Friday, October 31, 2008

Health Train Blogging

Only I can change my life. No one can do it for me.
Carol Burnett
US actress & comedienne (1936 - )

What blog subjects are the most popular? My recent review of the Blog Catalog, in order are:

1. Blogging

2. Arts & Entertainment

3. Technology

4. Humor

5. Health

So health is in the top five, but just barely. It is tied with Politics, and ahead of all the rest, law, business,financial,beliefs, social, and believe it or not social media.

At this time Health and Politics go together, entrenched in the economy as top talking points in the presidential campaign for the world's most powerful office.

An interesting observation from the Wall Street Journal by Robert Carroll points out the tax realities of each candidates. It gives a clear endorsement to John McCain's health policy proposals.  Would I put it in the arena of Health Care Reform?

NO.  This is merely a poorly conceived financial manipulation to have more people in the 'insured category'.  Both Obama's and McCain's Health Reform amount to a wallet biopsy.

Other issues, such as propositions in Arizona would ban programs such as universal payor or universal health plans.  Would Federal  law pre-empt  state law??

Thursday, October 30, 2008

Health Train Dining Car

image They aren't talking to one another, while they chew their food.

Sometimes a whisper is more powerful than a shout. Here's a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.

American primary care is a shambles, and it is now clear that it will not be viable in the future unless significant changes occur in our national attitude about its value and in the way we pay for it.

So what should we do?


The National Committee for Quality Assurance proposes a plan

Another interesting, and perhaps more far-reaching proposal (Download finalpcppaper.doc) has been made by Norbert Goldfield MD and his colleagues. Dr. Goldfield is a highly respected health care innovator,

The articles go on to elaborate how this would work, and how PCPs would be rewarded for acting as the fiduciary and patient advocate, unlike the gatekeeper model, which fails miserably.


Collapse, a book which discusses how societies choose to

suceed or collapse is a worthwhile read.


Given the current crisis, and quick fixes proposed by both Presidential candidates it becomes patently obvious the internal mechanisms of patient care  need to be 'fixed'' before any more money is thrown into medical care.  Physicians and educational programs need to climb on board the new Health Train.

Health Train Committees


Quote of the day:
Committee--a group of men who individually can do nothing but as a group decide that nothing can be done. - Fred Allen



The High Points:

A family physician shares her ideas on fixing our health care system. Someone better put Elizabeth Pector in charge of something, because her ideas need to be instilled stat. Like this one, explaining why physicians deserve equal rights:

When it comes to equality, doctors get the short end of the stick in our health-care system.....duh !!!

In short, as part of restructuring the health-care system, physicians need to be put back on a level playing field with the rest of the health-care players, so they can provide input prior to implementation of supposed cost-saving measures that often only transfer costs to doctors.

Another must read from KevinMD---how about just writing it out?

Point of Law  (you best believe it)

Health Train Express International


Perhaps we should emulate the Chinese in revising our health care system.  Long considered primitive regarding health care, China is taking a bold step toward caring for it's billion or more people.

The Chinese however may have an advantage that much like building a home, it is much easier and less expensive to start from scratch.  The United States is faced with disassembling a system that has grown over the past 100 years or more and transitioning to a better means of financing health care.   We see that a large barrier to transitioning lies in the financing. Converting to a new system will be disruptive financially, and  old habits are difficult to break.

The Wall Street Journal reports that China is aiming for universal heatlh care.


The proposed plan would be quite a shift for China. The draft plan’s overall goal is to cover 90% of the population within two years and achieve universal care by 2020. It aims to return to non-profit national health care, an idea that was largely abandoned in the country 1980s.

This all stands in contrast to China’s current system, which provides little government funding to government hospitals and requires patients to pay heavy out-of-pocket expenses. The WSJ notes that out-of-pocket payments made up more than 60% of health spending in China at the end of the 1990s.

The plan — drafted in consultation with groups including the World Health Organization, the World Bank, consultant McKinsey & Co. and a few Chinese university-based public health experts —-----The government also aims to set pricing standards for medical services.

Other news about Chinese health care, Pharma,Western style hospitals is in the Wall Street Journal. And what does Heparin have to do with hot dogs?

In China as in the United States reform has it's skeptics.

Health Train Express Roundtable

Today's Health Train Express takes us to

The View from other blog.

image Click Here

Post II

Financial Analytics vs. Health Analytics


Health Train Reform

I have reviewed the proposals of McCain and Obama.

Frankly I do not think either proposal is going to do much to improve health care, reduce costs, or satisfy anyone for very long.

1.The proposals do not address internal problems with delivering health care wisely , or efficiently

2.Both  proposals use tax policy to create change, and campaign issues revolve around tax credits and/or deductions.

3. Neither proposal addresses the increased utilization from baby boomers

4. Both proposals do not address medicare's approaching insolvency.

5. Each proposal is bound by partisan politics

6. We should not decide upon health care issues during

a heated political debate.

We should step back, and allow the financial crisis to cool down, assess the impact of the financial bailout program.

