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Sunday, February 27, 2011

Doctor, Do I Need This CT Scan ?


In a rather frightening statistic, it has been stated that anywhere from  1 in 250  to 1 in 80  patients who undergo  CT scans will develop cancer.  These  are numbers extracted from studies in the U.K and U.S.A. 

However these global statistics are almost meaningless for an individual patient, and exemplifies the idea that statistics can be manipulated easily to make a point or gain advantage.

For instance Spiral CT scans have resulted in early detection of lung cancer and a 20% reduction in death from lung cancer.

Certain CT scans can increase the radiation dose by a factor of 3X or more.

Having a CT - or CAT - scan puts patients at far greater risk of developing cancer than previously thought, scientists claim.

The radiation generated by the scans - an increasingly popular diagnostic tool - may trigger the disease in as many as one in 80 patients.

This is far higher than the often used figure of one in 1,000 - with women at particular risk as they are more sensitive to the effects of radiation.

Researchers now believe the dose of radiation delivered by a CT scan can vary wildly according to where on the body it is used.

In some cases, they suggest, a single scan can be the equivalent of 442 chest X-rays.

Unlike an MRI scan - which uses magnetic fields and radio waves and has no known harmful effects - a CT scan generates ionising radiation so each dose causes a slight increase in the lifetime risk of cancer.

The scans allow doctors to build detailed 3D images of internal organs, blood vessels, bones or tumours.

They were already known to carry a greater risk than ordinary X-rays, such as those used for breast screening, but the latest research suggests a bigger problem.

It found the dose of radiation received was larger than thought, although this varied according to the part of the body being scanned and the age and sex of the patient.

The researchers concluded there was an average 13-fold variation between the highest and lowest doses experienced by patients, says a report in the journal Archives Of Internal Medicine.

University of California Professor Rebecca Smith-Bindman, who led the study, said: 'The risk associated with obtaining a CT is routinely quoted as around one in 1,000 patients who undergo CT will get cancer.

'In our study, the risk of getting cancer in certain groups of patients for certain kinds of scans was as high as one in 80.'

1  = 442 

The typical dose delivered by a single CT scan was the equivalent of 74 mammograms or 442 chest X-rays, the professor said.

Researchers reviewed 1,119 patients in San Francisco who had been scanned in three body areas - the head and neck, the chest, and the abdomen and pelvis.

The scientists then worked out the radiation dosage of each scan and estimated the associated lifetime risk of cancer.

A heart examination might involve three scans, looking at different phases of the pumping cycle.

Prof Smith-Bindman said: 'This increases the information that we can get from the CT procedure, but increases the radiation dose by a factor of three.'

They were already known to carry a greater risk than ordinary X-rays, such as those used for breast screening, but the latest research suggests a bigger problem.

It found the dose of radiation received was larger than thought, although this varied according to the part of the body being scanned and the age and sex of the patient.

The researchers concluded there was an average 13-fold variation between the highest and lowest doses experienced by patients, says a report in the journal Archives Of Internal Medicine.

The scientists then worked out the radiation dosage of each scan and estimated the associated lifetime risk of cancer.

She said doctors need to reduce unnecessary use of scans.

Saturday, February 26, 2011

Mike Leavitt: Health reform’s central flaw

Mike Levitt, the former Head of HHS reflects accurately what Congress has allowed in Obamacare.  Among other observations he notes the following in his commentary in the Salt Lake Tribune.

It puts more power than is prudent in the hands of one person, and it is not an answer to our national health-care crisis.

Set Up to Fail…..Just say no,  Katherine.

The health care law has teeth!

Mr. President, I am performing a “tooth level surveillance’ as instructed in Obama-care.  I am sorry to report you are in violation of dental dictates.

Shortly after being appointed to the Cabinet in 2003, I sought the advice of  one of my predecessors. He cautioned me to be prudent in exercising the considerable regulatory power Congress had granted these offices, noting: “The place has more power than a good person needs or a bad person ought to have.” 

It puts more power than is prudent in the hands of one person, and it is not an answer to our national health-care crisis.

Examples of that astounding power include tooth-level surveillance. That’s in Section 4102 of the health reform law says, “The secretary shall develop oral healthcare components that shall include tooth-level surveillance.” It defines tooth-level surveillance as a clinical examination in which an examiner looks at each dental surface on each tooth in the mouth.

This determination is better done by a dentist.

There’s more: The health-reform law dictates that the secretary shall determine how drugs are dispensed at long-term care facilities, shall identify categories and classes of drugs that are of clinical concern and shall be permitted to use comparative-effectiveness research to determine coverage and reimbursements. The 2,700-page law has nearly 2,000 of these “the secretary shall” statements.

