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Thursday, September 30, 2010

Jerry vs. Carla (not Simon)


California is a reflection of what ails our great nation. The major party gubernatorial candidates offer us very little to chose from with their ‘platforms’…During the recent debate between former Governor, Mayor Jerry Brown and ex-CEO entrepreneur Carla Fiorina several points were glaringly apparent.

image image

Governor Brown, for all his experience seemed like a washed out politician-bureaucrat.  He has been a governor, a mayor, attorney general, and his political career seems pointless in the ‘great scheme of things. Once a possible Presidential candidate, he failed to generate enthusiasm for this post.

Brown has had a lengthy political career, spanning terms on the Los Angeles Community College District Board of Trustees (1969–1971), as California Secretary of State (1971–1975), as Governor of California (1975–1983), chairman of the California Democratic Party (1989–1991), the Mayor of Oakland (1998–2006), and is the current Attorney General of California (2007–present).[1]

Brown unsuccessfully sought the Democratic nomination for President of the United States in 1976, 1980, and 1992, and was an unsuccessful Democratic nominee for the United States Senate in 1982.

He has had a busy life of public service to California, and probably should retire, change focus, write some memoirs and books and perhaps teach political science at Berkely.

His performance in the debate failed to generate any enthusiasm on my part, and he and I are products of the 60s and 70s. He and I are about the same age, and I have decided to go quietly into the night and leave the stage to those younger, with brighter eyes, who are not singed with skepticism and cynicism.

CarlyFlorina also failed to generate any enthusiasm for me as well.


Attractive, well spoken, articulate she outshined Jerry Brown on stage and in content. There are some significant issues with her candidacy. Like Governor Schwarzenegger she has no previous governing or political cadence other than her time in the executive office and board of Hewlett Packard.

The following is quoted from Wikipedia.

Carly Fiorina (born Cara Carleton Sneed; September 6, 1954) is an American political candidate and businesswoman. She is the 2010 Republican nominee for the United States Senate representing California. Fiorina served as chief executive officer of Hewlett-Packard from 1999 to 2005 and previously was an executive at AT&T and its equipment and technology spinoff, Lucent. She currently serves on the boards of several organizations.

Fiorina was considered one of the most powerful women in business during her tenure at Lucent and Hewlett-Packard. The spinoff, from HP, of Agilent Technologies – which had been initiated by her predecessor, Lew Platt – was completed shortly after she joined the company in 1999. Under her leadership, in 2002, the company completed a contentious merger with rival computer company Compaq. In 2005, the Hewlett-Packard board forced Fiorina to resign. She attended the UCLA School of Law but dropped out after one semester. Fiorina received a Master of Business Administration (MBA) in marketing from the Robert H. Smith School of Business at the University of Maryland, College Park in 1980. She received a Master of Science in management from the MIT Sloan School of Management under the Sloan Fellows program in 1989. Fiorina worked various secretarial and receptionist positions, including a stint at Hewlett-Packard as a temporary worker through Kelly Services. She later worked as a receptionist at real estate firm Marcus & Millichap (including working briefly as a broker). During her speech at the 2006 ICSC convention in Las Vegas, Fiorina noted that her time at Marcus & Millichap helped her learn how to navigate the business world. Fiorina taught English in Italy; her first husband's career had taken them to that country.[4] She joined AT&T in 1980 as a management trainee and rose to become a senior vice president overseeing the company's hardware and systems division. In 1995, Fiorina led corporate operations for the spinoff from AT&T of Lucent, reporting to Lucent chief executive Henry B. Schacht;[5] she played a key role in planning and implementing the 1996 initial public offering of stock and company launch strategy.[6][7] Later in 1996, Fiorina was appointed president of Lucent's consumer products business, reporting to Rich McGinn, president and chief operating officer.[8] In 1997, she was appointed chairman of Lucent's consumer communications joint venture with Philips consumer communications.[9] Later that year, she was named group president for the global service provider business at Lucent, overseeing marketing and sales for the company's largest customer segment.[10][11]

In 1998, Fortune magazine named her the "most powerful woman in business" in its inaugural listing, and she was included in the Time 100 in 2004 and remained in the Fortune listing throughout her tenure at HP. Fiorina was #10 on the Forbes Magazine's List of The World's 100 Most Powerful Women for 2004.[12][13][14][15][16][17][18] She became regarded by many as being the first woman to head up a Fortune 20 company, and to have overcome the proverbial "glass ceiling".[19][20][21]

In 2008, Fiorina served as an advisor to Republican presidential candidate John McCain. In November 2009, Fiorina announced she would challenge incumbent Democrat Barbara Boxer for her United States Senate seat representing California.[1] On June 8, 2010, Fiorina won the Republican primary election.

