and nurses have embraced our plan.
We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis – a proposal that could save even more money and ensure the long-term financial health of Medicare. Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts.
Not all of the cost savings measures I just mentioned were contained in Congress’s draft legislation, but we are now seeing broad agreement thanks to the work that was done over the last few days. So even though we still have a few issues to work out, what’s remarkable at this point is not how far we have left to go – it’s how far we have already come.
I understand how easy it is for this town to become consumed in the game of politics – to turn every issue into running tally of who’s up and who’s down. I’ve heard that one Republican strategist told his party that even though they may want to compromise, it’s better politics to “go for the kill.” Another Republican Senator said that defeating health reform is about “breaking” me.
So let me be clear: This isn’t about me. I have great health insurance, and so does every Member of Congress. This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings. This is about the woman in Colorado who paid $700 a month to her insurance company only to find out that they wouldn’t pay a dime for her cancer treatment – who had to use up her retirement funds to save her own life. This is about the middle-class college graduate from Maryland whose health insurance expired when he changed jobs, and woke up from emergency surgery with $10,000 in debt. This is about every family, every business, and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades.
This debate is not a game for these Americans, and they cannot afford to wait for reform any longer. They are counting on us to get this done. They are looking to us for leadership. And we must not let them down. We will pass reform that lowers cost, promotes choice, and provides coverage that every American can count on. And we will do it this year. And with that, I’ll take your questions.
The ONC policy committee on meaningful use has published an updated matrix on the subject. It can be found here.
Someone in the GOP needs to learn how to use Microsoft Visio, or the Democrats need to come up with a better plan for improving our healthcare system.
Republicans imagination of the Democratic Healthcare plan
If you believe this nightmare chart created by Congressman Kevin Brady’s office (R-Texas 8th District), then you’ll need a PHD in obfuscation to figure out what the Democrats are planning. More likely, however, is that Brady is painting an overly bleak picture of what a government plan might look like.
Jokes aside, as this battle continues to play out, both sides are sticking to their guns; however, the Obama administration believes it has the trump card: 60 votes. Bloomberg News is reporting that “Obama Open to Partisan Vote on Health-Care Overhaul.”
We’ll follow how this plays out, and keep you apprised of any interesting happenings.
UPDATE July 22, 2009:
Corrected Visualization of the Democratic Healthcare plan (PDF)
A graphic designer, Robert Palmer, took it upon himself to “correct” the republican nightmare chart and made it significantly easier to understand. The updated chart, along with a PDF can be found on Mr. Palmer’s Flickr page. He also penned a note to Representative Boehner:
Dear Rep. Boehner,
Recently, you released a chart purportedly describing the organization of the House Democrats’ health plan. I think Democrats, Republicans, and independents agree that the problem is very complicated, no matter how you visualize it.
By releasing your chart, instead of meaningfully educating the public, you willfully obfuscated an already complicated proposal. There is no simple proposal to solve this problem. You instead chose to shout “12! 16! 37! 9! 24!” while we were trying to count something.
So, to try and do my duty both to the country and to information design (a profession and skill you have loudly shat upon), I have taken it upon myself to untangle your delightful chart. A few notes:
- I have removed the label referring to “federal website guidelines” as those are not a specific requirement of the Health and Human Services department. They are part of the U.S. Code. I should know: I have to follow them.
- I have relabeled the “Veterans Administration” to the “Department of Veterans’ Affairs.” The name change took effect in 1989.
- In the one change I made specifically for clarity, I omitted the line connecting the IRS and Health and Human Services department labeled “Individual Tax Return Information.”
In the future, please remember that you have a duty to inform the public, and not willfully confuse your constituents.
Sincerely,
Robert Palmer
Resident,
California 53rd District
The Certification Commission for Healthcare Information Technology (CCHIT) has responded to the Office of the National Coordinator’s recently released Meaningful Use matrix [pdf]–and responded with a vengeance.
The bottom line: “CCHIT recommends that meaningful use measures be either simplified for 2011, or postponed until 2013.” CCHIT Annotations to the ONC's Meaningful Use Matrix (PDF)![CCHIT Annotations to the ONC's Meaningful Use Matrix [PDF]](http://healthcareitblog.mtbc.com/wp-content/uploads/2009/07/cchit-annotations.png "cchit-annotations")
Its recommendation was formed by comparing the CCHIT 2008 criteria against the meaningful use matrix prepared by the National Coordinator’s Workgroup on Meaningful Use and finding that while many of the 22 proposed objectives are fully supported by the current certification, at least 8 have minor to major gaps with the CCHIT 08 criteria.
Why Postpone?
The commission argues that “the lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years,” and for this reason it recommends postponing the 2011 measures until 2013. It isn’t that some EHRs do not currently meet the standards drafted for 2011 (MTBC’s EMR does), it’s that CCHIT criteria does not currently cover or test for all of the proposed 2011 measures. Additionally, CCHIT does not believe that the marketplace is fully ready to support some of the reporting standards outlined in the draft.
CCHIT has prepared an annotated response to the ONC’s matrix which highlights the actual points in contention for 2011. CCHIT’s letter to the ONC further clarifies CCHIT position on the topic.
As always, we will continue to cover this story as new developments arise and as key shareholders continue to weigh in with comments and responses.
Why don’t you let us know what you think? Should the 2011 measures be postponed until 2013?
When you buy a car, the manufacturer usually offers some kind of warranty on your purchase e.g. bumper-to-bumper coverage for 50,000 miles or 5 years, whichever comes first. Or coverage for 100,000 miles for the power train and 50,000 miles bumper-to-bumper. Some are now offering oil changes for life, free car washes, dry cleaning, or the salesman will pick up your kids from soccer practice if you make a purchase now. Ok, maybe they won’t pick up your kids, but you will please! buy now?
Francois de Brantes
Francois de Brantes, a nationally known advocate of health care quality, is hoping to bring warranties to healthcare. He and a few associates penned an article in Health Affairs describing the benefits of a new payment model for physicians which may inspire physicians to improve patient outcomes by putting their skin (and money) in the game.
The warranties which de Brantes proposes–Prometheus Payment as he’s called it–flip the current medical billing payment model on its ear. Prometheus Payment offers set fees to providers for recommended services, treatments and procedures. However, unlike the current system where all fees are covered by third-party payers, the provider now becomes a party in the payment process by assuming fiduciary responsibility for outcomes–should patients develop an avoidable outcome, providers become responsible for half the costs. The warranty is based on the costs of these avoidable outcomes and is risk adjusted for elderly or frail patients.
de Brantes and his co-authors explain that “the warranty concept has filtered into the self-pay portion of health care, such as corrective eye surgery, general cosmetic surgery, and dental care, which are often based on a global fee that includes any necessary rework by the provider. But it has taken much longer for warranties to appear in the third-party payer system.” They argue that with this global-fee model, overall costs in the healthcare can be reduced while improving outcomes for patients by making (and paying) the provider for any expenses before, during, and after the procedure.
The abstract to the Health Affairs article reads:
How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding “warranties” to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers’ behavior and profitability. We conclude that warranties could motivate providers to improve quality and could increase their profit margins.
I find two points interesting.
This whole idea adds a new wrinkle to medical billing. As your billing service, we’d not only be incentivized to help you collect more money but also provide you tools to provide better patient care. Great news for you, we have a CCHIT-certified EMR which provides just the tools you need. Find out more here.
We will keep you posted if this model crops up at any payers near you.
Read more about Prometheus Payment:
On June 16 the Workgroup on Meaningful Use presented its recommendations on the definition of Meaningful Use. They prepared a preamble describing their overall path to this definition and a matrix to organize their recommendations for each year. For those who have been under a rock for the past 6 months, “meaningful use” is the defining measure by which the incentive payments included in the American Recovery and Reinvestment Act (ARRA) will be determined.
With this working definition, vendors, physicians, and hospitals can better plan for implementation and delivery of technology and services to achieve the measurable goals outlined by the Workgroup.
HITECH Act Incentives as outlined by the American Recovery and Reinvestment Act (ARRA)
Meaningful Use for Whom?
First it is important to note that “meaningful use” will have different meanings for hospitals and for groups in private practice. The preamble states “some features and capabilities will be recommended as required in an ambulatory setting before similar functions are expected to be widely used in the hospital.” This means that proving “meaningful use” will be a more rigorous exercise for private practices than it is for hospitals. However, private practices have a broader range of options and lower barriers of entry (cost, availability of technology, shorter implementation time frames, etc) when it comes to implementing technologies which can deliver “meaningful use.”
