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.

Sunday, September 30, 2012

Health Information Technology Video Film Festival



Health Train Express is designed to bring health care providers out of their own silos.

The health care industry is already involved in data exchange and interoperability. The next step in order to move forward is  to dissolve distance and barriers between information, science, medical science and social media.  Social media allows all to dip their toes into areas physicians have previously ignored either intentionally, time constraints, or accidental negligence.

It is equivalent to the ‘cocktail party’ of social circles….many of which have led to great discoveries and collaborations.

2012 and the Developer Challenge has thus far brought major innovative mobile health applications to the world stage. Winners will harvest not only a moderate of cash prizes, but attract the world stage of kick starter funds and venture capital. The cast of new possible star will create enthusiasm to industry critical analysis. This is occurring as electronic health records are adopted by hospitals and physicians alike.


Health2con is occurring in San Francisco next week and is anticipated to bring more new players to mHealth. Physicians and hospital managers as well as health information technology producers are observing the potential connect with other industries and adoption of not only information technology  robotic, analytic and even gaming applications in design of  healthcare and scientific problem solving.

Medicine X at Stanford University took place September 28th - 30th


Rhiju Das, PhD in his video found below  outlines the use of online gaming in analyzing and producing proteins and uses RNA as a model.  Players log in online to participate in analyzing structure of RNA, not only it’s nucleotide base,



Stanford Medicine X  Rock Health


Sonny Vu on Wearables: A Coming Revolution?

Dr. Larry Chu gives opening remarks at Stanford Medicine X

David Van Sickle on Asthmapolis

Rhiju Das, PhD on RNA Design Rules from a Massively Multiplayer Cloud Laboratory



Design Prototypes Emergency Situation on a Large Display. Adding Order to Chaos

Esther Dyson  A view from Space.

A well known creative and visionary Innovator, and Venture Capitalist (over 20 investments in HIT.  Artificial Intelligence is often invisible, embedded in things like ‘Siri’. Several markets for IT, Consumers, Employers especially HR People (human resources who want people to be healthy), and market for good health. Health Providers individually and in concert with Employers to optimize health, wellness, and good data from applications like Healthtap, Fitbit, Social Media is a large catalyst for adoption of mobile health applications.

Design Conundrums

Michael Graves, Architect & Patient distinguished for many architectural awards and a diversity of design fields. You can follow him on social media.

Our Present reimbursement system is a problem and hinders data collection.

Safecast, a data collection web site

How much data, where is it coming from, and is it accurate ?


All videos were taken from Livestream in real time.  Our thanks to them.


Friday, September 28, 2012

Patients Prefer Physicians’ Recommendations of Health Apps


But Will they Purchase them?

Patients Prefer Physicians’ Recommendations of Health Apps

File under: health technology, patient interaction, wellness
Friday, September 7th, 2012 at 5:35 pm

Doctors always have had a lot of influence with their patients. And now, as healthcare continues to evolve via new technology, this physician influence extends even to health apps.

Mitchell Research and Communications, in a recent survey of baby boomers, found that doctors have quite a bit of influence with patients in terms of their recommendations for apps for chronic and life threatening diseases. Among 600 baby boomers questioned in the survey, the consensus was that “they are more willing to download a health and wellness app based on their doctor’s recommendation and were much less likely to download an app recommend by their family or friends,” according to a review of the survey by John Pugh, the director of digital communications at Boehringer Ingelheim’s Global Centre in Germany.


For Boomers, Doctor Knows Best When It Comes To Apps


(You can read Pugh’s post on apps here on the PSFK website, or click here for the Mitchell report.)

Among the specific findings based on the baby-boomer responses to the Mitchell survey:

* 5% would download an app recommended by their friends

* 18% would download an app recommended by their family

* 60% would download an app recommended by their doctor

“Patients with chronic or life threatening conditions were 70 percent more likely to download an app to track their medical issues, while only half of users would download an app looking for general information or weight loss help,” Pugh wrote.

In addition, according to Mitchell roughly 1 in 4 (24%) of the nation’s 78 million baby boomers own smartphones.

Mitchell’s findings indicated that Boomers are likely to download apps, and they are in a life stage where they need to monitor their health:

* Almost half (49%) have downloaded six or more apps.

* More than one-fourth (28%) have downloaded between 1-5 apps.

Mitchell also noted that one-quarter  of Boomers (24%) have either been diagnosed with heart disease (15%), diabetes (7%) or both (2%).

“Seven-in-ten (70%) with diabetes are likely to download a mobile app dealing with diabetes,” Mitchell said in a statement. “Half (50%) with a heart condition would download a heart disease app.  People with serious diseases will download apps to help them live longer.”

The Health 2.0 Con will begin next week in San  Francisco. It will be focused on Mobile Health applications, and Developer’ Challenges.  The big question being asked is will patients (consumers) pay for eHealth and mHealth? 

What do you think?


The IRS wants your Health Insurance Premium


The Numbers just do not add up……… let’s print more money. Would you ever believe that your health care would involve the IRS as an enforcement arm of the government.

Yes, the collection and enforcement arm of the IRS with all it’s powers that be, including wage levies, seizure of assets, and bank levies will monitor your health finances. 

And rumor has it that there will be blood collection centers set up at each IRS office.