After resigning from HP, Fiorina was named to several board memberships. She was named to the boards of directors at Revolution Health Group (Steve Case-AOL) and computer security company Cybertrust. The following year, she became a member of the board of directors for chip maker Taiwan Semiconductor Manufacturing Company.[49][50][51] She joined the board of trustees of the Massachusetts Institute of Technology and the Foundation Board of the World Economic Forum. She is an Honorary Fellow of the London Business School.[52][53][54] [55]

In October 2006, Fiorina released an autobiography, Tough Choices, about her career and her views on such issues as what constitutes a leader, how women can thrive in business, and the role technology will continue to play in reshaping the world. Fiorina signed on with the Fox Business Network to become a business commentator on the network.[58] She is Chairman and CEO of Carla Fiorina Enterprises where, according to her political campaign Facebook page, she is "bringing her unique perspective and experience to bear on the challenging issues of our world, championing economic growth and empowerment for a more prosperous and secure world."[59] She has appeared at many public events. She rang the opening bell of the Wall Street stock market on the official day of the HP-Compaq merger and in 2000 she was the ceremonial host opening the largest EasyInternetcafé at Times Square and the opening of the Epcot ride Mission: SPACE.[60] In 2004, Fiorina was a member of the President's Commission on Implementation of United States Space Exploration Policy, which produced a report for George W. Bush. She has appeared many times on TV such as in 2007 on Real Time with Bill Maher.

In 2008, Fiorina joined as a part of the Senator John McCain presidential campaign. In early 2008, Fiorina was referred to in media sources as a potential vice presidential candidate.

The Los Angeles Times research of public records indicated Fiorina had failed to vote in most elections. Fiorina responded: "I'm a lifelong registered Republican but I haven't always voted, and I will provide no excuse for it. You know, people die for the right to vote. And there are many, many Californians and Americans who exercise that civic duty on a regular basis. I didn't. Shame on me."[99][100]

HP survived much because of her leadership which included axing the employment of 30,000 American workers. Her argument that it was necessary due to governmental regulations in the United States which prevent companies from operating economically on our own soil. This was a cheap shot because there are many factors that drive up costs for businesses in the United States.

Neither candidate will light fires for most voters, but if I had to vote, or lose everything I would have to vote for Jerry Brown….at least it is same old, same old, and he has been there before. Carly Fiorina has enough money to not work, having enjoyed entrepreneurship at it’s best. (however she did not start anything….she walked into several positions at the right time.) She has invested a considerable amount of her personal fortune into her campaign.

An important thing to remember is that the Governor has Veto Power.


And what does this have anything to do with health care? Damned if I know, but then again I am in the back 40 of the pastures.

I am going to take a hard look at lesser candidates and if nothing draws my attention I will write myself in for (other).

Wednesday, September 29, 2010

Do You Know What your Ratings are?

Internet web based rating sites have grown substantially in the past five  years.  At first I thought this would be a short lived phenomenon, however like most things on the internet they have flourished.

I must admit that I now Google for most of my colleagues’ information, because it is so efficient.  Usually the top rated first page results from a Google search brings up ‘Ucompare”, Healthgrades, Wellness,


If you don’t know the name and who John R. Morrow is and what he  does you need a quick brief on what he does and how it may matter to all of us.

John R. Morrow has founded, created and contributed to a variety of national and international ratings programs including; 100 Top Hospitals : Benchmarks for Success℠ a Thomson-Reuters product, The Patient Satisfaction Index™ a National Research Corporation product, The Hospital Value Index™ a Press Ganey & Associates property, and is currently in Beta with Distinguished Doctor™, a new doctor profiling initiative. Morrow was a Principal at HCIA/Solucient, CEO of CHKS (UK) Ltd, SVP at HealthGrades and is Principal at The Ratings Guy LLC.

