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Thursday, December 25, 2008

Health Train Analytics

No degree of dullness can safeguard a work against the determination of critics to find it fascinating.
  - Harold Rosenberg


This is my preface for today's stories

It's the end of 2008, and between nodding off and consuming egg nog there are some interesting blog writings, analyses, and reports emanating from various congressional reports, foundations, and health care think tanks.

If you are a pessimist the tanks are half empty or even empty, if you are an optimist the tank is half full.  If you are like most people, the 'tank' is meaningless and does not apply to the real world.

There is a certain amount of common sense that is lacking in many things we now have to deal with in our daily lives.


Robert Laszewski in THCB writes about two reports from the CBO detailing the options for reform of health care policy.

Caution, this is over a 600 page report, all written by Peter Orszag, Director of the CBO.

Mr Orszag is President-elect Obama's nominee for Director of the Office of Management and Budget.

Key Issues in Analyzing Major Health Insurance Proposals

Budget Options for Health Care (Volume 1)

Federal Perspective on Health Care Policy and Costs

Abbreviated summaries of the articles are here.

Key Issues

Budget Options, Volume 1

  • Robert Laszewski opines, "After reading these two reports, totaling more than 400 pages of some of the most valuable health policy analysis I have ever seen, I now know that I had no reason to worry that the CBO would just tell the politicians what they wanted to hear."
  • "It is also clear that, whoever the Congressional Democratic leadership appoints to succeed Orszag, a marker is down. The CBO is on the record about what the likely reform options will cost before anyone had a chance to bring political pressure to bear. And, that just might have been intentional."
  • "The work contains an inventory of about all of the health care reform options being discussed complete with a thorough cost/benefit analysis detailing their impact on federal spending."

More details are forthcoming for the reader at The Health Care Blog, 



I agree with Docanon that this is the best article on the subject I have read thus far.  Kudos to Mr. Laszewski......and to Peter Orszag.

Wednesday, December 24, 2008

Content for 2008 Health Train Express

The end of 2008 certainly has been remarkable. What unexpected cataclysmic events await us in 2009? Will what we have experienced in 2008 give us a better understanding of other impending chaos, without our taking serious proactive measures, rather than retroactive reflexes.??? Read more at Health Train Express

Monthly Content for Health Train Express—December 2008

Primary Care


Express 2008


Brain Train and Fitness




Cooling Down

Throwing Money


Transition Team

Arogant Physicians (Surgeons)


And have a safe and blessed Christmas.

Tuesday, December 23, 2008

Primary Care needs to get on the Health Train Express

Richard Reece MD of Medinnovation Blog is the rare breed of specialist (in his case, pathology) who waves the flag and cheers on the family physician, and general practitioner in their battle to survive.  Even I as an ophthalmologist will join his efforts and realize if primary care can be picked off then all of us are very vulnerable.  No specialist should be excited about the impending doom of PCPs and the secondary loss of patient access to healthcare in America. 

The American College of Physicians has sent a letter to President-elect Obama via HHS Secretary designate Tom Daschle requesting a ten percent bonus for primary care physicians alloted from the economic stimulus package.

Tom Daschle has been handed to our physician group without our input and/or comments. He has still yet to be confirmed, and all readers should make comments regarding his appointment. Daschle knows bupkas about caring for patients, and may be a great negotiator 'across the aisle' and deal maker to get healthcare legislation passed.  Perhaps the message has not been presented to our group.

Mr Daschle correctly analyzes our problems in the article he published in the Huffington Post.  Re Progressive Solutions to Health Care.

However, his ideas about a 'Federal Health Board,  for Healthcare' comes at a very inopportune time given the failure of our Federal Reserve Bank  for the Financial Markets.  It is doubtful that an agency of that size could truly keep track of anything.....

Monday, December 22, 2008

Health Train Interruption

Sorry I have been away the past week, moving from California to Georgia.  I've been looking for a 'retirement phase out" and appear to have found one.  Once I settle in I will be able to alot scheduled time to my newly acquired fondness of blogging.


Known for it's peanuts and peaches and pecans




Tuesday, December 16, 2008

Health Train Express--2008

The end of 2008 seems a good time to review the state of health information technology and the progress of Electronic Medical Record implementation.

Much has not occured since 2003 when GWB appointed David Brailer MD as the National Coordinator for Health Information Technology (ONCHIT). Initially, like all new things, ONCHIT attracted a great deal of publicity.  It stimulated the organization of CCHIT, a national certifying authority for producing interoperable information systems, assuring the compatibilty of different vendor offerings to move toward a goal of the National Health Information Network.

