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Thursday, May 31, 2012

President Obama's former doctor claims that the president lacks passion, feeling and humanity by Jarrett Stepman

The Real Barak Obama.

by Jarrett Stepman of Human Events

In a revealing new book, The Amateur, (available at Amazon and on Kindle) author Edward Klein interviews President Barack Obama’s physician, Dr. David Scheiner, MD, who blasts the president’s health care plan and says that President Obama has an “academic detachment” that he could never break through.
The doctor fears that if the health care plan is “the failure” he believes it will be, because of runaway costs and other problems, then any health reform will be set back for years to come.
These are only a few of many reveals in Klein’s book, which makes the case that President Obama is not the political machine that people fear, but an amateur with a messianic complex who is completely out of his depth.

Stepman also covers other events during the writing of this book, which are very interesting. An encounter with the Clintons arguing about whether Hilary will run for the presidency at some time in the future, Bill’s summation of Obama as “The Amateur” which led to the title of the book. Chelsea weighs in on Obama’s win, and favored her father’s promoting the idea of Hilary running for President.  He also interviews Doulas Baird, former Dean of the Harvard Law School, and his sucessor, Richard Epstein. The two have differing appraisals of Barak Obama. Epstein saw him as a charismatic figure who excited students, but lacked legal substance, and never wrote a scholarly paper.

In an exclusive preview of The Amateur by Human Events, Obama’s longtime physician reveals the lack of humanity in Obama’s character and with which he enacted the entirely politicized health insurance reform, The Patient Protection and Affordable Care Act, often called ObamaCare.

Scheiner said that he believes the president miscalculated politically and that the health reform is ultimately doomed to fail. Worse, Scheiner doubts the character of a man who holds the highest and most influential office in America: “I think there is too much of the University of Chicago in him. By which I mean he’s academic, lacks passion and feeling, and doesn’t have the sense of humanity that I expected.”
The author, Klein, later in the book, compares Obama’s personality to early the 20th Century progressive president, Woodrow Wilson. By quoting the historian Forrest McDonald, who called Wilson’s perception of himself, “little short of Messianic,” Klein says that McDonald’s description of Wilson “fits Obama to a T.”
The Amateur is set to be released Tuesday, May 15. It is published by Regnery Publishing, owned by Eagle Publishing, which also owns Human Events.
In the chapter titled, “Hollow at the Core,” Obama’s former physician, who is a liberal, blasts the president for being uncaring, and perhaps worse, incompetent.
“He has no cost control. There would be no effective cost control,” said Scheiner. “The [Congressional Budget Office] said it’s going to be incredibly expensive… and the thing that I’m incredibly worried about is, if it is a failure that I think it will be, then health reform will be set back a long, long time.”
Scheiner said that the Obama administration neglected the advice of real physicians and instead decided to let political operatives craft Obama’s signature health care law. People like Obama’s former chief of staff Rahm Emanuel’s brother, Dr. Ezekiel Emanuel, were the kinds of medical people that the White House consulted.
“Ezekiel is a medical oncologist, not a general physician,” said Scheiner.
The point that Scheiner was trying to make is that President Obama lacks the ability to understand the critical role of the doctor to patient interaction just as he fails to connect to people personally.
“My main objection to Barack Obama is that he is a great speaker and a lousy communicator. He isn’t getting his message across to people. He isn’t showing that he really cares. To this day he hasn’t communicated with members of Congress.”
Scheiner and other interviewees in The Amateur believe that President Obama has been a failure as a president, that he has failed to live up to the hype and has left a trail of betrayals in his wake.

Although Obama and Scheiner did not have a close relationship, Scheiner was clearly upset by how he was cut off when Obama became president.
“Obama invited his barber to his inauguration—his barber! But I wasn’t invited. Believe me, that hurt.”

Dr. Scheiner (an old fashioned GP) who makes house calls, sums up the current Secretary of HHS, Kathleen Sibelius as a ‘joke’.

Dr Scheiner is himself a liberal and favors socialized medicine, in the form of Canadian health care, so no one can accuse him of being against total health care reform.  Given his leftist leanings one would expect him to be supportive of Obama’s vision for healthcare.  However he is one of his most severe and unforgiving critics.

What a different world it would be if Hilary Clinton had been elected President.

Wednesday, May 30, 2012

Breast density notification bill on its way to state Assembly

Misdirected Concerns prompt ill-advised regulatory bill in California  State Senate.


By Jason Green

Daily News Staff Writer

Posted:   05/29/2012 07:51:12 PM PDT

Updated:   05/29/2012 10:29:51 PM PDT

The California State Senate unanimously passed a bill Tuesday that would require women to be notified they have dense breast tissue if it is detected by a mammogram, according to its author, state Sen. Joe Simitian, D-Palo Alto.

Senate Bill 1538, which now heads to the state Assembly, would also force health care providers to explain that dense breast tissue can obscure cancer on a mammogram and to discuss the value of additional screenings.

Last year, similar legislation received bipartisan support but was vetoed by Gov. Jerry Brown. Simitian said his breast density notification law has the potential to save lives: Two studies from the first year of a similar law's implementation in Connecticut have shown a 100 percent increase in breast cancer detection rates in women with dense breast tissue who had further tests.

"My hope is that we can get to 'yes' this year and that we can begin saving lives as soon as possible," Simitian said in a statement. "This bill simply requires that information that is already shared between doctors also be shared with a patient herself. This is about a patient's right to know. It is about giving patients the information they need to be effective advocates for their own health."

Santa Cruz resident Amy Colton suggested the bill in 2011 during Simitian's "There Oughta be a Law" contest. The registered nurse and breast cancer survivor was never informed of her breast density during years of routine

mammograms and only discovered that she had dense tissue after completing her treatment for breast cancer, according to Simitian's office.

Dense breast tissue and cancer are difficult to tell apart on a mammogram because both appear white. A January 2011 study by the Mayo Clinic found that in women with dense breast tissue, 75 percent of cancer is missed by mammography alone.