Matthew Holt published an article by Mr. Morrow in today’s The Health Care Blog.

Understand that all of this rating stuff is here, and it will remain so. It will be better to learn how to deal with it….it is not going away (until the flow of money stops to those web publishers.

Monday, September 27, 2010

Did you Know???

The IRS would apply the withholding to physicians' tax obligations for the year. The remainder would be refunded after doctors file their tax returns the following spring, but in the meantime, the federal government would hold that money, interest-free.

Physician practices face a 3% reduction in payments, as well as potential accounting headaches, under a little-noticed tax provision.

A little-known provision tucked into a 2005 tax bill requires the Internal Revenue Service, starting in 2012 at the earliest, to withhold 3% of payments to any contractor doing work for federal, state or local governments. The Medicaid program is excluded because it provides services based primarily on patient need. But Medicare, which is age-based, is not exempt.

The GAO issued another report in March 2007 finding that approximately 5% of physicians and others who billed for Medicare Part B services continued to receive money from the program, despite having significant outstanding federal payroll and income tax liabilities.

Supporters of the withholding concept say it is a necessary response to widespread failures by contractors both to pay their taxes and to render good service.

Physicians may be able to escape the withholding, even if the provision remains in place by 2012. The MGMA's Smith said defense contractors, not the medical community, appear to be the intended target of the 2005 policy. He remains hopeful that physician practices will be exempted.


Sunday, September 26, 2010

The Complete Meal

Thanks to Dr Wes for this,


“Parents the world over know the magic of McDonald's Happy Meals. There's something about the promise of a Happy Meal - the way it's packaged, the free toy - young families and especially kids find them irresistible. But anyone who's purchased one of these knows the reality: that toys within the Happy Meal are typically played with for no more than three minutes and the plastic tchotchkes are discarded faster than the accompanying 2% milk.

There's a common sense saying: "If it sounds too good to be true, it probably is too good to be true."


A complete meal for $0.99. (It may be small, but it’s what we promised.)


Even if we find that the $19.99 infomercial slicer/dicer doesn't work at home as it did on television, American's love the psychological reassurance that this time the government will make health care available to all without restriction, expense, or consequence, be they boys or girls, legal or illegal, young or old, right-handed or left-handed, with preexisting condition or not, - no one will be left behind in our new omnipotent era of Patient Protection and Affordability.
We should all know better, but the sad fact is, we're all suckers.
Not that some of the promises made wouldn't be useful, helpful, or even critical to many families. But to position health care reform (and the Patient Protection and Affordable Care Act in particular) as a win-win with no hard choices, no limits to health care for our seniors, no future commoditization of medicine, unlimited access to procedures and doctors, and all with no enormous financial cost, is to stick one's head in the sand.
Package it, spin it, wrap it in plastic - then put it next to a cheeseburger.
No matter what you call it, it's still



It has been said the greatest volume of sheer brainpower in one place occurred when Jefferson dined alone..." John Kennedy

When we get piled upon one another in large cities, as in Europe, we shall become as corrupt as Europe.
Thomas Jefferson

The democracy will cease to exist when you take away from those who are willing to work and give to those who would not.
Thomas Jefferson

It is incumbent on every generation to pay its own debts as it goes.   A principle which if acted on would save one-half the wars of the world.

Thomas Jefferson
I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them.
Thomas Jefferson

My reading of history convinces me that most bad government results from too much government.
Thomas Jefferson

No free man shall ever be debarred the use of arms.
Thomas Jefferson

The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government.
Thomas Jefferson

The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.
Thomas Jefferson

To compel a man to subsidize with his taxes the propagation of ideas which he disbelieves and abhors is sinful and tyrannical.
Thomas Jefferson


Seems to me that Thomas had it right.  Now, how can this basic principle of our Republic be applied today?

Friday, September 24, 2010

The Amazing Carelessness Of ObamaCare Grace-Marie Turner Investor's Business Daily, May 11, 2010

I don’t think Grace-Marie would mind if I give her attribution for this article she wrote.

All bets ARE off as to what really is going to transpire with health reform.  Passing this legislation was a sham for the democrats and President Obama, just to  pass something, workable or not.