The Details
Let’s go over some of the measures which are planned for 2011 and look at some examples of each item. More details for each of the items below can be found in the matrix. John Halamka, MD of the CareGroup Health System of Harvard Medical School and the chairman of the US Healthcare Information Technology Standards Panel (HITSP) said in Healthcare IT News that this matrix still needs to be populated with the most up to date standards and an implementation guide. These details will help vendors and physicians alike ensure that their software meets these measures. Expect this in July.
Each of the items below has associated metrics which will need to be reported to verify meaningful use; for example, one of the objectives calls for reminders to patients for preventive/follow-up care. In order to prove meaningful use, the EMR application must be able to provide a reporting of the percentage of patients over 50 with annual colorectal screening. Keep in mind that each of the items below has an associated measure (found in the matrix) which will require reporting to an authorized agency.
Items marked with a Yes! indicate that the MTBC EMR helps your practice meet or exceeds these measures.
What Now?
Now that you know the definition of Meaningful Use what should you do now? The answer is simple: get an EMR. Ok it is not that simple, but you will be happy to know that you have plenty of options in the marketplace. Dr. Halamka writes, “Hospitals and Clinician offices now know what is expected for 2011, so the time is now to begin your software implementations.” Never before have there been so many EMRs which provide such a high level of functionality and interoperability. Today’s major differentiators are not function, but price and service.
MTBC Can Help
MTBC’s CCHIT certified EMR (free to MTBC medical billing clients) can help your practice meet the goals of 2011. Click here to find out more about MTBC’s unified medical billing and practice managagement services.
However, if “free” is not your bag, you have plenty of other options beginning at the $1,000 range and your imagination as the only limit. Vendors have become very creative in their pricing with new options emerging such as monthly subscriptions, charges for each fax sent from the EMR, hosting fees for web-based applications, fees for technical support by email, server replacement plans (a la replacement plans sold by big box stores), 50¢ per 100MB of storage, and many others.
MTBC’s EMR rivals those of its competitors because it is implemented, supported, and updated completely free of charge of its premium medical billing clients. To find out more about how MTBC’s EMR can help you meet the goals of Meaningful Use, request a demo today and, if you are not currently an MTBC billing client, find out how you can download a free trial.
Watch this space for more information regarding meaningful use and its impact on the healthcare IT.
You maybe asking yourself why MTBC, a medical billing company, pursued and received CCHIT certification. What does medical billing have to do with electronic medical records? The answer for us is simple: improving our clients’ work flow improves their collections. The only way we could find to help improve our clients’ work flow was to provide them a great EMR software, free of charge. Click here to see how MTBC’s EMR can improve your work flow, and improve your collections.
Why CCHIT? Why Now?
Providing a free EMR is one thing, providing a certified EMR which is also free is entirely different. CCHIT, the Certification Commission for Healthcare Information Technology, is the recognized certification body in the United States for EMR applications. As per our knowledge, we are the only company providing a completely free CCHIT certified EMR. The software is free and we service it for free as part of our 5% premium medical billing service.
With the new ARRA incentives as a carrot ($44,000 to use an EMR? Thanks Dr. B!), many EMR vendors are promising that a costly EMR investment will pay for itself. This has yet to be seen and the government is still working out the details. MTBC clients no longer have to worry about such costly investments for the chance at the incentives starting in 2011. CCHIT certification is almost certainly one of the prerequisites to receiving these incentives, “meaningful use,” is another. Its not enough to simply spend a boat load of money on an EMR, you must begin using it as well.
With MTBC, physicians have a dedicated partner that is committed to providing the best EMR software that meets current and future requirements for certification and meaningful use while exceeding client expectations.
Watch this space for upcoming videos, downloads, and MTBC EMR client testimonials.
In the June issue of The New Yorker magazine, Dr. Atul Gawande contrasts 
the high-cost health-care system in McAllen, Texas, with the lower-cost systems at the Mayo Clinic and in Grand Junction, Colorado. McAllen, Texas is one of the most expensive health-care markets in the country. Only Miami spends more. He explores why costs in this Texas town have spiraled out of control while those in other parts of the country have remained fairly stable.
This article has become a must read for healthcare policy wonks and all those interested in the astronomical costs of medicine.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail
We are thrilled to announce that MTBC EMR v 4.0 has received the prestigious CCHIT 2008 Ambulatory Certification. The Certification Commission for Healthcare Information Technology is the Recognized Certification Body in the United States for certifying health information technology products.
MTBC’s new, upgraded Version 4.0 of our EMR is already being praised for its intuitive design, making clinical training optimally efficient while enhancing patient care.
Moreover, MTBC’s EMR 4.0 is free and supported free for clients of our Premium Plan, an unrivaled package of comprehensive practice management services. Our remarkable commitment to value removes the financial and administrative barriers that have prevented more than 90% of private practices from fully using an EMR.
MTBC’s EMR 4.0 is certified by the Certification Commission for Healthcare Information Technology (CCHIT), the gold standard for EMR usability, functionality and interoperability.
Request a copy, more information and a preview today!
UnitedHealth Group is again at the leading edge of technology and the delivery of healthcare services to patients and providers. Today UHC announced a new product designed to help patients secure medical insurance in the event they are no longer covered by another carrier.
In a way, UHC is offering insurance for your existing insurance. This first of its kind product is called UnitedHealth Continuity. It allows patients the right to purchase an individual insurance policy at some point in the future–even if the patient gets sick.
Patients who enroll in it will pay “20 percent each month of the current premium on the individual policy to reserve the right to be insured under the plan at some point in the future” (NYT). A typical Continuity plan is expected to average approximately $32 per month.
If the promised reforms of the incoming Obama administration materialize this service may become obsolete and in fact may become a free offering by all major insurance carriers. However, until that time, and with the job market collapsing, there are many people who may consider this a very welcome product. Additionally, if the Obama administration is unable to deliver on campaign promises to reform the purchase and delivery of healthcare insurance in the US, more insurance carriers maybe following in the footsteps of UHC.
UHC has been at the forefront of service delivery in the insurance space. It was among the first carriers to provide real-time claims adjudication–a service whereby physicians and their staff are able to immediately determine the patient responsibility on new claims.
Currently, MTBC is one of the only companies in the country providing this service for physicians who participate with UnitedHealth. Read more about MTBC and UnitedHealth here.
Ahem….what do we say about privacy and data selling…bingo it appears as if you read through the entire article why else would this type of data be shared with Wall Street Investors to make a market for selling some new analytic algorithms. Now get this the investors got to see this “private” information that a patient can’t even get access to see. This reminds me of ePatientDave, “give me my damn data” and this is a total abuse here as the data is not being used for better care but for “better money”. 
Now this also says something about access to revenue cycling too, payers and integrators might want to visit this scenario and make sure that it stays on a server for one and what levels of access will be granted. Now this gets worse as the types of information and patients were related to mental health, HIV, Parkinson's and more. How many investors glazed over these records? Accretive gets paid on the revenue boost is provides. There are a lot of these types of 3rd parties around in healthcare and here’s another one used by Blue Cross who had some bad algorithms.
Actually when it comes down to payer disputes you wonder did the hospital bill erroneously on purpose or did they get some bad algorithms and a bunch of promises? If I were one of these patients, court might be on my mind and I would want to know what investors on Wall Street potentially or did see my data! On their website they talk about bringing increased discipline to the revenue cycle so is that 
the revenue cycle on Wall Street?
Well Fargo just dumped one of these types of companies recently and remember the big data breach at Stanford, also the fault of a 3rd party, so with history being built here who wants to trust a 3rd party today if you don’t have to as patient records end up on the web and in the hands of investors on the street. The 3rd party folks are the algorithm makers though that promise better profits and use of money. This whole scenario though is kind of sad as they were supposed to be helping a couple non profits boost their revenue but the hospitals probably had no clue on the methodologies like showing patients records was in the plan.
“The screen shot also includes numeric scores to predict the “complexity” of the patient and the probability of an inpatient hospitalization, and a box to describe
the “frailty” of the patient.”
Tine to start licensing and taxing those data sellers and have a federal disclosure site so we all know what’s going on, beginning to make more sense every day! The link below will describe a bit of this brainstorm. BD
http://www.myfoxtwincities.com/dpp/news/stolen-laptop-debt-collector-lawsuit-jan-19-2012ST. PAUL, Minn. - Minnesota Attorney General Lori Swanson has filed a lawsuit against a debt collector accused of failing to protect the confidential information of 23,500 hospital patients after a company laptop was stolen from a rental car parked in the Seven Corners are of Minneapolis.
The lawsuit filed Thursday alleges Accretive Health, Inc., a debt collection agency that is part of a New York private equity fund conglomerate, failed to protect the confidentiality of patient health care records and failing to disclose its involvement in their health care.