If I may, as a former HHS secretary, offer a suggestion to the current secretary, it would be this: Use these expanded discretionary powers to grant states and the private sector more flexibility and more autonomy. Competition, innovation and new models of providing care and expanding coverage are the only ways we will reverse the dangerous course of future health spending. That simply cannot be done from Washington.

Please read the article… will confirm what we all say.

Perhaps Mike Leavitt should return to HHS…

Friday, February 25, 2011

Foreign Perspective on US Health Economics

I write for a financial newsletter on  Mergers and Acquisitions.   The M&A market during the first two months of 2011 has been sizzling. And the world markets have been watching the U.S. closely. Goldman Sachs, fueled by   bail-out bucks has fueled predatory acquisitions by huge IT internet social media concerns of startups and sizeable going concerns.

Mr. Eric Paternoster

Foreign analysts,SVP Eric Paternoster gave a presentation at the 2010  Infosys Analyst meeting……about the Healthcare Economy in the United States.In health care, hospitals are merging to form large health systems. This movement is occurring  because of realistic fear  of governmental mandates to form ACOs and the necessary capitalization of digital transformation, new administrative requirements for reimbursement, and operational considerations about outcomes, quality improvement and fear of rampant destructive competition. Regulators are hot at work determining which mergers will cross the line of FTC regs. It’s a great time for lawyers.

The reality of the finances are that even if American Medicine is not nationalized, by defacto, large monopolistic organizations are blooming.


Physicians need to keep up with these seemingly non health related issues, because it will effect both small and large practices, alike. At the end of a given day, tired, exhausted, financially depleted, overwhelmed, discouraged and depressed physicians may just roll over and go with the flow. In the stream of daily activities of  physicians, malpractice worry's, CME requirements, credentialing requirements patient care, Medicare worries, declining reimbursement, and the overall intrusion of insurance companies, demands for better outcomes, and general interference in their responsibilities for patient health and lives, who would not roll over, or change careers.

The malaise has trickled down to medical students, just beginning what used to be a privilege of authority granted only to those with ultimate responsibility for patient welfare. Today we are faced with demagogues in health care, the Sebelius’, the Berwick’s, the health care foundations, and all those wannabees who are sabotaging health care with politically correct statements. They come, they go at the end of the day we are left with the remains.

Thursday, February 24, 2011

Wednesday, February 23, 2011

Over the Horizon

The very recent success of IBMs Watson Computer signals not only the beginning of advances in computer intelligence but the announcement that IBM is about to  embark on disciplines such as healthcare. The one million dollar prize, which Watson earned playing Jeopardy for IBM, is being donated by IBM to a charity.  Watson beat two of the show’s most successful and celebrated contestants – Ken Jennings and Brad Rutter – to win a $1 million grand prize that IBM donated to charity.However, the Watson experiment indicates how truly important artificial intelligence and natural language processing can be for all kinds of business uses, including health care, law, call centers and a lot more.

IBM created Watson as part of the company’s effort to help business make sense of the explosion of data. Watson can analyze the meaning and context of human language and rapidly process information to find more precise answers to questions posed in natural language. IBM maintains that this holds enormous potential to transform how computers help people accomplish tasks in business, communities and their personal lives.

For you  techno-geeks the hardware looked like this:

10 racks (about 90) of IBM Power 750 servers with 2880 Power7 cores capable of running at 80 teraflops, 500 GB per second on-chip bandwidth, a 10 GB Ethernet network, 15 terabytes of memory and 20 TBs of clustered disk storage. Watson evaluated the equivalent of 200 million pages of content – or about 1 million books’ worth – written in natural human

The research and technology initiative will combine IBM’s Deep Question Answering (QA), Natural Language Processing, and Machine Learning capabilities with Nuance's speech recognition and Clinical Language Understanding (CLU) solutions for the diagnosis and treatment of patients that provide hospitals, physicians and payers access to critical and timely information. The two companies expect the first commercial offerings from the collaboration to be available in 18 to 24 months. IBM and Nuance will jointly invest in a multi-year research initiative targeted to the applications of the Watson technology to assist in the diagnosis and treatment of patients in combination with Nuance’s voice and clinical language solutions. In addition, IBM has licensed access to the Watson technology to Nuance. IBM and Nuance are currently engaged in a five-year joint-research initiative designed to advance next-generation natural language speech technologies, the results of which will be commercialized by Nuance.

Much of this work has already been accomplished on many smartphone applications. Nuance and IBM will continue its longtime collaboration with speech-recognition software developer Nuance Communications to bring the analytics capabilities of supercomputer Watson into the health care field. Nuance will feed its CLU (Clinical Language Understanding) applications into IBM's Watson hardware.