There are many comments circulating on the social media networks, first the blogs, now Facebook and Twitter. Rumor has it that facebook and twitter are passing google and RSS feeds by, so blogging is now old hat.  (it used to be a challenge to make a blog.) Thanks to all you super-geeks guys like me can pour it on with little effort . 

Many well known bloggers now don’t even write their own stuff, leaving it to ‘interns’ in the blogville.and syndicating many blogs into one place, such as Better Health.


I often wonder if these bloggers see any patients.  They always seem to be right there, posting my news just before I click on “publish”.

The big thing now is should doctors participate in social media? What are the rules? 

Fierce Practice Management analyzes this well

Despite all of the benefits and pitfalls surrounding the use of social media by physicians, formal rules for medical professionals to follow online are still in the making. But even as The American Medical Association Council on Ethical and Judicial Affairs, The American College of Physicians' Center for Ethics and Professionalism and other organizations continue to work on new policies, social media pioneers have identified some general do's and don'ts for practicing physicians

The  American Medical Association weighs in as well.


In summary,  or as a tweet should be, short and sweet.

Social media do's and don'ts

Here are social-media experts' answers to ethical dilemmas physicians face when using Facebook, Twitter or similar sites.

Should I accept Facebook friend requests from patients? Probably not. Keep your personal profile only for friends, family and colleagues. Create a separate business page to share general health information with your patients.

Should I respond to personal medical questions on Facebook or Twitter? No. Refer questions to the patient's physician. If the question comes from your patient, handle it through an office visit, phone consultation or encrypted e-mail exchange.

Should I post any identifying information about my patients? Absolutely not. It is unethical and illegal.

Should I blog or tweet anonymously? Probably not. Anonymity can make it easier for doctors to post content that is disrespectful to patients or that undermines patient trust in the profession.

Thursday, September 23, 2010

Inspector General Reports CMS to who?? or

Failure is an OPTION


A recent report in iHealthbeat from the California Health Care Foundation states that CMS did notcomply with identifying and reporting to the

Healthcare Integrity and Protection Data Bank as required by law, according to a new report from HHS' Office of the Inspector General, "ProPublica Blog" reports (Wang, "ProPublica Blog," 9/22).

Read more:


Since CMS cannot keep up with present reporting requirements, why should anyone believe CMS will be able to comply with  HHS’ demands for meaningful use reporting, or P4P, or outcome statistics. 

The system is set up to FAIL !!


Background on Data Bank

HIPDB aims to help hospitals and other organizations hire health care providers who are in good legal standing with health care regulations, and Medicare and Medicaid program requirements (Clark, HealthLeaders Media, 9/23).

Federal law requires CMS to update the database with information on:

  • Civil monetary penalties levied against health care providers, managed care plans and prescription drug plans;
  • Terminations of participation in Medicare; and
  • Revocations and suspensions of laboratory certifications.

Report Findings

The inspector general report found that CMS disciplined numerous medical entities but failed to report many of those actions to the database.

Some of the actions that CMS failed to report include:

  • 148 sanctions imposed against laboratories in 2007; and
  • 30 sanctions imposed against managed care plans and prescription drug plans between January 2006 and July 31, 2009.

Although CMS banned 45 nursing homes from participating in Medicare between 2004 and 2008, the agency did not report the terminations to the database until fall 2009, according to the inspector general report.

The report also noted that a division of CMS that tracks and reports action against Medicare-certified health care providers did not report any disciplinary actions to the database between 2001 and 2008.

According to the report, CMS did not report the actions because it mistakenly believed that it should report only fraud and abuse cases to the database ("ProPublica Blog," 9/22).


Tony West Health and Human Services Secretary Kathleen Sebelius (C) is joined by HHS Inspector General Daniel Levinson (L) and Assistant Attorney General Tony West to highlight the Obama Administration's work to fight Medicare fraud October 15, 2009 in Washington, DC. The departments of Justice and Health and Human Services have been working together closely to fight medical identity theft and other related crimes with the Health Care Fraud Prevention and Enforcement Action Team (HEAT).

The inspector general report recommends that CMS quickly begin reporting all disciplinary actions to HIPDB.