An estimated one in eight women will develop breast cancer, according to the National Cancer Institute. The risk for women with extremely dense breast tissue is five times greater than the risk for women with low density breast tissue, according to Simitian's office.

If the bill is signed into law, California would join a growing list of states, including Texas and Virginia, with breast density notification laws. Congress and 15 states have similar legislation pending.

While well intentioned this is an unecessary state law and should be governed by the state medical board or board of radiology. This would increase costs to administer and enforce. (we need less government and governmental expense)

Email Jason Green at


Monday, May 28, 2012

More on Patient Centric Medicine


Not only do physicians, hospitals, insurers, need to become more patient centric but also device manufacturers as indicated by comments from implantable cardiac device manufacturers.

Ted Campos adequately describes how he wants access to data collected from a device implanted in his own heart.

TEDx Cambridge

Give me MY DATA!
Getting Health Data from Inside Your Body

Hugo Campos believes that patients with implanted medical devices deserve access to the data they collect.

I have this complex little computer implanted in my body, but I have no access to it," says Campos. "The best that patients can do is get a printout of the report given to the doctor, and that's designed for doctors, not patients. Patients are left in the dark."

Campos's goal is a new twist on the concept of open access, one that has emerged as implanted medical devices become more common and patients increasingly use wireless devices and smart-phone tools to track their health and take control of their care.

Campos, who talked about his efforts at a TEDx conference in Cambridge on Saturday, has approached both device makers and the U.S. Food and Drug Administration to try to get access to the data. But manufacturers have told him that the device is implanted to deliver therapy, not to provide information to the patient. And doing so is not part of their business model. He believes that because device makers see their primary market as physicians rather than patients, they are less motivated to make this information available to the people who actually live with the devices in their bodies.

And perhaps physicians should use only devices that patients can access their own data. That might change device makers ‘business model’.  After all the patient (or their insurer) is buying the device…..not the physician.

Pulmonary Artery Pressure Sensor for CHF


Sunday, May 27, 2012

Back To The Future of Social Media


By now you must be sick of reading about social media on the Health Train Express. However I have more reason than ever to believe social media will continue to gain ground in healthcare….Doctors love technology however are mostly late adopters. They like certainty and want others to  work out the quirks. That is how most of us were trained. Primum non nocere.  Whether this applies to social media, I cannot yet say but it appears to be going in that direction.  We saw it with HIT as electronic health records entered the user market as a consumer product rather than a techie experiment.  HIX is at that point now for hospitals.  Not many doctors or hospitals want to use a non-FDA approved drug.  So this pattern is well understood.

It has taken medicine close to 30 years to absorb practice management systems, then electronic health records for routine usage.

The pattern will be the same with social media. Social media will gain traction in general and health care, doctors and hospitals will repeat their pattern of late adoption.

In a study in Forbe’s Magazine:

“IBM Study: If You Don't Have a Social CEO, You're Going to be Less Competitive

When IBM (NYSE: IBM) conducted its study of 1709 CEOs around the world, they found only 16% of them participating in social media. But their analysis shows that the percentage will likely grow to 57% within 5 years.

Why? because CEOs are beginning to recognize that using email and the phone to get the message out isn’t sufficient anymore.

The big takeaway: That using social technologies to engage with customers, suppliers and employees will enable the organization to be more adaptive and agile.

Simply put, Physicians,  CEOs and their executives set the cultural tone for an organization. Through participation, they implicitly promote the use of social technologies.  That will make their organizations more competitive and better able to adapt to sudden market changes.

Other key findings of the study include:

CEOs are changing the nature of work by adding a powerful dose of openness, transparency and employee empowerment

Companies that outperform their peers are 30 percent more likely to identify openness – often characterized by a greater use of social media as a key enabler of collaboration and innovation

While social media is the least utilized of all customer interaction methods today, it stands to become the number two organizational engagement method within the next five years, a close second to face-to-face interactions.

More than half of CEOs (53 percent) are planning to use technology to facilitate greater partnering and collaboration with outside organizations,

CEOs regard interpersonal skills of collaboration (75 percent), communication (67 percent), creativity (61 percent) and flexibility (61 percent) as key drivers of employee success

  • The trend toward greater collaboration extends beyond the corporation to external partnering relationships. Partnering is now at an all-time high. In 2008, slightly more than half of the CEOs IBM interviewed planned to partner extensively. Now, more than two-thirds intend to do so.
  • CEOs are most focused on gaining insights into their customers. Seventy-three percent of CEOs are making significant investments in their organizations’ ability to draw meaningful customer insights from available data.

The IBM study shows that CEOs and the companies they manage must constantly evolve to stay competitive. Partners, suppliers, employees and customers want CEOs to communicate with them on a personal level to build trust and to help align them to the organization’s strategy. There is a lot at stake here. And if CEOs continue to hide in their Ivory Towers under the guise of some old command ands control mentality, the next chapter in their career might be written somewhere else.

You and I do not want to be left behind.”

This is becoming all ‘too true’ in the healthcare space as we are witnessing with accountable care organizations, past events with HMOs, PPOs, and the emergence of major health reform bills.


Monday, May 21, 2012

What do Physicians Know about Incentives?


$20B in incentives go to waste each year, says study

Not much according to  Healthcare IT News in an article by Stephanie Bouchard, Contributing Editor.

“As the healthcare industry continues to move in the direction of using compensation incentives, a new analysis reveals that incentives as currently used are not an effective motivator for healthcare professionals and waste an estimated $20 billion in resources. “

More than 75 percent of healthcare incentives are so small or poorly publicized that providers aren't even aware of them, according to a new study that suggests more than $20 billion in incentives may be wasted annually.


Health Care Providers and Incentives: What Works—and What Doesn’t

“While healthcare employers are offering their doctors and nurses compensation incentives, many of those health professionals were not aware of the rewards being offered or were not able to distinguish incentive pay from base pay, ZS Associates’ researchers found. One-third of respondents who did know about the incentives did not find them motivating.