Jonathan Yarmis, an independent industry analyst known as Doctor Disruptive for his focus on disruptive technologies, likens IBM’s Jeopardy success with Watson to President John F. Kennedy’s pledge of putting a man on the moon.

Moreover, Yarmis said, “The health care announcement with Nuance is just Step 1. Given Moore’s law, in five to seven years this [Watson-like capabilities] is something your standard desktop computer will do. And two years after that it’ll be on your tablet and on your cell phones the following year. This statement is highly ambitious and goes where no man has gone before…predictions such as this have been laid fallow in the past.

However, without dreams there is no progress. Who would have predicted a handheld phone would have more computing power than early desktop PCs?

My bet is that it will all fit in a watch or a ring on your little finger .

Tuesday, February 15, 2011

Teamwork and the EMR potential


Numerous experts discuss the importance of teamwork to an enterprise for efficiency and safety. In healthcare this concept is a relatively new one in the clinical setting. EMR has many potentials and/or shortcomings in this regard and it will depend upon design and user interface optimization to reach it’s maximum potential.

Bob Wachter presents a scenario and back ground for discussing safety culture in medicine, such as the built in hold for surgeons to verbally perform checklists with other staff, such as sideness of surgery, type of surgery, and other important data with the support staff.  These are all designed to minimize or eliminate ‘never events’ like wound infections, wrong side surgery, wrong organ removal, and administration of medications to which  the patient is allergic.

These safety features can be designed into the record with visual graphics, such as an image of the body with a circle or X through the body part to be operated upon. Visual images are processed more readily than printed words, which are often lost in a jumble of letters, even if bold-faced our distinguished by a red color.

Team work can be enhanced by Vector Diagrams or simple block diagrams with participants and specialist each integrated into the overall flow sheet, rather than a list of consultants or tests. Transformation of events and participants should be automatically transferred to such diagrams without human input.

There are many readily appications which perform these actions in other industries and software applications available on the internet, to wit: 

Visual thesaurus: (type in a word)  This application builds a    word map, much as your brain does for many tasks.)  The display is intuitive giving instant meaning to relationships.  This usage of the application could easily be adapted to professional resources and the team for each patient in a hospital setting. For very ill patients with multiple system issues this can be very complicated. The Virtual Consult Manager ferrets out key relationships easily seen by all participants in the team. Each segment can display as much or as little of the information in that segment. The circles can be clickable and take one straight to the relevant data for each team member.

The Map can be structured in a hierarchal, chronologic, spider, cluster or other organizational aids.

There are SDK for development of the map for other industries that interface with languages inherent in EMR, such as XML, CSS,

A few examples:




Now imagine these images as dynamic and fluid with changes in relationships. The user would be able to ‘pull out’ each button to see further breakdowns in organization, plans, and treatments. 

You can trial this at Visual Thesaurus

Who is Reading Your Medical Records?

Privacy and Confidentiality issues are now out the physician’s domain and responsibilty.

Not surprisingly FierceHealth IT reports  that security breaches of personal health information is widespread.

Although paper charts were cumbersome, they were locked up at one location, not floating around in cyberspace.  I am sure these charts were read by others not authorized to do so, however it was near impossible to document this occurrence.

Today we have IT whereby access to medical records can be tracked and the burden for keeping it safe largely now lies with non-medical personel.   Pandora’s box was opened, with the use of EMRs,HIEs and HIPAA has lost the keys.

The situation will only worsen with implemention of health information exchanges.

FierceHealth IT reports

Hackers and other malefactors steal a surprising amount of personal health information by breaching computer security. Between August 2009 and December 2010, the electronic health records of more than 6 million individuals were compromised, and 61 percent of those security breaches were the result of malicious intent, according to Redspin, a leading provider of HIPAA risk analysis and IT security assessment services.

The Redspin report focuses only on breaches involving more than 500 people, which must be reported to the Department of Health and Human Services. This report is limited to breaches involving more than 500 people as required by HIPAA regulations.

The breakdown of events:

Business associates accounted for 40 percent of all the records breached. But that percentage, too, might be larger than reported. Although business associates are required to report breach incidents to healthcare providers within 60 days of their occurrence, it's not hard to imagine situations in which they fail to do so.

The report found that the security breaches occurred in 43 states, Washington, D.C., and Puerto Rico. Each breach affected 27,000 people on average, and breaches involving laptops and other mobile devices impacted on an average of 66,000 people. The latter accounted for 44 percent of all incidents and 65 percent of all records breached, suggesting that the theft or loss of mobile devices is as major a reason for breaches as hacking.

