Information provided by Health Train Express and Digital Health Space is informational only. We do not endorse specific solutions. Inclusions are provided as reference only. Readers should consult with their own consultants for further details.

Saturday, March 31, 2012

Dying in the 21st Century


Most of us will die in the Twenty-First Century

I happened to  run across this TEDxNewy 2011 (Newcastle, AU). Not only are we on a health train express we are all on the way to the end of the line.

Paul Saul

Peter Saul is Senior Intensivist in the adult and pediatric ICU at John Hunter Hospital, and Director of Intensive Care at Newcastle Private Hospital. Having trained in Cambridge, London, Sydney and Harvard, he came to Newcastle to help start up the new ICU at John Hunter, and never left. He has been accused of being an "ethicist", which he tries to deny, but does admit to having been Head of Discipline for Medical Ethics at Newcastle University in the past, and now provides ethical advice to the State and Federal health departments. Having been deeply involved in the dying process of over 4000 patients in the past 35 years, Peter has taken an interest in how we die, and how this has changed beyond all recognition in a single generation.

Paul Saul relates in a study of over 4000 patients medical records, only 1% had any documentation about how the patient wanted to die or the end of life treatment they desired. This leaves health professionals and sometimes family or guardians in a quandary as to when and if to stop life support.  Think about this, if 99 people out of a hundred don’t leave instructions their care can be extended significantly. The economics may be staggering since ‘end of life’ care is the most expensive, spent in intensive care units.

How we die lives on in the minds of all who survive us. Stress increases seven fold by dying in intensive care units. In the U.S. one in five will die in intensive care, in Miami three out of five, and in Australia one in ten.”

Comment: from Tonya Roberts:

“The key point is that we're not having conversations around our impending deaths, for reasons of fear predominantly. As a rule, we can assume that most of us don't want to die and not before we have to. It's a fine line b/w delaying death and prolonging life. Don't throw out the whole talk b/c of the euthanasia element. I felt the missed opportunity for the funded 'conversations' keenly - like with many cultural shifts, this one may need to happen at a political level first.

Least frequent, sudden death is rare now, increasing frailty and disability are now the most frequent means of dying.

Intensive care units may be misconstrued as ‘life-saving’  when they are ‘life extending’.

Saul goes on further to say that a continuous dialogue is needed to elevate awareness of choice on dying. If the dialogue ceases the awareness decreases rapidly.

People may need to use the political process to make the entire process patient and family centered rather than ‘medicalized’  This is also fraught with fear and resistance as demonstrated in the Patient Affordability and Care Bill, when fierce emotional reactions resulted yielding the term “Death Board”. This ‘split type’ of analysis does not serve patients or families well. Death cannot be codified by society.

Dame Cicely Saunders, the founder of the hospice movement made these remarks,

“You matter because you are you

And you matter to

The last moment of

Your life”


Friday, March 30, 2012

The Many Platforms of Social Media in Healthcare


Social media in health care began with the formation of a number of interactive web sites, including SERMO, and iMedXchange some time ago.  SERMO and iMedXchange are more formal, and almost a peer reviewed forum requiring authorization and proof of a medical license. They cover subjects organized by specialty category and have business management and policy reform categories.

One could also include the many ‘listserv’ forums as social media, although not immediately interactive it functioned as a ready solution for communications. Chat rooms came into existence in the form of mIRC, AOL messenger, MSN messenger, and other chats in Facebook, and Skype

If today’ s most popular social media is considered, Facebook, Twitter, MySpace, Tumbler, and Foursquare come to mind.

Google + is relatively new, beginning in July 2011, and not yet one year old. Despite the fact that Facebook is the most popular platform and twitter is heavily used, Google launched Google + and a videoconferencing capability for ten users simultaneously. For the uninitiated Google + is somewhat more cumbersome and technically  challenging for new users.

Each social media platform has its own set of strengths and weaknesses differing in  linking friends and messaging. One major factor is the extent of privacy settings, and who can see your posts.

Initialling designed for short texting (as in Twitter) and ‘friending’ as in Facebook iSocial media has grown into a marketing tool for business purposes in  and enhancing visibility and search engine ranking.

A recent study has revealed an increase in physician use of social media for both for personal and professional use.  Personal use far exceeds the professional ;use of social media, however the trend is changing as professionals become more familiar and standards for it’s use are  promulgated by medical societies.

Social Media in Healthcare 

source:  PowerDMSuite

In setting standards the medical organizations give implicit approval for the use of social media with emphasis on protecting patient confidentiality and privacy.  And many health organizations recognize the strength of social media as it relates to direct patient relationships and as a means of increasing their visibility in cyberspace advertising their hospital and meetings and centers of excellence.

Google abandoned it’s Google Health Record due to lack of interest on the part of patients, lack of a support base with EMRs and a nervousness on the part of health providers as to the security and privacy of patient’s EHRs

Google + with their new social media platform has expressed a direct interest in supporting advocacy and support applications for disabled people, and for professional use. They have already developed special screen readers for use in chat rooms and on Google hangouts for visually impaired patients.