The report makes four suggestions for improving incentive efforts:

  1. Increase the “at risk” component. Increase the amount of money that is truly at risk. If goals are not achieved, that will be reflected in the paycheck. That “at risk” amount needs to be greater than it commonly is currently, said Bernewitz, to get people’s attention.
  2. Sustain the signal. Instead of an annual summary of incentive payouts, provide regular summaries to increase awareness.
  3. Get the metrics right. Some incentive programs are so focused on metrics that the effect is to dilute the incentives, so employers should focus on a few critical outcomes and tie incentives to those, said Bernewitz.
  4. Communicate. Provide clear and frequent updates so employees can keep track of their goals and how they’re doing in achieving those through the year. Also give employees a chance to be a part of the incentive program design process.”

(author)SmileAs long as the metrics for incentives are correct and credible, physicians can buy into the new model for reimbursement. A key factor is reporting more than once a year, and perhaps quarterly.  The effects of change will not be apparent immediately.


Saturday, May 19, 2012

Improving modern medicine: Why social media is just what the doctor ordered


Alex Blau, MD, Medical Director at Doximity, is a graduate of the University of California San Francisco School of Medicine and trained in emergency medicine at Stanford Hospital and Clinics. He has been working in the emerging mobile health space since he was a senior medical student, when he founded MediBabble, an iPhone-based medical language interpretation tool now in use by more than 15,000 health care professionals. In addition, Dr. Blau has worked as a healthcare journalist, has been published in multiple journals and textbooks on emergency medicine, and has been an invited speaker at national conferences on early stage startups and innovation in

Improving modern medicine: Why social media is just what the doctor ordered

The potential is huge; but until very recently, physicians have been largely unable to take full advantage of what these connections have to offer. Specifically, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 prevents doctors from using email or text messaging, much less open platforms like Facebook or Twitter, to communicate about patient care without risk of being fined or fired.

Still, the potential for physician-focused, web-based networks is huge, and HIPAA-compliant tools and sites have indeed started to take shape and populate.

Healthcare itself has been (often rightly) criticized as slow to change. In fact, Dr. Leslie Saxon recently published an insightful article on why the Internet hasn’t yet had any real impact on how medicine is practiced.

But research has shown that as far as technology goes, doctors themselves have proven to be early adopters. Having seen the kinds of conversations that have already begun to take place, I strongly believe that the future of digital medicine will be anchored in these kinds of connections.

Think, for example, of the impact of having a rural doctor in Alaska be able to send pictures of a complicated emergency case to a former classmate now working at a stroke center in Boston — and getting real-time feedback. This is where, in my mind, social networking truly goes from entertaining to life-changing.


With physicians connecting in real time across specialties and beyond the traditional bounds of hospital walls, patients may soon be able to stop worrying about getting access to the right specialist.

Medicine’s brightest minds will be accessible from the remotest spots — on an airplane, at an underserved clinic, or in the thick of a disaster zone. Soon, any doctor with a mobile device will have the resources and reach to pull together a personalized, patient-specific team of experts for any given case. Sometimes, it will take as little as a question to the right expert in a sub-specialty to change the course of treatment for the better. In other instances, more lasting and meaningful collaborations might take shape.

Information itself is poised to travel differently, too. Facebook and Twitter are already showing us how effectively networked communities can transmit important data, and even bring obscure new ideas to the forefront of cultural debate.

For doctors, who have historically relied heavily on sifting through a surfeit of medical journals, this kind of hive-minding can help ensure that the most promising and thought-provoking research or techniques rise to the surface and reach a wider audience. Moreover, by posting, sharing, and commenting on articles and cases within their professional networks, physicians will become more active and engaged participants in the future of medical research and learning.

The existence of these large and overlapping communities of doctors promises to tap a goldmine of public health data. Using discussion threads about symptoms and outbreaks, the spread of infectious disease can be tracked automatically, as can the efficacy and speed of treatment plans. Complications of new therapies, previously unknown risk factors for common diseases, even entirely new disease entities may be identified from increased sharing of data that has until now lived in the filing cabinets and memories of individual physicians.

The social power of networks like Facebook and Twitter to connect, entertain, and enrich our lives is undeniable. It’s time to extend the networking paradigm to healthcare and reap an even more substantive set of rewards.

As a newcomer, Google plus and their unique video conferencing platform offers a ground breaking easy, and inexpensive video conference API (up to ten two way participants and live on air to an unlimited audience presents the opportunity for medical education.  On a one to one video hangout the opportunity to do a house call, see a patient for a post op visit, screen complaints and organize your time efficiently. Broadcast a surgical procedure on air with patient permission and some time delay with an expert physician moderator.  A prototype broadcast is available,

Live Broadcast Google Hangout Thyroidectomy


Friday, May 18, 2012

Meaningful Use Creep


One of the features of government is it’s inherent native ability to grow, creating a chain reaction of necessities for it’s survival.

Organizations always seem to add items piece by piece until a relatively simple idea becomes distorted.

Such now seems to be the case for meaningful use as defined by HHS for physicians to qualify for incentive payments.

GAO: Doctors should submit more data to get meaningful use money (amednews)


Hmm.  Isn’t GSA the outfit that went to Las Vegas ? Or was that the GAO?  Maybe they should check out their own house and stay out of Medicare’s business and healthcare decision making. There also appears to be some confusion in the details of who’s who in the debacle. Several sources used the term GAO and other used GSA. This investigator had some trouble finding the correct quotes made in the news.

The GAO has proposed new criteria for M.U. and in addition to that they propose new audits to  verify proper reporting by physicians in order to qualify for

Physicians soon could be required to submit more documentation to the Centers for Medicare & Medicaid Services to validate whether they are authorized to receive meaningful use bonuses.