Last July, Accretive lost a laptop computer containing unencrypted health data of about 23,500 patients of two Minnesota hospital systems -- Fairview Health Services and North Memorial Health Care.
Under both contracts, Accretive controls and directs the work of hospital employees and “infuses” its own employees into the staffs of the hospitals. Accretive gets base compensation and incentive pay for helping the hospitals boost revenue or cut costs.
“The debt collector found a way to essentially monetize portions of the revenue and health care delivery systems of some nonprofit hospitals for Wall Street investors, without the knowledge or consent of patients who have the right to know how their information is being used and to have it kept confidential,” Swanson said.
The state seeks an order requiring Accretive to fully disclose to patients:
- What information it has about Minnesota patients
- What information it has lost about Minnesota patients
- Where and to whom it has sent information about Minnesota patients
- The purposes for which it amasses and uses information about Minnesota patients.
One more the mergers and acquisitions speak out again on how health insurance companies have diversified their portfolios and are no longer “just an insurance company” with numerous subsidiaries both in the Health IT area and even others in what you might consider “unrelated” businesses. Here’s one example below with a 
diversified interest with a new division created to distribute hearing aids and offer incentives for those in certain areas of the us to sign up for insurance plans. I sometimes wonder how other insurers view this?
Here’s another example of what one might consider a business outside of what we might normally consider a related business with low incoming housing investments in New Mexico. One thing to keep in mind today is all the aggregated data that flows and the algorithms and SQL statements that bring some of this together. Data is big business.
Just a couple weeks ago we read about the investment with mobile health and again we venture down into the data business here again as the Optum division which has many subsidiaries has a huge focus on data, and part of the renamed group was the old “Ingenix” company that has consulted and provided data services for years and last year settled their case with the AMA with short paying providers for out of network services.
This kind of brings me around again to what I call the “Alternative Millionaire’s Tax” with companies that buy and sell data and this seems to be a good place for a mention here as the Optum Division has been making money for years with aggregating and selling prescription and other data. With big profits as such we certainly could entertain a license and tax situation for those making billions on the data selling business. As a short comparison from another Healthcare company, Walgreens has estimated their data selling business to be valued at just under $800 million, so again something to give some thought to as hospitals, providers, and patients struggle to afford medical care today.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. At a certain point in time we might need to REALLY think about the value of some of the data we analyze today and the cost and this is worth a mention as this is the big growth area for United, algorithms and software analytics via consulting services. It is also worth a note that United last year hired the former Assistant Attorney General for the State of Minnesota for their general counsel.
Below is one example of the algorithm/software business as the company created a clearinghouse business and collaborated with an medical records company to integrate the services with Epic and of course this means more data revenue for the company and puts a bit of stress on other smaller existing clearinghouse businesses in the US as well.
One more thing too is let’s not forget that they also own a bank with over $1 billion on deposit with health savings accounts and I would guess this also leaves them open to lend money on monies held here and somewhat compete with other banks. As you can read in the quote below the funds are largely generated by employers, in other words large US corporations so they seem to go hand in hand, right?
“OptumHealth offers three types of HSAs, as well as tax-advantaged health care 
savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”
There’s also the Chinese investment the company bought early in 2010.
If you were to stop and look you might also notice one more subsidiary that can consult with biotech and device companies to introduce new products to the FDA and you know when you think about it they might just have a subsidiary to handle the entire process from FDA approval all the way down to provider reimbursement too. 
One other related item too is the purchase of physicians groups which is growing and the acquisition of Monarch in Orange County is one big example of buying a huge managed care group.
Again, in summary with such large profits and a lot coming from the data end of the business, this looks like one company where licensing and taxing the data sold for huge profits could fit and there are many more as Hedge Funds, Facebook and tons of other companies are cashing in royally and this all leads to bottom line profits for running algorithms on servers 24/7 that you can’t see, touch or talk to as far as the consumer is concerned, but automated algorithms for data mining and selling are yielding huge profits for corporate USA while as consumers we are becoming “data chasers” to fix a lot of the flawed data that is out there today. It’s a good idea today to read up and see how the corporate USA scene has changed tremendously due to the huge array of mergers and acquisitions as companies are not the same ones they were 2 to 3 years ago by any means. BD
UnitedHealth Group (NYSE:UNH) today reported fourth quarter and full year 2011 results, highlighted by strong enrollment and revenue growth in each of UnitedHealthcare’s benefits businesses and strong revenue growth at all Optum business units. Full year and fourth quarter 2011 net earnings were $4.73 per share and $1.17 per share, respectively. Cash flows from operations were $7 billion in 2011.
The Company continues to estimate 2012 revenues in the range of $107 billion to $108 billion and net earnings in the range of $4.55 to $4.75 per share.
Is there money in those algos? This story might answer that. Why would this employee who was a contracted programmer take this code? It’s worth money and if you read often enough you know I discuss those algos and software is nothing more than a group of algorithms, words of Bill Gates. 
A co-worker said the employee said the accused confused he lost the drive containing the code and get this, it’s the software (aka algorithms) that cost $10 million to develop to track the billions of dollars that the US government dispenses “daily” to government agencies..these are some pretty commanding algorithms…so the programmer apparently took the code and who knows where it would go next? A lot of government code is open source but don’t think that is the case here…what’s the next security breach to occur? BD
Bo Zhang, 32, of Queens, New York, worked as a contract programmer at the bank. He was accused of illegally copying software to an external hard drive, according to a criminal complaint filed in U.S. district court in Manhattan.
Authorities said the software, owned by the U.S. Treasury Department, cost about $9.5 million to develop.
A New York Fed spokesman said in a statement that the bank immediately investigated the suspected breach when it was uncovered and promptly referred the matter to authorities.
Zhang told investigators he took the code "for private use and in order to ensure that it was available to him in the event that he lost his job," the complaint said.
The code, called the Government-wide Accounting and Reporting Program (GWA), was developed to help track the billions of dollars the United States government transfers daily. The GWA provides federal agencies with a statement of their account balance, the complaint said.
This is kind of an alarming incident but when you read further it does not stop the treatment process and the secondary outbursts are surgically removed. This affects about half of those treated to be on alert, but not all of those develop the secondary skin cancer, only about a quarter of the 50% risk group.
This sounds like a big step in recognizing undesired side effect with oncology treatments. BD
Press Release:
Drug Used to Treat Melanoma with One Mutation Sets off a Cascade that Results in a Different Type of Skin Cancer in Cells with Another Mutation
Patients with metastatic melanoma taking the recently approved drug vemurafenib (Zelboraf®) responded well to the twice daily pill, but some of them developed a different, secondary skin cancer.
Now, researchers at UCLA’s Jonsson Comprehensive Cancer Center, working with investigators from the Institute of Cancer Research in London, Roche and Plexxikon, have elucidated the mechanism by which vemurafenib excels at fighting melanoma but also allows for the development of skin squamous cell carcinomas.
The very action by which the pill works, blocking the mutated BRAF protein in melanoma cells, sets off a cellular cascade in other skin cells if they have another pre-disposing cancer mutation and ultimately accelerates the secondary skin cancers, said Dr. Antoni Ribas, co-senior author of the paper and a professor of hematology/oncology.
About 50 percent of patients who get melanoma have the BRAF mutation and can be treated with vemurafenib, Ribas said. Of those, a fourth of the patients develop skin squamous cell carcinomas. The squamous cell carcinomas were removed surgically, and vemurafenib was not discontinued for this side effect.
“We wondered why it was that we were treating and getting the melanoma to shrink, but another skin cancer was developing,” said Ribas, who studies melanoma at the Jonsson Cancer Center. “We looked at what was likely making them grow and we discovered that the drug was making pre-existing cells with a RAS mutation grow into skin squamous cell cancers.”
The 18-month study appears in the Jan. 19, 2012 edition of the New England Journal of Medicine.
The combined research team performed a molecular analysis to identify the oncogenic mutations in the squamous cell lesions of patients treated with the BRAF inhibitor. Among 21 tumor samples studied, 13 had RAS mutations. In a different set of 14 samples, eight had RAS mutations, Ribas said.
“Our data indicate that RAS mutations are present in about 60 percent of cases in patients who develop skin squamous cell cancers while treated with vemurafenib,” Ribas said. “This RAS mutation is likely caused by prior skin damage from sun exposure, and what vemurafenib does is accelerate the appearance of these skin squamous cell cancers, as opposed to being the cause of the mutation that starts these cancers.”
Ribas’ group found that blocking the non-mutated BRAF in cells with mutated RAS caused them to send signals around BRAF that induced the growth of the squamous cell cancers.