No one can make an educated guess until we see how our economy shakes out from the financial crisis.  There are many unknown factors operating in our free market system.

We do not know how, when or where the financial bailout will be distributed.  Initial funding has made most prudent planners skeptical as to whether the banks (the ones who perpetrated the crisis) will  judge correctly how to use the funds for the good of all of us, or probablly just go on playing the same their own behinds. One obvious warning is the admonition from GWB that they need to 'loan the money" and not hoard it.  Bankers don't give a rat's  a-s about customers...only what their shareholders think and do. They have no motivation to change their game, and we have rewarded them for their incompetence. Their excuses are lame.

If you are a big banker, or insurance company the rules are different than those for you and me.  This 'bailout money" had better be a loan and not an outright gift to them.  Foisting this debt off on the American Public is an outrage, and  probably justifies throwing out the vultures at the top of the predatory feeders. Why would anyone want to appoint executives from Goldman Sachs, and other financial institutions in charge of the hen house  to these positions again?

The manner in which this is being addressed should alert anyone with common sense that this is what will happen to health care financing as well.

For more information link to my other blog

Wednesday, October 29, 2008

Out of the Fog

The fog lifted quickly this morning.image It burns off in mid morning and things become clearer as I head off , not on call, not worrying about seeing 40 or 50 patients with itchy burning eyes, floaters, flashing lights, computer vision problems, chldren referred for evaluation of dyslexia referred by a  school psychologist for eye exercises. Mixed in with that mix are the retinal detachments, acute narrow angle or undiagnosed chronic glaucoma, the ocassional herpes dendritic keratitis, zoster, macular hemorrhage, vein occlusion and central artery occlusions. and the bread and butter for most ophthalmologists....that cataract !

But as I said I am not going to be doing any of that for awhile.....perhaps never.  I have made my mind up to become 'cognitive' again after several decades of assembly line medicine seeing 50 or more patients a day. image I sometimes lie awake at night, and also during the day (between naps). It must be the sleep apnea as well as my antidepressants and meds for bipolar spectrum disorder.  Now that you know the 'truth' about me you will understand the reason(s) for the nature of my writing.

I had always attributed my sense of anxiety and apprehension as well as occassional irritability and impatience to my sense of superiority in all  things medical and surgical. I mean I survived college, med school, internship, residency, military service in a combat zone, with several episodes of moderately severe depression which I always attributed to my meager financial resources,  and family responsibilities and seemingly endless nights on call and moonlighting to survive residency. Early on my anxiety would bring me to a therapist. It felt good to ventilate. image So after 30 years or more my last therapist told me that I sounded 'bipolar'.   Well, shit yes...!! How else would any normal human be able to have normal SSRIs with little sleep and staggering hours and workload without a bit of an imbalance in vital neural brainwash.??

Now, I don't know what bipolar sounds like.

There, I have exposed myself....image my hidden vulnerability.

I have not changed, but the world around me has changed. All the things I studied for and worked for are gone. (but not my family) So it's not my fault and it is not my responsibility to adapt anymore.  I now have a new fundamental understanding and gestalt for those 'old eccentric folks' walking around babbling and seemingly inappropriate....

During my 'seeking'  a career transition (a euphemistic saying to cover up boredom, burnout,or whatever) I visited a local Starbucks near a UC campus.  There it was....the future of the world, a lot of Apple Macs (all white) and lots of Asians. (no insult intended).

image image

I  am not certain what the p.c. term is for those of asian descent.  It seems many Asians excel into getting into the UC system.

This is a wonderful that they  move to the keep our universities full, since our own public school system cannot keep up feeding the greater University system.  The unemployment of college professors would be much greater without Asian participation.  What goes around in the business world also comes around in education.  So our educational institutions also participate in the global economy I am just concerned that our balance of education is negative. We need to export more students!!

If you haven't applied for a job in the normal workplace in the last ten years, you will be in for a shocker.  image

You have to do most or all of it online....No face to face


unless  you can penetrate the software algorithms screening for key words in your resume.

I am even suspicious that you do not have to write coherently, just put the correct keywords, or tags in the appropriate fields.

Guess the correct combination and your resume does not get filtered into some giant resume spam file.....


presto it appears in the 'incoming resume file for some lower level flunkie to bring into the dean's office, or the human resource filter to be forwarded to the appropriate department in whatever business you will be hired to continue your financial plans.


Health care vs. Health Care

Yesterday's posts were truncated by some other important issues.


Today I am a bit overwhelmed by what to post. The issues are legion.

Our first great event is the State of California being held in contempt regarding funding of Prison Health Reform  The issue is that  the courts are insisting that California write a bad check to initiate planning for the new prisons. (when I do that I get charged for overdrafts, and possible criminal charges.)


Our second great event is the State of California v. the County of Santa Barbara.  The state claims it overpaid Santa Barbara in Medi-cal funds. 


Just what I government using my tax dollars to fight with one gain less than zero...pure stupidity, audit it and report it, and don't make the same mistake again.