WASHINGTON (AP) - Nearly 6 million Americans - most of them in the middle class - will face a tax penalty for not carrying medical coverage once President Barack Obama's health care overhaul law is fully in place, congressional budget analysts said Wednesday.

The new estimate amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises.

The numbers from the nonpartisan Congressional Budget Office are significantly higher than a previous projection by the same office in 2010, shortly after the law passed.

The earlier estimate found 4 million people would be affected. The difference - 2 million people- represents a 50 percent increase.

That's still only a sliver of the population, given that more than 150 million people currently are covered by employer plans. Nonetheless, in his first campaign for the White House, Obama pledged not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000.

And the budget office analysis found that nearly 80 percent of those who'll face the penalty would be making up to or less than five times the federal poverty level. Currently that would work out to $55,850 or less for an individual and $115,250 or less for a family of four.

Average penalty: about $1,200 in 2016.


"The bad news and broken promises from Obama care just keep piling up," said Rep. Dave Camp, R-Mich., chairman of the House Ways and Means Committee, who wants to repeal the law.

There was no immediate response from the administration.

The Congressional Budget Office said most of the increase in its estimate is due to changes in underlying projections about the economy, incorporating the effects of new federal legislation, as well as higher unemployment and lower wages.

Starting in 2014, the new health care law requires virtually every legal resident of the U.S. to carry health insurance or face a tax penalty. The Supreme Court upheld Obama's law as constitutional in a 5-4 decision this summer, finding that the insurance mandate and the tax penalty enforcing it fall within the power of Congress to impose taxes. The penalty will be collected by the IRS, just like taxes.

The budget office said the penalty will raise $6.9 billion when fully in effect in 2016.

The new law will also provide government aid to help middle-class and low-income households afford coverage, the financial carrot that balances out the penalty.

Nonetheless, some people might still decide to remain uninsured because they object to government mandates or because they feel they would come out ahead financially even if they have to pay the penalty. Health insurance is expensive, with employer-provided family coverage averaging nearly $15,800 a year for a family and $4,300 for a single plan.

The Supreme Court allowed individual states to opt out of a major Medicaid expansion under the law. The Obama administration says it will exempt low-income people affected by state decisions from having to comply with the insurance mandate.

Most Americans will not have to worry about the insurance requirement since they already have coverage through employers, government programs like Medicare or by buying their own policies.

Many Republicans still regard the insurance mandate as unconstitutional and rue the day the Supreme Court upheld it.

However, the idea for an individual insurance requirement comes from Republican health care plans in the 1990s.

It's also a central element of the 2006 Massachusetts health care law signed by then-GOP Gov. Mitt Romney, now running against Obama and promising to repeal the federal law. The approach seems to have worked well in Massachusetts, with virtually all residents covered and dwindling numbers opting to pay the penalty instead.


Thursday, September 27, 2012

Expect The Unexpected


Caregivers are a hearty lot.  Social media can play a distinct supportive role in their activities. Most of us at some point in our lives will care for an aging parent or relative.  If not, there is certainty you will be in a relationship with someone who is a care giver.

When outfitting an expedition, one has to plan for everything: from the rare but potentially catastrophic dangers (raging lions, swollen rivers, thunderous storms) to the mundane, commonplace annoyances (fleas, thorns, thirst, hunger) that can be just as deadly.

When people look back in the future at the circuitous route of technological progress in the caregiving space, Rajiv Mehta will probably garner a decent mention. A tireless advocate on the topic, he’s devoted his considerable energy, and brain, to bringing about easier and simpler ways to manage the challenging, often misunderstood and frequently overwhelming issues around family caregiving.

 Wen Dombroski M.D. is also on this team of visionary leaders


Now he’s getting ready to launch the next version of his caregiving tools (called Unfrazzle). He gave a talk recently in Australia about the ‘journey’ that caregivers (even though they don’t know that’s what they are) set off on, and his sensible advice was to think of this as an adventure, and spend the time and effort necessary to outfit yourself for the journey. What I like about that analogy is that it effectively focuses the mind on the need to prepare, without triggering shutdown in the listener from calamitous tales of woe and horror that are never an easy sell. Looking forward to seeing the next rev when it’s live and hearing Rajiv present at a future Aging2.0 event.

Rajiv Mehta , “At Australia’s Health Informatics Conference 2012 in Sydney recently, I gave a keynote address on “Outfitting Families for Caregiving Journeys” highlighting the importance and challenges of dealing with the mundane aspects of caregiving — the overwhelming, and seemingly never-ending, torrent of widely varying, trivial tasks shared amongst a loose network of family and friends. Through stories of actual caregiving situations I make these issues “real”. In the talk I also describe my own efforts over the past few years to address this issue, and the opportunity for healthcare professionals to better prepare families for caregiving crises via addressing the mundane.
Rajiv Mehta is a NASA scientist with heady degrees from Princeton, Stanford and Columbia and four years as a product manager at Apple , who has devoted himself to sharpening the cutting edge of technology and caregiving, working with the Quantified Self movement, developing Tonic, a mobile-based self care assistant and joining the board of the Family Caregiving Alliance. Now he’s getting ready to launch the next version of his caregiving tools (called Unfrazzle). He gave a talk recently in Australia about the ‘journey’ that caregivers (even though they don’t know that’s what they are) set off on, and his sensible advice was to think of this as an adventure, and spend the time and effort necessary to outfit yourself for the journey. What I like about that analogy is that it effectively focuses the mind on the need to prepare, without triggering shutdown in the listener from calamitous tales of woe and horror that are never an easy sell. Looking forward to seeing the next rev when it’s live and hearing Rajiv present at a future Aging 2.0 event.