The discovery of the squamous cell cancer mechanism has led to strategies to inhibit both the BRAF mutation with vemurafenib and block the cellular cascade with a different drug, a MEK inhibitor, before it initiates the secondary skin cancers, said co-senior author Professor Richard Marais from the Institute of Cancer Research in London, who developed the animal model for the study.
“By understanding the mechanism by which these squamous cell cancers develop, we have been able to devise a strategy to prevent the second tumors without blocking the beneficial effects of the BRAF drugs,” Marais said. “This may allow many more patients to benefit from these important drugs.”
Ribas said that this is one of the very few times that oncologists understand molecularly why a side effect to cancer treatment is happening.
“The side effect in this case is caused by how the drug works in a different cellular setting,” he said. “In one case it inhibits cancer growth, and in another it makes the malignant cells grow faster.”
Studies currently are under way testing BRAF and MEK inhibitors in combination in patients with metastatic melanoma, Ribas said.
“Our data provide a molecular mechanism for the clinical toxicity of a targeted oncogene inhibitor that apparently contradicts the intended effects,” the study states.
The study was supported by Roche, Plexxikon, the Seaver Institute, the Louise Belley and Richard Schnarr Fund, the Fred L. Hartley Family Foundation, the Wesley Coyle Memorial Fund, the Ruby Family Foundation, the Albert Stroberg and Betsy Patterson Fund, the Jonsson Cancer Center Foundation and the Caltech-UCLA Joint Center for Translational Medicine.
UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2011, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 11 of the last 12 years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.
Jon goes back to Foxconn-revisited…in his usual style and he says we need to make our factories look more like those in China. Workers live in dormitories and don’t know each other, cuts down on commuting and friendship. 
Workers are finding ways of improving their conditions, hotlines with trying to stop suicide and put nets around buildings to catch jumpers…I think we remember this from a year ago and he says in the US we call this “treating the symptoms”.
“It’s me, Siri, in your pants pocket working on giving you testicular cancer”…If it works for those factories, electronics would cost more..modern work fare…a game to the rescue…this is great humor but there are somethings I does make one ponder…there’s just one level and this is it…(the middle class) as algorithms are marketed and designed and sold to consumers.
He shows the work of the algorithms in place for sure in a humorous way. Why are health insurance companies getting into the low income housing business though? I hope this is not a Foxconn plan to create communities with jobs that pay little and have medical care on campus? What is up with this?
The same company owns a subsidiary that will basically give you a free hearing aid made in China if you sign up for their health insurance…more below…and the subsidiary they built to distribute and coming to Walmart soon as I understand…
He moves on to the next part, a game that has one level…hmmm…we another insurance company banking on this too…data to sell? Will this make you healthy? I prefer real knowledge.
I just ask is there where we are headed with mining and selling data today and big corporations taking over our day to day decisions? The more information they have to judge and discriminate, the ability to control and humiliate the middle class grows. 
At any rate with the use of algorithms today that have teeth and the amount of flawed data out there, are we going in this direction? I put this out for an awareness and perhaps to generate some though processes. I like technology and the good things it brings but am not oblivious to how it can also be abused as well and a NYU professor says it even better than me, read and listen up.
I sure hope Richard Cordray understands math and the power of the algorithms when used both in an intuitive and good manner and the reality of those who design for pure profit that hurts consumers. You can see, smell or touch them, but they are running on server 24/7 every day making like impacting decisions, crafted by some of the smartest programmers and developers that the money on Wall Street can buy.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. BD
“Wall street hires the best software developers money can buy. They write clever algorithms. These algorithms will only get more clever as time goes on. Which means they will always be changing. Now, writing software to detect what other 
software is doing is 100 times more difficult. Which in the software world means 100 times more expensive. Which means hiring people that do not exist, since Wall Street already snapped up the best, and you need the best times 100 (you can't make it up in quantity and just get 100 times more wizards, because many will have poor social skills, and you need these people to communicate).”
“You see the folly of trying to regulate the markets in real-time? Real-time raises the cost exponentially times a million. To a level that all the kings in the world couldn't afford. It would be one thing to track in real-time, things that had known behavior. Like your checking account being overdrawn. Maybe credit card fraud in the making (which, by-the-way, hasn't been perfected yet, despite lots of money and time thrown at the problem). “
http://www.thedailyshow.com/watch/mon-january-16-2012/fear-factory
To go back a little bit in time the chip was also set up to communicate with personal health records like Healthvault. The latest development on the chip was the ability to 
communicate real time glucose readings. The FDA has approved the product and the HealthLink software.
In addition, Medcomp who makes vascular access catheters will use the chip in vascular ports for identifying the port in a patient for proper medication dispensing. As it read here though the use with Medcomp still needs to secure FDA approval. This chip keeps coming back around with many lives. BD
DELRAY BEACH, Fla., Jan 17, 2012 (BUSINESS WIRE) -- VeriTeQ Acquisition Corporation ("VeriTeQ" or "Company"), a marketer of implantable, radio frequency identification ("RFID") technologies for patient identification and sensor applications, announced today it has acquired the VeriChip implantable microchip and related technologies, and Health Link personal health record from PositiveID Corporation. VeriTeQ is majority owned and led by Scott R. Silverman, former Chairman and CEO of PositiveID and VeriChip Corporation. PositiveID has retained an ownership interest in VeriTeQ.
VeriTeQ will focus on three main areas: patient identification and personal health record (PHR) access through the VeriChip implantable microchip and Health Link web-based PHR; implantable sensor applications; and identification of medical devices within the body. VeriTeQ will also focus on identification and sensor applications for animals.
VeriTeQ's acquisition also includes the rights to a Development and Supply Agreement with Medical Components, Inc. ("Medcomp"), a leading manufacturer of vascular access catheters. Under the terms of the agreement, Medcomp will embed the VeriChip microchip in its vascular ports to facilitate identification of the port in a patient and proper medication dispensing.
I am curious about this as a year ago blood levels were at the lowest in 10 years and maybe it’s just me, but instead of big fine, would improving the system and getting more folks on board to get donations help? 
The Red Cross relies on donations and is a non profit right and does fining them fix anything? BD
“An average of 91 cents of every dollar the Red Cross spends is invested in humanitarian services and programs. The Red Cross is not a government agency; it relies on donations of time, money, and blood to do its work.”
The American Red Cross, the biggest U.S. supplier of donated blood, failed to correct violations of blood-safety rules, raising the risk that ill-suited blood will be used in transfusions, U.S. regulators said.
The U.S. Food and Drug Administration fined the Red Cross $9.59 million, according to a letter from the agency to the Red Cross made public on Jan. 13. The organization has been cited 14 times since 2003 and fined about $46 million for similar offenses.
The Red Cross didn’t ensure that all staff had adequate blood-safety training and hasn’t created a complete list of prospective donors who were disqualified from giving blood, according to the letter. The Washington-based consumer group Public Citizen this month urged the agency to levy sanctions.
The organization is “fully committed to meeting all FDA standards, has made significant progress in working with the FDA to comply with their regulations,” according to the statement.
Everyone needs to watch this video and you will see both pros and cons and the pro folks are promoting as the algorithms used to mine this data brings in additional revenue and sells algo services. How much information “do we really need”? Those selling this business will tell you that you can never have enough. Those on the other side will tell you it’s an invasion of your privacy and you know what, that side has more going for it by far with reality.
If you listen to the attorney here she makes good points that there are folks not paying bills for a reason, divorce is one that comes to mind. You have to realize that all of the information they mine via public information may not be accurate. I have written about this before and the “flawed data” that is out there. One state has all but barred CoreLogic due to the fact that their bots were slowing down the servers and they and other mining companies were not paying for quarterly updates, so when you as a consumer do get a record rectified, you can’t get rid of any blemishes.
Welcome to the world of discrimination by the algorithm….
Watch the video here and learn about how much digging they are going to do.
Aggregated information contains flaws…this is the problem. Score would not agree to go on camera the video states. Again I said I do hope our new Consumer Financial Czar knows about math and the Attack of the Killer Algorithms. What a big part of the problem is that that cookie cutter employees are told to use what is on their computer screen for their decision making processes and if it is flawed…well you get that picture. Right now due to the overload put on servers and the Wild West effect of unproven algorithms here…it’s time to license and tax those folks like CoreLogic who make huge profits from mining free taxpayer data, give something back. Why should data mining companies be allowed to make billions, tie up governments servers to where states have to install software to block their bots and then dump a load of flawed data on consumers?
Those algorithms have teeth and watch the video below as Kevin Slavin tells you how it all works with rogue algorithms that go out of control and lead to things like flash crashes. I used to write code and I know what folks are capable of with mismatching data for profit and it hurts the consumer. We need some data sources to check but not to this level as it is going to make everyone mad and crazy as the flawed data will flow and the middle class will become nothing but data chasers fixing everything corporate USA has loaded in the data.
