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, June 30, 2012

#mHealth is Here, Now along with #hcsm



Top Paid Medical Apps for iPhones (from the iTunes store)



1. Pill Identifier ($0.99)


Pill Identifier allows you to identify more than 10,000 different over-the-counter and prescription pills based on their appearance. Search by imprint, size, shape or color.

2. Pregnancy ++ ($2.99)

Developer: Health & Parenting Ltd.

Pregnancy ++ tracks the course of your pregnancy, including your weight, diet and exercise. It also includes HD fetal pictures, a kick counter and a contraction counter.

3. Baby Connect (Activity Logger) ($4.99)

Developer: Seacloud Software

Baby Connect tracks your baby’s everyday activities (including feeding, sleep, growth, health and vaccines) and creates graphical reports and trending charts. The information can be shared between parents, nannies and other child care providers.

4. Instant ECG: An Electrocardiogram Rhythms Interpretation Guide ($0.99)

Developer: iAnesthesia LLC

Instant ECG is an app for health care professionals, which teaches the basics of reading electrocardiograms (ECG). The app offers video demonstrations of 30 different arrhythmias to teach and then test a provider’s ability to diagnose irregularities.

5. MedCalc (medical calculator) ($0.99)

Developer: Mathias Tschopp and Pascal Pfiffner

MedCalc gives health care professionals access to more than 200 different diagnostic formulas, scores, scales and classifications that help measure a person’s health.

6. Pill Reminder by ($0.99)


The Pill Reminder App keeps track of all of your medications, vitamins and supplements. Set up reminders to take your meds or refill a prescription, and check for drug interactions, dosage information and possible side effects.

7. Anatomy 3D: Organs ($1.99)

Developer: Real Bodywork

Anatomy 3D: Organs teaches users about structure and function of internal organs using 3D models, videos, audio lectures, diagrams, quizzes and a glossary.

8. Diagnosaurus DDx ($1.99)

Developer: Unbound Medicine, Inc.

Diagnosaurus DDX helps health care providers accurately diagnose patients quickly at the bedside. Providers can search over 1,000 differential diagnoses by organ system, symptom and disease, and use a special feature to consider alternative diagnoses when multiple conditions are possible.

9. Everyday First Aid ($0.99)

Developer: Portable Monster LLC

Everyday First Aid offers users information on how to handle an emergency. The medical information is based on guidelines from the American Red Cross and other health organization, and tells you how to handle situations including choking, wound cleaning, jellyfish stings, tick bites and heart attacks with illustrated training guides.

10. Drugs & Bugs ($5.99)

Developer: Haymarket Media

Drugs & Bugs is an app for medical students and health care professionals who care for patients with infectious diseases. It provides information on more than 100 antibiotics and nearly 200 bacterial pathogens, and allows providers to compare the effectiveness of various drugs.


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Friday, June 29, 2012

Hangout Therapy for Immobilized and Challenged Patients


Virtual Photo Walk Tour, Capture Image of Toronto Canada, courtesy VFW.

Today’s Health Train Express delivers us to a wide variety of global tourist interests. The power of technology is readily harnessed with new, innovative and affordable consumer devices.


I have been privileged to work with many talented individuals, our cofounders, Bruce Garber (in Boston, MA), our announcer, video producer, and John Butterill  Ontario Canada) CEO of Virtual Photo Walks.

VPWs are routinely broadcast, as scheduled events.

In today’s VPW we had several patients challenged with advanced neurologic diseases, multiple sclerosis which render them non ambulatory.

The technology necessary for this is a simple webcam, laptop with broadband internet and even works well with smartphone or tablet pc’s running on a cell network for the VPW.  The broadcast locations were all transmitted using either an Android device or an iPhone using 4G cell connectivity.

I have included several previously archived events. The live events can be viewed via a ‘Google Hangout on Air’  (HOA).

KOMU TV news Anchor Sarah Hill is a journalism professor at the University of Missouri and is a pioneer Google Hangout person, championing it’s use in health, charitable fund raising, news gathering and in education.

Follow her narration of our next virtual photo walk.



Australian Beach


Japanese Cherry Blossoms




Virtual Photowalk in Singapore

For future events go to . Also please visit our YouTube Channel at  Virtual Photo Walk for the archives.

Virtual Photowalks invites requests for specific patients to be scheduled. Photowalks are global in nature and we have resources on all continents (we are working on Antarctica)


Something This Way Wicked Cometh.



The New Yorker this morning has an article by Atul Gwande MD with that ominous title.

Pumping up the rhetoric seems to have been the present outcome of the Supreme Court Decision about the Patient Protection and Affordability Care Act.

Here comes the list of the present ‘winners’ and ‘losers’


It's the bitter pill 24 hours after the supreme court decision(s) on PPACA.

The decision leaves a trail of winners and losers, from Main Street, USA, to the very steps of the Supreme Court. For some, it's a mixed bag. Here's a look:


Casey Quinlan, a 59-year-old breast cancer survivor who lives near Richmond, Va., and millions of other uninsured people. Starting in October 2013, the uninsured will be able to sign up for taxpayer subsidized coverage either through private insurance plans or the Medicaid health care program. Coverage commences on Jan. 1, 2014. The law eventually is expected to provide health insurance to about 30 million of the estimated 50 million uninsured Americans. Insurers will not be able to turn away people with a history or medical problems, or charge them more.

Hospitals. Their stock zoomed Thursday after the Supreme Court ruling guaranteed them millions more paying customers. Some analysts expect the law to reduce uncompensated care losses borne by hospitals by about half. Currently about one-fourth of the care provided by hospitals is never paid for, either because debts can't be collected or the patient is uninsured.