Next:  Social Media and Telehealth:


Tuesday, September 25, 2012

Health Information Technology Moves at The Speed of Light


The title of this post is both literal and figurative. Yes data does travel at the speed of light, however progress in developing a nationwide interoperable network has been much slower.

The idea of a NHIN has been around since the early 21st Century and there have been many regional attempts, a few which have been successful, thus far.

Regional health information exchanges have made some progress, however ‘buy in’ is still difficult to promote in competing hospital systems.

Fueling this progress has been the following, promoted by the “Open Government” policies which encourage and entrepenurial spirit in both government and the private venture capital market.  No longer will government be the main engine for building a national network, it will function as a “convener” as stated by Aneesh Chopra

The White House and ONC announced that providers and public health agencies in Minnesota and Rhode Island began exchanging health information using specifications developed by the Direct Project, an 'open government' initiative that calls on cooperative efforts by organizations in the health care and information technology sectors. (February 2, 2011)
The press conference was moderated by Farzad Mostashari, MD, ScM, Deputy National Coordinator for Programs and Policy, ONC, and includes remarks from Dr. David Blumenthal and Aneesh Chopra.

There is has been progress in the NHIN is outlined here:

It was obvious from the enclosed video from this meeting that the principals (lots of fist pumps, back slapping, and handshakes)

Speakers included industry and government professionals who helped make the Direct Project launch a success: Mark Briggs, MSc, Chief Executive Officer, VisionShare; Glen Tullman, Chief Executive Officer, Allscripts; Sean Nolan, Chief Architect, Microsoft Health Solutions; and, Albert Puerini, Jr, MD, President and CEO, Polaris Medical Management, President and CEO, Rhode Island Primary Care Physicians; and, Todd Park, Chief Technology Officer, U.S. Department of Health and Human Services.

Some consternation was expressed about the barrier of HIPAA as it is now structured. Many secure transactions already do occur via the internet and some of those secure features should be used to transmit health data.

It becomes obvious technology is outstripping regulatory and legal concerns. It became obvious as well that ‘data” can be transmitted packaged in secure email as a pdf or text file from provider to provider. That is an elegant and simple means to do so.  It does not allow for data fields for analysis, however that is another matter. And it is truly separate.

The basic patient centric model involves only provider-patient-provider interaction, and this must take precedence. The rest is frosting on the cake. (author’s opinion)

Insurers and government agencies who want that data should develop a system that can extract what they need as a separate and isolated goal.


Sunday, September 23, 2012

Looking for a Donor Organ?


We often associate searching for almost anything by querying Google. In fact the word “Google” is now synonymous with searching.

Social media now provides a new means of obtaining information. Now we can “Facebook” it.     

ABC's Robin Roberts, host of Good Morning America, (left) talks with Mark Zuckerberg, the founder and CEO of Facebook, in late April about the social network's push to get users to enroll as organ donors. This week Roberts is expected to receive a bone marrow transplant to treat  myelodysplastic syndrome.If Facebook has anything to do with it, more organs will be making their way to patients in need.

As reported in iHealthBeat (published by the California Health Care Foundation (CHCF)

Four months ago, Facebook launched an initiative that aims to leverage its network of 161 million users to more quickly match patients who are waiting for organ transplants with possible donors.

Blair Sadler -- an attorney and senior fellow at the Institute for Healthcare Improvement -- said the new Facebook feature "shows the enormous potential of social media," noting that people are more likely to be persuaded to donate by friends and family than by activists or public health officials.

Through the initiative, members of the social networking website can declare themselves as organ donors under a new "Health and Wellness" section, which includes biographical information and updates on their health. The section also includes links to state donor registries

In a recent opinion piece published by the Hastings Center, Sadler argued that more should be done to fully leverage the power of social media networks.

The announcement was greeted with great enthusiasm by leaders in the organ donation field. Andrew M. Cameron, the surgical director of liver transplantation at Johns Hopkins Hospital, stated in the New York Times,

Historically, 98 percent of registered organ donations come through the states’ departments of motor vehicles donor registration programs. While this is the most successful strategy for recruiting registered donors in most states, the numbers could pale by comparison if the full potential of social media could be harnessed by state donor registries.

Interactions with the DMV occur infrequently for most young people, compared to Facebook interactions, which occur multiple times every day. Indeed, if the full potential of Facebook and other social media were to be engaged over an extended period of time, it is possible that enough young people could be registered to address the needs of their own generation and beyond.

Facebook California ogan donor registrires

Inspiring stories of lives saved through organ and tissue donation could be posted on Facebook or tweeted to friends. To create the “stickiness” and staying power Gladwell describes, organ donation organizations need to embrace this new technology in a way that translates possibilities into reality.

State registries must also be easy to find and use. If the common perception is that in order to register as an organ donor, one needs to go through the DMV, people may be less inclined to donate. But if people know that they can register easily by visiting a Web site and clicking a button or two, their willingness should increase. State registries could include social sharing on their sites, so that once a person joins the registry, he or she has the option to share this information via Facebook, Twitter, and other social networks which should drive awareness among family and friends.