AND THERE’S MORE….
Just wait until this kicks in, CoreLogic has formed a partnership with FICO who is already in the process of selling algorithms with mismatched data which connects public information about you and combines it with your credit score to tell if you as a medical patient will take your prescriptions.
Somebody needs to start calling some of these folks on “mis matched data” the discriminates as now we have “Discrimination by the Algorithm” and it’s showing in more places all the time. Last time I wrote about the FICO mismatched data it all ended up over at the Daily Kos via another publisher as an awareness. As far as I am concerned the FIOC Medication 
Adherence Scoring is nothing but mismatched data analytics created to sell software and is the work of some “underground” think tanks on how to generate more money and profits. You can find my comments too on the Daily Kos on this as another author included them in her column who was in total agreement. Do you know how common flaws are? Look at this link and see about the 31k that are “living” but Social Security says they are dead.
Also give a listen here to NYU Professor Siefe as he tells you how the numbers are spun and marketed and how naïve and gullible we are. He’s a mathematician and makes sense and get his book, Proofiness, the Dark Side of Mathematical Deception” too. After watching the video I think the folks promoting this service are pretty gullible and naïve too and have never written a stick of code or SQL query and they just gob on to make money and the consumers get hurt.
This mis use of data and selling it all over is starting to turn normally peaceful folks into those who are not so peaceful. In healthcare they just put the doctors medical claim information out there for digital illiterates to work with and it is flawed to the hilt! Why should Hedge Funds, Facebook and tons of others out there be able to make billions with free data and cause extra expense to the States for slowing down their servers and have the state governments put blocking software in place to stop the bots? Do read Part 7 here as I cover a ton of flawed data situations that are out there to include a nice interview with the AMA on all the dead doctors I found out there:) That firm HealthGrades merged with a PR company I guess to help them market some of the flawed data and dead doctors? You figure that one out….
The link below has parts 1-7 on the Attack of the Killer Algorithms series and again some of my wishes that Richard Cordray understands math and algorithms or we are completely sunk as the middle class if not.
The thanks we get today is becoming data chasers as consumers to fix all the flawed and corrupted information that has been compiled and used against us. If everything is ok, then nothing to chase; however, “cookie cutter” employees today are not trained on how to work with flawed data and see everything as a blemish and thus there’s no level of forgiveness and understanding. If they challenge or ask questions, they might get fired and are told to rely on that computer screen.
This risk assessment scoring is not just limited t consumers…see what a bank is doing to small businesses in Wisconsin and even stating that a “church” is not showing enough profit! This will make your hair stand on end and again we need learn to work with flawed data and honor consumer privacy and license and tax the data sellers.
If you have not had enough yet, companies like this are now coming to the rescue of the consumer for shopping for insurance…total lack of respect with the name with providing services for consumers…. InsureMonkey….It may be a new way of selling insurance and pricing with focus on just pricing but do we have to be called “monkeys” now…with current economic conditions the name is not very cute right now.
Are we all just monkeys now and are insurers going to just eat up the additional flawed data and require consumers to prove their innocence? …There’s a lot more out there than you think and again we will be chasing and fixing flawed data forever as well as reaching a new level of discrimination against the middle class. BD
All of this information helps the company look deeper into payment histories, and most of it is available through the public records system.
CoreLogic says the idea is to supplement what the major credit bureaus find. Experian, Equifax and TransUnion only search public records for bankruptcy, tax liens and judgments.
The added information has the potential to hurt consumers with previously undetected blemishes.
Not everyone is comfortable with the extra information being shared. Attorney Chi Chi Wu with the National Consumer Law Center says there is often more to the story than numbers on a screen.
With even more personal information being shared, experts agree, consumers should check for errors that may hurt loan possibilities.
Well this is good news on the CIO store front in the fact that when the burn out there’s new life at the end of the road and a new on begins. From what I read and heard he was kind of stuck when working for the government and I understand that completely. Dealing with a bunch of “non participants” and digital illiterates that won’t at least try is not fun. 
As he said in post CIO interviews, the execution was the difficult part of the job, in other words getting folks to move on project and he saved a few billion for the government with his projects. Our US CTO is stuck on the word innovation and touts it all the time like tons of other do, but in the CIO area it’s more about collaboration and not the innovation dog and pony show. Where’s Salesforce.com going to use his talent, developing more business outside the US…a bit of an irony but everyone has a job to do. If you happened to catch the Oracle event this year, Larry Ellison called Salesforce.com the “roach motel” of the clouds, and there was quite the showdown but they have a good service to sell but the competition in the public is so Larry Ellison and why we all watch him. Practice Fusion uses Salesforce.com to host their free medical records service as well. BD
Salesforce.com, best know for its sales, customer service and collaboration software for business, is raising its ambitions by aiming at the international businesses and sales to foreign governments that have been the mainstays of companies like I.B.M.
On Monday, the company named Vivek Kundra its executive vice president of emerging markets. Mr. Kundra was the country’s first chief information officer from March 2009 until August 2011. His job was to move the government’s computer infrastructure spending — $80 billion a year — toward cloud computing. Mr. Kundra has extensive experience in technology at several levels of government, and has been a frequent visitor to the technology industry’s conferences.
http://bits.blogs.nytimes.com/2012/01/16/salesforce-hires-vivek-kundra-and-looks-overseas/
The plan gives employees the option of using a telehealth visit in the situations to 
where the patient's regular doctor may not be available, after hours and so on. In addition the medical records from MDLiveCare will also integrate with Microsoft PHR HealthVault. I am guessing this is the ability to import your video or telehealth visits with the doctor. This is not the first company to provide this service and one thing you can say for sure is that teleheatlh is on the move.
MDLiveCare work with LabCorp as well if a lab test was needed. BD
SUSSEX, Wis., Jan 16, 2012 (BUSINESS WIRE) -- QuadMed, a nationwide leader in employer-sponsored healthcare solutions, will deploy state-of-the-art telehealth technology across its network of worksite healthcare clinics through a new partnership with MDLiveCare.
MDLiveCare offers access to a national network of board-certified physicians and licensed therapists, in conjunction with QuadMed's network, providing quality healthcare services via secure video, telephone, and email communication.
Under an exclusive agreement, QuadMed will utilize MDLiveCare's proven telehealth technology to create a 'Virtual QuadMed' approach that significantly expands the scope of its clinics, giving employees and their family members another way to access QuadMed providers and services.
The new telehealth capabilities will also allow QuadMed, which operates clinics for nationwide companies like MillerCoors, Northwestern Mutual, Briggs & Stratton Corp. and STIHL, Inc., to provide more convenient care to smaller employers and employers with a distributed workforce.
I grew up in Arizona and there’s a lot of land out there with no civilization present for miles, especially on the Indian reservations. The project as this states below incorporates many different cultures in northern Arizona. On the Indian reservations consumers may have to travel a short distance to get to a “hot spot” to transmit their data but a short drive to a hot spot could be a lot more convenient than a long drive to the hospital Rural area really stand to benefit with remote monitoring. 
What is also nice here is that you know who’s getting the information and the purpose as it gives more information than a voice phone call with actual data being looked at and transmitted. What is also good here is winning the trust of the Indian community to try the service. This a trial program and it will be evaluated in a year’s time to see how well it is working and if nothing else, the reservations are getting better wireless service and coverage, which they need anyway. BD
Gisele Sorenson knew where each person with congestive heart failure lived. With a map in hand, she set out driving in northern Arizona — across tribal land and to the Grand Canyon — to find out whether the former Flagstaff Medical Center patients had wireless access.
The answer was key to determining whether patients could be remotely monitored via Bluetooth technology to help reduce their chance of being readmitted to the hospital. What Sorenson found is that not everyone would be able to use a cellphone to immediately transmit medical data, but many were close enough to a hot spot to send the information within a few days.
"Just having them come into the hospital isn't the answer anymore for a lot of reasons," said Sorenson, the hospital's telemedicine director.
The devices send the readings straight to the phone, which sends them directly to Kelly DeGraff, a hospital nurse. She then can look at the data and determine whether a follow-up call or text is needed. One patient she's been in contact with is Joe Alini, who has been dealing with kidney failure and heart problems.
The project is backed by the National Institutes of Health, Verizon, Qualcomm Incorporated and Zephyr Technology. It isn't specifically aimed at American Indians, but they will benefit. Nearly 30 percent of patients at the Flagstaff Medical Center are American Indian, the majority being Navajo. Seven percent of them have had congestive heart failure, compared with 4 percent of non-Native patients.