Stocks of big laboratories also rose.

insurance companies had a see-saw day, down sharply at first but recovering some lost ground. They'll get millions of new customers also, but they face new federal regulation and taxes they fear will drive up costs.

Family practice doctors. The law provides a pay boost for those treating Medicare patients, and takes other steps that could make general practitioners the new gatekeepers of a more efficient health care system.

Democrats. President Barack Obama and former House Speaker Nancy Pelosi devoted a vast amount of his first term to passing a health care law that has divided the nation.

Solicitor General Donald Verrilli Jr. Obama's top Supreme Court lawyer was maligned for his performance in both the health care and Arizona immigration cases.

Chief Justice John Roberts - The darling of conservatives, Roberts finds himself in the unusual position of being praised by the left and criticized by the right following the health care ruling,


The National Federation of Independent Business. The law imposes fines on employers that do not offer coverage, but companies with fewer than 50 workers are exempt,

Republicans. From presidential candidate Mitt Romney, to congressional leaders like House Speaker John Boehner, R-Ohio, and Senate Minority Leader Mitch McConnell, R-Ky., it will get harder for Republicans to argue that the law should be wiped from the books. However, Republicans could regain the upper hand by targeting unpopular provisions for repeal, like tax increases on industry, cost controls and cuts to service providers.

States that didn't prepare. About half the states now find themselves in the position of the little piggy that built his house out of straw. Many Republican-led states held back on carrying out the law's plan to set up new insurance markets, confident the Supreme Court would toss out the whole thing.

Justice Antonin Scalia. He sat glumly and silently as other justices read their takes on the health care law. Scalia was more vocal than any justice in his distaste for the law


Thursday, June 28, 2012

Supreme Court Decision on PPACA


First-person Impressions from Today's Supreme Court Decision on Healthcare

My friend and colleague +Ann Waldo (an attorney with whom I've worked on some healthcare privacy issues) was able to attend today's Supreme Court decision.  She shared some first-person impressions via email, and gave me permission to share them more widely here.  Ann wrote:
"Family and friends,  here’s a summary of my take on the Supreme Court decision that Doug and I were privileged to attend in person today.  I’m still pinching myself that we got to be there.  I sat up front in the Supreme Court Bar section, approximately four feet from retired Justice John Paul Stevens and about 10 feet from the Justices.  The day was full of formality – the Deputy Clerk was wearing a morning suit with tails!  What a pleasure to be there.
I do realize, of course, that not all of us view the underlying law the same way, and I’m not trying to open a political debate.  Just sharing with you my impressions of being present on this historic occasion

“First of all, it really was breathtaking just to be there on such an historic day.
The mood in the courtroom was silent but extremely suspenseful.  Chief Justice Roberts started out by saying in very strong language that the Commerce Clause does NOT permit Congress to compel citizens to buy something they don't want to buy, whether insurance or broccoli.  He said the Constitution allows the regulation of commerce, but not the compulsion of commerce.  He went on for about 10 minutes about how the framers of the Constitution would have understood this in a common sense way – the government simply cannot compel people to buy an unwanted product.
I was sitting (in the second row, unbelievably!) along with the Solicitor General’s lawyers, and they all seemed to stop breathing.  Roberts continued, saying that allowing the mandate as an exercise of regulating commerce would be a vast government overreach, and would fundamentally change the relationship between government and individuals.

So – it really looked like the mandate was dead as a doornail, and my mind was racing ahead to the next logical question - the severability question – i.e., how much of the law would instantly evaporate.  I, like most in the room, was listening hard for clues as to how much of the law would disappear (contemplating the massive changes to contracts, payment arrangements, delivery systems, ACOs, performance measures, children’s health, keeping kids under 26 on their parents’ insurance, etc.)

But then the Chief Justice suddenly switched gears.  He said that if a law is unsustainable under one constitutional theory, but supportable under another theory, then it must be upheld.  He then analytically worked his way to a firm conclusion that the mandate is a tax.  Even though Congress didn’t call it a tax, it is administered by the IRS, it is collected on 1040s, it is based on income and dependents, and it raises revenue – it’s a  tax.  And, of course, Congress has almost plenary power to enact taxes.  (I’ve been saying for months that I wish the Democrats had just called it a tax, for then all these lawsuits would have been dismissed summarily.)
The bottom line – a person can choose to decline to buy insurance and pay the tax without breaking any law.  Thus, it’s not a real mandate; it’s a tax.  Thus, it’s Constitutional.

Roberts did a brilliant job of threading the needle. In my opinion, he showed real leadership by following the law, not politics or his personal views.  (He even implied he didn’t favor the law.) And by unexpectedly voting with the liberals, he helped undermine the growing perception of the Court’s own partisanship.  There’s no question that he elevated his own historical position as a powerful Chief Justice.

He also threaded the needle on the Medicaid expansion.  Although he ruled that while the Medicaid expansion as written was overbroad and coercive (which was the first time in history that the federal spending power has been ruled to be so heavy-headed as to be unconstitutionally coercive on the states), he found a way to avoid knocking millions of poor people out of newly eligible care by making the Medicaid expansion essentially optional at the state level.
Justice Kennedy delivered a blistering dissent.  People have been saying he was a swing vote and might vote to uphold the mandate, but no way, that was far from true.  He was adamant about how the mandate exceeded the government’s powers, and he didn’t buy the argument that it was really a tax.  Powerful, articulate positions.