We have had some success in early development of “Blind Veterans Help Desk” as part of the Veterans Workshop.  This non-profit organization will facilitate the use of Google technology so that deaf veterans and blind veterans can assist each other and also facilitate caregivers improving communications and assistance to patients requiring support and/or in home health service. Google hangouts may reduce the frequency of at home visits by visiting nurses, or post hospitalization.  In my opinion the potential is endless.

We will be announcing a mechanism for interested parties to contribute to veterans wellness through the Veterans Workshop

We expect an announcement and demonstration around Memorial Day of this year.

Thursday, March 29, 2012

If Health Care Reform Falls, Look in the Mirror


Karen Dolan 

Karen Dolan is a fellow at the independent Institute for Policy Studies and Director of the Cities for Peace and Cities for Progress projects there. She specializes in domestic economic inequality issues.

At times those sitting dispassionately at the sidelines see much more than we do, those who are immersed in a chaotic system, and are attempting to salvage what we use on a daily basis.

Hypothetically we all want the same, an improved health system with benefits for all,  but are fearful of the unknown even if the present system is untenable.

In her Huffington Post Blog,

“Supporters of Obama's health care reform are "keeping a stiff upper lip" reports The Hill as reaction to three tough days of oral argument and questioning on aspects of President Obama's Affordable Care Act (ACA)."

“The entire health reform effort seems to hang in balance, dangerously. It looks like a very real possibility that Americans who do and will need health care, and who do or will have health conditions -- i.e., pretty much everyone -- will again be excluded from coverage for pre-existing conditions and others priced out of coverage at alarming rates if the unusually conservative and ideological Supreme Court backs the GOP”

It didn't have to be this way. We had the power to make things different. In fact, we still have the power to make things different.

“As poorly as the administration calculated, strategized, composed and communicated their reforms, they did what Administrations do. They brought industry to the table, they excluded single payer advocates, they vastly overestimated their ability to bring the other side on board, they vastly underestimated the extreme ideology that opposed reform and they botched the messaging of all of it.”

“Candidate Barack Obama campaigned on universal coverage. He told would-be supporters that, if he were "starting from scratch," single-payer would be ideal. Indeed, he even understood that the only true reform, that would sufficiently control costs and actually achieve universal coverage, was a single payer, government-sponsored health care system. The evidence is overwhelming that only such a system can achieve those goals.”

Of course this smacks of downright socialism, yet we already have a large segment of the population using socialized funding for healthcare (seniors, disabled, children in poverty.

President Barack Obama however, not only quickly abandoned any thought of a fight for a true universal system, he set his left flank where he wanted to end up: the public option.(VIDEO Robert Reich).   In addition to current private plans, geographical regions would have another choice, a "public option" which would have the power of the federal government behind it to negotiate down premiums.

But progressives did fight for the public option. With some notable exceptions, almost exclusively. Instead of being the rallying grassroots campaign and reasonable solution desired by all progressives, universal, single-payer health care became the pariah of the organized progressives, scoffed at and scorned as unachievable.

The administration should have allowed it, encouraged it, engaged it, used it. Progressives should have fought like hell for it.

“So, while progressives, Democrats, Americans who want affordable health care for all of us go forward wringing our hands and "keeping a stiff upper lip," blaming the misinformed conservative ideologues in Congress, in the Supreme Court, in Tea Party get-ups, perhaps we should take a long look in the mirror.”

If we had ended up with a single-payer system, then of course the "individual mandate problem" is non-existent. Even if we had ended up with a "public option," we would not have had this the question before the Supreme Court this spring. Justice Kennedy himself suggested so in his comments that the Individual Mandate problem could be avoided by a tax funded single payer national health service.

“This is a fight for the most basic value a society can have. Will we care for our people or let them become sick, bankrupt, disabled and die unnecessarily because we failed to fight for an affordable quality health care system that covers everyone. Will we slash every other government program virtually out of existence to fund an ever-escalating for-profit insurance system? Isn't it time to fight for Medicare for all?”

(GML)  It’s time to cut our losses, and not travel down a doomed path guaranteed to fail miserably at building a system that will keep us healthy. Perhaps we should not call it ‘health insurance’.  That system has not functioned effectively for many years.”


Twitter Melts down covering Three Rounder at SCOTUS may be a Technical Knockout


News reports seem to be biased towards a favorable decision for the plaintiff (28 states, and AAPS.

The participants are licking their wounds and the states appear optimistic about a decision.

The defendants’ counsel came out of his corner of the court ring stumbling and staggering as he was unable to make the first jab. A quick glass of water from his corner energized him a bit.

SCOTUS will have more than two months to decide a ‘winner’  Health Train Express proclaims that it will be a split decision with one vote carrying the prevailing party. I am making no predictions. Either side will lose no matter the decision. The costs will be measurable for administrative cost, insurance company losses, and the delay in  planning and implementing a good plan should Obamacare, or parts of it be negated.