Saying that the Medicare incentive program is vulnerable to making improper payments, the Government Accounting Office examined the process, called attestation, that CMS uses to validate whether physicians have met meaningful use requirements. The agency recommended that CMS examine its process for auditing the incentive program and collect more information from physicians before payments are made so they won’t have to return money to CMS.

CMS agreed that its process for verifying meaningful use eligibility could be made more efficient for the agency — and more stringent for those applying for incentive pay.

The current process, called ‘attestation’ depends upon

The Medicare incentive program is facilitated directly by CMS, and the Medicaid incentive program, like the Medicaid program, is administered at the state level. The GAO examined the eligibility and reporting requirements for the Medicare program, and the reporting and verification processes in four states that have a Medicaid incentive program up and running. As of March, 44 states had programs in place, and 40 had begun issuing incentive checks.

What needs verification

Medicaid requires additional reporting that Medicare either does not require or does not verify until after payment is made. The GAO would like to see the Medicare requirements expanded to match those of Medicaid.  One example is that to meet the requirement that data be sent electronically to an immunization registry or immunization information system, Medicaid program participants must submit the name of the registry where they sent data and whether it was sent successfully. Medicare participants are required only to attest that it was done.

CMS also agreed that it needed to evaluate its auditing process to ensure its effectiveness. Kuchler said its auditing program is being implemented and that a contract was recently awarded. It plans to start audits later in 2012.

About 10% of hospitals and 20% of professionals receiving incentive checks will be selected at random for auditing. Some also will be targeted for audits.  Kuchler said whatever CMS does with the GAO recommendations, it “is conscious of not adding unnecessarily to the burden providers face in reporting for this program and will certainly factor in the element of additional time in its determinations as we move forward.”

Among the GAO’s recommendations was for CMS to offer to collect quality measure data from Medicaid program participants on behalf of the states. But CMS rejected that recommendation, saying the states that have launched incentive programs already have portals in place and that there are no significant barriers to states collecting this information on their own.

It seems to Health Train Express and our new partner, Digital Health Space that MU reporting would be electronically be verified when the information is submitted via billing or through whatever means they propose to collect the data. If no one is going to receive the data or look at it, why report it? 

And as usual the fine print is

Physicians who received improper payments would have to return the money to CMS.

So, what else is new? 


Thursday, May 17, 2012

Social Media or Search Engines……The Chicken and/or the Egg?


Just a short time ago physicians and scientists had primarily one readily available search engine, sponsored by the National Library of Medicine and the NIH. It was and is still called “PubMed”.  Numerous iterations developed in the past two decades to search a variety of data bases held by the NLM.  You had to be an “insider” and educated about Boolean logic and commands to optimize a search for the most meaningful answers.  Too many answers can be worse than too few.

Google ranks high for health research, but all search engines lacking.

The top four search engines all provide "rich" health and medical information, but none of them stand out as the best, according to a new study published in the Journal of Medical Internet Research.

The researchers, from the University of Missouri and China, compared the top four search engines--Google, Bing, and Yahoo!--for usability and search validity. They noted that most people use just one search engine when conducting research on a health-related topic, and then view the websites only on the first page of the search. The researchers wondered if this was the best way to obtain information.


Patient online health research has been on the increase and can improve patient care, but has been known to be faulty. Online searches are also increasingly being used by patients to compare provider costs and by physicians to augment their own research.

Search engines themselves are the subject of scrutiny and evaluation with changing search engine algorithms. The most popular search giant Google also has a Google Scholar feature. Google’s engine has been tweaked to assess relevance instead of ‘page rank’. Page rank serves well for marketing and sales but does not serve scientific research well.

At a time when I trained the typical physician would request the medical library (librarian) to direct a search and provide a list to the physician. Today the size of medical libraries is shrinking and the staff is as well. Some of their strengths have been replaced by ‘self service’ using modern internet technology and access to library subscriptions for full text article.  This has proven to be efficient for most users.

At times physicians and patients use the same search engines, and I always want to source another reference that a patient would not have access to.  After all they reimburse me to add some value to the visit about  their illness that they would not already have access.  My own opinion is reflected aptly by this opinion,

“And while 90 percent of the physicians said that more access to online medical information and resources improved the quality of care at their organization, a fifth said that patients' online health research has "been detrimental, leading to misinformation and incorrect self-diagnosis." In fact, more than half (53 percent) of those surveyed ranked "patient misinformation" as the top barrier to good doctor-patient communication, trumped only by lack of time with patients (78 percent).”

Notably, the survey revealed that physicians get their online health information from some of the same sources as patients with search engines, such as Google and Yahoo, ranking second only to medical journals as resources used by physicians.

It’s another item to “Google”

Leveraging the advances in search engine software has been increased processing power, memory and the transition to mobile devices, such as smartphones, tablet pc, and voice recognition software, such as iPhone’s Siri.

Where is the connection (if any) between the chicken and the egg and Social and Search?

Before:    1999                                                        After:  2012

Image Detail   Image Detail

If you have clicked on the above links to search engines or use one of the above you quickly realize that the landing page offers much more than search with the presence of social media platforms as well as advertisements.  Search and social are a driving economic infrastructure which has become vital to health care and physicians (whether they recognize it, or not)


The interaction of patients and physicians may begin in social media and rapidly transition to a ‘search’.  The mergers of several internet giants include Google, YouTube, and searches can include both directions to include scientific video programs, and educational courses on YouTube.


Like it or not, online health information--regardless of its accuracy--likely will supplant doctors as the primary source of health information as consumers grow more eHealth savvy.

Wednesday, May 16, 2012

First Surgery Broadcast Live on Google Plus Hangout


Small print:  time delay due to  hospital and legal restriction on live broadcast.

Patient centric medicine, openness and transparency  are some of the new “buzz words” we see in social media and from health care consultants.

Many patients desire this,  asking for more information to the point where some physicians become uncomfortable being this open with a patients’ private concerns. However we are all witnessing in social media patients requesting the use of social media, be it Facebook, twitter, email, or even newer platforms such as Google.