The association of course is slated to look at cost and then secondly improve the market place and this is not new. Private insurers have seen some golden opportunities to make money with insurance exchanges and the government 
exchange for consumers has been halted according to the statement made in this article from the Governor’s office. They are not the first state as Kansas is yet another state who has backed away from the idea, even though under reform this is mandatory by 2014. Sure there are parts of the reform bill that need some change and this is just simply due to current economics and changed times, especially with technology. We have seen leaps and bounds since the law passed with Health IT and somethings need amending.
Wisconsin with their new governor has not been very happy with a lot of what has occurred since taking over and I am guessing the recall action is still alive and well. Just a couple days ago another company called “InsureMonkey” (which I hate the name) put out a video for online shopping for insurance. I guess we are all monkeys now when we don’t have insurance from employers. It’s just one more effort to aggregate data and they earn the same as any commissioned sale rep for selling policies and their privacy policy is a bit unclear to me, but that’s not unusual today as we see this quite commonly with legal terminology written beyond the understanding of the average layman.
I said a while back if a platform is all we are looking for, use the one at EBay for goodness sakes and save some money. It’s still the same old race as to who can create the most “saleable” algorithms for consumer use and of course the branding and marketing enter here as well and thus so why I think branding with the name “monkeys” sucks.
Again, I think HHS is ready for major overhauls here as they are not keeping up with regulating insurers and big business plays the business intelligence and algorithm game to the max for profits and we end up with some unintentional consequences due to that fact. I said back when Sebelius was nominated that we needed a leader that had some Health IT in their background and over the last two years the job has expanded to where about 70-80% of the decision making processes for that job would involve Health IT and we are certainly at that point today. We need more than just figureheads for executive departments. BD
Six of the largest health insurance companies in Wisconsin have formed a new trade association, including four that used to belong to another group that includes Dane County's main insurers.
The new Alliance of Health Insurers is led by board president James Riordan, president and CEO of Madison-based WPS Health Insurance. Other members are Anthem Blue Cross and Blue Shield in Wisconsin, Humana, Managed Health Services Insurance Corp., UnitedHealthcare of Wisconsin and WEA Insurance Corp.
The alliance, announced Friday, "will advocate for essential and effective industry regulations that serve to foster innovation, eliminate waste and protect Wisconsin health care consumers," the group said in a news release.
As the article mentions we are all pretty much aware of the daVinci robot for many 
surgical procedures and now the university has some open source action taking place with research and will be providing a few other universities including Harvard and Johns Hopkins. After distribution has been made to to all, the robots will be connected via the internet for data sharing and collaboration.
The daVinci is not going away any time soon but through collaboration we might see some new innovation and research and the ability to share and perhaps create additional options for surgical robots. BD
The cost and complexity of commercial robot surgeons has meant slow penetration in the market and to only one player–Intuitive Surgical’s da Vinci.
But that could all change if researchers at the University of Washington (UW) carry out their plans to accelerate innovation in surgical robotics.
UW researchers will do final testing and then ship their latest version of robots named Ravens to five universities, including Harvard University, Johns Hopkins University, and the University of Nebraska-Lincoln.
The software running the robots is interoperable with the Robot Operating System, a popular open source robotics code. Once installed at each campus, the Robots will be connected to each other via the Internet to allow for data sharing and collaboration.
http://www.zdnet.com/blog/emergingtech/robotic-surgeons-get-open-source-boost/3101
Not only is the Department of Managed Care requesting payment, but they want interest paid too. Blue Cross said they settled matters on claims back in 2010 but perhaps this is another new issue as they paid fines a couple years ago.
Yes we are back to those nasty algorithms again that determine payment and if the 
code doesn’t run write or is not written correctly we have flaws. The full amount due is waiting a full audit of all the claims. Back a couple years ago Blue Cross used this ugly algorithm…again processes to where no human usually touches the claims and the servers running 24/7 make the decisions. Here’s a 3rd party along with Blue Cross that got caught on a stress test algorithm. This one was pretty blatant and Med Solutions shut down the website back when I wrote the post over this.
We might still have this court case tied up too where Blue Cross used Ingenix 
(division of Untied Healthcare) algorithms to short pay. The AMA settled a suit with all carriers using the United/Ingenix algorithms a couple years ago for almost 15 years of short pay on out of network claims.
Insurance companies live off of their algorithms for every step of business they conduct and why we need to get into the math and algos.
This particular algorithm was pretty nasty to where parameters set in the code cancelled women who had breast cancer too. The word “fraud” detection is used and sometimes with the way the SQL statements are written, you false positives.
You know we go through all this trouble to certify and make sure medical records software is compliant and accurate but look what happens with the payers here and they have rogue algorithms running making decisions and denying care or money every where you turn around.
Now you can see why I was motivated to write about the “Attack of the Killer Algorithms” in healthcare and in the financial world too. Check all 7 part at the link below. All I can wish for is that our new Financial Consumer Chief doesn’t sit in denial in this area as we need help auditing corporate USA algos. BD
The California Department of Managed Health Care ordered Anthem Blue Cross of California to pay health care providers for services provided dating back to 2007 after a financial claims audit discovered alleged errors in how the company paid claims. Under the order, the company will be required to pay interest on any claims that are found to have been improperly paid.
The order stems from an audit conducted by the DMHC in 2008 that examined claims payment practices at the seven largest health care providers in California. The department launched the audit after it saw an increased number of complaints from providers about payments that were either late or inaccurate. In some cases, claims were inappropriately denied, the department said in a statement.
The DMHC required the plans to pay providers the money they were owed and to demonstrate improvements to the plans' claims processes to prevent future errors. Carriers also entered into settlement agreements to pay administrative fines for their allegedly improper claims practices. To date, six of the seven plans have undertaken provider remediation efforts.
Rodger Butler, a spokesman for the department, said as many as 2.6 million claims submitted to Anthem Blue Cross have been called into question. Butler said the department has not assessed a total for how much Anthem Blue Cross may owe because it is awaiting the results of a review of those claims.
http://insurancenewsnet.com/article.aspx?id=325961&type=lifehealth
I like all the new technologies but again we need consumer trust to have ideas take off and become beneficial. If a consumer can be assured that their information is 
safe and the fact that they are not generating data for additional corporate greed, as much of this information is ending up at hedge funds, social networks and so forth then we could have a winning situation. Technology and what it can do and where will continue to evolve and present itself, and then it is up to the consumer as to whether or not to buy in. For someone with chronic conditions to monitor, this could be great, but it still need to be a matter of “choice” and not force fed for profits to sell data. We see so much of that today and this is one of the reasons that mHealth is having a slow go in many areas.
Why should a consumer have to contribute via their data to big corporate profits to adapt a healthier lifestyle or why should one be forced as it’s not getting any better for the consumer today with data being sold right and left, and we continue to read about corporate profits based on this fact and we have no transparency of what is really being mined and sold as there’s no real laws that provide a place for public disclosure but rather we have these finely crafted privacy statements that sometimes are very confusing and when you use certain services, you agree in a round about way to release your data, so it’s mixed bag.
A couple years ago I would have never seen myself making a post like the one below but marketing and selling data today is on steroids, so much to the fact that state servers are slowing down to a crawl with data mining bots and some states have had to put software in to keep 
the bots out so consumers like you and me can have access, why the sites were created in the first place. Again, the consumer loses again as corporate greed in one way or another locks us out, give that some thought.
A good comment made here too is that the companies are not going to try to use such monitoring systems for diagnosis but will remain with monitoring as the FDA would need to become involved if diagnosis were a model here. If you have not seen the video at the link below, check it out as there are some good examples that show how consumer data is used, and again corporate USA gets all of this for free and makes billions.
Implementation is important today and I see a lot of bad ones out there, again tossed in the face of a consumer without full explanations of how the entire circles work. If something like the car was forced upon consumers rather than remaining a choice, then we at some point reach a conclusion of “who wants a car” that’s going to be a vehicle to promote corporate greed and profits? Of course that would create a whole new market for “old cars” that do not have this built in for the sake of privacy <grin>. The same can be said for a pen or pencil you use too, will there be cheap monitors there too? From earlier this year you can read more about biometric monitoring with Ford and Medtronic.
There’s also a lot of work with cars that drive themselves too so think about this one if you were to add health monitoring here? The car could be a bit scary when it comes to the data and who gets it as someone will hold you accountable perhaps at some point with a risk analysis report. If one were a diabetic could they only get car insurance on vehicles that monitor? That’s the way as an example that risk assessment works for profit and cherry picking would continue.