Social media could also allow donor registries to advertise at no cost.

Of course all of the good features of Facebook would have to carefully be evaluated to eliminating the possibilities of PROFITEERING.  And this is a significant precautionary warning.  Identity verification, accountability and tracking are essential requirements.

The Facebook listing could easily become an eBay or Craigslist, Organ For Sale’

Medical professionals will be skeptical (and for  very good reasons)


Saturday, September 22, 2012

Harvard Medical School takes Medicine 2.0 by storm


Medicine 2.0'12

Or was it the other way around?

If  you were on twitter last week and were following #med2 it became apparent that this was an active meeting.

Medicine 2.0 Trailer

Several observations and questions result from the reporting by Dave Harlow who wrote in Health Works Collective about the nuts & bolts and speakers at the Medicine 2.0 social event of the year in Boston, MA.

1. The interest in health care social media #hcsm follows the significant acceptance of electronic health records.

2. Boston hosted 500 cutting-edge health care practitioners, academics, researchers, app developers and students – and all of those appellations applied to some of the participants simultaneously.

3. The program organized by Gunther Eysenbach who publishes the JMIR is also known for his philosophy on open source publication for medical peer reviewed aticles via the internet. (self-description:

JMIR is the leading peer-reviewed eHealth/mHealth journal (Impact Factor: 4.7),
ranked #1 in Medical Informatics, and #2 in Health Sciences/Health Services Research

The event played to a full room, if not a sellout crowd in Boston.

4. The integration of multiple social media platforms, twitter, twitpic, flickr, facebook for announcement, meeting progress, couple with visuals (static and video) allows for non-attendees to observe and gain from a distant meeting. And many events are archived on social media sites such as YouTube, Ustream and other network silos.

5. Speakers presented a rich mix of expertise and content. Topics ranged from the international presence of social media, publisher expertise, physician experts in various specialties, to patient advocates who have developed content such as Patients Like Me, Pharma, Entrepenurship  and Social Media How to topics.


How and Why is Health Care Social Media growing and is the sky the limit or are their significant barriers.

1. Curiosity. The early adopters are enthusiastic users of the new form of social intercourse, and are verbal champions for the new medium. Those observing on the sidelines are cautiously dipping their toes into #hcsm #medsm. Quickly their use increases as they experiment with the platforms. Ingenuity creates new uses with each adopter. Rather than being a structured entity such as an electronic health record, it allows for creativity in content and direction.

2. The powers that be, (medical societies, medical boards, state licensing authorities have found social media an efficient way to disseminate information.

3. Licensing authorities are struggling to maintain relevance in a society that is rapidly discarding old paradigms of communication. And in many cases are led by leaders who are not using social media.  This struggle at times leads to confusion about other areas such as patient physician telemedicine, remote monitoring.  This is evidenced by the recent controversial decision about telemedicine in the form of emails, instant messaging and video telemedicine by the Oregon State Medical Board’s Statement on TelemedicineAt the same time a video was posted on the OSMB’s website on Telehealth . Clearly the usual and customary standard of care is in a state of flux. In a state of mind where health care costs are extreme, which is better? No care, or care that is affordable and accessible.?


Friday, September 21, 2012

How A Low Literate Adult Experiences the Healthcare System


October is Health Literacy Month

"Health literacy is the currency of success for everything we do in health, wellness and prevention."
- 17th U.S. Surgeon General, Richard Carmona, MD, MPH, FACS

What is health literacy?

Health literacy refers to an individual's capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment. It is a shared responsibility, meaning both the patient and the healthcare provider must communicate in ways that the other can understand.

The American Medical Association has found that poor health literacy is a stronger predictor of a person's health than age, income, employment status, education level and race.

The problem is widespread: almost 9 out of 10 Americans lack the knowledge and skills needed to manage their health and prevent disease. Understanding the breadth of the gap between an average American's comprehension of healthcare and the high level at which health information is communicated is a vital first step to improving patient safety and treatment adherence. 

It has been estimated that low literate adults increase health care costs by $ 76 billion dollars a year. That figure rivals the amount of ‘fraudulent billing’ and other financial losses to Medicare.

Yet the Patient Protection and Affordability Act completely misses this important fact.

Imagine you are sitting in an exam room feeling sick, stressed and anxious after hours of waiting in the hospital to be seen. You are wearing nothing but a loose fitting hospital gown and have goosebumps because the room is so cold. Finally your in rushes your doctor and within what feels like seconds is preparing to send you on your way. She hands you a piece of paper and says, "Read this and let me know if you have any questions."

The paper reads:

Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

How did you FEEL reading the passage?


“Inspect hcae esoh along its eritne length, and ecalper any esoh that is dekcarc, nellows, or swohs signs of noitaroireted

Can you translate that sentence?

Or what about this one?

“kcehc the egral and rewol rotaidar sesoh rellams retemaid sesoh, ecihw run morf the engine eht llawerif.”

Definitely ‘food’ for the spelling checker

Low illiterate patients experience this phenomenon.  Low literate adults often nod in agreement even if they have no idea what they read, or hear.

October is Health Literacy Month

Little known amongst physicians are the presence of literacy scholars, devoted to Health Literacy.