Justice Ginsburg delivered a strong dissent to the majority decision that the mandate violated the Commerce Clause.  She said that not buying health insurance is not remotely like not buying vegetables, because individuals who don’t buy insurance and get sick impose substantial costs on taxpayers and other people who pay for insurance, and that slippery slope arguments are absurd. “

A big day, an amazing decision.  We’ll all have to stay tuned for reactions and next steps. The political battle lines are certainly being hardened already.
P.S. In case you’re not  clear on what the contents of this extremely complicated law are, here’s a small summary.  There’s a lot more too, much of which has to do with overhauling how we improve quality and save money by paying hospitals and clinicians for the quality of their results, rather than the expensive, terribly expensive status quo method of paying for each service ordered. 
But here’s a quick summary of some of the major effects on individuals:

* Insurance companies no longer have unchecked power to cancel your policy, deny you coverage, or charge women more than men.
* Soon, no American will ever again be denied care or charged more due to a pre-existing condition, like cancer or even asthma.
* Preventive care will still be covered free of charge by insurance companies--including mammograms for women and wellness visits for seniors.
* By August, millions of Americans will receive a rebate because their insurance company spent too much of their premium on administrative costs or CEO bonuses.
* 5.3 million seniors will continue to save $600 a year on their prescription drugs.
* Efforts to strengthen and protect Medicare by cracking down on waste, fraud, and abuse will remain in place.
* 6.6 million young adults will still be able to stay on their family's plan until they're 26."l

All of the above are well intentioned and meaningful. However there remains much to decide as the law proscribes a rigid administrative bureaucratic structure that will increase costs dramatically with formation of accountable care organizations, a nationwide health information network (which is still largely inoperative and only in the planning stages. In addition to the ACOs and the NHIN a new paradigm for reimbursement must be designed, converting from a procedural base to one of  excellence of outcomes. And there is still uncertainty how and what measures will be utilized


Wednesday, June 27, 2012

Governor Brown Loves the Children !


SACRAMENTO -- Advocates on Monday made a last ditch effort to persuade Gov. Jerry Brown and Democratic leaders to back down from a plan to eliminate Healthy Families, the medical insurance program that serves children from low-income working families.

Axing the program to save tens of millions of dollars is a key provision in the budget that Brown and Democrats worked out last week as part of an agreement that spared more painful cuts to safety net programs for the poor. More than 900,000 children would be required to change to the Medi-Cal system over the next year and a half, forcing them to find new doctors in what critics say is an already overwhelmed system.  (and the medi-cal system is fee for service with even fewer doctors)

"Medi-Cal already faces serious challenges in providing access for 3.5 million kids served by it today, and it's straining to serve them well," said Wendy Lazarus, founder and co-president of The Children's Partnership, which outlined demands in a letter co-signed by 64 groups.

"But by putting added pressure on a very fragile Medi-Cal system now, the plan will endanger access to care for as many as 4.5 million kids."

Healthy Families provides medical, dental and vision care for children who don't have insurance but who do not qualify for Medi-Cal. A family of four can make up to $30,000 and qualify for Medi-Cal, while a family of four can qualify for Healthy Families with an income of up to $56,000.

Democrats on Monday began taking up 21 trailer bills that will enact


various aspects of the budget, including one specifically on Healthy Families. They will work through the bills in committee before taking a vote on Wednesday. That is the last day Brown can take action on the budget: He can either veto it, veto parts of it, sign it, or take no action, which would automatically enact it into law.

Only a majority of votes are needed for each bill in both houses, so Democrats, who have wide majorities in each house, could spare a handful of no votes. If enough rise up against it, the budget deal would collapse with the end of the fiscal year looming. That doesn't look likely, however, as advocates can count only two Democratic lawmakers opposed to the dissolution of Healthy Families. They need a minimum of seven to block it in the Senate and 12 in the Assembly.

Sen. Leland Yee, D-San Francisco, is one who opposes the dissolution, along with Assemblyman Richard Pan, D-Sacramento. Yee said if he can't persuade colleagues to support abandoning the plan to eliminate Healthy Families, he wants a strong assurance that children moving to Medi-Cal won't lose coverage.

"It's incumbent on all of us to do what we can to change the governor's mind," Yee said. But short of that, he wants to "ensure children in Healthy Families are not going to be left holding the bag."

One of the biggest concerns is that doctors who receive Healthy Families patients do not accept Medi-Cal patients. Doctors and health providers receive a higher reimbursement rate from Healthy Families than from Medi-Cal.

By dissolving Health Families, the savings would net $13 million for the rest of this year, and another $54 million next year and $78 million the following year. But the state stands to lose millions of dollars in federal matching funds that will be cut off once Healthy Families is dissolved, critics said. And it will likely forfeit $200 million for each of the next two years that it would have gotten through an industry-paid managed care organization tax, which helps fund Healthy Families.

The tax is set to expire at the end of the month, and extending it would require a two-thirds vote, and Republicans, who have criticized the move to shutter Healthy Families, are unlikely to vote for it.

"This has the potential to make our budget worse, not better," said Anthony Wright, director of Health Access California. "In order to get a little savings now, we're potentially blowing a bigger hole in the budget in the future, one that will reverberate onto kids' programs and kids' services."

Contact Steven Harmon at 916-441-2101. Follow him at

Alaska Medicaid Agency To Pay $1.7M To Settle HIPAA Case


Why our health system is so expensive.

Does this appeal to your common sense? No ! Robbing Peter to pay Paul. The State of Alaska should have been required to use the funds to train their workers in HIPAA

This case was over three years ago, when HIPAA was just coming into effect nationally.