The cost of these breaches to the HIT systems goes far beyond the hardware and software systems put in place to secure the records as seen in this typical scenario which FierceHealth documents.:

Enforcement of breaches is a nightmare to all concerned in regard to notifications. All suspected people whose records were breached must be notified by HHS, after the breach has been reported, One breach must be assumed to involve all records compromised.  So the problem is multiplied enormously with the requsite expense of notifications. The enforcement burden on HHS and/or Justice, obviously strains the system and probably has not  been accounted for in the cost of  health care. 

Even unintentional breaches can be triggered by an innocent clerk entering the incorrect data field on a mailing list.

We learned last week that a contractor to the University of Texas Medical Branch in Galveston waited more than a month to inform the health system that an employee now in jail on charges of identity theft had access to records of more than 1,200 patients. And the California Department of Health Care Services sent out 50,000 letters with the recipients' Social Security numbers printed on the mailing labels.

HIPAA  has been modified to have a “threshold factor” and organizations are not required to notify HIPAA if no harm has been done. That proposition involves proving a negative, a conundrum and catch 22 if there ever was one.

One CEO expert offered that putting the key on the gateway should also have ‘shredding” of the records by simple effective encryption techniques. That would seem obvious to anyone.

According to Fierce Health the CIOs of every health organization from hospitals, to nursing homes are on alert ! There are dangers here when a politically motivated attorney general may decide to go after a hospital to enhance his reputation.

Read more:

Security officers have new motivation to protect healthcare data – FierceHealthIT

Sunday, February 13, 2011

Telecommute Week February 14-18


This week ask your patients to stay home and tele-complain and have tele-treatment.  How about tele-reimbursement and/or tele-admissions, and don’t forget tele-surgery all you tele-docs.

I found this article on Gigaom.

Did you know that next week, February 14 through 18, is Telework Week? Companies and individuals are challenged to telecommute 1 or more days next week as a way to increase productivity, save money, reduce environmental impact and help employees achieve a better balance between work and life. I’ve gathered a few data points to help you convince your manager to embrace telecommuting, whether that’s during Telework Week or any other time of the year.

In general, the people who telecommute tend to be well educated with a college degree, in a higher income bracket and around 40 years old according to WorldatWork. The report went on to say that the number of telecommuters continues to increase, due to improved home Internet connectivity, increased fuel and commuting cost, and companies embracing improved work-life balance initiatives.

According to the Telework Research Network, if the 41 million Americans who hold jobs that could be done from home chose to do so for at least one day next week, the savings would be $772 million dollars in total, including:

  • Commuter cost savings of $494 million
  • A savings of 2.3 million barrels of oil totaling $185 million
  • Traffic accidents reduced by 775, for a savings of $93 million

Companies can save over $6,500 per employee if that employee telecommutes just one day a week. Citrix Online is saving $2 million dollars in physical space costs by reducing seats in its office by allowing employees to work remotely.

Access Economics estimates that if Australia had a 10 percent increase in the number of people who telecommute for 50 percent of their worktime, the country would gain over $1.4 billion AUD per year ($1.4 billion) with reduced time and costs for travel, lowered office expenses, better employee retention, infrastructure savings, less fuel used and more.

Even the United States government is embracing telecommuting. Employees in the General Services Administration (GSA) are joining up with government agencies, companies and other organizations to pledge to telecommute at least one day next week. According to the GSA, about 50 percent of employees telecommute at least once a week already, which “leads to real estate cost savings and increased productivity, and helps reduce the agency’s environmental impact.” Telework Research Network claims that the Telework Enhancement Act of 2010 could result in a $15 billion a year savings for United States taxpayers with agencies saving $850 million in real estate costs and $2.3 billion in absenteeism every year while employees save up to $2700 in transportation and other work expenses and have fewer illnesses.

Whether you work for a small business, a multi-national corporation or a governmental agency, the benefits associated with telecommuting are similar: better balance and quality of life, reduced cost savings for both the employee and employer and a smaller environment footprint.

What are you going to do for Telework Week?  I am tele-sleeping..

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Sunday Morning (very early)


Similar to what we read daily in regarding to health care I found this tidbit regarding another unintelligible, inexplicable and mysterious document dated back to the 15th century,  long before Medicare, HMOs, and ACOs

We are not unique !!  Someone from a far distant and unknown galaxy comes this story !!

Mysterious Ancient Document  Reveals – Nothing !

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Thursday, February 10, 2011

Don Berwick vs Congress


Don Berwick MD must have been on call last night.  His testimony at the  Senate Ways and Means Committee was a good thing for those wanting to repeal the Health Reform Law.