During the ensuing years, the most successful vendors became CCHIT certified, but now without annual costs paid for by the vendorss themselves to become certified each year.  These applications also are the largest companies and the most expensive software.  While bolstering interoperability, at the same time many vendors have disappeared because of  the CCHIT requirement.  The industry consolidated leaving fewer vendors.

All of the media excitement and cheerleading is now led by promises (mostly empty) of bailout funding.  Admittedly some states have ponied up to the bar with funding for EMRs. However, these 'integrated systems and EMR are limited to mostly public sector agencies. Little money has trickled over to private practice.  And this group needs it  most.

MRI (The Medical Records Institute) released it's Status Report, 2008, by it's  CEO C. Peter Waegmann.

iHealthbeat regularly charts the progress and adoption of EMRs several times each year.  It is my estimation that these figures are biased.   Many users report the use of EMRs which do not offer many functionalities which should be inherent in an EMR.

It is true that some practices have adopted electronic prescribing. and one or two other functionality.

The Chart below is taken from National Health Care Surveys done by the CDC.

infosheet_nhcs_fig1 (1)

The fact that EMR adoption has lagged does not take into  account the adoption of health information technology available via the internet and other sources.  The parallel development of Health 2.0 online services and mobile devices, such as smartphones, Personal digital assistants, and others hand held devices reflect the interest and willingness of physicians to utilize IT when cost effective. Adding to this strong trend is the deployment of high speed 3G cellular technology which empowers internet use almost anywhere.

A new survey found that 58% of U.S. physicians surveyed go online for clinical information at least two times per day. More than three out of four respondents said they go online for clinical information more often now than they did a year ago, according to the survey.

By now, most providers are familiar with software offered by third  parties as downloadable applications.

In 2008, 84% of physicians surveyed reported using the Internet and other technology to find information about pharmaceuticals, biotechnology and medical devices, up from 64% in 2004, according to a survey


Utilization of Health IT by Patients

A new survey found that 31% of non-elderly Americans with private health insurance and Internet access have used an online physician or facility finder. Meanwhile, 16% reported using an online health plan selection tool and 10% have used an online health care cost information tool.

Privacy Issues

In 2008, 62% of U.S. adults age 21 and older said they were not too or not at all confident that electronic health records would remain confidential, while 12% of survey respondents said they were extremely or very confident that EHRs would remain confidential

The area of explosive growth of health IT is in electronic prescribing. 

Fueling this growth is CMS's indication that users will receive a 2% bonus for using ePrescribing.

What does 2009 have in store?

iHealthbeat reports:

Nearly half of health IT professionals surveyed said that Democratic control of the White House and Congress will strengthen efforts to promote patient safety and the use of health IT, according to a new survey from the Healthcare Information and Management Systems Society.

Fourteen percent of respondents said that Democratic control of the White House and Congress will weaken efforts to promote patient safety and the use of health IT, while 29% said that it would have no impact and 9% said that they did not know what kind of effect it would have, according to the survey.

Meanwhile, 20% of respondents said that President-elect Barack Obama's proposal to spend $50 billion over five years on health IT is sufficient to advance health IT adoption, while 46% said that the funding would advance health IT adoption but that additional funding would be required to truly accelerate adoption. Fifteen percent of respondents said that Obama's proposed health IT funding is insufficient.

Results are based on a November survey of 622 health care IT professionals.

Source: HIMSS, "2008 Presidential Election"


This appraisal is based upon uncertain funding, intense competition for federal dollars, an exploding federal deficit, and many other unknowns. 


Saturday, December 13, 2008

Health Train Express--Denoument

Today we are changing from the train to an airliner. I do my best 'creative thinking', or perhaps I become a bit delusional at 40,000 feet. Perhaps it is the reduced atmospheric pressure or  decrease in oxygen.  No is the end result here that is important rather than the science.

An economic survey, or just reading the news tells us that financial institutions have failed.  Our industrial production base has changed, and what was once the bastion of middle class attainment, the automobile companies in the United States have tanked.

As I fly over the United States I see Wall Street in ruin, empty houses, unfinished home construction, and

a hole in the ground where the world trade center used to stand, the midwest where steel factories and other heavy manufacturing plants lay rusting in the cold damp winters, and in the warm humid summers.

We in health care bemoan our sad state of affairs as health  care costs have risen seemingly without end and naysayers who say most of our money is 'wasted' with little evidence for better outcomes and better health. 

Actual facts dispute this. Evidence and statistics show that mortality has changed. Fewer heart disease deaths, a drop in mortality from infectious diseases, and relatively more deaths from cancer. The increase in death and morbidity from cancers may more be a reflection of  increasing survival .

Despite these facts healthcare has now become a major backbone of  financial care provides employment for millions of Americans. 