Don’t waste my money on idiocy!!

Needless bureaucracy and expense.

Alaska Medicaid Agency To Pay $1.7M To Settle HIPAA Case

Alaska's Department of Health and Social Services -- which oversees the state's Medicaid program -- has agreed to pay $1.7 million to settle possible violations of the HIPAA Security Rule, Modern Healthcare reports.

Leon Rodriguez, director of HHS' Office for Civil Rights, in a statement said, "This is OCR's first HIPAA enforcement action against a state agency, and we expect organizations to comply with their obligations under these rules regardless of whether they are public or private entities" (Zigmond, Modern Healthcare, 6/26).

About the Possible Violations

In October 2009, Alaska's DHSS submitted a breach report to OCR indicating that a portable electronic storage device that might have contained protected health information had been stolen from the car of a DHSS computer technician (HHS agreement, 6/26).

After investigating the breach, OCR found that DHSS had failed to:

  • Address the encryption of devices and media;
  • Complete a health data risk analysis;
  • Conduct health data security training for employees; and
  • Implement controls for devices and media (Goedert, Health Data Management, 6/26).

Details of the Settlement

In addition to paying the settlement, DHSS agreed to review, revise and maintain its policies to ensure compliance with the HIPAA Security Rule.

As part of the agreement, a designated monitor will report to OCR regularly about DHSS' compliance efforts (Cadet, CMIO, 6/27).


Online Program Lets Docs 'Prescribe' mHealth Apps


How many physicians actually prescribe mobile health applications to their patients by writing an Rx or having a list to give to their patients?  Believe it or not some patients do not know what is on the market and readily available for mhealth. Those who are familiar with mobile health and/or remote monitoring will look to you as an “expert” on mobile and remote monitoring.

If you are not an expert or have meager knowledge of this subject , and little time to research the subject you have two choices:

1. Assign responsibility to a staff member

2. Look at our resource white paper on mobile health, and remote monitoring.

3. Do both.

Social media is an excellent source of information, in blogs, on Facebook, Twitter and Google plus. Numerous discussion groups occur on Google plus Hangouts. This link will guide you how to join Gmail (necessary) and start a hangout.

Health Train Express and Digital Health Space produce a ‘Hangout Doctor” at 5 PM Pacific time Monday through Thursday. Circle ‘Digital Health Space’ for up to date information

Happtique, a mobile health application store aimed primarily at healthcare providers, plans to launch an mRx program that will give hospitals and physicians a mechanism for prescribing mHealth apps to patients. Following a two-month pilot this summer, Happtique expects to launch its patent-pending mRx technology in the marketplace.

Happtique offers a full suite (catalog) for both iPhone and Android OS solutions and is catalogues by specialty as well as by profession. Register here


Tuesday, June 26, 2012

Smart Medicine, SmartPhones



The evolution of computer processing power has led to a reduction in size of the most commonly used device used for computing and social media tasks.  The tower shrunk to a desktop or all in one format, the desktop was replaced by laptops and tablets. Tablet PCs, notepads, netbooks are morphing into mobile devices of assorted sizes and utilities, merging with video capabilities.

These changes are key to ‘meaningful usability’ in a medical or hospital environment.

Health care and medicine have lagged behind in the use of social media

How the iPhone set the bar for other smartphones in healthcare -

iPhones could be considered the technology that truly kick started the mobile revolution in home care. Small, easy to use and powerful, the iPhone was the first smartphone to really capture the attention of physicians, and to develop tools and resources for healthcare.
Recent data shows nearly 65 percent of hospitals are supporting iPhone use on their networks, and another 83 percent are supporting its larger cousin, the iPad. 

Dozens of developers create add-ons, plug-ins, special lenses, and apps that can turn the iPhone into any number of use-specific healthcare tools, including:

  • Image-viewers: Recent studies have shown that the iPhone can be an acceptable viewer for MRI, X-ray and other images, although with the caveat that it shouldn't be used for primary diagnosis.  
  • Diagnostic tools: Developers have created strips, touchscreen devices and other tools to diagnose everything from malaria to e. coli infection via the iPhone. 
  • Remote monitors: iPhones can read and transmit data from remote monitoring devices. For example, the iPhone has been employed as a scanner to take glucose readings from strips of nanosensors under skin.
  • Microscopes: A cheap, $50 lens turns the iPhone into a field microscope. It's not the same as powerful lab microscopes, but can enlarge images 350 times, which can be more than enough to see tissue abnormalities and even some diseases.
  • Electrocardiograms:  A pocket sized device attached to the back side of a smartphone can transmit a remote rhythm strip to a physician or hospital from a 911 first responder.
  • iPhones also have hefty enough processing capacity to access patient records, Being

    Another key component in the iPhone revolution in healthcare clearly is consumers. Saldana estimates that of the 7,000 users who access his hospital's MyCare patient portal, 80 to 90 percent do so with iPhones. It was one of the main reasons his team moved early on to enable the hospital's Epic electronic medical record system for iPhones, and later iPads.

    And iPhones certainly are upping the ante in terms of patients' expectations, Feldman adds. "Particularly now that patients have access themselves to their data via portals, so often my patients are as up to date as I am on their labs. It would be embarrassing if they have faster access than I did."

    Physicians will be dragged into social media by their own patients and consumers who will annoyed by not having that functionality with their physician or medical group. Physicians will come to realize the efficiencies of not having to contact the patient about ‘normals’, and the lab data normality can be programmed into the software.