We need more government involvement in healthcare (sarcasm)


Tuesday, October 28, 2008

Health Train Express Travels through the Cloud, or should we say Fog??

What's in a name? Is it a cloud or fog? It depends upon your altitude.....and the dew point....

Sublimation....the transformation of a solid directly into a gas, ie dry ice to vapor.

Microsoft has announced it's new "Azure"'s answer to Google's online microsoft look alike solutions available on the internet. They are calling this "Cloud computing".  We'll see if it a cloud or fog (vapor)  soon. Cloud Computing according to Wikipedia


This announcement reveals a major shift in software development applications for health solutions in both business and clinical applications.  Look here for more information at a later date on specifics about cloud computing and healthcare.

Our medical practices have gone from being solid business platforms into vapor at times. Is this sublimation? At one time our medical practices were a sublime portion of our daily lives.

Monday, October 27, 2008

Happy Hospitalist Express





For most of you out there, I will never meet you. You will live long, prosperous, healthy lives. You will raise families, remain gainfully employed, go to church, give back to the community and generally live. You will play by the rules. You will have your ups and downs and life will go on. What I describe in my blog and experience in my life as a hospitalist represents a very skewed representation of America. I am often lambasted by others for being unHappy and distressed with my situation. That couldn't be farther from he truth. What I try and present to you on the Happy Hospitalist is the gross abuse running rampant in our health care system. The abuse, I believe, entirely the result of third party rules and regulations, has become intolerable for many health care providers. Enough to make many quit. The abuse running rampant by the few has also had the effect of driving up prices for everyone looking for health care security.
So I ask the question, what type of patient are you? Are you contributing to the demise of the third party model so ingrained in our current culture.

More Medicare Nonsense


CMS in it's infinite wisdon has declared war on those of you who are recalcitrant to adopt eRx. AmedNews reports this morning that since the  ''carrot" didn't work as fast as they wanted it to, and eRx adoption is lagging they would up the stakes.

With electronic prescribing still far off the radar screen for many physicians just weeks before new Medicare e-prescribing incentives kick in, the Centers for Medicare & Medicaid Services hosted an event here in October to jump-start an all-out push for widespread adoption of the technology.

(Most of the attendees were vendors, administrators, and a few physicians who have already adopted eRx (1400 attended).


Only about 2% of eligible prescriptions nationwide in 2007 were ordered electronically. While physicians in some states used the technology more extensively, few states broke the 3% mark when it came to paperless drug orders.

Prescriptions sent electronically


Rhode Island





North Carolina




New Jersey



New Hampshire

Source: RxHub, National ePrescribing Conference, October. RxHub is owned by SureScripts.

Back to top.

The power of incentives

In Massachusetts, the number of prescriptions sent electronically surged after the state's Blue Cross Blue Shield plan started offering e-prescribing incentives in 2004. Medicare officials hope to see a similar boost nationwide from the bonuses they will begin offering in January.


Electronic prescriptions written




















Note: Incentives took effect in Q1-2004.

Source: Blue Cross Blue Shield of Massachusetts



"A Clinician's Guide to Electronic Prescribing", October (


In other news from AmedNews:

Caught unaware, doctors get delay in FTC enforcement of ID theft rules


When the FTC begins enforcing the rules, failure to comply could mean administrative penalties or up to $2,500 in fines per violation.

According to AmedNews the rules extend to

"If, on a regular basis, a physician allowed a patient to leave knowing they were not going to be paying immediately, even for a co-payment or deductible, the provider would be considered a creditor.

The AMA and other groups won a six-month reprieve for doctors to implement a prevention program originally mandated for Nov. 1.

The so-called "red flag" rules require entities that regularly extend credit, or defer payment for services, to establish a written program for preventing identity theft as well as detecting and responding to warning signs of such thefts. The commission first released the rules last November as directed by the Fair and Accurate Credit Transactions Act of 2003.

Until recently, physicians and health care facilities were largely unaware of the regulations, which were thought to pertain mainly to banks and other financial institutions that offer credit in the traditional sense. But in recent weeks, the FTC signaled that the rule was intended to apply more broadly, including to the health care arena.

So, have a nice day.

Sunday, October 26, 2008

Health Train Express & Halloween

I decided to post my Halloween 2006 blogpost here, again. I brought it forward from my original iteration, RiversideHealth