The economicengines of the United States are service industry,  healthcare, education,  government (at all levels), regulatory agencies,public safety,the judicial system, technology, and communications. ( I leave entertainment as another driving force)

My previous post relates to the merger of health, prevention and entertainment.

Stepping back from all of this I think, what better use of our resources is there than keeping one another healthy.  What finer product is there than the human body?  What product grows and maintains itself automatically for up to 75 to 85 years?


Friday, December 12, 2008

Brain Train Express


For those of you who have not noticed videogaming is a 3 billion dollar industry, and is fluorishing during hard times.  For one thing it has a lot of 'bang for the buck',  compared to theme parks, movies, and does not use any fuel.

It also turns out that 16% of the gaming market has to do with health and fitness.  Yes,that's correct, you couch potatoes can use brain power as well as fitness training with interactive Wii (Nintendo) games.

Here are some examples:

















Brain Train Express


For those of you who have not noticed videogaming is a 3 billion dollar industry, and is fluorishing during hard times.  For one thing it has a lot of 'bang for the buck',  compared to theme parks, movies, and does not use any fuel.

It also turns out that 16% of the gaming market has to do with health and fitness.  Yes,that's correct, you couch potatoes can use brain power as well as fitness training with interactive Wii (Nintendo) games.

Here are some examples:

















Health Train Express Transition

The gulf between the macrocosm of health policy planners and the microcosm of health care providers, ie physicians, grows wider day by day.


Evidence of this abounds as other participants in the health process compete for a seat at the table of transition teams for the new Obama administration.  

What does Tom Daschle really know about providing healthcare to that patient on the exam table?


His choice was as an arbiter for political disagreements and an attempt to create the coalition to pass some type of health care legislation.  One cannot even begin to predict the outcome....whether it will call for a universal payor plan or another throwing of the dice in regard to reimbursement plans, or another game of insuring the uninsured by shuffling the deck of poker cards.

Health care unfortunately has become a game of chance.


Will you have a job?  Will you become disabled?  Will you become uninsurable? Will you be able to find a family physician? Will you, will you , will you?

Medicine and Politics seem to be following a new course of increased transparency of their own process. The internet has led to this development but still lacks user friendly search engines and other health 2.0 applications to find, organize and interpret raw data and commentary.  If one visits the Obama Transition Web site,  and searches you will find numerous sources and opportunities to participate .



Senator Tom Daschle is now the designated head of Health and Human Services.

The issues are complex and the economy has now complicated it further.  A bailout and stimulus package is a false hope. The  real problems are systemic.  Throwing money at our failed health care system is almost as bad as giving it to the IRS.

Health Care Transparency and others

New buzz word "Transparency" is upon us all.  Wikipedia lists a number of industries, and uses for this term, however it does not list 'healthcare".  I am not sure what that means.

Much of today's post will not relate to health train express, so I will link you to my posts over "there".

Monday, December 8, 2008

Health Train Express Bailout 2018

Medpolitics has an  article written by  Paul Hseih MD regarding parallels between the home mortgage crisis created by 'universal home ownership' encouraged by not so wise financial market manipulations, and 'universal health care" as is being currently proposed by the Obama administration.

Paul Hsieh, MD is the co-founder of Freedom and Individual Rights in Medicine.

Are we at the beginning of a "Health Care Bubble"  destined to failure?

More bubbles please!!

Sunday, December 7, 2008

Cool Down the Health Train Express

See full size image

How would you like to become a popsicle?

A cardiologist in Louisiana has developed a non invasive technique to cool down the body of patients with strokes, acute myocardial infarction, for any disease whose body temperature can rapidly be cooled (ie, within six to ten minutes) to produce hypothermia. 

It has long been recognized that hypothermia slows down the metabolic processes and improves the liklihood of healing without further damage to vital organs such as the brain, heart, kidneys, and liver.

This technique has been in use for decades for transporting donor organ tissues.

The device, is demonstrated by Paul McMullen M.D., cardiologist at the Ochsner Clinic, named "THERMOSUIT HYPOTHERMIA THERAPY.  It is currently undergoing clinical trials at a number of Universitys and Heart Centers.  

The therapeutic modality is already in use in Europe and approved by CE (Conformite Europeene). for use in hospitals

"Way cool"  Pick your flavor(s).

Friday, December 5, 2008

Throwing Money at the Health Train

As long as we are at it, how about throwing  50 or 100 billion toward those underpriveleged hospitals and doctors.  This is a national crisis which undermines  the health and welfare of all.   Get it while the spigot is flowing.  Do we want cars or health??

iHealthbeat reports: 

Lawmakers Consider Adding Health IT to Stimulus Package

Congressional health care leaders are considering adding health IT provisions to an economic stimulus package being developed by aides to President-elect Barack Obama and congressional staff, Government Health IT reports.