Peter MorrisonPeter Morrison, Health Literacy Program Manager

This week I was privileged to attend a tweetchat #hchlitts which focused on this topic.  The guest was Peter Morrison, BA, Health Literacy Program Manager, Peter is an American Medical Association certified vendor-consultant providing communication assessments for healthcare agencies, the unique AMA vendor-consultant for this service in Texas and one of ten nation-wide. By developing health literacy interventions in collaboration with the end user (low literate patients and English Language learners) and national leaders.  Peter has developed a suite of health literacy services with proven efficacy throughout the state of Texas health literacy services.

His leadership in the field of health literacy is evident in several instances, including a collaboration request by Joint Commission on a nation-wide hospital assessment project, selection as one of ten nation-wide American Medical Association consultants for the Communication Climate Assessment Toolkit (CCAT), featured health literacy expert in articles published in Patient Education Management, Community Literacy Journal, and Patient Education and Counseling, as well as presentations at national conferences, including the 2012 Health Literacy Leadership Institute. He is also a certified adult literacy instructor, community health Promoter, and has extensive experience in health literacy training design and facilitation.

Most states have their own Health Literacy Projects: This page offers a Portal to these agencies

October is Health Literacy Month


Information provided by:

The Literacy Coalition of Central Texas

Thursday, September 20, 2012

Major FCC Development in HIT for wearable Body Sensors


FCC finalizes wavelength ruling for medical body area networks

The Federal Communications Commission has officially set aside a portion of the nation's wireless spectrum to wearable medical sensors, reportedly becoming the first nation in the world to do so.

In a Sept. 11 announcement, the FCC finalized a vote taken on May 24 to set aside spectrum in the range of 2360-2400 megahertz for medical body-area-networks, or MBANs, with the 2360-2390 MHz range restricted to indoor use. The decision, to take effect on Oct. 11, means wearable sensors will be able to send and receive non-voice data in that range without interference from Wi-Fi or other devices, though they'll still be considered secondary users.

This announcement sets in play the further development of remote monitoring either in hospital ICUs, during transportation in and out of hospital as well as remote-monitoring from the home or chronic facility facilitating  Real cost savings as opposed to governmental edicts, such a PPACA

The medical device can now be certified by a standard, and a secure protocol established.  Undoubtedly the FCC will want to finalize and certify the device(s) as reliable and accurate under a variety of circumstances.

The light is now green for device and remote monitor companies to proceed.


Wednesday, September 19, 2012

New Requirements for Non-Profit Status of Hospitals


More IRS and HHS chicanery:

A little known tax provision listed in Obama Care adds additional mandates on all non-profit hospitals in order for them to maintain their non-profit status.  If all new requirements are not met, hospitals may lose their non-profit status and be fined $50,000 annually. 

The new mandatory requirements read right out of a community organizer's handbook.  Any non-profit hospital must meet the following new requirements or lose non-profit status and face a $50,000 fine annually:


The citizens’ community’ will decide the following:

1. Meet the community health needs of all citizens

a. Health needs will be determined by persons who represent the broad interests of the community served by the hospital

2. Meet the financial assistance policy requirements which include:

a. Eligibility requirements and whether service includes free or discounted care

b. Must show how the hospital came up with the prices for care

3. Must impose price controls so to charge the same for all people whether patients have insurance or not

4. Must provide audited financial statements to show how the hospital spent their money servicing the community healthcare needs

a. If not all needs are being addressed then why not and what is being done to address the needs

The trick to these new regulations is that they are ambiguous.  There are no specific guidelines thus; someone (federal bureaucrats) will need to decide pricing, financial assistance guidelines and how the hospitals get paid. What this tax provision does in the real world is give the government and the Health and Human Services (HHS) Secretary Kathleen Sibelius dictatorial control of over 50 percent of all hospitals in the United States.  Their oversight and mandates will impose price controls and force hospitals to provide regular care to everyone regardless of insurance or ability to pay. 

Through new ambiguous regulations hidden within laws and with the largest set of tax provisions in the last 20 years, the IRS and HHS are now in financial control over a majority of U.S. hospitals and the healthcare industry.

Please ensure all your friends and family know the truth. Please forward this email and get the word out.  November 6th is election D-Day.

The Team at Generation America


Monday, September 17, 2012

Gazing into the Future for Social Media in Health Care


Engage or Die

Written by a prominent social media expert and marketing guru, Brian Solis, the image portrays the folly of denial and remaining static.

Social Media is a difficult market to explain or stay current. It seems to ebb and flow each day.  Analytics has become a byline for return on investment.

Physicians will often compare efficiency on the amount of time or money invested to return an increase in reimbursement.  That metric however will soon become less important for those providing care with insurance reimbursement.  One issue that may not be entirely expected is that many more physicians will not interface with insurance companies, nor Medicare.  In most states there is no requirement to accept Medicare in order to be licensed.

In today’s health care environment being listed in a provider directory is essential to maintaining a patient base.  Belonging to a provider panel, IPA is essential. The effect of planned accountable organizations has yet to be determined.

Physicians during the last decade have been inclined to distance themselves from financial liability as profit margins have declined.  In return for relief from liability and more regular hours physicians will accept employment, and leave the driving to others.

During the past two years concierge medicine and direct medicine have become a new financial model which decreases overhead for doctors and perhaps patients as well. With the profound reduction in bureaucracy it may also improve quality of care.