Friday, November 03, 2006

Halloween and RHIOs

Several nights ago we participated in the annual ritual of door to door "trick or treating".
It seemed to me there are some analogies between Halloween night and RHIOs.
We are all looking for some "treats" without being "tricked". Some of the takers would shove their whole hand enthusiastically into the candy barrel and come out with a fistful of treats, while some would gingerly pick out one. My wife cautioned me to hand them out one at a time or we would soon run out. The same can be said about enthusiasm for RHIOs. Some are enthusiastic takers, and givers, others are reticent about their choice(s). One thing was for sure, I had to go out and replenish the barrel several times.
We had just moved into a new family neighborhood, and discovered there were literally thousands of children coming to our door. Having been on the far side of the half century mark for some time, we had recently been living in the relative quiet and senior demographics of the desert. There were wonderful fairies, pumpkins, spidermen, supermen, fantastic fours, and even a few dated ninja turtles, coming to our door that evening. In the desert we were lucky if we saw one or two. The future of our country abounds in Riverside neighborhoods.
It came to me that we are not building health IT and/or RHIOs for ourselves but for our children. How critical this need is demonstrated by recent articles about outsourcing not only transcription services but actual health care delivery, such as surgery, and diagnostic testing where these services can be obtained for 10% of what it costs in the United States. A bit shameful for us.
Physicians are now faced with the annual adversarial role with CMS, and it appears, as usual that our fees will be slashed 5.7% on the average. If you do the math, this makes RHIOs and EHRs even more unlikely.
Then there is legislation pending that would mandate EMRs with funding from Congress through a variety of sources. Which is the trick, and what is the treat?
As for me, give me thoseimage

little foil wrapped chocolate balls.

Saturday, October 25, 2008

HealthVault Express

I was planning a post this AM, and my internet is flaky, fortunately I use Live writer from Microsoft. It's a simple task to write off line and then save a draft and/or upload to the blog.

The internet is a complex "spider" of networks and supposed redundancy. This morning I only have access to google, and whatever is on their servers. The rest of the bilions of sites are unavailable.  I guess Google will save the world. I wonder if HealthVault is up.

This brings to mind the fallibility of all things electronic. Imagine you are at your docs office and he want to pull up your PHR which is stored in Healthvault and/or Google Health. What now?

Or how about your front or back office running an EMR on as asp solution?  Nada!!  Although not requiring much hardware investment and offering 24/7 maintenance .asp solutions are not as cheap as you might think.

That's the downside....

The upside is that my internet has never has gone down for more than an hour or so.  But never say never...I live in a fairly metropolitan area of Southern California.

With a client-server configuration, I have personally been the victim of servers, client work stations fizzle out and be down for a day or even up to a week while a part or major component is replaced, along with the software that may have been lost. Not a happy situation either.

More bad news....I called my ISP to see just how long the outage will  be.  I received one of those messages. "We are experiencing an outage in your area"  (how do they know  where I am...must be one of those caller ID thingys.  The voicemail was upgraded to

"If you would like a call when the technical difficulty is fixed, push one.  (how do they know I don't have a rotary phone?_) For you late season "boomers" go to wikipedia or google....  "we will call you back between the hours of blah blah blah...  This does not sound good.  How will they voicemail blast this message?  


Friday, October 24, 2008

Health Train Billboards

Obama Has Spent $113 Million on Health-Themed Ads

image My initial reaction was how many uninsured children would benefit from money thrown at TV ads.


image October 16, 2008, — New York – A 5,000-person, five-country study released today by Edelman shows that people want more active, trusted, and personal health interaction with companies, organizations and brands, effectively rewriting the “rules of engagement” in health.



Health Populi  image Jane Sarasohn-Kahn

A majority of employers who don't sponsor health would be unwilling to contribute over $50 per employee per month for coverage

U.S. employer sponsored health system is experiencing some bipolar behavior: there is a cadre of large employers who want to continue sponsoring health benefits as part of overall compensation. But, for at least one in 3 employers, most would not be willing to pay $50 more.......................


Health Train Billboards

Obama Has Spent $113 Million on Health-Themed Ads

image My initial reaction was how many uninsured children would benefit from money thrown at TV ads.

Gene Train Express


Quote of the day:
The effort to understand the universe is one of the very few things that lifts human life a little above the level of farce, and gives it some of the grace of tragedy. - Steven Weinberg


The rapid scientific progress in genomics is now translating into almost everyday clinical applications. It becomes obvious,although expensive at this time, that DNA analysis will cause a revolutionary catalytic disruption in how medicine will be practiced.

One-stop' embryo test unveiled

A gene mapping test could tell parents-to-be if embryos are affected by almost any inherited disease, UK scientists have claimed.image

The team from London's Bridge Centre say the £1,500 test could detect any of the 15,000 inherited diseases in weeks.  The claims for this new technique, called karyomapping which analyses chromosomes, is that it is a universal 'one size fits all' test. The human genome project has allowed mapping our DNA.

The economics of genetic testing is a double edged sword. Initially this testing will be expensive. Most payers will not pay for this testing, at first.  As the early testing translates into "assembly line" techniques the cost will diminish exponentially.  The upside is that proper testing will allow forecasting and accurate diagnosis of genetic conditions, allowing for targeted specific conditions.  Patients will benefit from designer drugs modeled to prevent allergic and cross reactions in some patients. It may become possible to design antibiotics against drug resistant organisms. 