Even I was surprised when one of my social media friends requested that her thyroidectomy be broadcast live via a Google Hangout.

Without going into great detail, the video is presented without editing, and accurately  reflects the typical technical difficulties in the operating and unexpected glitches. The surgery went very well, and for a first time amateur hangout the recording went fairly well.

I had technical support from several other social media friends, handling network connections, and also two moderators advising me and controlling cameras, and audio.

Let’s join the surgery.

This undertaking was done with the full consent of the patient and the surgeon. The primary concern was delaying the transmission of the live feed. 

We are in a ‘brave new world’ with advances in health information technology, patient centric medicine, openness and transparency.  We have left behind the ‘cloistered’ spaces of the operating rooms, and the mysteries of the hospital.

It is important for our patients to become more informed (if they wish to) about their environment, especially to reduce their apprehension about what is occurring when  they are under anesthesia

Even as an experience surgeon when I returned to the video recording, it was quite exciting to watch  as an observer.

We hope that patients will see this video, have questions and comments, and surgeons alike will see the possibilities to watch a family member have surgery,  even from the comfort of their own home.

As a point of information this event was not sponsored by Google and was the product of myself, Dan McDermott, Mike Downes and Hermine Ngnomire.

This presentation is the beginning of a work in progress.  My vision and prediction is that this type of broadcast will become routine for patients and their families when and if desired.

The technology is readily available and very inexpensive. It can be accomplished with a Laptop PC, a webcam, and Wifi and in some cases hangouts can be run on 3G or 4G cellular networks.

Hangouts such as this for home health care, post discharge for patients at home, in home health services for disabled patients and technical assistance for patients and their families with durable medical equipment. The cost savings could be enormous.

We also had several anchor news people connecting with us from FOX LA and

I expect this to open a conversation and controversy.  Let’s hear from the readers.



Monday, May 14, 2012

HealthTrain is getting an Overhaul


At times there is so much information we go off the track. I am optimistic the new blog design will allow readers to move around to different posts, without following a timelines.

It’s easy to believe I have been at this blog for almost ten years, beginning in 2004. The world of blogging has evolved into social media. I do not believe blogging is dead by a long shot. It facilitates writing about topics of interest and in many cases serves as a ready made web site.

The most commonly used blog platforms seem to be WordPress and Blogger. Wordpress has the advantage of sophistication and adaptability, Blogger fits into Google’s scheme of things and is easy to use and integrate with gmail, greader, gsearch google plus and gwhizz (the last one is of my making)

Beginning with my next several posts there will be some major changes. The goal is to emphasize content. The plan is to reduce clutter and utterly irrelevant links on my pages.  As it turns out no one uses those links anymore.

Several years ago the links to other pages, and places were more important, backlinks were almost essential and readers came from other bloggers who linked to your blog in return for reciprocity. That is not the case today.

Even RSS feeds are a thing of the past, unless you are wedded to readers.

For my purposes twitter, facebook and Google plus offer much.

The new Blogger Dynamic views will allow readers to skip around and not be confined to a timeline.

Impact of California’s Recession on Health Care


It would be inappropriate to ignore the effect of further cuts in California’s budget upon health in California. He proposed cuts to hospital and nursing home funding to lower MediCal costs; a 7 percent cut in In-Home Supportive Services;

"Amazingly, a year and a half into Brown's governorship and we still hear nothing of the unemployed," Del Beccaro said. "California will continue to face chronic budget deficits because so many people remain out of work.  Of course unemployed people do not have health insurance, and even if eligible many cannot afford COBRA coverage, either. 

Unemployment also has secondary direct and indirect consequences upon health. Reduced income affects nutrition. It becomes critical that low income people are educated about nutrition and the federal SNAP (formerly called “ Food Stamps “).

Physicians do not operate in a vacuum and it is important for them to inquire about employment.

A great percentage of the population in the U.S. is obese and paradoxically malnourished.

Gov. Jerry Brown's May Revise of California Budget 2012-12


While reductions to public services (IHHS) are significant the overall effects on Medi-Cal could be far worse.

Unemployment continues to be a major contributing cause to reduced state income and an ever upward spiral of deficits.  Has it reached a point of no return? Would you bring a business to California

Knowing what you now know, would you open a medical practice in California? Are you considering leaving California, or just leaving medicine.?

Medical Tort Reform in the Nutmeg State


While not a complete avalanche for malpractice tort reform, the docs of the nutmeg state seem to have held off the attempt to ease restrictions on filing malpractice suits against physicians.

The Connecticut Mirror  (Hartord, CT) reports:

You don't see this every day: The speaker, majority leader and minority leader all on the losing side of a 74-69 vote in the state House of Representatives.

On a bipartisan vote, the House on Thursday gutted a bill aimed at loosening the requirements for bringing a medical malpractice lawsuit, an issue that has sharply divided health care providers and plaintiffs' attorneys.

The bill would have altered a 2005 tort reform law that requires anyone who files a medical malpractice lawsuit to submit a written opinion, called a certificate of merit, from a "similar" health care provider to the one being sued, testifying to the appearance of medical neglect.

It sailed thorugh the Senate last week, but its backers were stunned Thursday night when the House gutted the bill by rejecting a Senate amendment that effectively had become the bill. After the rejection, the House leadership shelved the bill.

Eleven Republicans -- many of them lawyers -- joined 58 Democrats in support, but 41 Republicans teamed with 33 Democrats to kill the measure after opposition on the floor led by Rep. Prasad Srinivasan, R-Glastonbury, the only physician in the General Assembly.

Rep. Prasad Srinivasan, R-Glastonbury

The measure was aimed at preventing what health care providers said were frivolous lawsuits that contributed to rising malpractice insurance costs. But critics of the requirement have said it's too restrictive. They have pointed to cases that were dismissed because the physicians who wrote the opinion letters weren't considered "similar" to the ones being sued. In one case, a court dismissed a lawsuit against an emergency physician because the certificate of merit was written by a doctor who described himself as practicing trauma surgery, even though most of his work time was spent in an emergency department.

