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Monday, June 30, 2014

Revolutionary Hologram Guided Surgery is a Heartbeat Away

It sounds like something out of a sci-fi thriller, but an Israeli holographic imaging system for the operating room is poised to revolutionize surgery in the near future.

Though only in the clinical beta prototype stage, the world’s first 3D holographic display and interaction system for medical applications was already featured on the TV show Grey’s Anatomy and has been tested successfully by surgeons at Israel’s Schneider Children’s Medical Center in Petach Tikva.
This proprietary digital technology from RealView Imaging in Yokneam projects hyper-realistic, dynamic 3D holographic images of body structures “floating in the air” without the need for special glasses or a conventional screen.
The physician can literally touch and interact precisely with the projected three-dimensional volumes, providing an unprecedented tool for planning, performing and evaluating minimally invasive surgical procedures.
As reported in the Israeli Times

Sunday, June 29, 2014

Doctors4 Patient Care Direct Payment Models

In this article Hal Scherz MD discusses direct payment models, the VA Crisis and other related items such as America's Web Radio,(available as a mobile app on iTunes) The Doctor's Lounge, and Doctors 4 Patient Care.

Doctors 4 patient care continues to be a strong force for physician opinion for freedom, and for eliminating much of the bureaucracy and governmental regulation preventing effective medical decisioins.

Tuesday, June 24, 2014

The Feds are Enforcing Privacy Rules With Stiff Fines for violating HIPAA Regulatons

Groups hit with record $4.8M HIPAA fine

And finally, not all data breaches are electronic:

This breach involved records from a hospital emergency department that should have been shredded ending up in a dumpster in front of the hospital. "It was a windy day. Security forgot to put a lid on the dumpster. The records are down the street," Hinkley recounted. Ultimately, school children nearby ended up collecting the records and returned them to the hospital. "The security guard said, 'not my job,'" said Hinkley. "How could someone seeing papers (flying about) not think, 'Gee, is that something I should think about?'"
The incident could well serve as the poster child for inadequate employee training, added Hinkley. The key is to "have it be owned by everybody from the first person the patient sees to the last one they see and everybody that touches their data in between."

EHRs and other digital storage or HIT network has been delayed, despite HIPAA regulations. Implementation may be delayed due to a multitiude of mandated changes in health reform. Institutions are hard pressed to comply due to financial limitation meeting all their responsibilities. 


The second category of Disruptive Men is those who disrupt conventional wisdom creating catalytic innovation. These individuals or groups innovate and create 'sea changes' in medical  practice and administration.

Many changes are initially perceived as 'disruptive' rather than as a catalytic innovation. This applies to adopting electronic health records, changes in reimbursement from volume based payment  to quality of outcome. This group includes administrators as well as physicians.  Progress may be seen as creating inefficiency initially. Diffusion of innovation as described by Everett Rogers, a professor of communication studies, popularized the theory in his book Diffusion of Innovations; the book was first published in 1962, and is now in its fifth edition (2003).[1]  