The larger issue, as to the legal severability of Obamacare may be the deciding punch in the contest.

In Supreme court matters this is the most frequent outcome…all the way to the end.

The Three Round Contest went something like this:

Medicaid expansion issue

Severability Issue

Individual Mandate Issue

Anti-Injunction Act Issue

The details are forthcoming here:

The Decision Expected by June 2012

The End


Tuesday, March 27, 2012

Inland Empire Health Information Exchange

Inland Empire HIE

Inland Empire Health Information Exchange will “Go Live” April 1, 2012.

The Inland Empire Health Information Exchange (IEHIE) is a collaborative of Riverside and San Bernardino County hospitals, medical centers, medical groups, clinics, IPAs, physician practices, health plans, public health and other healthcare providers. IEHIE brings needed technology to access and securely share electronic patient health records for more than 4.1 million people living in the Inland Empire. The IEHIE gives healthcare providers immediate access to a state-of-the-art electronic health records network. IEHIE technology allows doctors, clinics, hospitals and other healthcare providers to electronically review and access medical records, resulting in timely, safer and improved quality of healthcare for the patients in our community.

With that announcement the real purpose and mission begins.

Physicians, provider groups and hospitals are all at different stages of implementing eHR.

Many providers also are using practice management software and focused software solutions already implemented for practice workflow.

The health information exchange means nothing without proper use by providers.  It is perhaps the last link in the workflow equation, but may present it’s usefulness at the first patient encounter with the provider who requires historical information about a patient, or a laboratory result.

Not all health information exchanges are created equal nor do they provide identical information. HIE is not something that is delivered in a 'black box' and is just plugged in.

Similar to planning for an electronic medical record, it will be important to assess a workflow of a practice to determine where the HIE fits. It may have several applications at different segments of your workflow....pre-visit, admissions, laboratory portal and others.

Anticipate that your HIE may not deliver all that you expect initially. Each component of the EMR and medical record requires interoperability to exchange information, and each type of data set uses different standards.

The standards have been designed by the NHIN so that any NIST certified electronic medical record should work with the IHIE. Meaningful use requires that your EMR communicate with the IHIE.

The Inland Empire Health Information Exchange can also be utilized by providers who do not yet use an EMR by using the WEBportal for laboratory, imaging, and patient identifiers. Patient identifiers can be assigned, such as diagnosis, immunization and others

Inland Empire EHR Related Links & Resources: (RESOURCE CENTER)

Electronic Health Records Desk Reference 

Eligibility Crosswalk

IEEHRC's Meaningful Use (Stage 1) Reporting Guide

Health IT Tutorials for Physician Practices


The key to choosing an EMR or eRX platform is studying workflow to determine how and which EMR will serve  you best.

Geriatrics Health App is Already Here

Longevity Studies have shown people who are married and/or have significant others live a healthier and longer life. 

Social media and Google plus Hangouts offer a special tool to empower social media participants, healthcare providers and staff to establish a significant other partnership with seniors who are alone, widowed, divorced, and/or childless.


Even when well, socialization, having a meal together virtually, can enhance and improve quality of life for the elderly.

Visit a senior center, nursing home, assisted living facility and train personel for this activity. The benefits will be amazing….both for patients, families who are distant from their loved ones, and you.  Put a face on your social media activity with Google plus hangouts, Facebook video and/or Skype.

Top Geriatric Social Media Sites

Geriatric Social Media  Hashtags  #

Social media opens social world to elderly, disabled

Monday, March 26, 2012

Excerpts from Monday's Supreme Court arguments


over whether legal challenges to President Barack Obama's health care law are premature under the Anti-Injunction Act, which bars lawsuits against a tax until after the tax is paid:

Solicitor General Donald Verrilli: This case presents issues of great moment and the Anti-Injunction Act does not bar the Court's consideration of those issues.

Donald Verrilli


Robert A. Long:  (amicus curae, friend of the court)

Somewhat to my surprise, "tax" is not defined anywhere in the Internal Revenue Code.

Justice Sonia Sotomayor:

Assuming we find that this is not jurisdictional, what is the parade of horribles that you see occurring if we call this a mandatory claim processing rule? What kinds of cases do you imagine that courts will reach?

Justice Antonin Scalia:

If it's not jurisdictional, what's going to happen is you are going to have an intelligent federal court deciding whether you are going to make an exception. And there will be no parade of horribles because all federal courts are intelligent.

Justice Stephen Breyer: What we want to do is get money from these people. Most of them get the money by buying the insurance and that will help pay. But if they don't, they are going to pay this penalty, and that will help, too.

Justice Samuel Alito: Today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax. Has the Court ever held that something that is a tax for purposes of the taxing power under the Constitution is not a tax under the Anti-Injunction Act?

Verrilli: No, Justice Alito, but the Court has held in the license tax cases that something can be a constitutional exercise of the taxing power whether or not it is called a tax. And that's because the nature of the inquiry that we will conduct tomorrow is different from the nature of the inquiry that we will conduct today. Tomorrow the question is whether Congress has the authority under the taxing power to enact it and the form of words doesn't have a dispositive effect on that analysis. Today we are construing statutory text where the precise choice of words does have a dispositive effect on the analysis.