Congressional sources say that one strategy would be to attach the Wired for Health Care Quality Act to the economic stimulus legislation (McCloskey, Government Health IT, 12/4).

Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and ranking member Mike Enzi (R-Wyo.) introduced the bill (S 1693) to create a national electronic health record system more than a year ago, but privacy issues and funding concerns prevented the legislation from reaching the floor.

On Thursday, an aide to Enzi said the senator has not seen enough details of the economic proposal to know whether adding health IT to it would "blow the budget."

Blow the budget??  You mean if all this stimulus package fails it will be the providers and hospitals that caused it all.

Health Policy Experts Urge Caution

At this week's annual e-Health Initiative conference in Washington, D.C., health policy experts raised concerns about driving health IT adoption through a financial stimulus program.

Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said that efforts to finance health IT would be most effective if they are linked to specific standards or functional and performance requirements focused on health outcomes.

He said that although direct financing could increase health IT adoption, he is "not sure that by itself, it would lead to better care."

Democratic National Committee Chair Howard Dean, a physician and former governor of Vermont, cautioned that standards and uses of systems underwritten by a stimulus would have to be widely tested and accepted prior to purchasing (Government Health IT,

Unlike the financial world and credit fiasco, as well as the impending demise of the big 3 (not so big anymore), throwing money at the healthcare system will not cure the problems..

Thursday, December 4, 2008

Health Train Express Consensus

While most folks have been tuned to the recent financial crises, industry bailouts, mortgage melt downs, there have been significant proposals from the health insurance industry, set forth by the American Health Insurance Plans (AHIP),

The Wall Street Journal reports:

Ideas about how the U.S. can achieve universal health care are coming thick and fast. The insurance industry itself is stepping up to the nation’s suggestion box with another proposal.

insurance universal coverageThe trade group America’s Health Insurance Plans, or AHIP, called for universal coverage, a more centralized insurance market and cost-reduction that would slow the growth of the nation’s ballooning health-care spending by 30% in five years.

Consensus is emerging on universal healthcare, as reported in the New York Times

Tuesday, December 2, 2008

President Obama's Healthcare Transition Team

Every physician and almost every potential patient has dealt with the chaos and inequity of our current non-system. It takes an enormous effort to navigate to and from a medical clinic, hospital, navigate forms, bills, and payments, what is covered, and what is not covered.  What used to be  a rather simple transaction between doctor and patient has degenerated into a blizzard of paperwork, information technology and more. While HIT is promoted as a 'cure' it also raises many questions as to expense, privacy and converting healthcare providers into data entry clerks who will utilize more time entering data than caring for patients.

Healthcare transparency is upon us, and also health care policy planning.  Tom Daschle has the following to offer.  All of us should 'bury' him with our ideas.

Health Train Express applauds this relatively new approach

Arrogant,Abusive, and Disruptive on the Health Train Express

In today's email newsletters one from the New York Times caught my eye.

This is old, but still disturbing news. The article fails to mention what steps hospitals, medical staffs, and others have initiated to curb these episodes.  Human behavior is at times unpredictable. What is also not mentioned is the disciplinary process, nor the response of the attending surgeon in their example.

It is also very interesting the article mentions (as an afterthought) that the incidence of these 'outbursts' have diminished recently. Could this be attributed to the mandate of decreased hours for residents in training.

It also does not attribute what the support staff did ,if anything, to enable this type of behavior.  Does the nursing supervisors, and hospital administration have an avenue and procedure when this occurs.

This article is entirely one sided. How about this picture?

We have surgeons in the operating room, who bear total responsibility morally, ethically, and legally who may have been up for 24 hours or more, may have had their office hours disrupted to be in the operating room, at times at night with unfamilar and at times untrained personnel doing a procedure.  Thrown into a life and death situation under these circumstances can tip an otherwise 'balanced surgeon' into 'anger'....Throwing a scalpel can be construed as assault with a  deadly weapon.  There are legal means of dealing with this situation, far beyond hospital discipline.

The New York Times lumps all episodes of surgeon unhappiness or anger into one category.  Do they include a loud admonition to nurses that are talking, or an anesthesiologist playing loud rap music or  even playing music without the consent of the operating surgeon?  Is blood squirting up to the ceiling because a nurse or assistant was not paying attention to the operation?  Did a critical piece of equipment fail causing irreparable damage?

None of these episodes can be lumped into one category, and each must be addressed individually.  All hospitals  now have procedures and mechanisms to avert this behavior. 

Compared to other issues in our health care system, the uninsured, the inaccesiblity and unfunded mandates, this is a miniscule problem for American Health Care.  There must be other issues the NY Times can print to fill up their space.