So what’s next, dialysis in the car while one drives:)
Again technology will continue to evolve and how we use and implement is the key to success without giving away “free taxpayer data” for bigger corporate profits and items as such should always be a choice along with transparency and disclosure other than the jumbo we are presented with today. Our new consumer financial chief’s area of responsibility is going to grow quickly and I hope he understands algorithms, math, deception and has a tiny bit of IT in his background to fully investigate what needs to be done to help protect consumers today, or we do have “The Attack of the Killer Algorithms” in any direction we will turn.
Richard Corday has his hands full and will need his own group of geeks and engineers to keep up with what corporate USA is doing today and determine when discrimination by algorithm occurs. The link below contains parts 1 to 7 on my viewpoints on the Killer Algorithms that have teeth and live amongst us. Information is running on servers 24/7 with no real consumer transparency today and thus I believe this is the ultimate factor that actually created the “Occupy” movement out of sheer frustration as you can’t see, talk or touch those algos that make life changing decisions that affect all of us in split seconds with data and sometimes severely flawed data that we have to chase and correct. BD
Ford Motor Co. is building on its in-car health monitoring initiative by teaming with Microsoft and Healthrageous to research how people can monitor their health and promote wellness with connected devices while in their vehicles. The companies are taking advantage of the spotlight at the massive 2012 International CES trade show in Las Vegas this week to show off a prototype called “the car that cares.”
Healthrageous, a Boston-based producer of online and mobile apps for self-management of chronic diseases and preventive health activities, is embedding its “digital coach” technology into the Microsoft-powered Sync communications and entertainment system now common in Ford vehicles.
“Sync will be Ford’s key technology supporting activities in the health and wellness sphere,” Gary Strumolo, manager of “infotainment,” interiors, health and wellness in the Ford Research and Innovation division, said Wednesday at the CES Digital Health Summit.
Novartis was also in the news for the recall of several over the counter drugs in the last week and has closed one factory in the US until corrections are made.
The changes in restructuring and layoffs are slated to begin in the second quarter of this year, not that far away. There was also a clinical trial that failed to prove it was lowering blood pressure as patients who took the medication actually did worse so it appears that drug in it’s current formulation is not going to offer any relief in the immediate future. BD
ZURICH (Reuters) - Novartis AG is cutting nearly 2,000 jobs in the United States ahead of the patent loss of top-selling blood pressure drug Diovan as it braces for tough market conditions and a slump in sales of another key drug.
Novartis is the latest in a long line of global drugmakers to cut their sales forces as the industry faces its biggest wave of patent expiries in its history.
The group will book a one-off charge of $900 million in the fourth quarter after a clinical trial showed patients taking its blood pressure pill Rasilez actually did worse, meaning sales of the treatment, previously tipped to rake in sales of more than $1 billion, are likely to plunge.
The Swiss drugmaker is currently in talks with regulatory authorities on both sides of the Atlantic about whether this drug, once seen as a Diovan successor, could end up being pulled from the market, a spokesman said on Friday.
The Basel-based group has already cut thousands of jobs and shut several sites, notably in Britain. It has also shifted its focus to specialty medicines in a bid to boost profitability and protect its bottom line.
http://news.yahoo.com/novartis-slash-nearly-2-000-u-jobs-070115452.html
This case beyond the ugly pornography charges get even more interesting with the new charges added on. Somehow when the company billed for their services someone forgot that there are audit trails. 
The doctor was a medical director of a company that provided monitoring services surgical procedures using the Internet. It appears that even when the web was down at certain locations, the service was billed anyway. Doctors were not able to monitor either due to no connection or tech issues with getting the service live.
The charges are that the billing took place whether or not the monitoring by physicians took place or not, and, this is a big and here, employees posed as doctors to monitor and now we have crossed another line here with employees logging on to monitor a procedure to where a doctor was promised and should be there as part of the service. On top of that the type of surgeries were neurophysiologic, so complex and specific in nature. Modern technology does a lot for healthcare but it also has to be present to create a billing. BD
Dr. Daniel Joachim, 51, was charged Wednesday in federal court along with Maryland company Physicians Analytical Services Inc., according to U.S. Attorney Jim Letten's office. Joachim and the company are accused of fraudulently billing insurance companies and pension and benefits programs for surgical monitoring services.
Joachim was first charged in federal court with receipt of child pornography in August 2010. He is accused of trying to receive sexually explicit images of children and faces a mandatory minimum sentence of five years in prison if convicted, according to court records.
The superseding bill of information handed down Wednesday retains the child pornography charge but adds the health care fraud charges, Letten's office said.
http://www.nola.com/crime/index.ssf/2012/01/health_care_fraud_charges_adde.html
Here we go again, more flawed data except this time it’s on the side of research and not on the the consumer side of aggregated data. The research was very popular as of course it talks about the benefits of red wine and Resveratrol. Even back in 2009 Dr. Oz and Oprah went after the Anti-Aging Scammers that were using their names.
There’s a lot of flawed data out there whether it is created or gets put in place with aggregating data that is either erroneously input or combined with other data and this is an awareness warning for all. I go after the flawed data that haunts consumers all the time with data mining and actually we should charge and license those folks who sell this data as much of it mined from the web is erroneous and yet we are grilled at the stake over those assuming all is accurate. Hershey even jumped on the bandwagon back in 2008 with saying chocolate was healthy with 
the resveratrol compound.
This is a good audio broadcast to listen to as Professor Siefe from NYU explains some of how the research and journals gets fabricated with marketing fogging up the horizon all the time. BD
There’s a ton of healthcare addressed here.
The University of Connecticut, in what clearly seems like an attempt to get ahead of damaging news, has announced an “extensive” investigation into research misconduct involving one of its scientists, Dipak K. Das.
According to a press release, the university has notified 11 journals that published Das’ work about the alleged fraud. One area of interest for Das, a government-funded professor of surgery and director of the Cardiovascular Research Center, has been resveratrol, a substance in red wine that has allegedly been linked to improved cardiac health
The abuses in one lab do not reflect the overall performance of the Health Center’s biomedical research enterprise which continues to pursue advances in treatments and cures with the utmost of integrity,” he added. “We demand full compliance with all research standards and policies by our faculty and staff.”
According to the release, the 11 journals where Das may have published fabricated data are:
American Journal of Physiology – Heart & Circulatory
Antioxidants & Redox Signaling
Cellular Physiology & Biochemistry
Free Radical Biology
Free Radical Research
Journal of Agriculture and Food Chemistry
Journal of Cellular & Molecular Medicine
Journal of Nutritional Biochemistry
Journal of Pharmacology and Experimental Therapeutics
Molecular & Cellular Cardiology
Molecular & Cellular Chemistry
This is good news as I have ranted about mobile apps that do “one thing” for a long time and with what is written here, device agnostic software along with 
agencies leveraging each other’s gains is nice. We have way too much glut and too many “me too’s” out there and not only in healthcare but even at CES this was mentioned as well. We have device fatigue. If you read the link below I did a little out of the box commenting with software used for medical records and then some.
Now if he can just slowly break Aneesh away from the “I” word above and talk more about collaboration things will work better I think. I kind of got tired of hearing Chopra talk about how programmers could get rich to stimulate them into writing code. Some got stimulated alright but not enough for the government as many went to work writing algorithms that mine social data instead. As mentioned, a government mobile apps store would be great and again with sharing between agencies with some APIs and scripting one agency can benefit from another. BD
Federal Chief Information Officer Steven VanRoekel launched an interactive dialogue on government mobile policy on Wednesday that he said would be the first step toward a government wide mobile roadmap due out in March.
That roadmap, VanRoekel said, will address a range of issues from ways the government can save money -- such as by buying smartphones in larger quantities -- to serving citizens more effectively through public-facing apps.
As things stand now, too many agencies and bureaus are putting time and effort into mobile projects without leveraging each other's gains, he said.
It also will include information about building internal mobile applications to help federal field officers, such as U.S. Forest Service workers and Border Patrol agents, do their jobs more efficiently.
VanRoekel's office is considering something along the lines of a governmentwide apps store so one agency can adopt or retrofit an app another agency has developed, he said. Apps placed in that store would probably be required to be "device agnostic," he said, so the government wouldn't become overly dependent on a particular provider of mobile devices.
http://www.nextgov.com/nextgov/ng_20120111_3812.php?oref=topnews
He likes most of what technology has done but says not to use it a surrogate for 
caring for patients He talks about how fast we are and out of the hospital and how technology has given us better quality of life.
The videos were done by the discover channel and are short and answer one question. BD
One more…what is integrated medicine?
This look very promising and the technology is pretty fascinating. In the video you see a couple children who could benefit without the needle stick, and adults for that matter could benefit too. Similar efforts have been made too with an implant under the skin but if the contact lens could do it all, much more convenient. 