It also calls for CMS to "educate staff and contractors about the types of adverse actions to be reported and the time frames for reporting" (HealthLeaders Media, 9/23).

CMS Response

In a response to the inspector general's office, CMS acknowledged its reporting gaps.

The agency said it will take steps to scale back manual reporting and strengthen the necessary infrastructure for meeting reporting requirements ("ProPublica Blog," 9/22).

Tuesday, September 21, 2010

Resident Work Hours- More Reform

OSHA (The Occupational Safety and Health Administration) has now entered the fray concerning physician resident work hours

image image

Public Citizen, AMSA, and the  committee of residents and interns have sent a petition to the Secretary of  OSHA. Who signed the petition?

According to Katherine Matos writing on the health care blog,

The petition requests that OSHA exercise the authority granted under §3(8) of the Occupational Safety and Health Act to implement the following federal work-hour standard:

Previous attempts to do this were via the regulatory powers of numerous graduate medical education programs and their ‘guidelines’ from the Accreditation Council of Graduate Medical Education Programs, whose threat was the de-certification of a specialty program or an overall withdrawal of the institutions graduate medical education credentials.

This new and innovative approach reveals the growing influence of student doctors and young doctors at a national level.

Arguments have gone on for decades regarding the near ‘servitude’ in post graduate medical education programs.

Program directors and trained doctors have often used the argument that shortening resident work hours would greatly impact on their ability to follow disease states, and impair patient care by frequent transfer of their care to other residents.

Residents have argued that the long work hours impact on the quality of care, and studies have shown the error rate increased substantially with long work hours and lack of adequate sleep periods.

There have been numerous studies demonstrating the adverse effects of sleep deprivation in resident physicians.

JAMA,   NEJM, A Study performed at the Johns Hopkins University,

Mental Health

  • One study described “house officer stress syndrome.” Caused in large part by sleep-deprivation and excessive work load, physicians-in-training may suffer from (1) episodic cognitive impairment, (2) chronic low-grade anger with outbursts, (3) pervasive cynicism, (4) family discord, (5) depression, (6) suicidal ideation and suicide, and (7) substance abuse.
  • Four studies demonstrated that residents are unhappy, face high levels of stress, and suffer “major problems” in their personal relationships with others.
  • Three studies demonstrated that on-call residents reported greater mood disturbance and increased negative mood than those who were rested.
  • One study found that as many as 30% of residents experience depression during their residencies.
  • A study published in the Archives of Internal Medicine found that 21% of residents reported depressed scores on the Center for Epidemiological Studies-Depression (CES-D) scale and that depressed responses increased with longer work weeks. Two other studies also found increased rates of depression among residents that correlated with high work hours.
  • Pregnancy
    • A NEJM study reported that premature labor and preeclampsia or eclampsia was twice as common among pregnant residents as the wives of male residents and that residents working more than 100 hours per week in the third trimester were twice as much at risk for preterm delivery than those that worked fewer than 100 hours.
    • The pre-term labor and preeclampsia risk was validated by a study published in Obstetrics and Gynecology.
    • One study found that infants born during residency significantly more likely to be born with intrauterine growth restriction.
  • Percutaneous Injuries (such as needlestick injuries)
    • A JAMA study of self-reported percutaneous injuries in residents found that substantially increased risk during day shifts after overnight call as compared with day shifts not preceded by overnight call.
    • “An Annals of Surgery study from 2005 found that 20 to 38% of all procedures in one urban academic teaching hospital involved exposure to HIV, HBV or HCV.”
    • A NEJM study found that 99% of all residents had suffered a needlestick injury by their final year of study. Fatigue was the second most common reason given for the injury.
  • The Response from OSHA thus far:

    ‘A clear shot over the bow of current resident work hours.

    A large part of this article is quoted from The Health Care Blog

    Monday, September 20, 2010

    New venue

    I was busy the past several days working on relocating health train express onto a new ‘track’.  I had some difficulties transporting images from my present location, so health train express will remain on this track while I resolve some ‘geek’ issues.