An earlier version of the bill would have changed the requirement for the author of the certificate of merit, from requiring a "similar" health care provider to a "qualified" one. That drew opposition from health care providers, who argued that it would gut the 2005 malpractice reform measure.

The bill the Senate passed Friday would not remove the law's reference to the need for a certificate of merit from a "similar" health care provider, but it also provides another option: The letter could be written by a health care provider who the court determines has enough expertise in the type of health care at issue in the complaint that he or she could testify as an expert on the standard of care. The certificate of merit would have to include a detailed basis for the provider's belief in the evidence of medical negligence, and identify one or more breaches of the standard of care.

Legislators from both parties described the proposal as a reasonable compromise, but the Connecticut State Medical Society said it did not endorse the bill as a true compromise.


2012 The Year of mHealth


Mobile Technology

HealthWorks CollectiveREGISTER NOW: An exclusive, live webinar
May 23rd at 1pm ET/10am PT

How does mHealth improve patient access to better care?

Mobile Health, or mHealth, is a rapidly growing strategy that many healthcare professionals say can increase efficiency, cut costs, provide better customer service, and help handle tough circumstances such as a remote or incapacitated patient. mHealth consists of the use of the latest communication devices and technology to bring healthcare services to the patient. Advocates claim the applications of mHealth are numerous, aiding with: remote monitoring, behavior modification, data collection, step-by-step instruction, question and answer forums, doctor visits, and even diagnosis.
Join us as our panel will provide their expert advice and answer your questions, as we ask:

  • Has the public accepted the idea of mHealth? Do they agree that a "remote" doctor consultation provides value to the patients and improves the care process?
  • Does this technology interfere with the professional ethos of physicians to examine and treat individuals holistically?
  • Are there privacy concerns involved in taking healthcare to the communication networks?
  • What are the Telehealth, Web, and Mobile phone models, and why does the model you use suit your needs best?
  • What's in the future for mHealth?

If you cannot attend the live session, please feel free to register and you will receive an email notice when the archived webinar is available on-demand.

Register now to join us and ask these experts your own questions!

ImageDr. Marc Mitchell, MD, MS founder and president of D-tree International, is a pediatrician and management specialist who has worked in over 40 countries in Africa, Asia, and Latin America on the design and delivery of health care services.

ImageAlex Blau, MD, Medical Director at Doximity, is a graduate of the University of California San Francisco School of Medicine and trained in emergency medicine at Stanford Hospital and Clinics.

ImageHerb Rogove, DO, FCCM, FACP, is President/CEO of C3O Telemedicine, which is a multispecialty virtual practice that solves the problem of quick and affordable access to specialists in Tele-ICU, Tele-Neurology/Neurocritical Care and Tele-Psychiatry.

ImageModerator Brian S. McGowan, PhD is a research scientist who has worked as a medical educator, mentor, accredited provider and commercial supporter.

Sign up for this exclusive webinar »

The Battle over Health Care


Now that we have “Obama Care:” we have a proposal that indicates Americans do want a major health system revision. 

If one reviews the long term evolution of how this played out in Congress, Democrats were intent on getting ‘anything’ passed for the political expediency and gain, while Republican’s cool reception seemed to be more of a “we can get a better bill”, and were reticent to pass a global sweeping law that despite it’s voluminous size missed major key points to control costs.

eJanardan Prasad Singh, and Rosemary Gibson in “ The Battle over Health Care” continue on the theme of their previous book, “Wall of Silence” which was critically acclaimed.

Each of these books are available in electronic form. I read parts of Wall of Silence and found it emotionally draining, even after 40 years of treating patients. Equanimity and imperturbability only go so far.

The battle (s) over health care is by no means over. Passage of Obamacare sets the framework from which hopefully better solutions will arise.

According to Gibson the conundrum resides in the fabric of the American economy, corporate attitudes, profit margins, durable medical device manufacturers, and an insurance industry that has a firm lock on health care.

Gibson and Singh take a broader perspective on health care reform not as a single issue but as part of the economic life of the nation. The national debate unfolded while the banking and financial system teetered on the brink of collapse. The authors trace uncanny similarities between the health care industry and the unfettered banking and financial sector. They argue that a fast-changing global economy will have profound implications for the country’s economic security and the jobs and health care benefits that come with it, and they predict that global competition will shape the future of employer-provided insurance more than the health care reform law.

The judicial review serves as an interlude or recess in the process while the Supreme Court is faced with unlocking the myriad details of the law including but not limited to the ‘individual mandate”

One could say that politics should play no role in your healthcare, however the basic underlying relationships between the free enterprise system, insurers, providers, and patients has evolved into near anarchy….thus the government steps in.

Gibson and Singh provide the stage on which we are players, however they do not propose a solution.

Sunday, May 13, 2012

A New Beginning in the Digital Health Space


Today’s post is the first using our new and as yet unproven template design. So follow along with me and send me your comments via twitter @glevin1 or on Google Plus.

The first design is called “Flip Card”.

We’ll be departing the station with some entertainment, “World’s 25 best Health Systems. Hope you enjoy the content and the music.  Blogs should not be boring, they should be fun.

Here we go !

World’s Best Health Care



Sadly, the United States lags behind many other nations in applying telemedicine, however with concerns about increasing cost of conventional office visits it is now becoming  more common.

In Europe SAMU or (SAMU - System of Emergency Medical  Assistance)  in France- has been in operation for many years. A similar system operates in Brazil.


Telemedicine  incorporates the use of broadband and/or satellite communication between provider-provider provider-patient and provider-provider depending upon the need.

Telemedicine is defined the use of telecommunication and information technologies in order to provide clinical health care at a distance. The term includes a wide array of functionality

Most patients and providers picture a physician at one end of a link sitting in front of a video monitor talking to a patient in a different location.  However telemedicine is much more inclusive, including the following.