    Security Issues:

    The one lagging item on the iPhone agenda continues to be security. iPhone users are famous for finding workarounds,

    While not HIPAA compliant smartphone experts say they had good luck with "just put[ting] on the lock screen, which encrypts the data on the device and ... set[ting] up remote wipe/locate, which are all free features of the phone." These issues still abound how to encrypt data over the cell and wifi networks.  The military does this already with Blackberry devices, which are standard military issue for email and communication in DOD medical facilities.

    The capability is there and someone is going to come along and develop this capacity.

    And last but not least is social media.  Email is slow compared to using Twitter which can actually function much like a pager with a message displaying and a sound alert much like the now obsolete digital pager. It also facilitates a quick reply if desired.

    How the iPhone impacted the handset industry

    How the iPhone set the bar for other smartphones in healthcare -


    And during slow times, there is always:



    Monday, June 25, 2012

    Torrid Rate of Growth for Digital Health Funding


    After investments in digital health doubled from 2009 to 2011, the torrid pace of growth has continued in the first half of 2012. Rock Health’s founder Halle Tecco stated why they released a report at this time. “The impetus of this report was the notable growth in venture funding of digital health–so much so that we are seeing 73% more investments than the same time last year. As we strive to foster innovation and entrepreneurship within the space, we want to best characterize the landscape to paint a clear picture of where our field is going.”

    In order to understand this dramatic increase in HIT spending, look only as far as the Department of HHS incentive plan for HER and HIT coupled with the incompleted plan for PPACA.

    The driving factors for this dramatic increase:

    Either Way the Patient Will Lose in This Round


    The opinions expressed herein are solely those of the author:

    Gary DSC_1168  Gary M. Levin MD


    Let me state unequivocally that we need to reform our health system, but not in the manner being attempted by our present Congress, nor President Obama.

    The Health Reform Law was passed almost two years ago and spontaneously ignited a ‘food fight’ of incredible proportions, with over reaction from each side, Republicans being accused of ‘Darwinian theology’’ for their health reforms, while Democrats are accused of being flaming socialists wealth redistributionists and even communists.

    Speaker Nancy Pelosi said we would not know what was in the bill until after it passed.  That was and is a profound oxymoron and understatement.  No one really knows what it will cost, if it can be funded in the short or long haul, much of the administration is still not in place and there remains much to be accomplished.

    Pandora’s box has been opened and no one really likes the details. Democrats surely must regret passing a nonpartisan act. Republicans are so incensed at being ‘bullied’ into submission that they are not likely to approve most Democratic proposals for anything. 

    Perhaps our political system has gone off the rails, defying rational thought in favor of lobbyists.

    The act  was passed with little review by grass root healthcare providers in the trenches.  Yes, the American Medical Association (representing only about 160,000 out of close to 800,000 doctors and hundreds of thousands of other providers, hospitals, durable medical device manufacturing companies) endorsed the Act. The AMAs endorsement did not include me. The only groups that seemed to have the attention of the congress were insurance companies and pharma.

    I would say that this Law is not the best or even near the best approach to health reform.  That is a very sad thing that so much time has been wasted in our effort.


    During a financial crisis when debt is escalating out of control, isn’t it best to reign in spending, stop borrowing money to fight wars or other programs. Let’s take a breather and put  PAPCA on hold….makes more sense that to have e SCOTUS make a critical decision based on the constitution to overcome our intransigence.

    The law was badly conceived and written and passed, without concern for the implementation. It was passed as a political expediency by Democrats, without Republican support.

    Haste makes waste !

    Can a health system be designed by Congress? Or for that matter, Health and Human Services?

    Thursday, June 21, 2012

    The Doctor’s Tablet A Blogger’s Anniversary


    Gary DSC_1162

    I start each day reviewing blogs and the social media stream(s).  It offers up a wide variety of topics on “what’s hot”. Admittedly most of it is in the health care field and now overlaps with 'social media’. I am beginning to not like that term, for the time being. Although diminishing in ‘bad press’  “social media” harbors some lingering stereotypical attitudes, unless one know how to use it and avoid the ‘bottom dwellers’ who are there. 

    Our presence in social media should elevate it’s content, and health care providers will not be lessened if we take on a leadership role.

    Doctor's Table

    Today I want to congratulate and encourage “The Doctor’s Tablet” which is approaching it’s  six month anniversary of blogging.  Directly from their “about page” here is what they say about themselves. 

    “This dynamic blog, written primarily by Einstein faculty, reviews the latest in medical research and development while bringing you a unique glimpse into how doctors use their knowledge, skills, experience and intuition to make diagnoses, treat patients and strive to provide compassionate care.

    Each week, College of Medicine faculty share observations and insights from the front lines of medicine and translational research. The thoughts and words are their own. The Doctor’s Tablet  editors, Paul Moniz, managing director of communications and marketing, and David Flores, social media manager, provide editorial guidance.”

    As most experienced bloggers will advise, “Content is king”.  I have found networking with other credible bloggers is important. Linking with twitter, facebook and Google Plus serve to attract readers.

    The Doctor’s Tablet has  a unique strength in it’s expert sources from many New York Hospital Institutions, and their physicians.

    Our best wishes for continuing success for The Doctor’s Tablet and welcome to the ‘blogosphere’.


    Monday, June 18, 2012

    Stockholm Syndrome: Not What You Think


    Gary DSC_1168 (640x424)

    Societal Stockholm Syndrome may also explain Psychologist Dee Graham has theorized that Stockholm Syndrome occurs on a societal level.

    Stockholm Sweden seems to be advancing toward mobile health applications and utilization well ahead of the U.S.