All food for thought for every physician, and American


Sunday, March 25, 2012

Health Reform Updates


Monday  The Day At the Supreme Court

Will your line at the doctor’s office exceed the line at the Supreme Court on Monday?

Legal challenges to the Affordable Care Act finally come to the Supreme Court on Monday, when the public will learn for the first time what the justices ask about President Barack Obama's signature legislative achievement.

1200 pages and endless discord and argument now Does it all come down to two attorneys? 

As US solicitor general, Donald Verrilli is representing the Obama administration and will argue that the court should affirm the constitutionality of the ACA.


Washington lawyer Paul Clement is no stranger to the podium at the nation's highest court. To date he has argued 55 cases before the justices. He is representing Florida and 25 other states in their challenge to the constitutionality of the ACA's individual mandate.

As the high court begins three days of oral arguments over the constitutionality of the Affordable Care Act — the sweeping health care overhaul some call Obamacare — many legal and political experts agree the decision in HHS v. Florida will be among the most important in American history


Premium Support in Medicare

Two Success Stories For Public Reporting Of Provider Performance Information

Why doctors aren’t prescribing health apps to patients

Study: Small medical offices lead in EHR adoption growth

U.S. leads many nations in health IT 


Patients recognize quality and security benefits of EMRs

The need for health IT workers is growing

We’ll expand further on these topics later this week.

Saturday, March 24, 2012

The New Social Media Paradigm in Medicine

Our patients are our allies in the pursuit of health and wellness.  This is no longer a euphemism. We have seen the onset of the new age….patient-centric medicine, the medical home, open access to information, even patient participation in medical meetings.

The twitter health care social media hashtag, use it to be heard.

Many others can be found here

Today, courtesy of Medpage Today, The American College of Cardiology broadcast a live webinar on heart disease.  The premise of the course was that, Patients who "see” their diseased arteries are more likely to lose weight and follow other ’heart-healthy’ advice. Graphic visualizations and angiography demonstrate changes from atherosclerosis and hyperlipidemia.   The topics included Late Breaking News from Clinical Trials of Stem Cells. (Texas Heart Institute), and analysis of Coronary Artery Calcium focused on patient compliance for achieving weight loss. Other topics included

The most successful physicians are the ones that accommodate those patients who are interested in bringing information to their visits.  Most of our patients are curious about their health and how we practice our art. Even if we are rushed for time it pays to receive their information openly and consider it for a patient by telling them you will need time to review the information and then respond with an answer. This does not have to occur during the visit.  This positive reaffirmation to a patient that their material will be reviewed is a powerful tool for patient awareness and compliance with anticipated treatments. Furthermore it builds confidence and expands the informed consent process for treatment protocols and/or surgical procedures.  The additional resources of references from the internet, library reference sources, and prepared brochures on commonly seen diseases should be made available for your patients.

Email attachments or twitter links sent to a patient can deliver the message when they arrive home or on the next day, saving office time, your time and staff time.

Friday, March 23, 2012

A Moronic Social Media Post on Health Train

(not meant to be a serious blog post)

The following discussions are ongoing in The Club Car. No jacket, tie or fee required for admission

Will Social Media help repeal Obama Care? 

Can Social Media reduce deficits, or save the Medicare trust fund?

Will your next health insurer be Facebook? Google? or Twitter?  It may be so.

Even now some companies have targeted their web presence linked to a url address as they position themselves for page rank in Google’s new algorithm.  The shear volume of traffic on Facebook makes it a ‘gateway’ landing page.  The sheer industrial size of Facebook’s servers would benefit anyone wanting to host their company’s web pages (gratis)  Just slip a link to re-direct a one line landing page over to your Facebook name page.


Check our formula for the answer:


Everyone wants your



One of the most well-known and effective copywriting formulas is the AIDA methodology. AIDA stands for Attention, Interest, Desire and Action. To write compelling copy, you should attract Attention, arouse Interest, stimulate Desire and present a call to Action. As marketing changes in the online world, I’ve found it more effective to change one component of the formula — Interest. Of course, you absolutely want your reader interested in your copy. But in online marketing, if you’ve done your job on the first step — Attention — by writing a killer headline that has gotten your reader to click on your article or scroll down to read more, you’ve already piqued their interest. Now what you should do to really sell or convince is show an Advantage.

The Ultimate D.I.Y. Repair toolkit :  Available Online from

Robot Hands Self Installation

What has any of the above have to do with Health Train Express? Just testing headlines and content for AIDA, which  stands for Attention, Interest, Desire and Action

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Learn on The Health Train Express Social Cruise



Relax and get your new tablet or ultra book or maybe even your ancient Dell Desktop, and follow along.

Social Media in Healthcare is a moving target. Like the stock market at times the best indicator is the moving average indicator. Social media sites grow rapidly, wane and flux and at the same time the user base shifts from platform to platform.