When faced with specific questions regarding the costs of reform, and it’s impact upon availabilty of care providers he failed to deliver answers, stating that was not his area of expertise.  It’s obvious Dr. Berwick never ran his own medical practice.  He seemed more bent on the propaganda and rhetoric of the Obama administration, Nancy Pelosi and Harry Reid..

It unfortunately does confirm that some doctors know bupkas about finances. and not just those in private practice.


He even went so far as to tell the committee that they would like the system once it was in place for several years.  Most of the changes will not occur in 2011 and only begin to create an impact in 2013.  I agree with some of the utopian ideals that Dr Berwick espouses, however it is obvious that neither side has drilled down on the impact of true costs to patients, employers, or care providers  The bureaucracy will be stultify everyone concerned.

Even Berwick states that early predictions are way off. 

The healthcare reform law, beating the Medicare actuary's predictions, has so far strengthened the privately-run Medicare Advantage program, Medicare chief Don Berwick testified on Thursday. Enrollment is up six percent while premiums are down six percent, Berwick told the House Ways and Means Committee.
The Centers for Medicare and Medicaid Services actuary had predicted that Medicare Advantage enrollment would drop 7.4 million over the next few years - starting this year - and that premiums would rise. Berwick said the initial results show that the prediction was incorrect. "I have the facts on the ground before me now," Berwick said. "The facts are that Medicare Advantage is looking stronger and stronger."

Can it keep up?: Berwick said he doesn’t know how long Medicare Advantage plans will continue to grow. “It looks like the industry thinks there’s a good future for Medicare Advantage,” he said, adding that he hopes it will keep expanding or at least stabilize.

So how can anyone predict where this will be in 2020 ?

High-risk enrollment low: If Medicare Advantage was the good news for the Department of Health and Human Services on Thursday, then high-risk insurance pool enrollment was the bad. Enrollment over the past three months is up 50 percent to 12,000 - well short of the 375,000 originally predicted by the end of 2010. HHS said the low enrollment is consisent with the experience of the Children's Health Insurance Program, and they unveiled new tools on Thursday to help boost the high-risk program's visibility.

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Dr Price Tears into Don Berwick (CMS)

A live web video from the hearing on Health Reform Repeal Legislation.

Web Video Live



Rep.  Tim Price M.D.

You listen, you decide,  but a must view for everyone.

Google Health What’s Wrong With It

Google AccountsSee all those ‘blue letters’  they don’t print.

In the hope that someday it might save me or my family some time (or maybe my life)  I have been entering medical data into GH the past year or so.

Yesterday my wife has a doctor appointment and I went to and logged in. I reviewed the data.  It was easy to read online.  I decided to print it and take it with us to the appointment.

As usual when going to the doctor one is rushed, so I clicked on the pdf tab and print and walked off.  As I was running out the door and driving to the doctor I glanced at the print out. Much of it was blank, and'/or unreadable.

Now you may ask why. Why? Because Google was intent on making a ‘pretty display’ of basically boring data.  So a great deal of it was in color, blue to be exact, which does not print at all on B&W printers (which many people have if they use a laser printer, or more likely a deskjet of MFP which has an empty color cartridge (which mine did ).  I will bet you a buckwheat that most people have an empty color cartridge (because they are too expensive, and not really needed 95% of the time.

So Google if you are listening and not busy searching, please fix your Health web site so it is not useless for many people.

Wednesday, February 9, 2011

Rocket Science 101

That old saying you don’t have to be a rocket scientist is just not true when it comes to your EMR and the ‘certification stamp’ on it.

You show me yours, and I’ll show you mine.

Each year, just scrape off the old label, and apply the new one…..there will be a new national committee with new rules…..

The ‘stamp’ must be approved by a collection of agencies and committees in a pyramidal structure which is constantly shifting every several years or so, and makes the Bernie Madoff or Enron scandal look benign.

Here is how it begins 

ONC Accepting Applications for Certification Bodies' Accreditor

The Office of the National Coordinator for Health IT has opened a 30-day window to accept applications for organizations seeking to be the approved accreditor of certification bodies under the permanent health IT certification program, according to a Federal Register notice published Tuesday, Modern Healthcare reports.

Health care providers seeking to meet meaningful use requirements can use electronic health record systems approved by ONC's authorized testing and certification bodies. Under the 2009 economic stimulus package, health care providers who demonstrate meaningful of certified EHRs can qualify for Medicaid and Medicare incentive payments (Conn, Modern Healthcare, 2/8).

Read more:

Now listen up !!

Distinction Between Temporary, Permanent Certification Programs

ONC issued the final rule on the temporary testing and certification program in June 2010 (iHealthBeat, 7/2/10).