Maybe the CES show was not very exciting, but this make up for it. This is still work in process but the lenses would work and could send information to an insulin pump, done in real time. The video is great and explores a few other potential uses of monitors creating information with contact lenses. BD
Millions of people worldwide live with type 1 diabetes, a chronic medical condition that requires constant, daily vigilance to maintain proper health. People who have type 1 diabetes must check their blood sugar (glucose) levels multiple times a day, which can be an unpleasant, painful process. Researchers at the University of Washington are developing a solution that would painlessly monitor glucose levels through tears rather than blood and provide feedback to the patient immediately, should a problem begin to develop.
Diabetes is a potentially devastating disease with no known cure. The pancreas of a person who has type 1 diabetes does not produce insulin. The failure to strike the right balance between food and insulin intake can lead to extreme physiological reactions—from crying jags to loss of consciousness. The long-term effects of uncontrolled blood glucose imbalances can be even more devastating.
Non-Invasive Blood Glucose Monitoring
Today, people with type 1 diabetes use needles to prick their fingers multiple times throughout the day, every day, including meal times, to collect blood samples that allow them to monitor and maintain healthy glucose levels, which is critical to reducing the impact that diabetes has on the patient’s health. The never-ending, daily blood draws are not only unpleasant for the person with diabetes, but they also provide limited information.
http://www.microsoft.com/casestudies/Case_Study_Detail.aspx?CaseStudyID=4000011273
The one doctor below makes a very good comment as to why this went so long as several ER doctors had flagged his prescribing methods, and yet if there’s bad record keeping, the medical board is all over a doctor. 
!2 patients died since 2006 and he was known as the Candy Man by some patients. When you look at the one example of a patient being prescribed over 2000 pills in six weeks, I think that’s a flag. The other issues at hand were female patients with drugs for sex. This should prove to be an interesting case and all the traffickers are not on Florida. For 15 years the DEA had complaints about the doctor. This was pretty bad when other doctors get in touch with the DEA to report you and looks pretty obvious. BD
(SANTA ANA, Calif.) — Emergency room doctors at a Santa Barbara hospital saw a disturbing trend for more than a decade — patient after patient hooked on prescription drugs shared the same physician.
Despite their complaints to state medical authorities and federal law enforcement, Dr. Julio Diaz continued practicing even though 12 patients had died since 2006.
His arrest Wednesday on federal drug trafficking charges came as no surprise to some who knew him. What stunned them is that it took so long.
"I don't really understand what happened there," said Dr. Chris Lambert, an emergency physician at Cottage Health System who was one of the doctors to flag Diaz's prescribing patterns. "Physicians these days get censured for bad record keeping — the medical board is on them immediately for making an error in a chart. But what happened in this case? How did it slide along?"
Diaz hasn't been charged in connection with the deaths, which remain under investigation. He is accused of illegally prescribing large amounts of painkillers to patients who didn't need the drugs and for accepting sexual favors as payment from some women.
Lambert said the complaints about Diaz date back roughly 15 years, and doctors reached out to the DEA about four years ago. DEA spokeswoman Sarah Pullen said the investigation into Diaz began in mid-2009, but she was unaware of any prior complaints against him.
http://www.time.com/time/nation/article/0,8599,2103834,00.html
This is pretty amazing that the man had a spinal injury and could not walk for 3 years and now is out of the wheelchair 
and moving around just fine. The device blocks pain receptors which allows him to move. When you look at the alternative of just under 300 pain tablets a month, what change.
The device actually learns how much stimulation he needs for the pain, we have “device” learning here. BD
Jeff Hardick shot up from his chair in the waiting room at St. Luke's Hospital in Fountain Hill, strode over to neurosurgeon Steven Falowski and wrapped the man in a bear hug.
A month ago, that would have been impossible."I gotta give you a hug," Hardick, 51, of Bangor, said, "because you saved my life."
Hardick spent the last three years in bed, slumped in a wheelchair or stooped and grimacing while tottering around with the aid of a cane. He struggled due to constant, crippling pain from a back injury. He was prone to blacking out and falling down. He couldn't work or drive and was mired in depression.
Falowski placed a device onto Hardick's back that sends an electrical current to block pain receptors. It is one of 13 devices available nationwide after the manufacturer, Medtronic, gained Food and Drug Administration approval in November. Hardick is the second person in the nation to have the device installed, Falowski said.
The Hardicks said the road to the new device was littered with doctors who told Hardick he would spend the rest of his life in a wheelchair. Jeff said one doctor even told him to wear a helmet because of his blackouts. He took 270 pain pills a month, plus antidepressants and a sleep aid.
He hasn't touched pain medication since the surgery.
http://www.lehighvalleylive.com/bethlehem/index.ssf/2012/01/bangor_man_benefits_from_new_m.html
It does look like a site where one would book travel and they make a commission 
from the policy that is sold. All information is aggregated by location and a consumer can shop from there, but maybe this is more like “Cheap Flights” <grin>.
Below is an image that shows a Co-Pay Saver from United and it has pop up windows that describe whether or not you are getting first class or coach.
The name is correct as this seems like a bit of a zoo just like shopping anywhere for insurance. They license the technology out to health insurers as well. You know not too long ago I sad Ebay would be the place for insurance exchanges but perhaps they have a better search agent going here, but no word on if you can use PayPal.
If this doesn’t work here you might be venturing to Walgreens soon as it has been mentioned they could be considering selling insurance too, but hey they might just put a kiosk in the store and collect the commission from InsureMonkey, ok you heard that speculation here first.
The government has a page too that helps folks search for insurance and the company does not do any ratings yet but outsources that part of the business to another company. BD
InsureMonkey allows consumers to compare insurance providers online to find the best rates.
http://www.youtube.com/watch?v=zCeGP_4obyw
Imagine getting your Excedrin bottle out and getting a lot more pain killer for the buck? There could be a run on the products before they all get pulled from the 
shelves for those who may abuse pain killers. On the other hand when one needs a strong pain killer like after surgery, you only get Excedrin. The opioid drugs are sold by Endo Pharmaceuticals as Percocet, Endocet, Opana and Zydone.
I have been on this kick for at least 2 years now with my bar code campaign for FDA recalls for both drugs and devices and we have nothing yet except a whole lot of inconvenience for consumers.
You can read more here….and here...
In addition, the factory being closed will produce shortages possibly, so this is no win all the way around.
In addition it’s getting easier and more secure with bar codes too if you read the article about about Microsoft Tags being able to create QR codes as well and these can go through an encrypted server. Below is an article I wrote about a man who died because he was mistakenly implanted with a “recalled” device that was missed from being pulled, so enough is enough with pharma and device companies not doing something here as things will happen but no plan for a disaster is a disaster. BD
CBS/AP) The Food and Drug Administration and Swiss drug maker Novartis warned yesterday that over-the-counter medications may be
mixed up with powerful painkillers.
Officials advised consumers to stop using the products following hundreds of complaints about broken or incorrect tablets winding up in pill bottles.
Novartis recalled 1,645 lots of drugs including Excedrin, Bufferin, NoDoz and Gas-X. These drugs may have accidentally been packaged at the Lincoln, Neb., facility with powerful prescription painkillers made at the same facility. The opioid drugs are sold by Endo Pharmaceuticals as Percocet, Endocet, Opana and Zydone.
During an inspection, FDA inspectors uncovered a manufacturing problem that could allow pills to become stuck in the machinery and carry over to the packaging of other products, Cox said. The agency says the investigation is ongoing and would not comment on potential penalties against Endo or Novartis.
The FDA and Endo Pharmaceuticals recommend patients examine their prescriptions to make sure all the tablets are similar in shape, color, size and marking. If one or more of the tablets look different, patients should return the medicine to their pharmacist.
Consumers should visit www.novartisOTC.com for a full list of recalled products, and they can call Novartis at 1-888-477-2403, Monday through Friday, 9 a.m. to 8 p.m. EST. Patients can also call Endo Pharmaceuticals' call center at 1-800-462-3636.
| Healthcare IT, also known by the acronym HIT, is all about using information technology solutions such as hardware, networking, and software to help improve healthcare, save lives, reduce costs, and improve profit margins for healthcare organizations. Healthcare IT has always been important but recently it has been receiving more attention because the government and consumers (patients) | are demanding better service from care providers and healthcare IT is a good way to improve service.The healthcare system, especially in the USA, has some critical problems such as nurse and physician shortages, spiraling costs, poor consumer (patient) service, and lower revenues which lead to mergers | or acquisitions. Healthcare IT is in even worse shape because outdated infrastructure, legacy architectures, and monolithic applications prevent positive change from occurring. Healthcare IT can, if used properly, help reduce costs, improve care provider productivity (which can then alleviate some of the shortages), and significantly improve customer service to patients. |