    President Obama is beginning another round of promoting ‘Obama care”.  Public opinion is overwhelming against the overall scope of reform..  Today’s Wall Street Journal Blog focuses on this,

    “Health Care on the Agenda: Following mid-term elections, the Obama administration this week will once again focus on pushing the overhaul of the health care system, with the president giving a health-care speech on Wednesday, reports the WSJ. Public support has continued to wane, particularly in light of unpopular moves like some insurers saying they must raise premiums well beyond the anticipated 1% to 2%. Some provisions of the law take effect this week, including the one allowing young adults to stay on their parents’ plan until age 26.”

    No doubt he has heard the rumblings from the outcome of primaries this past week.  

    What is interesting in the above commentary is that the insurers were at the table of reform machinations, and now have backtracked on their estimates of the increased cost to them caused by health reform.

    Stay tuned…………..image

    Saturday, September 18, 2010

    Pew Internet Project


    The Pew Internet Project's Susannah Fox discusses the research group's latest healthcare findings at Health 2.0. Europe. The Pew Internet project is a non-profit research organization based in Washington DC that studies the social impact of the internet.



    She elaborates on several patterns of usage for patients with chronic diseases, diabetes, cancer, lung diseases, hypertension and those with acute illness.  Patients with chronic diseases are more likely to see or ask a health professional.  Only 62% of patients with chronic illness seek advice from the internet, while 82% of healthy individuals seek advice from the internet. 93% of those with chronic illness seek their health from health professionals rather than the internet.

    Patients seek knowledge from each other, via blogs and sites such as  ‘People Like Me”, listservs, rather than health education websites.

    The internet is a supplement to health care and has been over-rated as to it’s importance.  Further development is necessary.

    Watch the video .

    Tuesday, September 14, 2010

    Reviewing the Past

    Yesterday I was privileged to witness the growth of our Inland Empire Health Information Organization. After one false start five years ago it now will happen.   Bottom line,  you just follow the money and the open pocketbook of the U.S. Congress (your taxpayer dollars)

    I had been away for almost five years after planting a seed for the development of this important initiative.

    Five years ago when David Brailer MD was head of ONCHIT few knew what was being planned nor what would come to fruition.

    For those who want to look at some of those days click here…..

    I don’t really remember writing some of these blogs , but this one was particularly funny (at least to me)

    After a long hard search I found my original blog post announcing the formation of the Riverside Regional Health Information Technology Group  WHAT WAS I THINKING??? circa February 2005 (over five years ago)!!!

    Sunday, September 12, 2010

    Health Information Exchanges and Electronic Medical Records Part II


    Part I in my previous blog   ………………


    I describe HITECH and APPA and the negative reward system to create incentives for physicians and hospitals to acquire and use electronic medical records.


    Today I am going to describe several critical and key issues which will greatly impact on providers in their daily work.

    Here is the scenario.

    Dr Gofaster is an internal medicine physician who attends patients at two different hospitals, BeHospitalized Medical Center and Don’tbeAdmiited Center for Cardiac Arrest.  He is on call for both E.Ds

    His iPhone do it all sounds an alarm and he receives an SMS from BHMC E.D. Dr Gofaster sees the patient and records his EMR for patient  I.Dont Wantadiehere.  Following admission the next day he sees his patient but is unable to see the ED notes because the outpatient system is entirely different and not connected to the inpatient EMR. (my experience in the federal US Army AHLTA system.)  He experiences some difficulty using the two differing systems in one hospital.


    Dr Gofaster’s iPhone do it all goes off again summoning him to the ED at DBAMC.  He arrives in five minutes, sees the patient and has a problem using the entirely different EMR in the second ED.  After admission he goes to the floor and sees another inpatient. He is again stymied using the inpatient EMR since it is different from BHMC.  He either forgot his password or left it in his wallet in the car.

    Summary,  two different hospitals,  Four different EMRs

    Four different passwords that require changes every 90 days.

    Dr Nowslowingdownmore attempts to enter his password incorrectly three times in a row…the system now tells him he is locked out and he must answer 4 challenge questions, which  he cannot remember nor answer.

      His alternate choice is to dial 1-800-IDONT-SEE-PATIENTS, he is placed on hold after answering four voice mail prompts,  #,@,!,&,&  unless it is on the weekend when he must enter at least 1 number,  one  upper case letter, one lower case letter, and be no less than ten digits long.

    Upon contacting a support specialist (who is in Singapore) he is asked what version is his hospital software.