Under the temporary program, vendors can receive certification for products designed to help health care providers meet Stage 1 requirements of the meaningful use program (iHealthBeat, 9/7/10). ONC has selected six ATCBs for this purpose (Mosquera, Government Health IT, 2/8).

In January, ONC issued a final rule to establish a permanent health IT certification program for EHR systems and modules. The permanent program separates the testing and certifying of health IT products.

The final rule stipulates that ONC will choose one organization -- the ONC-approved accreditor -- to accredit groups aiming to become a health IT certification body (iHealthBeat, 1/4).

After an entity is accredited by the ONC-AA, it can apply to become an ONC-authorized certification body (Goedert, Health Data Management, 2/8).

Are you still with me?

Application Details

Applicants looking to become the ONC-AA must provide details that include:

  • How they would track the conduct of ONC-ACBs;
  • How they would adhere to the standards that specify general requirements for entities that approve organizations such as the ONC-ACBs;
  • Their experience in evaluating how certification bodies conform with general requirements for product-certifying bodies (Government Health IT, 2/8); and
  • Procedures for responding to and investigating complaints against the ONC-ACBs.

The selected ONC-AA will serve in that role for three years and can be re-selected after a competitive process (Health Data Management, 2/8).

Read more:

Let me slow down a bit for this next one. Raise your hand if I need to repeat any of this.

Certification Programs




I hope to be publishing my blog more regularly. The past week I had a major malfunction of my computer.  Always the one to make things better by adding dual monitors (for more screen real estate) I managed to corrupt several drivers, then my hard drive. (at least I had a good backup). After recovering the system (and having one full day of Window Updates (150 or thereabouts) I am considering upgrading to Windows 7.   It can’t be any worse than what I went through this past weekend. My blogging platform has been Windows Live Writer. It’s much  faster than posting on the blogger platform, and the bonus was getting all the new plug-ins. 

So stay tuned for more blogs from The Health Train Express

Monday, February 7, 2011

Holy Cupcakes Batman

“Holy cupcakes Batman”, said Robin the boy wonder. Holy cupcakes is what ran through my mind as I sat through the Superbowl yesterday. It was so bad I couldn't eat my pizza or popcorn (my contribution to the food pyramid)

My biased opinion is not the product of Left Coast thinking since a good friend of mine from the Right Coast who actually lives in the Southeast USA came to a similar conclusion. So all you pickup gun-toting Dixie-landers, listen up. The names and location of my friends will not be disclosed so they are protected from the gun-toting pickup truck types who like to shoot deer with their kids as a right of passage.

Football is not an example of preventive medicine, health or wellness. The only positive things I see are the conditioning of the gladiators in preparation for a season and the “big game'. And I am not certain about that, given the history of anabolic compounds used to produce muscle mass while further diminishing the intellectual capacities of the participants.

Some readers may wish to click away from my blog since some of it will repel the 'next' generation' and football addicts.

Waiver notice: This post will be offensive to some readers with it's non-obscene, anti-pop culture, and politically incorrect opinions, and unspoken thoughts of most watchers (non-scientific, highly biased opinion poll with limited cohort) (my family of five).

A great deal of my post is taken from my documentation and observation of one personal anecdotal story about my son-in-law who won a superbowl ring in 1986. (that makes me an expert.)

First of all, if you like two hours of weekly pain and concussions, it is not a bad life. You are overpaid, the weekly schedule is cool. Work one day a week, train for five and home most of the time except for a weekly trip occassionally to a distant playing field, all paid by your employer...great health insurance and disability coverage. Free access to pain medications, personal trainer, PR person, endorsements, sometimes a free car by your local car dealer for the season and home games.You live in the nicest home in a gated guarded community, your kids wear the best clothes,they have every new most wanted toys, you are well known in town, so you have to go to a place where hopefully no one will recognize you during your extra-curricular activities (maybe a foreign country or carribean island. You have a wide variety of hoodies, and sun glasses which you wear once and throw away. You can always tell your wife, "honey not tonight I have a broken collar bone (nose, ankle, back, or whatever, or all of the aforementioned." Save your strength for those away game “groupies” Wifey gets the house, fur, fashion coutre, BMW or the Escalade (maybe politically correct hybrid car, or most likely all of the aforementioned. If you get really injured you may sit out a whole year of work on the injured list and then be traded to a competitor. (it's always nice to get a new home and a new community to try out.)

I also wonder if human resources of the NFL uses multicultural hiring practices, hiring Asian, Hispanic, African American players (that does not seem to be a problem as to the latter. It's a great exit strategy for escaping from the ghetto. (sorry for the bad taste here) The only people that can use the N word are Ns. Whatever has happened to us Honkies? “N's and “MAs (Mexican-Americans) as well as 'SE' (slant eyes) should use the 'H' phrase too.