Thursday, October 23, 2008

Health Train at San Francisco

By now those of you who read my blog regularly realize that I did not go on a media fast.  It didn't seem quite right in the middle of the Health 2.0 ver 3.0 in San Francisco. If Matt, Sarah, Michael are working, who am I  to be a slack? So I am monitoring Health 2.0 from afar.image

I received an email from Wellsphere asking if they could link to my blog here at Health Train Express.  The "train" is getting new routes.

I must admit as I have extracted myself from all the 'wonderful' things of patient care, image

the only thing I miss is the personal  interactions between myself and patients.  I always aimed for the best outcomes, and was disappointed and somehow always felt guilty when the outcome of an eye surgery was not what I assumed to be perfect. I always had to go back and review what I might have done wrong, and discussed it with colleagues. I tried to keep my 'ego' out of the equation.

I am now a 'voyeur' enjoying academic discussions, patient care, and via several listservs, Sermo, iMedexchange focused on deep thought and practical questions with not only ophthalmologists from Brazil, Thailand, Hong Kong, Australia, Iceland and beyond. 

image Nancy Turett in her blog shares her excitement about Health 2.0 and I can see why. These gatherings are educational but also are the physical manifestation of 'blogging'. It is the real world of virtual social blogging.  Friendships are made, and lost in a virtual world...a good deal like having a pen pal who sometimes answers your letter.  Putting a face and a voice on the blog seals the deal.

image At Health 2.0  Gary Karr lists  Seven Great Health Care Policy  Blogs.

I expect to see some  updates on your flights back home.


Wednesday, October 22, 2008

Health Train Genetic Transcription

John Hamlaka, M.D. the Chief Information Officer at Harvard Medical School and the Beth Israel Deaconess Hospital  has "donated"  his genome for the PGP (personal genome project.

It is now in a public space, accessible to anyone who can read AGTC code.

Audio transcript--John Hamlaka M.D.

Thought Leader #1

Thought Leader #2--David Altshuler

Thought Leader #3

I took a wrong turn surfing looking for blog material and happened upon these wonderfully informative daring innovators

Listen to the will need either iTune or Windows media player.

from Harvard Medical Labs

Episode 1- The Science of Social Networks--Audio

Episode 2- The Secrets of Aging--Audio

Episode 3- The Art of Perception--Audio

Episode 4-  And Coverage for all ? --Audio

Episode 5- Striving for Global Health--Audio

Episode 6-  Your Genome, Your Future--Audio

You may find the accompanying text from Harvard Medical Labs here.

Successful Health Train Reform

In many ways healthcare and education have taken a similar path. Education has endeavoured to equalize the playing field by increasing the number of pe0ple who are educated, thereby elevating them from impoverished lives, both economically and socially.

Despite increased spending in education, and a number of 'innovative' techniques' some of which have suceeded in their own relaively narrow segment, the effort has largely failed....left behind.

Max Ladner and Dan Lips write about the Heritage Foundation and about "A  successful model for education reform."

Parallels can certainly be drawn between our educational system and our health care non system.There  remains a large number of uninsured.

Obesity and dys nutrition abound fueling chronic diseases.

Florida has excelled in education outcomes. The tools have been a liberal use of charter schools, (300)......

— Standards and Accountability

— Ending Social Promotion

— Focusing on Reading

— Expanding School Choice Options

— Improving Teacher Quality

The Goldwater Institute elaborates further on the report from the Heritage Foundation.

Does this sound familiar?  Our government and payors have thrown more and more money at these issues in medicine, the underinsured, the medically indigent, the lack of physical fitness, and malnutrition without measurable success over the past ten years, except for some improvement in heart diseases. 

We physician leaders need to step back, out of the box, and ponder if some of education successes and failures apply to health care as well.

Health and wellness education and training needs to begin in elementary school.

M.D. O.D. also relates public education and public health issues in his recent blog, a guest editorial from ACEP by David Baehren M.D.

Evan Madianso likewise associates "affordable housing"  and "affordable health care  (brought to you by the feds. 

See   Freddie Mac  and    Fannie Mae. and yes they are still in business, have a web site and 'doing well' Thank you very much!!!

Health care needs a bailout, but we do not want it from the feds, for all the obvious reasons.


Tuesday, October 21, 2008

Health Train Rest Stop

Well, frankly I need a break from blogging, healthcare and politics.  I am going on a  7 day media fast (not fest).

So you all enjoy Health 2.0, don't step on the homeless people, and use protection!!!

See you in a week.

Health Financial Markets Impacted

iHealthbeat reported this morning that the merger between WEBMD and HLTH was cancelled due to current economic situation.  They cited several reasons for cancelling the merger which was announced in February 2008

In a statement, Martin Wygod, chair of HLTH and WebMD, said, "The boards of directors of HLTH and WebMD believe that, in the current economic environment, it is important for a growth company like WebMD not to be encumbered by $650 million in [HLTH's] long-term debt that would be coming due in 18 to 36 months" (Washington Post, 10/21).

Health IT experts tackle vendor collaboration

Dan Michelson -- chief marketing officer of physician software vendor AllscriptsMisys Healthcare Solutions -- recommended that physician group buyers "contractually obligate" their vendors to provide systems that can easily share data with other vendors.