Telemedicine can be broken into three main categories: store-and-forward, remote monitoring and (real-time) interactive services


Real Telemedicine in Action, Ready for the big time

Thousands of heart patients can take advantage of new technology at two Piedmont hospitals that makes their lives much easier.

Cone Health and Forsyth Medical Center are part of a pilot program testing Carelink Express by Medtronic. Carelink allows doctors to collect information from defibrillators and pacemakers in five minutes, much faster than before.

Steven Klein, cardiac electrophysiologist at Cone Health, said hospitals used to call in technicians at all hours of the day to get information from the implant.

“Once they made the decision to do it, it would probably take 30 minutes to an hour before someone could get there to look at the information,” Klein said.

And if there’s nothing, patients can be released more quickly, saving them money, Klein said.

“The patient care is improved because they don’t have to spend so much time in the emergency room,” Klein said.

Carelink device also allows doctors to get information while the patient is at home.

The pilot program will last for another six months. If things continue to go well like they have been so far, the technology will expand to other parts of the country, Klein said.

Surveys indicate the increasing use of telemedicine in daily operations. It will undoubtedly become main-stream as reimbursement standards address the cost of this functionality. Even with the expected increase in capital investment the savings will more than offset the  expense and a documented ROI.


Saturday, May 12, 2012

Summary of HIT Meetings and Offerings in May and June


HIT offers multiple events in May and June 2012

Here are the first 14 events scheduled on/after May 11, 2012

MAY 14

DOD, VA Meeting on Data Sharing, Integrated EHRs

May 14-15, Alexandria, Va.

MAY 14

Health 2.0 Spring Summit on Health IT, Innovation

May 14-15, Boston


Harvard Summit on Leadership in Health IT Sector

May 14-18, Boston

MAY 15

Meeting of ONC's Meaningful Use Panel, Subgroup 2

May 15, Online, Teleconference

MAY 16

Meeting on Taking Small Steps in Mobile Health

May 16-17, Palo Alto, Calif.



Brookings Event on Mobile Technology, Health Innovation

May 22, Washington, D.C.

MAY 24

HealthTech's Annual Exhibition, Conference

May 24-25, San Francisco



Meeting of ONC's Meaningful Use Panel, Subgroup 2

May 30, Online, Teleconference


Meeting of ONC's Meaningful Use Work Group

June 5, Online, Teleconference


Third Annual HDI Forum & Health Datapalooza

June 5-6, Washington, D.C.


Summit on Issues Related to Health Data Privacy

June 6-7, Washington, D.C.

JUN 12

Conference on Health-Related Video Games

June 12-14, Boston

JUN 14

Summer Summit on Successful Use of Digital Health

June 14-15, San Diego


Mayo Clinic's 2012 Symposium on Health Innovation

Sept. 9-11, Rochester, Minn.

Read more:

CHCF releases results of Medi-Cal Survey


According to a new survey by the California HealthCare Foundation, most Medi-Cal enrollees have a favorable view of this essential health coverage program. However, barriers to access and enrollment exist.

If upheld by the Supreme Court, the Affordable Care Act could add two to three million people to the Medi-Cal program, potentially exacerbating the issues raised by enrollees.

CHCF announces a Sacramento briefing that explores the results of this survey of more than 1,000 Medi-Cal enrollees — the largest of its kind. Presenters will explore the experiences and attitudes of enrollees to illuminate where the program excels and where improvement is needed.

They will also consider implications of the findings for state lawmakers and program officials who are considering ways to slow the growth of Medi-Cal spending as they prepare to integrate millions of new enrollees. A series of short videos will offer individuals' reflections on their experiences with the Medi-Cal program.

Presenters and panelists include:

  • Len Finocchio, associate director, California Department of Health Care Services
  • Elizabeth Landsberg, director of legislative advocacy, Western Center for Law and Poverty
  • Chris Perrone, deputy director, Health Reform and Public Programs Initiative, CHCF
  • Tresa Undem, partner, Lake Research Partners

The conference will be broadcast via Webinar or you  can attend in person.


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Thursday, May 10, 2012

Health Information, Social Media and Broadcasting



At this point in my writing most of you now realize I have become indoctrinated in all aspects of social media, from Twitter and Facebook to the new G on the block. No not Guy…but G+.  Google plus offers some unusual features, the best of which in my opinion is the  Google Plus Hangout.  A new feature which just ‘rolled out’ is the ‘Hangout Live On Air”.  

A normal hangout allows for a total of 10 participants, nine others besides you. Google now owns You Tube and has integrated many features from YouTube into Google and vice-versa.  The integration of this feature allows for an unlimited audience as the broadcast occurs beyond the limited 10 in the hangout. In addition the HOA is recorded, archived and can be viewed at anytime.

What does all this cost…you ask ? Zilch, if you discount the need for a broadband internet connection and a computer capable of supporting a web camera.

I hope that some of you will join the G+MD hangouts to be held regularly to organize this as a regular “Hangout Event”  It will be titled  “Medical Minutes”.

The initial hangouts will consist of some ‘housekeeping tasks” and organizational information. If you use twitter set a hash tag for #glevin1. Announcements schedules will be sent via twitter and Google plus. The Stream is at +Digital Health Center.


Report: Some Good News California Health Care Spending Grows, Rate Slows


Despite my gloomy report yesterday on the failures of many medical and group practices, todays statistics offer some encouragement.

Total spending on health care in California grew by almost 300% from 1991 to 2009, but the state's spending growth rate has slowed in recent years, according to a new report from the California HealthCare Foundation, the Los Angeles Times' "Money & Co." reports.

According to the CPI as published by the U.S. Dept. of Labor the overall rate of inflation for the CPI is 2.7% for the last 12 mos. (03/12) and 0.3 for 03/12.