It was so bad yesterday that I had to resort to Keith Olbermann's tweets. Keith has been traded to the Tweet network. (but he can work from home now). Actually I laughed harder there than I have ever since my three boys came back to live at home, out of work. The economy is so bad wifey and I had peanut butter and jelly sandwiches watching our old fashioned non digital, non-HD 36 incher with a TV tube, (wifey and I wear binoculars so that we can see the individual players faces and the confetti at the end of the game), whilst my spawn were in their bedroom watching the Superbowl on a 52” HD TV (also recorded on a DVR). “Holy cupcakes” once again.

Did I mention my middle child bought a car for 'cash' from his savings (he deserves it since he is totally disabled with cystic fibrosis) and he bought it with the lump sump SS benefit which SSA held up for three years, only relenting when we took them to court......the judge slapped SSA in the face, saying only an idiot would not see he is disabled. (spends 5 hours a day doing respiratory treatments and taking 5,000 dollars/month of medications. (you lucky taxpayers are paying for his health care which is probably a lot better than yours or mine). I personally don't begrudge that one ounce. I would not want to live his life. If he has one good day a week we are thankful (maybe he could join the NFL), and get even better care, and not be on the taxpayer's dime. Thank you Uncle Sam for my boy's life. First thing he said when he took the keys and we drove off was, “I can find a job now and work part time, even if its one day a week.”

The trip to the car dealer was our “Pre-Game” show. (it really was a show since my eldest son-in-law harassed the salesman, 'jewing him down' ( I can say that since I am a “J”). Phil almost 'queered' the deal. You guys better not use that phrase or I will take you to federal court.

However, I digress, and back to the sport's section. Tomorrow is another day and I have to face medicare, outcome studies, meaningful use, a deadline to get my EMR or forfeit whatever from medicare. Cheez Batman, Holy cupcakes.

This is a fictitous post that someone else must have posted, since my computer was frazzled by microsoft's latest update.

I hope your team won !

Friday, February 4, 2011

The Medical Conspiracy ?

Paul Levy 1

Paul Levy, formerly the CEO of a large hospital writes in today’s The Health Care Blog’ about conspiracy theories  Here are some excerpts for clarity on my comments which are also posted at the original blog post.

He mentions excerpts from a writing of George Bernard Shaw, and I am not entirely certain which part of his post is the quote or if the entire article is from Shaw’s “The Doctor’s Dilemma, Preface on Doctors”    

George Bernard Shaw (1986-1950), Nobel Prize for Literature (1925-refused),  but accepted it at his wife's behest.  He is the only person to have been awarded both a Nobel Prize for Literature (1925) and an Oscar (1938),

Quotes, to follow

“The truth is, there would never be any public agreement among doctors if they did not agree to agree on the main point of the doctor being always in the right

But for this very reason no doctor dare accuse another of malpractice

That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice.

But the effect of this state of things is to make the medical profession a conspiracy to hide its own shortcomings.

Public ignorance of the laws of evidence and of statistics can hardly be exaggerated.

If I attribute these comments to the wrong person, I  apologize.

It seems to me GBS was wrong about many things.


Thursday, February 3, 2011

Information Explosion


Health is not the only space being driven by information. It has received the lion’s share of exposure, however we should not forget the rest of the spaces, government, military, financial, industry, and technology. The amount of recorded data multiplies almost exponentially for each industry, much like a nuclear fission reaction., and there is significant fallout.

Our ability to understand and incorporate into a useful knowledge base overwhelms our capacity to understand the information to frame it into useful form.

The federal government IT efforts, and others have and are continuing to build software to extract and display this deta into images understandable at first glance. Without this the data is useless.

The same limitations apply to medicine, and medical research.  Who has not read a journal article that quotes ad nauseum statistics which only a statistician can interpret?  How many of us skip to the conclusions to ferret out what the article is all about?  That’s me!!

The web site is a not so secret open source for information ranging from The Open Government Initiative to an almost infinite number of data sets, including open data sets from all the major US Government Departments

The best way to find out what is in there is to explore the  site.  It is pretty amazing !

Health Train Express’ Best for Today



The California Health Foundation sends a daily eletter ( iHealthBeat)about  topics of interest to medical professionals


There are a number of remarkable items in today’s publication.