    Stockholm uses city-wide mobile phone system to document elderly care

    For nearly 2,000 care workers in Stockholm, a smart phone has become the most important tool in their daily operations. The goal is to make life easier for care workers and care providers and to give relatives access to various eServices that are provided via the city's website. City officials presented the solution in a World of Health IT session during the pan-European eHealth Week 2012 in Denmark.

    “The idea to use a mobile documentation solution for both public and private providers of care for the elderly was mooted years ago,” said Stefan Carlson, Head of Technical Development and Administration at the city of Stockholm's IT department.

    Carlson and Lindquist said that mobile documentation in elderly care has been "a big success".
    "We are now planning to offer this (solution) in medical care as well. And we are planning to add new features like the eKey, a solution that uses the mobile phone as an electronic key to open the doors of homecare customers' homes without having to carry a key chain all the time", Carlson said.

    An agreement was reached with Finnish IT-provider Tieto in 2007 to provide a Stockholm-wide mobile communication service. With all relevant information being digitized right away, the City of Stockholm can offer eServices to the elderly or their relatives. The care documentation can be accessed via a secure web connection, so that relatives, for example, can see exactly what care was provided and when.

    Unnecessary driving is reduced. Every care worker can access the day's schedule immediately, without having to drive to the office first.

    Expansion to medical care on the horizon

    Carlson and Lindquist said that mobile documentation in elderly care has been "a big success".
    "We are now planning to offer this (solution) in medical care as well. And we are planning to add new features like the eKey, a solution that uses the mobile phone as an electronic key to open the doors of homecare customers' homes without having to carry a key chain all the time", Carlson said.

    Homecare services for the elderly in the city of Stockholm are provided by around 5,000 care workers who are employed by either one of 30 public care units or by one of the around 100 private care providers.

    Together, the public and the private sector share responsibility for around 30,000 elderly customers who are visited on a daily basis by the homecare service. 

    Health Train Express commented that smartphones and even public video conferencing assets such as google hangouts, Skype could be use to enhance home care visits, and post operative follow up.


    Friday, June 15, 2012

    Do Doctors have an Obligation to Engage in Social Media?


    Part I of II parts……

    According to KevinPho MD

    Some physicians may be hesitant to participate in social media outlets, like Facebook,


    Twitter, or Google Plus

    Well, get over it.

    Pediatrician Bryan Vartabedian addresses this topic. “Indeed, physicians have lost control of the online message, especially with, according to recent data, 60+ percent of patients visiting the web first when looking for health information.”

    I can only agree wholeheartedly and substantiate Kevin’s observations after spending the past year exploring these platforms. Some are using it as a marketing device to draw in people, much more focused than email  that was so prevalent several years ago.  In fact it is much more effective given the huge advertising revenue that Facebook generates and their linkages to many gaming sites. And market studies reveal that most gamers are young adults 20-35 years old.

    While Facebook truly began as a social site for young adults it has evolved into a powerful media powerhouse. It’s recent IPO although touted as a ‘failure’ was not.. millions of people bought into  Facebook, crashing the computer system of NASDAQ.

    You will find multimillionaire medical device and pharma companies marketing a  presence and followers on Facebook. Many companies hire a full time social media director to actively respond to followers, either on twitter and/or facebook. Google plus features an even more  ‘intimate’ relationship due to it’s format and Google Hangouts. Talking and seeing your ‘friend’ is much more powerful than typing, and reading. It also prevent misunderstanding in tones and nuances in a video format.

    Twitter is NOT a noisy meaningless platform once the user understands how to use Hashtags. For instance I followed the American Society of Cancer by following the meeting using #ASCO12. This is a common method for those in the know to be linked to many conferences such as  AMA12  and others. A more complete hashtag directory for specialists and medical conferences will be found at, which presently represents the most complete hashtag directory in healthcare, incuding health IT, Healthcare consultants and others.

    I use Tweetdeck an application that was recently acquired by twitter. With this application it is possible to open multiple hashtag columns and follow an unlimited number of subjects in a columnar form.

    Going forward, doctors need to incorporate social media into their practice, or better yet, learn some basic search engine optimization techniques for their websites. Without these skills, sithe medical profession risks losing further influence of the online message, as more patients will be persuaded by charlatans, who now rule the web’s health information.

    The Real Reason Some Doctors Fear Social Media according to Howard J Luks MD, a well known physician social media expert is a number of issues.

    Are you social? Do you genuinely like people? Many physicians do not fear social media because of HIPAA concerns. The real reason some doctors fear social media is because social amplifies how you are already perceived in real life. If you are a “jerk”, guess what? You will be a bigger jerk on social media, and you can no longer hide. You need to first “be social. 

    Doctors tend to socialize within a limited circle, on the golf course, in the hospital, with referral physicians. It gives us a biased and limited exposure to people in real life and in other ways where you are the authority figure. Basically it allow one to ‘get down’ with humanity in it’s own environment, something from which we insulate ourselves in the effort to become imperturbible and deal with situations with equanimity.  I find myself much more approachable, but often have to remind my contacts to not call me ‘Dr.”  It’s as difficult for them as it is for me, but it brings to life for patients that we all are human and subject to the same emotions and life stresses compounded by our duties as doctors.

    Part II of II

    The End of the Diva Paradox

    Seth Godin is a blogger and Marketing Consultant, who makes some interesting points:

    As people share more, they have access to more opinions from the people they trust about the products and services they use. This makes it easier to discover the best products, and improve the quality and efficiency of their lives.