The Yellow Pages are dead, and have been replaced with the search engine, and social media is fast becoming an additional resource, facebook, google plus and perhaps a new social media platform of the year will arise.  Social media platforms are interactive and require regular and frequent updating to eliminate the impression they are stale and old news.  Many search engines have new algorithms that  evaluate how often content is  updated and may position your rank according to those criteria.

In terms of business planning medical concerns need to be proactive and plan to  include social media in their marketing budgets, just as was done during the yellow page era.  Twitter and Facebook identifications will become common place in printed material, email, stationary and other brochures.

Any physician seeking to engage in social media should read several primers on social media, outside the health care field, written by Brian Solis

The Hidden Power of Your Customers: 4 Keys to Growing Your Business Through Existing Customers

Now Is Gone: A Primer on New Media for Executives and Entrepreneurs

Social Media ROI: Managing and Measuring Social Media Efforts in Your Organization (Que Biz-Tech)

The End of Business As Usual: Rewire the Way You Work to Succeed in the Consumer Revolution [Hardcover]

Once you have these under your belt we can go on to more specific applications in health care.

Friday, September 14, 2012

Mappy Health Train Express


What word rhymes with happy? Why Mappy of course ! What social media platform gives instantaneous information,in real time as to outbreaks of infectious diseases? Mappy can track the outbreak of mosquito borne diseases, influenza outbreaks, and a multitude of other potentially harmful infectious diseases.

Mappy was the result of a ‘Challenge” by HHS for development of innovative health software. 

HHS describes it’s new application, developed by: Social Health Insights.  Early on it is tracking the outbreak of West Nile Virus

“We are Tracking Disease Trends, 140 characters at a Time !”


Twitter challenge sparks innovation in tracking local health trends
New web-based app leverages Twitter for real-time early warning of disease outbreaks.

Local public health officials can use a free new Web-based application, MappyHealth This link takes you to a non-Federal Government site, to track health concerns in real time in their communities using Twitter, the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) announced today.

MappyHealth is the winning submission of 33 applicants in a developers’ challenge, “Now Trending: #Health in My Community,” sponsored by ASPR. Health officials can use data they gain through the app to complement other health surveillance systems in identifying emerging health issues and as an early warning of possible public health emergencies in a community.

The challenge grew from a request made by local health officials to ASPR for help in developing a Web-based tool that could make social media monitoring more accessible to local health departments. Studies of the 2009 H1N1 pandemic and the Haiti cholera outbreak demonstrated that social media trends can indicate disease outbreaks earlier than conventional surveillance methods. However, many Web-based apps look back after a disease outbreak, rather than attempting to identify health trends as they emerge in real time.

This more than clever and highly usable application (web based) allows for selection of criteria by selecting criteria on the top banner, such a condition, location, and twitter trend.  A visually captivating feature is the ‘running ticker tape” display of trends in episodes such as tick-borne diseases, typhoid, tuberculosis, varicella with indications as to increases or decreases in the last 4-24 hours depending upon the magnitude of each criteria.

Social Media here performs well for quick display of important information translated from tabular chart data sets into friendly, usable and easily identifiable data sets in a graphic user interface.

Kudos to Social Health Insights, LLC



Thursday, September 13, 2012

Governance….is it in the Right Place?


There seems to be a similar problem with government and healthcare.

It comes down to governance. Congress and the executive branch seem to be inept at the least, incompetent, or at times malicious.

It is time to take back not only the United States, but healthcare as well. Our leaders despite their best attempts have failed and continue to fail.

I read a blog by a respected family physician yesterday, who has decided to leave the practice that he started almost 20 years ago. He is the type of physician who has always been an innovator, beginning with his use of EMR over 15 years ago. He is known for speaking at national meetings about the benefits of health IT long before there was an ONCHIT, or RHIOs and the ARRA and HITECH. You can read his story. He  articulates very well his consternation with his group practice which took on a life of it’s own and clearly sets his new goals with firm guidelines as to how it will operate.

Rob Lamberts MD has been a dedicated physician who has worked within a difficult system. ….he is making a healthy move for himself and his family. We cannot expect providers to operate in a health system for the betterment of their patients in a constant state of frustration which evolves into what I call a “traumatic stress disorder” We cannot expect more physicians to fall on their sword to overcome the enormity of what government has done to us all (in the name of balancing budgets, preventing fraud, proper coding, treatment paradigms and more. When I read of Dr. Lamberts decision I was ‘blown away’. He is not the type to make a compulsive move.  He has acted responsibly and given more than 90 days notice to his partners and patients, alike.

I cannot speak for Dr. Lamberts, it would be far easier to throw up one’s hands and go with the flow. He knows, he already had started a successful medical practice, investing hundreds of thousands of dollars, or more likely millions of dollars in his medical practice, adding new physicians, equipment, and facilities.  Anyone who has started a medical enterprise knows the pitfalls of taking on new associates. Contrary to popular opinion group practices can be more inefficient than small closely held or solo organizations.  Eliminating insurance will eliminate much overhead, and rightly give back that responsibility to those who buy it…the patient.  This one feature will engage and empower patients in their health care costs.

Before I digress further, let me close and stay on topic.

Good luck Rob Lamberts, M.D.  You are far from alone. I only hope that most on a new path will succeed. The next step is to leave medicine altogether, some get an MBA then become health care executives (at least they have choices then). Some will become ‘entrepreneurs”, some will become disabled, or retire early.