If you are a newbie, intermediate or advanced social-izer the best source for all learners or more advanced users is a Prezi course by Bertalan Mesko M.D.

The course is on Webcina and you can read about it here. Dr Mesko is an organizer from the get go. He has produced a great deal of content in social media in an articulate graphic and easily understood format.

For those of you who have never read or produced a Prezi presentation it will prove to be an interesting and captivating tool. The only other presentation tool I have seen or used that approaches Prezi is Pearltrees. Other useful slide deck platforms are Google Presentation and Slideshare.

Dr. Mesko has sixteen icons on the landing page, each a rich source for social media, bloggers, wikis, and stories about Google.

No matter where you are on the learning curve for social media, web search, rss feeds, Bert Mesko puts together an array of amazing tools. Each venture into his social media space nets me a wealth of new features.

Perhaps that is what makes social media so enticing to users. Each trip into the social sphere gains the user. I would definitely bookmark Webcina for easy reference.


Thursday, March 22, 2012

The California Health Benefit Insurance Exchange


California is a leading state in formation of Health Benefit Exchanges. The Health Reform Law as specified in the Patient Care and Affordability Act two years ago mandates the formation of Insurance Exchanges for each state to create a structure to make available plans for the uninsured or uninsurable.

California frequently goes where no man has gone before, or where others dare not trend. Unlike many states who have chosen to push back on federal mandates with legal means, or refusal to initiate a health benefit exchange, California is travelling down the tracks at great speed.

I took some time to sit in on a Webex presentation (archive available) of the recent California Health Benefit Insurance Exchange today. For those who missed it (probably 99.999% of my readers) The link(s) here will take you to an archive of the meeting. The Agenda is also here..

This is the second anniversary of the passage of the Affordable Patient Care Act. (2010)


Important points of the California Health Benefit Insurance Exchange meeting follow:

Health provider and Public misperception is that the Health Insurance Benefit Exchange program is a government run entity. This is not true. The current involvement is a grant mechanism as a startup for HBIEs. This grant funding will end in December 2014, after which the HBIE must be self sustaining from it's own business model.

Should the state(s) decide not to build their own exchange, then the federal government has the option or mandate to do it for each state.

I thought it important for a physician to attend this meeting. I was unable however to attend the “executive session” which was not broadcast.

The development of the California Health Benefit Insurance Exchange is well underway.

Mission:: For all Californians to have Health Care. The CBHIE goal is to develop a marketplace

California's unique challenges

California is larger than most countries, and most states, with great diversity in income, rural/urban, ethnicity,languages, education,

California Timeline for plan and implementation relatively short.

Consumer centric: rural urban education

Exec Director Peter Lee

Business development..tracks

CBHIE Human Resource Needs for staffing

Qualified Health Plans by Price Waterhouse

CBHIE Enrollment System: Critical Backend IT platform

Assessing Federal Regulations

Setting standards for QHPs

Multi-state plans may be exempt from some requirements

CBHIE Will include dental plans, mental health,

Standard rates

At The Table was Donald Berwick MD former CMS head


Several shifts in Individual markets ,Group, Medi-Cal, Uninsured, Undocumented ? 1 million

Exchange prediction is working from vague statistics and estimates.

Enrollment penetration: 2014 20% 2019 100% Rates will be critical

Market surveys.

Beware of program  being construed as a 'government program”

Balanced approach, linked to health services

Spectrum of support services

Much of Health Benefit Insurance Exchange planning involves outreach and research into transitions, loss of employment, moves, divorce, connecting graduation, education, student loan program

Pre-enrollment from other plans from public programs, and for life transitions.

Wednesday, March 21, 2012

Innovative uses of Health 2.0 and Social Media


Imagine a ‘Wiki” to empower patients

Several Health Wiki’s are already online.

WikiPublicHealth  (WiKiPH)  is  a U.K. based information source. It remains an open source for articles by anyone. It appears to allow anyone to register/log in/and create articles

Health Wiki News 


HealthWikiNews is an already established site closely moderated by an advisory panel. It is hosted on WordPress.

Imagine that you have asthma, and rather than give you a set of instructions about what to do if you have an attack, your doctor invites you to help write them? Would that make patients feel more engaged and empowered in managing their health care, and would that ultimately make them happier if not healthier?

These questions are being raised by Dr. Samir Gupta, a respirologist at St. Michael's Hospital.

His research has found that a wiki - a website developed collaboratively by a community of users, allowing any user to add and edit content - can be an innovative new tool for developing individual asthma action plans.

West Wireless Institute: aggressively advancing the mHealth ecosystem

Founded by billionaire entrepreneurs Gary and Mary West, and guided by a blue chip laden executive team with all of the elements required to both think big and execute, the Institute has burst onto the scene in 2011.

Post image for West Wireless Institute: aggressively advancing the mHealth ecosystem, interview CMO Joe Smith, MD

There is no single organization worthy of mention in the same breath with San Diego-based West Wireless Health Institute when discussing the contribution of non-profit groups to the mHealth movement.