    Running the Business and Marketing

    Medical Practices and Hospitals are competing for patients and dollars given the prospects of health reform, and decreasing reimbursement with increased utilization. Ordinarily conventional print advertising such as yellow pages, or a professional marketing campaign with video and/or TV radio are now prohibitive.

    The cost of a social media platform is near zero, no additional hardware or software acquisition is necessary. It is essentially a ‘gift’ from several well funded and successful entities that are an integral part of today’s digital world for this new generation. Despite physician’s ‘fears’ about HIPAA, the medium offers much to you.

    Businesses will be rewarded for building better products  - ones that are personalized and designed around people. We have found products that are “social by design” to be more engaging. ~ Mark Zuckerberg, CEO, Facebook.

    We have prepared a brief “White Paper” for the whole story, free for just a click here.


    Tuesday, June 12, 2012

    Health Insurance Benefit Exchanges? More Bureaucracy, at What Expense?


    A new paper published by the Galen Institute warns that states which fall into lockstep with Obama Care's health insurance exchanges will end up in a bureaucratic morass with exchanges that won’t work, won’t increase access to affordable health care, and…Rita E. Numerof, Ph.D., writes in “What’s Wrong with Health Insurance Exchanges…” that the solution to affordable coverage won’t be found in cookie-cutter compliance with Obama Care's bureaucracies, but rather in removing regulations that make coverage unaffordable today and in reducing barriers to competition and consumer choice.

    If the Supreme Court declares the health law unconstitutional, the Obama Care exchanges will be void.  But that will not obviate the need for states to tackle the very real problems that drive out competition and drive up the costs of health coverage.

    “Rather than focusing on compliance with PPACA, legislators should take inventory of the problems plaguing the health insurance markets in their states. Then they can confront the most critical issues of insurance coverage, care delivery, and payment reform to ensure that residents have access to affordable care and enjoy better health outcomes at lower cost,” Numerof concludes.

    Some states already have started the process of studying the changes needed in their individual and small group health insurance markets, and some also have begun putting in place the cornerstones for web portals and marketplaces to help consumers select from a range of health insurance choices.  They are working to reduce barriers to competition and consumer choice and untangle the bureaucracy and regulations that make coverage unaffordable today.

    Many states also are working to  inoculate themselves against the threat that the federal government would swoop in to create exchanges if they don’t take action on their own. These states are assessing their own needs and resources and not allowing the federal government to dictate how they proceed.

    States will play a major role in the next phase of health reform.  Those states that are working now on assessing their own challenges and resources will be better prepared to take the lead in the future.

    The Federal Government has mandated that HBE’s be formed by states and will underwrite initial organization, however there will be no prolonged funding of HBE’s. The PAPCA also mandates that if states do not accept grants and/or form their own HBE’s the federal government is mandated to step in to do so.

    Many health policy experts consider the health insurance exchanges, where most of the 32 million Americans expected to gain coverage will compare and purchase health insurance, to be the backbone of the Affordable Care Act.

    The exchanges also have become a battleground in the fight over President Obama’s signature legislative achievement. Each state must have a marketplace in which consumers can compare coverage, learn whether they qualify for subsidies, and ultimately purchase a plan. If a state does not have a framework in place by 2013, the Department of Health and Human Services will come in and do the job itself.

    Many Republican-governed states have slowed or halted work on implementing a health insurance exchange, saying that it is prudent to wait until the Supreme Court rules on the law’s constitutionality. That decision is expected by the end of this month.

    But many officials acknowledge that if the law is upheld, their states will want to run their own exchanges. This collaborative is more evidence that states across the political spectrum are still planning to meet the health overhaul’s deadlines.

    The California Healthcare Foundation thought up the idea of working with states on health insurance exchanges in early 2011. Eleven states initially participated; that number grew to 17 as work got underway and the word got out.

    The collaborative, officially Enroll UX2014, includes New York and Washington, which have embraced the Affordable Care Act, and Republican-governed states such as Kansas, New Mexico, Alabama, and Tennessee.

    The states worked with the design firm Ideo to come up with a consumer interface that determines how many options consumers should see at one time, for example, and the order in which those options should be presented.

    Dr. Numerof is co-founder and president of Numerof & Associates, Inc., a strategic management consulting firm.  The Galen Institute is a non-profit research organization based in Alexandria, VA, that focuses on free-market ideas for health reform.

    Monday, June 11, 2012

    A Plea to SCOTUS



    Many are waiting for the  SCOTUS decisions regarding the Patient Care and Affordability Act. Whichever way it goes, the impact will be disappointing and most likely anti-climactic.  I am not placing any bets, and there have been no ‘wikileaks’ from staffers, clerks, Drudge, or even Wikipedia’s founder.


    Sunday, June 10, 2012

    Medical School----A Radical Departure




    Published: 09 June 2012

    A bold new medical school curriculum is being mapped during the planning phases of the University of California at Riverside.

    UCR officials had originally planned to open the school this fall, but a lack of state funding amid the budget crisis derailed the school’s attempt at accreditation last year. Since then Dean Thomas Olds has secured commitments of $100 million over 10 years, largely from UC sources, local government and community health organizations. He believes the sum is sufficient for accreditation.

    G. Richard Olds M.D., Dean

    The school is located in Riverside California in the Inland Empire region. The area which also includes one other private medical school serves a large population of underserved and Latino's. Many graduating medical students from the local private university leave the area, or become missionary evangelists.

    To begin with, the region has only half the physicians it needs. The national average is 220 doctors for every 100,000 people. Here, the ratio is 110 to 100,000.