Health Care is much too important to allow politicians to control and make decisions which have repeatedly gone sour.  They ignore good advice, take direction from the wrong directions, from powerful self-interest groups, foundations, non profit organizations, academia, pharmacy and insurance conglomerates. 

Sometimes we wish for something and when we get it we realize what a mistake it is or was.  Perhaps now is that time to reassess what health reform should be, not what it is turning out to be.  As we step through meaningful use stage I, stage II and eventually stage III it becomes apparent how flawed PPACA has become. It was all there, but no competent people read it before it was passed by a highly partisan congress.  Each side was out for it’s own selfish motives, righteousness and truly unconcerned about the burdens and extent of PPACA.

Yes, it is time to retrieve our responsibilities as physicians to govern. Most of us were intensively trained in decision making.  As regulations increase bureaucracy increases exponentially, with increasing cost, complexity, and diminished accountability.

Numerous new forms of physicians practice have appeared, concierge practices, direct practices, and cash retainer practices.  All do away with the physician being responsible for processing insurance claims. 

The present situation evolved shortly after Medicare developed mandatory assignment with direct payment to the provider. Then it progressively became worse, fueling medical inflation.  Following the curve I expect the same will occur with Obama care….Although I want health care for all and affordability.  Obama care is wrong for our patients.


Tuesday, September 11, 2012

Mitchell Poll Reveals that Boomers will Purchase Health Care Apps


How important is social media to mobile health apps?  Very, according to Mitchell Research, a national polling company based in East Lansing, Michigan. Susie Mitchell is founder of MitchellPR a consulting firm focused on helping technology deliver mobile health and wellness apps to Baby Boomers.  A 30 year journalist and public relations veteran, she has a keen understanding of the 78 million person cohort. She is president of the nationally recognized marketing research, public relations and public affairs firm Mitchell Research & Communications, Inc. writes the BoomerTech blog and a weekly blog for AARP called App of the Week.  She is co-author of the book, Growing into Grace: Adventures in Self Discovery through Writing, which assists women in finding peace with their lives as they age.

There is a lot more to purchasing a mobile health app.  Providers need to be involved, and training sessions increase the likelihood they will be used as designed. 

And price point for the app is important.  About 36% would spend $1 or $2 on a medical app and 30% would spend $3 to $10.  This is good news, for app developers, insurance providers and doctors.

A common conversation amongst Boomers is that we all want to live longer and we all want more active lives.  Ask almost any Boomer what he or she thinks about getting older and you’ll hear the proclamation, “I’m not giving into aging.”

And we often say we will go to great lengths to keep the tentacles of Father Time at bay.

Now a new study shows that a majority of Baby Boomers (those born between 1946-64) who own smart phones are willing to put their money where their mouths are and purchase health apps that help monitor and combat chronic diseases.

The takeaway

Boomers want to help manage their chronic disease care, they are willing to pay for the mobile apps to help them―but they need assistance in learning how to use the apps.  There’s an opportunity for health care providers to develop 12-step type app/disease management programs to help get this medical giant under control.

What is troubling, however, is the resistance of older Boomers to be digitally connected.  The group that needs help the most is missing out on terrific apps to help them manage chronic disease. 

Lessons learned

·Just because chronic disease apps exist doesn’t mean they are used.
·Just because someone downloads a chronic disease app doesn’t mean he or she will use it.
·There needs to be a human liaison between the app and the Boomer user.
·Once the group gets comfortable together, they are willing to share their ideas and outcomes, which will make adherence to the app more likely.
·And, once they get used to it they are very likely to share their app with friends, increasing the number of users!

Searching for support groups:  Facebook groups, Twitter lists, Google Circles are a good place to find others who are familiar with health apps. Search YouTube, there are many professional and amateur training videos available.

Doctors need to step it up and encourage Boomer patients to download and use the health care apps.  If they don’t already own a tablet, trends show they will be purchasing one soon.

In my next post we are going to discuss the ideal platform…smartphone vs. tablet and operating system, iOS vs. Android.

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Thursday, September 6, 2012

The Real Low Down on Social Media, Is it B.S.?

Stolen from The Gilmorr Gang

Well, despite my commitment and interest (prurient, perhaps) I am beginning to sense a high ‘smell factor’.

Does this apply to #hcsm as much as other venues?  I think not. Most of our content is real and applies to very interesting and important content. I mean there are some interesting pundits pundit ting constantly about reform, deficits, HIT, Medicare, ACOs, PPACA……in addition to SOPA…

Is it my civil right to Google, tweet or Facebook?  Ask my spouse….no rights without responsibility.

Please do comment here, or on G+Gary Levin or +Digital Health Space ,  Facebook me, or even G-d forbid a quick ‘tweet @glevin1 .

Waste in the American Health Care System?


Source: Institute of Medicine


According to the influential Institute of Medicine, (AP) — The U.S. health care system squanders $750 billion a year — roughly 30 cents of every medical dollar — through unneeded care, byzantine paperwork, fraud and other waste, the influential Institute of Medicine said Thursday in a report that ties directly into the presidential campaign. (As printed on the BenefitsPro website today) in an article posted by Ricardo Alonso-Zaldivar , in an article titled, “Waste Not, Heal Not.” 