West Health Policy Center

West Wireless Health Council

West Wireless Health Fund

The opportunity presented itself to interview the Institute’s Chief Medical Officer Joe Smith, MD, PhD. During our conversation I was able to ask Dr. Smith about each of the projects and how they have progressed to date. The complete transcript can be found at the mHealth home page.

The organization also offers Fellowships.

More  trends in HIT, will they facilitate Health Reform by enabling cost reduction?


IBM has unveiled a clinical-analytics platform to provide doctors with insight into patients' conditions using natural-language processing and machine-learning capabilities similar to Watson.


IBM is moving on from "Jeopardy" to finding treatments using genetic data. The company announced it has developed a data-analytics platform called Clinical Genomics that uses algorithms and analytics similar to that of Big Blue's Watson supercomputer to find treatments for conditions based on a patient's genetic profile.

IBM's Clinical Genomics fits into the growing trend in health care of using big data to develop personalized medicine, which is the ability to use a patient's personal genetic characteristics to prescribe medical treatment for conditions, such as cancer, hypertension and AIDS.

Sunday, March 18, 2012

Who Reads Instructions?

Okay, I have always been an early adopter. And that extends to the recent introduction of Windows 8 (Metro)  Metro seems to be designed to be a GUI that is an enlarged smartphone screen. It is meant to be used on a touchscreen tablet.

Perhaps  Redmond intended Windows 8 to be sympatico with Windows phone users even though that market is still very immature and follows on a merger (purchase) of Nokia by MSFT.  Nokia as you will remember almost tanked with it’s now defunct Symbian OS. 

Loading the OS as a self installing .exe file from a USB stick was straightforward, even though it took several reboots and several long pauses with no indication whether it had crashed.  Patience paid off and the opening screen appeared. Warning the opening screen is a mono-color with a strange looking fish in the center. For aquarium lovers, you already realize it is a ‘siamese fighting fish’.  There must be some hidden meaning in that logo. Perhaps the code spells out Steve Jobs.

I bring this up on Health Train Express because there are probably many of you who are tempted to try Windows 8. I don’t think I would rush to use it for your office systems as yet. Reserve it for playtime.

Have no fear, despite the warnings of non support, I have not needed it thus far and have used it for almost three weeks.

I took out my backup insurance by copying all my important documents, photos, and personalized settings to an external hard drive and also to the cloud. In the past I have had some very bad experiences whereby a backup program in one OS was incompatible with a recovery in another new OS.  With that in mind, all went well, and because I use the cloud now for 90% of my computing both online and offline.

Beginning with blogger I have steadily migrated to more and more of Google’s offerings because of it’s synchronicity and it’s overlap of social media, document sharing, email and it’s android relationship.  In the near if Google’s chrome becomes more prevalent the need for Windows is less.

Because I blog and work in social media a great deal of the time, Chrome presents the most usable means of switching from Google + to twitter and Facebook.  The addition of Google Hangouts is the pudding in the pie.  Don’t forget YouTube as well.

Other than not working with my AIO HP all seems fine. It has a generic HP printer driver that shines. Printer drivers are the acid test for compatibilty, since printers are very finicky and exacting.

The only thing Google needs to do is develop a HIPAA compliant secure video conference and you have a low cost ready made teleconferencing solution that could alter the cost equation for healthcare.   What used to cost about 50,000 for a telemedicine set up now costs not much more than a laptop or tablet pc. P.S. it also works on a smartphone reasonably well.

Two projects in which I am directing are the use of it for a “Virtual Photo Walk” and “ Blind Veterans Help Desk”.  The later seems like an oxymoron, however I have a dedicated Veteran’s Advocate who convinced me it was worth a trial.  It seems useful for partially blinded patients to socialize.

Finally, I am glad I did not read the instructions, especially since there are no really official instructions, or accompanying help file.

It took about a week of experimenting with all the icons, buttons and learning to swipe using the mouse on a laptop. Microsoft promises a new $ 75.00 dollar swipable mouse pad in the near.

Where do Health and Social Media Intersect ?

Online Health Care Discussions 98% Patient Driven


A bold statistic reveals how little medical providers are participating in the use of Social Media regarding health issues.

Recent statistics show that close to 90% of providers are familiar with or use social media such as twitter, facebook or google in their daily activities.

Dike Drummond MD writes on “HealthWorksCollective” and reveals that providers provide less than 2% of information except in the case of lung cancer where it jumps to a “whopping 9%” in online chat.  In a number of cases the majority of the discussion is driven by the patient’s caregiver. Alzheimer’s disease tops that statistic as you might expect.

The authors of this infographic focused on disease specific discussions and found the most discussed topics to be

  • Depression
  • Fibromyalgia
  • Breast Cancer
  • ADD
  • Asthma
  • Cardiovascular Disease

Infographic and article source:  NMCITE


Despite predictions about the adoption of social media for physicians in reality social media is more often used by caregivers.