    The shortage of primary care physicians is even more severe. Instead of the 80 per 100,000 that is the national average, the Inland area has 36 per 100,000. In some areas of the Coachella Valley, there are 10 primary care doctors for every 100,000 people.

    Based on those numbers, the region needs 3,000 more doctors. By 2020, Olds estimates that shortage will be closer to 5,000.

    Part of the solution, he said, is to recruit heavily from the local region, focusing on students who have shown a commitment to community service and shifting the training of the young doctors from an in-patient to an out-patient emphasis. He also wants to hire a staff with a high number of primary care physicians. In many medical schools, he said, up to 75 percent of the teaching doctors are specialists.

    If the UC Riverside School of Medicine opens in fall 2013, it won’t look like other medical schools.

    It will not have its own medical center — students will be farmed out to local hospitals — and the school’s dean, G. Richard Olds,  says the way doctors will be trained is a 180-degree shift from the current medical school model.

    Among those differences:

    A focus on producing more primary care physicians — rather than specialists — who would establish practices in the Inland area.

    Emphasizing illness prevention — instead of focusing on treating people who are already sick — by working in cooperation with local health agencies.

    Using outpatient and community clinics for much of young doctors’ training instead of nearly exclusive use of a large hospital setting.

    Today, only one in six new doctors is a general practitioner, Olds said. The other five are specialists. That imbalance has shifted the way medical care is provided, he said, focusing more on making sick people well, rather than keeping them from getting sick in the first place. He wants to reverse that.

    Drawing support and funding from local government, healthcare networks and private entities, instead of relying mostly on monies from the state level.

    “We’re probably the only medical school doing what we’re doing,” Olds said. “If enough of what we do works, in 20 to 30 years, everybody will be doing it.”

    UCR officials had originally planned to open the school this fall, but a lack of state funding amid the budget crisis derailed the school’s attempt at accreditation last year. Since then, Olds has secured commitments of $100 million over 10 years, largely from UC sources, local government and community health organizations.


    Friday, June 8, 2012

    Social Media for Health Care, Headed to the Cloud?


    Oracle, in a move that m ay portend the future of social media in medicine and health related industry, is marketing a  cloud solution that involves social media  integrated into business cloud offerings. Their business model is explain in their data sheet on cloud social media.

    Oracle’s offering has the advantage of being secure, unlike public social media platforms.

    I predict that EHRs will also incorporate secure social media, whether client/server based or on the cloud.

    Facebook already has a secure API, at which provides a secure HIPAA compliant feature.

    Health Train Express will be surveying numerous vendors as to their plans for social media. Social media is present on numerous Health Information Exchanges as a messaging service.

    Evident is the increase in physician use of  Twitter, and the popularity of physician bloggers, talk radio, and Facebook. Blogs have been around for a long time. Health Train Express began in 2007, or thereabouts as an heir of Riverside Health Information Exchange’s newsletter.

    Blogs seem to function as an outgrowth of the ‘journal’, a diary of thought delivering a stream of consciousness for whomever is writing. Much of the material is excellent and  written by credible sources.  For those in the ‘know’ missing some blogs is a bit like not having your morning newspaper with coffee.

    For some of us the daily social media read and/or tweet has become a necessity and may contain important information for the day’s clinic or a sudden change in  schedule.

    The utility of mobile applications magnifies what social media is for users. The hand-held device, be it a smartphone, tablet pc or some iteration thereof combines a ready reference source, calendar, email utility , or as a social media client.

    If you understand twitter hash tags twitter offers a means of following meetings, such as #ASCO12 the meeting of the American Society of Clinical Oncology for 2012.

    Symplur offers a complete directory of known popular medical hashtags. It is an evolving list. The most recent important addition is  #medsm. There is no official body with authorizes or certifies hashtags, however perhaps  one will develop in a clearing house to avoid confusion, as occurs sometimes.

    It would be a simple matter to include # tag search in any electronic health record system…demand it.

    Ultimately the physician must take into account:

    Monday, June 4, 2012

    The Real Meaning of Social Media in Medicine


    We must encourage every committee, every conference, and hospital board to actively recruit and include patients in every  aspect of the care process from design to implementation to resolution.

    Nothing about us without us.

    From the exam room to the board room.

    Invite patients and you will include artists, poets, and writers in creating health policy.


    (Regina Holliday) HXD , Boston 2012


    Friday, June 1, 2012

    Secure Social Media ?? Oxymoron?



    Despite being social, Facebook has added a key component that will attract health professionals and patients to interact in private on Facebook.

    Now that 0ver 85% of providers use some form of social media it is a fertile ground for inclusion in the health care digital revolution.

    PR Web released news about Facebook’s new secure API.  The application by

    Details on the Register Patient Facebook App for Physicians

    Cost: Free feature included as part of RegisterPatient system
    Functionality Specifics:
    Application can be installed on provider’s Facebook page creating a HIPAA compliant secure patient portal with the following functions:
    ●    Secure online patient registration
    ●    Appointment Requests with real time appointment availability
    ●    Prescription refill requests
    ●    Secure patient to provider messaging

    The announcement is timed perfectly for the upcoming announcement from HHS regarding inclusion of patient’s in digital eHealth for meaningful use stage II.

    The application links directly to the provider’s account and duplicates the same secure patient portal that can be installed on the provider’s website. Providers initiate usage of the Facebook application from within the RegisterPatient admin area and can complete the setup in just a few minutes.

    This promises to give a large boost to use of social media. also has several other functionalities to enhance patient involvement and inclusion.

    Social Media continues to be a brave new world.