Health Train 2008

Health 2.0's annual conference begins tomorrow in San Francisco. Although registration deadline has passed and there are over 900 attendees, an additional room has been opened across the hall from the main room.  There will be large screen presentations, and audio.  You will be able to attend the breakout sessions, and exhibit hall.

You can't go in the ballroom for the main sessions, but you can attend the breakout sessions, the exhibit hall, the "unconference" lunch, the IDEO session (there are actualy only limited spaces available anyway


Prognosticators are theorizing how our current economic crisit will affect health care reform and what the impact will be on Health 2.0, Web 2.0 and health information technology adoption.

HIT funding has been slow at the best....will this kill it?  Or will it drive Health IT due to the necessity of cost containment, and efficiency?


Richard Reece M.D. analyzes our current predicament(s) and gives a futuristic prediction for HealthCare 2020 at


image Richard Reece, M.D. (photo from his blog)

Monday, October 20, 2008

Economic Transformation

The real bad news


Always listen to your elders....the indians knew this.

Health Train Express International


Perhaps we should emulate the Chinese in revising our health care system.  Long considered primitive regarding health care, China is taking a bold step toward caring for it's billion or more people.

The Chinese however may have an advantage that much like building a home, it is much easier and less expensive to start from scratch.  The United States is faced with disassembling a system that has grown over the past 100 years or more and transitioning to a better means of financing health care.   We see that a large barrier to transitioning lies in the financing. Converting to a new system will be disruptive financially, and  old habits are difficult to break.

The Wall Street Journal reports that China is aiming for universal heatlh care.


The proposed plan would be quite a shift for China. The draft plan’s overall goal is to cover 90% of the population within two years and achieve universal care by 2020. It aims to return to non-profit national health care, an idea that was largely abandoned in the country 1980s.

This all stands in contrast to China’s current system, which provides little government funding to government hospitals and requires patients to pay heavy out-of-pocket expenses. The WSJ notes that out-of-pocket payments made up more than 60% of health spending in China at the end of the 1990s.

The plan — drafted in consultation with groups including the World Health Organization, the World Bank, consultant McKinsey & Co. and a few Chinese university-based public health experts —-----The government also aims to set pricing standards for medical services.

Other news about Chinese health care, Pharma,Western style hospitals is in the Wall Street Journal. And what does Heparin have to do with hot dogs?

In China as in the United States reform has it's skeptics.

Sunday, October 19, 2008

Health Train Express--Sunday Edition

On the heels of Colin Powell's endorsement of Senator Obama, we can begin to look at the options for health care reform that the two candidates espouse.

Before I talk about that I make the following observations.

Few if any Physicians have access to the national stage in a manner that prominent senators, governors, and other publicly elected officials enjoy.  We have relied on our national organizations, the AMA, specialty societies, lobbyists.

There are other major players and foundations ,fund policy analysts, and speakers on the national circuit of speakers that elaborate on options for health care reform. In fact there is an alphabet soup variety of publicly funded organizations active in these matters. Some are underwritten by non profit organizations that are actually underwritten by payers.

National Health Policy Resources

Kaiser Family Foundation

Robert Woods Johnson Foundation

The American Hospital Association

U.S. Non- Profits Health Data and Statistics

The following two interviews detail the essentials of  the two candidates platform for health care reform.



Both interviews courtesy of the Kaiser Family Foudation

Health Train Transformation

Morality, like art, means drawing a line someplace.
Oscar Wilde
Irish dramatist, novelist, & poet (1854 - 1900)

Today's post, is indirectly related to healthcare. Electrifying news this morning, as we awoke from slumber. 

To me it was almost as punctuating as the events of JFKs assassination, and the bombings of 9-11.   Colin Powell who was George Bush's Secretary of State, and critical of the Iraqi war as it boged down, endorsed Barak Obama for the Presidency.

Colin Powell  has such enormous stature from not only his role and experience in government, but also his eminence as a person of great integrity and moral stature. 

Mr. Powell did not have to endorse anyone, he could have remained silent.  His love of his country and performance of his duties leaves no doubt as to how this will impact the election.

The sad thing is that George Bush did not listen to what Colin Powell was telling him (and we as taxpayers paid for it). 'res ipsa loquitor'. (the thing speaks for itself).

This is the final nail in the coffin of the Bush administration.

This announcement also comes as the Iraqi Government begins to renegotiate terms for our remaining in Iraq. 

Saturday, October 18, 2008

Californians' health premiums rise 5 times faster than pay

The Sacremento Bee reports

In California from 2000 to 2007, annual premiums rose from $6,227 to $12,194. During that same period, the median pay went from $25,740 to $30,702.

About 6.6 million are medically uninsured in California.

On average nationally, health premiums rose 78 percent, lower than California's rate, during the seven-year period. However, earnings in California outpaced the rest of the country, which saw wages rise by 14.5 percent.