There are opportunities for education and training of care-givers in health to enhance their efforts to support either their clients or their family using social media such as facebook, twitter, and Google +

Google + further enables social media with Google Hangouts affording a direct video conferencing ability amongst ten participants.

Further information is available at Digital Health Space on Google Plus.

Physicians should lead their staff in developing this modality.

Saturday, March 17, 2012

ACOs Gaining Ground in Illinois


ACO is the hottest three-letter word in health care

Accountable care organizations take up only seven pages of the massive new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.

New Insurer-Hospital ACO Touts Early Success.

With only six months of data, the largest hospital system in Illinois, Advocate Health Care, and major health insurer Blue Cross Blue Shield of Illinois (BCBSIL) are declaring some early successes with its provider-payer accountable care organization, which is the largest commercial ACO, Scott Sarran, BCBSIL's chief medical officer, said in a Kaiser Health News article.

Advocate Health Care based in Chicago and BLBSIL's ACO called AdvocateCare has 250,000 PPO members and 125,000 HMO members, according to Sarran. In its first six months of 2011, the ACO resulted in hospital admissions per member dropping 10.6 percent, compared to 2010, and emergency department visits decreasing 5.4 percent, Kaiser Health News reported.

Even though the federal government offers under the 2010 health reform law a platform for Medicare ACOs, providers and payers have joined forces to create their own ACOs outside of the Medicare Shared Savings Program. For example, Hoag Memorial Hospital Presbyterian, Blue Shield of California and Greater Newport Physicians IPA just weeks ago announced its intent to create an accountable care initiative, and Pioneer ACO Atrius Health recently hinted in a FierceHealthcare interview that it is considering partnerships with commercial insurers, having already begun talks in reducing costs.

"If we're doing this in the Medicare arena, why can't we do this in the commercial environment, as well, and then be rewarded for the benefit we bring to the reduction in total expenses in Medicare PPO patients?" Atrius Health President and CEO Gene Lindsey said.


"Before, we were limited to the fee-for-service revenue that would be associated with caring for those patients. So this opens up a whole new vista in healthcare finance when we are looking for new ways to fully fund the programs of care that we want to offer," he said.

The administration forming ACOs will take considerable effort and startup costs amounting to several millions of dollars according to:

What are ACO start up costs ?

That's the"$64,000 question"

We have three separate estimates, with disparate figures.

The projected start-up costs of an accountable care organization (ACO) can vary widely, depending on who you talk to. The Centers for Medicare & Medicaid Services (CMS) estimates that it will take $1.7 million per ACO, based on a 2008 study of the Physician Group Practice Demonstration project, according to an Institute for Health Technology Transformation white paper released last week. The American Hospital Association (AHA), however, estimates ACO start-up costs are between $5.3 to $12 million, depending on hospital size. The Institute for Health Technology Transformation reports that it could take $7.5 to $11.3 million for a 200-bed hospital or $1 to $11.7 million for a 200-physician practice.


FierceHealth IT offers further details


Wednesday, March 14, 2012

We Won’t Know What’s In There Until We Pass It


When the Affordable Patient Protection Bill (APPA) bill was in congress many congressman could not or did not read the entire bill.  The bill was 1200 pages of the “Secretary of HHS” shall implement the following”…………..The bill was global, including many issues with health IT, public health, ACOs, and  set deadlines for implemenation without regard to the impact of each phase.

Some said that we would not now what was in it until it was passed.  That statement is probably the most true statement of the entire furor over health reform.

The initial phase included forbidding exclusions for previous illness and doing away with uninsurabilty as well as allowing dependent minors to remain on parent’s policies until the age of  25.  Those two items surely drove up the cost of health insurance.  Someone had to pay for insuring uninsurable people. Surely it sounds wonderful and it immediately reduced political pressure about health reform.

It may have been a bit backward to set up the financing after increasing the expense. I don’t understand the math but then again I don’t print money.

Torn Money

Jeff Young, at the Huffington Post describes it this way.

“The good news is that health care reform could lead your employer to put a little more money in your paycheck. The bad news is that if they do, it's probably because they aren't providing you with health insurance anymore.

The Congressional Budget Office estimates that 4 million fewer people will get health benefits from their employers in 2016 compared to what the agency projected a year ago. More people will end up on Medicaid, the government health program for the poor, and more companies will decide to stop offering health benefits and let their workers buy their own coverage through insurance "exchanges" the government will establish in 2014. The Congressional Budget Office doesn't estimate how much wages might increase for those who lose company health benefits.

How could this translate into bigger paychecks for workers? Economists consider health insurance to be part of how much companies "pay" workers because fringe benefits cost them money, said Paul Fronstin, director of the Health Research & Education Program at the Employee Benefit Research Institute. If a company decides to stop providing health insurance, they are likely to pay a little more. Companies may choose to offer workers extra money that could be used to help pay for health insurance instead of providing benefits themselves.

The Congressional Budget Office also says this will allow the government to raise more money to pay for health reform because wages get taxed but money spent on workplace health benefits doesn't. Employers that drop workers from their insurance rolls also will pay penalties to the government.