Medical care commodities             
                        09/11  10/11 11/11 12/11 01/12 02/12   03/12     
2 .3 .2 .2 .6 .8 .4 0.8 0.4 end 03/12 3.3

CHCF publishes California Healthline.

Report Findings

According to the report, "Since reaching its peak of 9.7% in 2003, the pace of growth in health spending has been decelerating. By 2009, towards the end of the recession, spending grew [by] 4.5%, similar to the U.S. rate of 4.6%, and the slowest pace since 1999." Although medical inflation continues to exceed the general increase in the CPI the rate of increase is declining,  with the general CPI at 2.7%  and the Medical CPI at 3.3%

The report also found that:

  • Health care spending in California per capita in 2009 was $6,238, the ninth-lowest in the U.S.;
  • Spending on health care accounted for 12.2% of California's economy, a smaller portion than most states;
  • Hospital and physician services accounted for the majority of health care spending, at 63%; and
  • Medicare and Medi-Cal, California's Medicaid program, accounted for nearly 40% of the state's health care spending, compared with 27% in 1991 (McMahon, "Money & Co.," Los Angeles Times, 5/9).


Wednesday, May 9, 2012

Shocking Medical Financial News

During the initial period of my medical practice in California (1970-1980) the finances of running a medical practice seemed straight  forward. In 1980 things began to change and by 1986 most physicians were bracing themselves for what seemed to be an Armageddon.

Looking at physical facilities for medical clinics and hospitals and the  development of marketing techniques and continuing profitability of insurance companies and their stockholders it  became apparent who was suffering the most…providers and patients.

I had the opportunity to review financial reports from the California Health Care Foundation.  I knew things were bad, but had no idea how bad it has become.


Beginning in 1999 until  May 1,  2012  there were 260 medical groups that were closed due to financial failure and/or absorbed by another entity. 5,695,685 lives were effected by these group closures.  NUMBER/PERCENT OF CLOSURES DUE TO FINANCIAL PROBLEMS 97/ 37.3%.

The CHCF report is 46 pages long and can be found amongst these other reports:

PDF File 1

PDF File 2

PDF File 3

ZIP File 4

PDF File 5

PDF File 6

PDF File 7

PDF File 8

PDF File 9


Approximately one in five Californians lost continuity of coverage, or moved to another group. The not so hidden legal costs are obvious and added to the legal tort fiasco.  Other financial impacts are not accounted for by the inefficiency involved in transferring care to  a new doctor or medical group.

In Summary":

Highlights for 2009 include:

  • Health spending in California reached $230 billion, triple 1991 levels.
  • California's per-capita spending of $6,238, was the ninth lowest in the nation. By comparison, the US spending per capita was $6,815.
  • Health spending accounted for 12.2% of California's economy — a smaller share of the economy than most states or the nation.
  • Hospital and physician services continued to account for the majority of spending, totaling 63%.
  • Medicare and Medicaid accounted for nearly 40% of California health spending, up from 27% in 1991.

Read more:

What will health information technology, health information exchanges, electronic health records, accountable care organizations, outcome studies, new ICD codes, elimination of procedural based reimbursement accomplish.

How will our system increase the number of primary care physicians.

All these issues face the current and next generation of health experts and physicians.


Tuesday, May 8, 2012

My Struggles with Social Media


Breaking Blogs (from Summify)

Doctor’s Love-Hate  Relationship with Electronic Health Records…It goes something like this  LOVE/HATE

Creative Destruction, What it Means for Healthcare, Clinical Practice and Consumers?

It goes a bit like this, Creative Destruction

Insurers Embrace 'Virtual' Doctor Visits’ (does this mean they will pay for them?)


Strategic Investment in Health Resources (Financial)  Editor’s note: Dave Chase is the CEO of, a patient portal & relationship management company that was a TechCrunch Disrupt finalist.


Following in a long shadow cast by eminent blogger and social media expeert, Dr. Mike Sevilla (formerly known as Dr Anonymous) Health Train Express will partner with Digital Health Space for a series of interviews on Google Plus Hangouts, Live on Air

I am developing a list of interested social media experts in health care for an interview. Social media in healthcare is a  rapidly developing function for patient involvement in a niche unrelated to HIPAA regulations.  Our goal is to educate providers and hospitals how to use the new platforms safely without violating the law.

Check back here or at Digital Health Space for upcoming events.


Friday, May 4, 2012

Social Media and Meaningful Use…will be Symbiotic for Digital Patient & Provider Empowerment


Now that is a mouthful, one that came to me while reading an article from Healthcare  IT News.

Jennifer Dennard, Billian's HealthDATA, Porter Research, talks about “Blowing the Social Whistle on Patient Acquisition” Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA, Porter Research and Connect with her on Twitter @SmyrnaGirl.


Social Media seems a total disconnect from criteria for meaningful use of electronic medical records and the ability to qualify for incentive funding by Medicare.  Well, guess again. One of the Meaningful Use, stage II requirement is digital inclusion of patient involvement in access to electronic portals, and medical data.

Not only does Stage II of Meaningful Use call for patient portals and the like it will require enticing patients to use them

This is where Social Media becomes almost essential to a medical practice. “The ‘empowered patient’ responds to this type of marketing – they don’t even pay attention to traditional media. They are the influencers. As Stage 2 of Meaningful Use comes out and providers are required to activate patients online, they’ll need to grab the empowered patients they already have and turn those folks into evangelists.”

It’s a marketing concept not unlike that used in traditional consumer areas. Connect with consumers online, establish trust and credibility with those fans/followers, and then make them an evangelist for your product. Eventually, their fans, followers and family members will also become your customers. That’s the simplified version, anyway.

Sengbusch and his team realize that providers will often jump out of their comfort zone to engage with patients in these more social areas. He stresses that it’s important docs realize “they don’t personally need to be on social media, but they need to be open to their brand being on social media so the can capture positive reviews and become aware of patient advocates.”

And now the added attributes required for Stage II meaningful us.