The ‘nuclear option’ of $750 billion dollars does little to itemize and correctly identify needless spending. It lumps it all in one bucket, private medicine, institutional medicine, government medicine (military and/or Veterans Hospitals and outpatient (ambulatory) or in patient health care.

President Barack Obama and Republican Mitt Romney are accusing each other of trying to slash Medicare and put seniors at risk. But the counter-intuitive finding from the report is that deep cuts are possible without rationing, and a leaner system may even produce better quality.

Here are some of the quotable from the article:

"Health care in America presents a fundamental paradox, ……

"The past 50 years have seen an explosion in biomedical knowledge, dramatic innovation in therapies and surgical procedures, and management of conditions that previously were fatal ...

"Yet, American health care is falling short on basic dimensions of quality, outcomes, costs and equity," the report concluded.

If banking worked like health care, ATM transactions would take days, the report said. If home building were like health care, carpenters, electricians and plumbers would work from different blueprints and hardly talk to each other. If shopping were like health care, prices would not be posted and could vary widely within the same store, depending on who was paying.

If airline travel were like health care, individual pilots would be free to design their own preflight safety checks — or not perform one at all.

IOM panel members urged a frank discussion with the public about the value Americans are getting for their health care dollars. As a model, they cited "Choosing Wisely," a campaign launched earlier this year by nine medical societies to challenge the widespread perception that more care is better.

Politicians inflame opinion and obscure the reduction of useless health care as ‘rationing of care’, when in reality inefficient and wasteful health spending creates shortages and unintentional rationing causing many to go uninsured.

More than 18 months in the making, the report identified six major areas of waste:

Unnecessary services ($210 billion annually);

Inefficient delivery of care ($130 billion);

Excess administrative costs ($190 billion);

Inflated prices ($105 billion);

Prevention failures ($55 billion),

Fraud ($75 billion).

Adjusting for some overlap among the categories, the panel settled on an estimate of $750 billion.

The present mindset is that our health system. or lack thereof is not and major reform is necessary, which brings us to step II.  Our usual cure for a problem (i.e., to make things more efficient and  less expensive are to throw money at the problems, which includes things such as incentive payments to MDs for acquiring electronic health records, the HITECH Act which provides resources for training health IT personnel, the enormous expense of designing, planning and implementing Accountable Care Organizations, the inefficiencies of disruptive technology and disruptive reorganization. 

If one want to create more chaos and dysfunction, then do exactly what is happening now. 

Examples of wasteful care include most repeat colonoscopies within 10 years of a first such test, early imaging for most back pain, and brain scans for patients who fainted but didn't have seizures.

The problem with preventive recommendations and/or recommended testing and treatment protocols is that they are often wrong, are used for many years, and then rescinded, creating confusion and loss of trust by patients.

The expected outcomes are far from being accomplished by PPACA.  It remains to be seen if it will be affirmed by the next congress.


Health Insurance–Motivated Disability Enrollment and the ACA


Jae Kennedy, Ph.D., and Elizabeth Blodgett, M.H.P.A.  September 5, 2012 (10.1056/NEJMp1208212)

The United States relies on employer-based health insurance to cover working-age adults and their families. As a result, Americans who are unable to engage in full-time work because of a chronic health condition must not only seek out wage replacement but also pursue alternative sources of health insurance.

We believe that HIMDE is an important driver of the unsustainable growth in enrollment in public assistance programs for people with disabilities. The Social Security Administration currently has programs — such as the Ticket to Work and Medicaid Buy-In programs — that address this problem by preserving health insurance benefits for disability-program enrollees who return to work. These programs cannot address the system wide cost and structural factors contributing to HIMDE, but certain reforms included in the Affordable Care Act (ACA) do address such factors — meaning that stabilization of federal disability programs through a reduction in HIMDE is an unacknowledged but important benefit of the ACA.

Although Medicare and Medicaid funds are not as immediately vulnerable as SSDI, and the cost of these programs is a perennial concern. Unsustainable enrollment growth in disability programs contributes to this cost because Medicare and Medicaid coverage are closely linked to receipt of SSDI and SSI: SSDI beneficiaries receive Medicare 24 months after their financial benefits start, and most new SSI beneficiaries are simultaneously deemed eligible for Medicaid coverage.

In addition to making the private insurance market more accessible, the ACA will also change the public insurance landscape for disabled workers. The law originally required all 50 states to provide Medicaid coverage for persons with incomes below 138% of the federal poverty level, but the Supreme Court has ruled that such an expansion is not mandatory.4 The effect of Medicaid expansion on HIMDE will therefore vary by state. States that currently have very low income-eligibility thresholds or do not cover childless adults will dramatically increase the number of adults eligible for Medicaid if they opt to expand their programs. Adults with potentially work-limiting disabilities residing in these states will be able to obtain Medicaid without first obtaining SSI through disability eligibility.

The current process of directing applicants to SSI and/or Medicaid for benefits creates added bureaucracy and eligibility also requires asset determination as well as prior income from Medicare employment contribution.

The system is ‘rigged’ against those who never or could not gain enough credits to be eligible for SSDI.

Wednesday, September 5, 2012

A Simple and Inexpensive Message


This inspirational quote says it all. No need for multi-million dollar studies by institutes, government agencies, nor non-profit agencies.