Jobs would remain the most common way for Americans to get health insurance. The new projections about health care reform don't say fewer people overall will get insurance at work, just a smaller number than the budget agency previously thought. This year, 154 million people are covered by their employers and 161 million will be in 2016, the Congressional Budget Office says.

There's no guarantee things will play out that way. Economic and budget projections are constantly changing and the parts of the health care law that are supposed to expand coverage don't exist yet. Moreover, Fronstin said, economists' assumptions about companies treating benefits like pay aren't always accurate in the real world.

Reading further it becomes obvious there are many  ‘what if's’ an unspoken hope that the present economic doldrum will come to an end, and the planners have given themselves more than ‘wiggle room’ to call it a success.

Whatever it is we should not blame “Obama Care”  Much of the ideas were formulated long before he came into office.

The Patient Affordability and Protection Act is the correct term. That term seemed the most innocuous and benevolent term for major disruption and uncertainty in the health system.

Part II (later this week)

Health Insurance Exchanges, to be….or not to be. Who will do it?


Tuesday, March 13, 2012

At Long Last ! Inland Empire HIE to go Live April 1 2012



Gary M. Levin M.D.

I feel like the great grandfather who set something in motion that might have occurred anyway.  I do have the satisfaction of knowing I was right all along back in 2002 when I am sure I was hailed as the “Don Quixote’ of the Inland Empire. There were few then that could appreciate the vision of what we see unfolding.

All I can add is a profound  “Thank you   to those who took up the  baton when I laid it down, as I weathered several serious illnesses. There are now many community physicians, paid consultants, and champions of the movement. My dream and ambition would not have occurred except for them.

Ten years passed. And today I read some good news.

“  One of those exchanges is Inland Empire Health Information Exchange (IEHIE), which is made up of 48 providers in Riverside and San Bernardino counties, and is scheduled to become operational April 1.

At a time when the value and sustainability of public health information exchanges (HIEs) are being questioned, Inland Empire Health Information Exchange (IEHIE), which plans to go live on April 1, is making a case for both.

IEHIE, comprising 48 healthcare organizations in Riverside and San Bernardino counties including hospitals, physicians and payers, boasts an operational self-funded business model and a collaborative spirit. These two critical components make IEHIE unique, according to Executive Director Richard Swafford.

There is no public funding or state grants for IHIE. Any public funding comes from county stakeholders, a large managed care medi-cal organization (IEHP) which serves 600,000 participants and multiple hospital and physician group stakeholders.    From day one IHIE was drawn up and implemented by the stakeholders without public involvement and it will be sustainable. 

The collaborative spirit carried over to the business model. All stakeholders agreed to pay for value-added services via a fee structure determined by participant type – payers by number of lives, medical groups per physician and hospitals by bed size. IEHIE was formed as a 501(c)3 organization, with the goal of breaking even, not making a profit, Swafford explained. Although the HIE infrastructure contract with Orion Health, whose Orion Health HIE platform is powering the exchange, was completed some six months ago, it wasn’t signed until the current 14 pilot participants paid their fees in advance. “We aren’t relying on grants as a mechanism for sustainability,” he emphasized.

Sustainability has always been the glass barrier for RHIOs and now HIEs. Some of the most successful HIEs failed shortly after the startup grant money was gone. (Santa Barbara Exchange, started by David Brailer MD, the first head of ONCHIT.)

IEHIE’s strategy is also to be the utility for entities that want to leverage other programs and capabilities. The accountable care organization (ACO) model, for example, requires the ability to share patient information in order to effectively participate in an ACO environment. “We rely on our participants to tell us what their requirements are so we can integrate them into our overall strategy,” Swafford said.

When the community-based HIE goes live April 1st, Gagnon predicted, “We’re going to knock everybody’s socks off.”

Monday, March 12, 2012

Online Web Rating Sites: FAIL WHALE




Columnist Ron Lieber writes that consumers are not posting online reviews of their health care experiences as often as they are posting online reviews of restaurants and other services.

Lieber writes that websites such as HealthGrades, RateMDs, Yelp and Angie's List have offered a platform for health care reviews, but "listings are often sparse, with few contributors and little substance." He adds that there is a "demand and supply problem: many people want this information and more consumers would trust it if the sites had more robust offerings."

According to Lieber, some physicians have "silenced patients away" by asking patients not to review them online or by suing patients who do so.

In addition, some patients might choose not to review their doctors "for a far more ordinary reason: if they live in a small town or are only one or two degrees of social separation from physicians or their family members, they may not want to create any awkwardness," Lieber writes.

He also notes that some patients might "idolize their doctors," adding that it is "exactly this sort of unquestioning mind-set that may cause such low participation (or disproportionately positive reviews) at many review sites."

Lieber writes, "The only solution, then, is to keep populating these sites en masse if you dare and your doctor doesn't seem to be the suing sort, taking care all the while to tell the truth and be fair" (Lieber, New York Times, 3/9).