    Thirty minutes later he is  ready to record his EMR.  As he logs in the log in page announces that the system is down for the next 4 hours for maintenance, with the message. “We are sorry to inconvenience you, doctor.

    Dr Nowslowingdownmore heads to his office and starts his workday in the office.  He enters the first patient room. Patient

    I.Wantagohome is pacing because he needs to leave (he is an attorney)  Dr N. Slowingdownmore attempts to log in his office system, but receives a message

    he must change his password and he cannot use any of his old passwords.  He is locked out while attempting to answer two of his six alternate secret questions and answers.


    Dr N.Slowingdownmore gives it up and pulls out his trusty No.2 yellow pencil and waits ten minutes while Betsy tries to find a progress notes sheet (they are buried under some old floor mops in the storage room).  Dr. Slowingdownmore notes that his pencil has never been sharpened and their are no pencil sharpeners, so he pulls out a scalpel  blade to sharpen it.  In the process he slices the tip of his index finger on his writing hand off.

    Dr. S swears loudly, throws his iPhone against the wall, shattering it as it falls to the floor. 

    His medical assistant  Suzie Icantakeitanymore brings in a certified letter from the medical staff office placing him on probation due to his incomplete hospital  charts.

    Get the picture, all you do-goody HIT folks and Politicos???

    Names have been changed to protect the guilty.

    Saturday, September 11, 2010

    Health Information Exchanges and Electronic Medical Record Negative Reward Incentives



    Health Information Exchanges and Electronic Medical Record Negative Reward Incentives are still controversial. The American Recovery and Reinvestment Act includes a wide variety of mandates, including HITECH to stimulate acquisition of EMR and building a national health information exchange network.

    As a student and consultant of health information exchange development and the federal and state government incentives for ‘rapid’ development’ of medical digital records, I am struck at the lack of organized medicine’s and individual practitioners opinions regarding EMRs.

    Congress has been sold a ‘bill of goods’ much like buying the Brooklyn Bridge for $1.00. (And the price will go up next year if you don’t buy it now). This is very much snake oil medicine, at its worst.

    Let me be clear about one thing.  I am not anti-EMR or anti-HIE development.  The present developmental plans benefits mostly health information technology vendors

    I am not a Luddite, by any means, however from all the information I have been able to gather, there are few if any  studies that document meaningful return on investment.

    This “catalytic innovation”, a term which I coined five years, ago is a disruptive technology.

    Physicians and patients should contact our senators and representatives in Congress and at the state level to change the formula for incentives. The EMR products offered to physician practices and consumer electronic health records,  are not mature enough to invest billions of dollars at the taxpayer’s expense. The timeline is defective in several ways.

    1. Evaluation, study and implementation also require training time.

    2. The HIT industry does not have the manpower and/or resources to accomplish this within the specified time period.

    3. There has been very limited success for practitioners and hospitals to adopt EMR.

    4. The impact of the health reform legislation has yet to be determined on the overall cost of health care. Numerous early studies indicate the cost to the consumer will rise substantially with health reform. Certainly the stated goals are admirable for our society. Early indicators are that the insurance industry will do it’s best to maximize profit during the early years of health reform as a hedge against future legislation requiring expanded coverage of benefits and the mandates from the states to eliminate the ‘uninsured’. States are not in the health care business and previous experience with major risk policies reveals that States depend upon private insurers to manage and indemnify the policies and operate Medicaid and Medicaid HMOs. The same market forces will continue to impact the model and many insurers will refuse to offer these policies or drop contracts with the state.

    5. It will require several more years prior to penalizing those who do not adopt EMR, when the current  products of choice are inadequate, and based upon old models of billing and collections.

    6. Certainly if the stated goal of medical homes as well as non-procedural reimbursement methodology the present plan is not in line with the goals of increasing efficiency, nor collecting meaningful information. Our currently available EMR  systems address neither the purported goal of meaningful data for individual practices, nor promoting best outcomes. The current Gantt chart time line will  stimulate the acquisition of poorly designed clinical information systems.

    7. The term meaningful use (for whom?) is inadequate and is not defined in terms of the differing type of practices, or hospitals.

    more……in my next blog post.