Wednesday, February 2, 2011

February 3, 2011 8AM Express News


We are going to be reporting on developments on HIT progress that are important news.  Our sources reveal that HIT in healthcare is making progress. There are differing opinions on the rate of growth depending on which side of the argument you lie.  Most physicians are still skeptical that the huge investment will pay the dividend claimed by vendors, CMS, insurers and the pundits, while some who have adopted EMR in their practices say they would never go back. Well, I think not if I had invested between 50 K and 100K  USD and managed to persist through the adoption process successfully, or not I would be happy unless the EMR was a ‘pig in a poke’,  reduced my income, and consumed more of my time being a  data entry clerk.

EMRs are only going to make it easier for those who read our reports, clerks, utilization reviewers, and audits. 

80 % of Internet Users Seek Health Care Information Online

Judge's Health Reform Law Ruling Could Affect Several IT Provisions

Stakeholders React to GOP Bill That Could Cut Meaningful Use Funding

Judge Voids Health Reform Law on Basis of Individual Mandate

Study Suggests Some Health Providers Lag in New Coding Transition

Job Growth in California's Health Care Sector Slowing to a Crawl Amid Ongoing Recession

Report Finds Doctors and Public Agree on Many Health IT priorities

VA seeking advice to Upgrade Health IT to Open Source Software to Upgrade Legacy Systems

States Line Up for Grants from ONC’s Health Information Exchange Challenge Program

Health IT Tools Do Not Improve Care Quality, According to Study

Publisher of Wall Street Journal Sues for Access to Medicare Data


Obama Cites Importance of Health IT in State of the Union Address

Disruptive Women in Health Care  Health Care Roundup features Hope Ditto and the state of the world…disruption seems to be the key word for 2011 thus far. Health care is not alone. It is a good read!

Tuesday, February 1, 2011

Are We There Yet?



Are you waiting for Health Train Express on the train platform? Have a seat and call  911.

If you are at all wondering if your doctor will be there next time  you call,  you are operating in reality. In a recent survey sponsored by a well known EMR vendor the results are stunning.  Practice Fusion’s independent consultants found the following:

Key findings:
* 41 percent of doctors report that their practice is doing worse this year compared to last year. Compared to 26 percent who report their practice doing better and 31 percent report no change.
* 59 percent report that new technology has made things easier for their medical practice.
* 73 percent report that the computers in their practice are over three years old on average (21 percent in the five to six-year-old range).
* 69 percent of doctors report being satisfied to extremely satisfied with their career despite these challenges.
* Doctors were also asked to report their practice's top negative pressures and positive trends in a series of open ended questions.
* Issues relating to practice administration (31 percent), insurance and reimbursement (26 percent) and difficult patients (11 percent) are the top negative pressures on the practices.
* Positive trends are led by advancements in medicine (22 percent), patient quality (19 percent) and improvement in the healthcare workforce (15 percent).
* 80% of US physicians practice in groups of 9 or less according to the AMA.

View Practice Fusion's 2011 State of the Small Practice info graphic. Raw data from the survey is available free upon request. Practice Fusion is also offering physician sources across the country to talk about their own experiences managing a small practice.
Survey Methodology
The Practice Fusion State of the Small Practice study was conducted by internet survey in December 2010 with MDLinx. Responses to 10 questions were collected from a national sample of 100 physicians. The majority of respondents were primary care providers in practices with fewer than six providers.

Admittedly this was not a very scientific study, nor was their any indication of the demographic of the study group, not taking into account the geographic location, age of the physician, or medical practice. The statistic lumped all small practices from 1-9 physicians.   That is quite a spread. The resources of a one or two man group are far different than  three or more individual practitioners.

"Small primary care medical practices are the backbone of the US healthcare system," said Ryan Howard, CEO of Practice Fusion. "These are family doctors on the front lines, they're passionate about caring for their patients and our survey indicates  that they're struggling. “

EMR vendors as part of their service will evaluate a medical practice for implementing a system. This includes a thorough analysis of costs and return on investment.  They know the financials  within which physicians operate.  If anything they are biased toward selling their system,, and having a client be able to purchase and pay for it.

This survey by Practice Fusion (which offers a totally free EMR which operates in the cloud) points out that even with a ‘free EMR”  practices cannot afford the down time or the cost of minimal hardware investment.

Most small practices, and larger ones are operated with less than optimal physician/staff ratios.  The staff has to be multi-tasking in their job description. This is not always possible.

How many times do  you receive an answering machine when you call the  doctor’s office?  My observation is it occurs a great deal of the time. The message is ‘if it is a medical emergency to call 911 or go to the emergency room.” 

How about that for improved quality of care?  Government studies do not measure that metric, “the first mile to the health care system”.

Let me have your thoughts on this matter.

You can tweet me @anophthalmus, or leave a message on facebook/garylevin