What is clear is that health care is becoming less and less affordable," said Anthony Wright, executive director of Oakland-based Health Access California

The system is broken and needs to be fixed," said Wright, who called for greater oversight of the insurance industry.


Quote of the day:
An ignorant person is one who doesn't know what you have just found out. - Will Rogers


I want to share an article posted on SERMO by it's creator,

Dan Palestrant M.D. (give this link a moment to load, and then click on the video should open in iTunes it is an iTunes video cast          image


click to JOIN   LICENSED PHYSICIANS ONLY, all applications are 'vetted'.


Please excuse the length of the quote, it is included since SERMO is a protected secure website accessible only to licensed physicians. 


Those of you who are physicians should JOIN

The pictures are mine, inserted and are not part of the original posting. (all that plain text gives me nystagmus, and I'm a picture guy.)


From The Founder: Knowledge is (Still) Power

I'd like to introduce a concept called information asymmetry.

Exchanges, whether it is swapping ideas in a community like ours, or goods and services in a marketplace, always work best when the information held by both parties is symmetrical.  Both parties need to be on an equal footing for the information exchange to be fair and mutually beneficial.  In economic theory, this is referred to as how "perfect" your information is.  As such, it makes sense that the party that has the "more perfect" information has an advantage. In any business transaction (such as when buying a car) if the seller knows something that the buyer does not, there is an information asymmetry and therefore an intrinsic disadvantage for one of the parties (hence the prevalence of Lemon Laws).

The Rise of Asymmetry in Medicine

As physicians, we combat information asymmetries by sharing insights from one another and benefitting from each other's collective experiences.  However, the shift towards outpatient medicine, where physicians no longer enjoy the collective gathering places of the doctor's lounge, grand rounds, or even the nursing station has left physicians "solo" in operating our practices.  Add to this the increasing time pressures that have caused us to sever other ties, and it is no small wonder that physicians feel a growing sense of loneliness and isolation.  This isolation has compounded the information asymmetry for physicians and we are unable to benefit from each other's insights in advancing the collective good of our profession.  The bottom line is that "hearing" each others' voices is a necessary prerequisite before we can have a collective voice and overcome information asymmetry.
The impact of information Asymmetry on our Earnings
Isolation and information asymmetry have had a dire financial impact on physicians. They have allowed critical changes over the past 25 years to the financial mechanisms that underpin our profession. As our isolation has become more acute, the parties that we must exchange our goods and services through (ie insurance companies) have not stood still. They have benefitted from better organization, better technology and ultimately better information.   This did not happen by accident.

Insurance companies and government agencies have leveraged information that we don't have-around costs for drugs and procedures and treatments for example-to gain advantages over physicians.  Rather than a perpetuating a system where a physician's time, efforts, and skills are rewarded based on market value, payers have incredible advantage because their information is more "perfect".   How is it that demand for physician services is exploding and physician supply is flat to declining (as physicians are retiring earlier and increasingly opting out of primary care) and yet reimbursement and physician earnings continue to plummet? Focus on the asymmetry of information.

Information asymmetries have features that can make them very attractive (if you are on the right side of the asymmetry).  They perpetuate positions of strength or authority (they are also threatened by anything that creates a level playing field or meritocracy), while creating great leverage for the party with the more perfect information.  Knowledge, or in this case "information", is indeed power.
Sermo's Role in Regaining Information Symmetry…and Physician Influenceimage

From the moment it launched, Sermo has been a medium physicians have used to overcome information asymmetry in our practices.  Indeed, the information is perfectly symmetrical among physicians within the Sermo community.  Given a level playing field, new insights, new methods, and new strategies have emerged through Sermo.  Quite to my shock, we are starting to erode that information asymmetry that had appeared so daunting, so destructive, to our profession.  The evidence of this abounds.  New clinical insights that never would have been given their due are routinely discussed in Sermo.  Difficult patient situations, clinical dilemmas, and most certainly some of the most vexing economic questions that face physicians are far less daunting when the collective brainpower of this community can be applied.  The axiom has held true: No one of us is smarter than all of us.
Creating a Healthcare Information Exchange

Very quickly we learned that the knowledge, and consensus of physicians on Sermo also has tremendous value to outside entities.  The Sermo Team has worked to build a business model that enables physicians to project our collective voice on every subject to outside entities.  New modes of exchange like AskRx, Clinical Trials, and Earn HotSpots have created an entirely new paradigm  for Exchange with outsiders that need to understand physician perspective to advance their businesses. The community is proving incredibly adept at engaging outside entities on this community's terms and even at changing the rules and forcing outside entities to reevaluate their practices.  This Exchange mechanism has unlocked the power to regain our influence over the players that control the decisions, investments and policies that shape the healthcare landscape in this country. 

This community has been both consistent and emphatic in making sure its voice is heard outside Sermo,

Friday, October 17, 2008

Health Train Travelling Taxes

Following last night's 3rd and thankfully last presidential debate I am taking a grim view on the possibility for real reform in our health system. 

The reality here is that we have two candidates with diametrically opposed views on health care reform.