    Sunday, September 5, 2010

    Rising Stars in Health Reform

    Sermo has arisen in the past three years as a powerful media voice for the grass roots of physicians.


    Sermo Named to Fast Company Magazine’s List of World’s Most Innovative Companies

    Largest Physician Community Recognized as ‘Political Force’ Behind Healthcare Reform Efforts

    Cambridge, MA, February 24, 2010 — Sermo (, the world’s largest online community for physicians, today announced it has been named to Fast Company Magazine’s list of the world's most innovative companies. Sermo earned its ranking for providing a free web service – referenced by Fast Company as a ‘facebook for doctors’ - where physicians can collaborate and improve patient care. The company was also cited as a ‘political force’ after 11,500 physician members composed, signed and delivered a petition opposing the American Medical Association's acceptance of the House healthcare reform bill in the summer of 2009.

    To create this year’s list, Fast Company’s editorial team analyzed information on thousands of businesses across the globe to identify creative models and progressive cultures. Sermo was recognized alongside the most respected healthcare innovators in the world, including athenahealth, GE, Cisco, Patientslikeme, and Kaiser Permanente.

    “Since launching in 2006, more than 20% of all US physicians have joined the Sermo community,” said Dr. Daniel Palestrant, CEO & Founder of Sermo. “As the physician community has grown, so too has our client list, which now includes 10 of the top 12 pharmaceutical companies. These companies are engaging physicians through our social media offerings built specifically to increase brand awareness and provide valuable market intelligence not possible through other channels.”

    Unlike other models, Sermo is free of advertising and free to physicians. Revenue is generated as clients purchase products to interact with specialists. To learn more about Sermo’s social media offerings, visit

    The complete Fast Company Most Innovative Companies list and related stories appear in the March 2010 issue of Fast Company magazine, on newsstands currently and online at

    About Sermo
    Sermo is the largest online physician community, where over 112,000 physicians collaborate to improve patient care. Sermo provides access to its community for clients that need fast, actionable insights into treatments, drugs and devices. Learn more at

    Of some interest is the fact that Sermo and the AMA originally were in a partnership which dissolved within the first  year of their agreement.  Sermo’s contention is that the AMA does not truly represent any majority of American Physicians and  has a conflict of interest in holding the copyright for the CPT codes.


    Another embryonic politically active forum is   This organization abruptly sprouted last year during the health reform debates. For more information go to their website. 

    Health 2.0 International

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    Medical Social Networking has gone global, from the U.S. to the U.K. and beyond into specialty societies.

    A quick google search will bring up many social networking sites, some with authentication required, membership requirements,and also open networks.

    Thursday, September 2, 2010

    The Elephant in the Boa Constrictor


    Richard Reece M.D. who writes Medinnovation Blog aptly analogized HIT  and the Government. 

    The Elephant in the Room

    Before resigning in frustration as the first “HIT Czar,” David Brailer observed in a 2005 in a New Times Times interview , “The elephant in the living room is what we’re trying to do is the small physician practice. That’s the hardest part, and it will bring this effort to its knees if we fail.”

    The Blind Men and The Elephant

    The second metaphor is the Blind Men and the Elephant. Our health care system is an elephant. Everyone feels the elephant’s parts differently. Doctors hanging on to the tail feel the system is an encircling rope, purchasers touching the leg feel it is an immovable tree, plans holding the trunk feel it is a squirming snake, and government officials riding on the head feel it as a global positioning satellite devices, capable of controlling the direction of the elephant.


    As Dr Reece so eloquently espouses:

    “What concerns me is what will come out the distal end of the boa constrictor once the digestive process ends.”

    Certification Central

    The ONC has announced the approval of both CCHIT and the Drummond Group as agents for certifying interoperability and other standards for EMR.  Both groups fulfilled the requirement of the ONC and the NIST.


    This ruling should bring much relief to CCHIT and those vendors who have participated willingly and volunteered to develop and test the standards. CCHIT has been in operation since 2006.


    Some were critical and concerned that CCHIT represented mainly vendors, while the Drummond Group would be more unbiased. Competition is always a good thing, and should enhance affordability for those vendors seeking certification for EMRs.

    This is another ‘elephant for the boa constrictor to swallow.


    boa constrictor