Senator McCain advocates that our health non system challenges are limited to the premiums and availablility of health care coverage.. This does not speak to all the other areas in health care that need reform.  His  proposal will be a battle of the payers, and the employers and a new book of IRS tax codes. Insurers have no real interest in providing more payments for more patients, nor hospitalizations.  His proposal is not well thought out, and fails to address most of the fundamental challenges for patients and providers alike. 

Senator Obama takes the short universal payor. Although he has not mentioned it lately and backed off when pressed at the debate, his other statements are otherwise. Senator Obama also wants to use the tax codes ( but in a different manner)

Joe the plumber might as well be you the citizen, lawyer, doctor, small business man or even a large integrated health system.

Senator Obama wants to take some of your income and give it to the "guy behind you".  Senator Obama wants to make life easy for you by giving your decision making and accounting to the U.S. government to decide who should give what and who should take what.

When pressed about mandatory mandates Senator Obama was asked how much a fine would be for the employer or employee who did not provide health insurance. He fumbled a bit and mentioned that was only for the 'rich' ,those businesses that had income greater than 250,000.

Some expert economists point out that even many medium and large enterprises, such as General Motors are having problems paying the rent. This type of health reform will bankrupt some large enterprises as well.

Neither Mr. McCain nor Mr. Obama have much real world experience in running a business, making payroll or having employees they are responsible for. 

I doubt if  McCain or Obama are able to add and subtract numbers with less than nine zeroes...That is apparent since Obama sees the divide at 250,000 dollars. If you are above that are rich, if you are below that, then you are eligible for whatever grandiose federal programs he imagines.

It seems that Obama actually overtly and covertly sees our country still in terms of class warfare facing both sides off against one another.

My fundamental analysis  is that tax codes should not be the determining factor how we finance and deliver health care. The fundamental flaws must be dealt with by providers and patients.

Thursday, October 16, 2008

Health Train Express, Number Six on the List of Most Important Voter Issues


Graph from The Health Care Blog article by Chris Weaver.

Media coverage of two issues - health care and taxes - nearly doubled. Health care stories increased across all media from 256 stories to 439. Tax stories rose from just over 400 for the week to nearly 800 between the weeks ending Sept. 29 and Oct. 6, according to stories polled for the LexisNexis Analytics dashboard.    This spike in incidence is not unrelated. Tax stories are hot as voters stare at a growing deficit and watch their 401k's plunge, but tax talk has also become a predictable symptom of health care reform stories.  

An excerpt from a New York Times article states,  (link)

"It is health care, advisers said, that they believe resonates more than other issues for Americans who are worried about their economic condition," they wrote. "It is a less threatening way to talk about the economy - showing pictures of shuttered banks, for example, could create more worry - that aides said tested well across demographic groups, but particularly among older voters who have been slower to warm to Mr. Obama."

Of course, this construction fails to appreciate the other important issues under the umbrella of health policy - id est the health part.

Rising to the occasion, the conservative Washington Times reminded us Tuesday that millions of uninsured people have a tough time finding treatment, and in a worst case scenario, camp out for days, waiting to see doctors at a Wise County, Va., health fair. It's not all about the taxes after all.

No physician has to be told this observation by pundits of what is wrong about the American HealthCare non-system.image

The portions of the debate on health care seemed to be 'muddle' on both sides.  Mr Obama appears to have backed off on his plan for UNIVERSAL PAYOR.  Mr. McCain's proposals regarding tax advantages for his program at times seemed conflicting, confusing and very unclear...and it does nothing for helping the "uninsured"...He use "Joe, the plumber" at several points attempting to relate "spreading the wealth" as a for socialism. The he used Joe' s   plumbing business as an example for small business as an example for capital, loans, and his tax bracket.  Poor Joe is a busy guy..

Neither candidate demonstrated understanding the root causes of the problem for providers.....increasing costs and fixed overhead for delivering care.  The root causes are increasing baby boomer usage,  and the internal bureaucracy of evaluating, regulating, and paying for health care. 

Health IT and data mining are forecast to evaluate outcomes, and the efficiency and accuracy of treatment.  It will take many years to develop statistically valid data on preferred patterns, and evidence based medicine...By the time this occurs, it is likely that treatment paradigms will have shifted, due to technology, and drug advances.  Don't get me wrong I am all for studying our outcomes, but a billion or so dollars down the line I doubt if we will truly save one nickel. (image hearsay, and highly biased prospective prediction) (shoot the messenger)

On a more positive note, Elizabeth Edwards and HEALTH CARE NOW seem to be on 'our side' in regard to health insurers.

Other items in today's blogs

Wall Street Journal  Hospital closes in Chicago

Medinnovation blog  Geeks, formulas, and algorithms

Trusted MDTrusted MD  Health 2.0  busted??

Guarranteed Health Care  Treatment delayed for months, policy cancelled when payment one day late.

Fresh MD  New perspectives on American Health Care, why are we bitching  ??

That's it for's time for my medications.