Adopter categoryDefinition
InnovatorsInnovators are the first individuals to adopt an innovation. Innovators are willing to take risks, have the highest social class, have great financial liquidity, are very social and have closest contact to scientific sources and interaction with other innovators. Risk tolerance has them adopting technologies which may ultimately fail. Financial resources help absorb these failures. (Rogers 1962 5th ed, p. 282)
Early adoptersThis is the second fastest category of individuals who adopt an innovation. These individuals have the highest degree of opinion leadership among the other adopter categories. Early adopters have a higher social status, have more financial liquidity, advanced education, and are more socially forward than late adopters. More discrete in adoption choices than innovators. Realize judicious choice of adoption will help them maintain central communication position (Rogers 1962 5th ed, p. 283).
Early MajorityIndividuals in this category adopt an innovation after a varying degree of time. This time of adoption is significantly longer than the innovators and early adopters. Early Majority tend to be slower in the adoption process, have above average social status, contact with early adopters, and seldom hold positions of opinion leadership in a system (Rogers 1962 5th ed, p. 283)
Late MajorityIndividuals in this category will adopt an innovation after the average member of the society. These individuals approach an innovation with a high degree of skepticism and after the majority of society has adopted the innovation. Late Majority are typically skeptical about an innovation, have below average social status, very little financial liquidity, in contact with others in late majority and early majority, very little opinion leadership.
LaggardsIndividuals in this category are the last to adopt an innovation. Unlike some of the previous categories, individuals in this category show little to no opinion leadership. These individuals typically have an aversion to change-agents. Laggards typically tend to be focused on "traditions", likely to have lowest social status, lowest financial liquidity, be oldest of all other adopters, in contact with only family and close friends.
LeapfroggersThe phenomenon when resistors upgrade they will often need to skip several generations in order to reach the most recent technologies.

As the diffusion process progresses and the innovation gains popularity, observers and adopters often credit the 'disruptors' as creative individuals. The conventional wisdom of doing more to increase productivity is replaced by thoughtful analysis of the tasks at hand.  Also as the diffusion occurs improvements occur in the original idea which make it more acceptable and useful.  The disruptive process if fine tuned by early disrupters, making it also more acceptable to current process.

How experts explain technology adoption cycle

The accepted premise is that every new technology goes through the following phases:
  1. Hype: Search for next big thing leads to Hype around any new technology.
  2. Struggle: Adoption of these Bleeding Edge technologies depended on the Visionaries who had the vision, energy and money to make it work.
  3. Success: Mainstream adoption required convincing the Pragmatists who needed success stories and support system around the technology.

Not all innovation is accepted or gains popularity. 

Monday, June 23, 2014

Real Health Care Reform Should be Affordable

The average Floridian pays way too much for health care. Roughly, 18 percent of your income goes towards your health care, on average. Now research from Harvard shows that health care spending will grow faster than the economy for at least the next 20 years.

The Affordable Care Act was supposed to prevent this, but it cannot. Rather than reform health care, the law merely expanded health insurance, a costly system that leaves patients behind and is largely responsible for spiraling costs.

What Geometry Can Teach Us

 Insurance Plan Reimbursement                                      Patient--Provider Payments    

Think back to your eighth-grade geometry class. You probably learned that the shortest path between two points is a straight line. You can apply this same logic to spending, where the cheapest option involves only two parties. In health care, the two parties that matter are you and your health care provider (your doctor, the pharmacy, etc.). You spend the least money when you pay them directly. onsider how health insurance works. Your money exchanges hands multiple times before it reaches the provider. It first goes to a third party (either the insurance company or the government, such as in Medicare and Medicaid). From there, those entities negotiate compensation schedules with providers and facilities. Both of these steps add bureaucratic and administrative costs to health care’s price tag. And although insurers attempt to lock in reasonable prices on your behalf, they often come up short.Why? Because they’re not spending their money: They’re spending yours. They thus have less of a financial incentive to get the best deal. Businesses and bureaucrats are no different from you and me; if you give them someone else’s money, they’re more likely to spend it foolishly.
Now consider how health insurance works. Your money exchanges hands multiple times before it reaches the provider. It first goes to a third party (either the insurance company or the government, such as in Medicare and Medicaid). From there, those entities negotiate compensation schedules with providers and facilities. Both of these steps add bureaucratic and administrative costs to health care’s price tag. And although insurers attempt to lock in reasonable prices on your behalf, they often come up short.
Why? Because they’re not spending their money: They’re spending yours. They thus have less of a financial incentive to get the best deal. Businesses and bureaucrats are no different from you and me; if you give them someone else’s money, they’re more likely to spend it foolishly.
The same problem affects you once you have health insurance. After you pay your premiums, insurance gives you the illusion that you’re spending someone else’s money. The health insurance trap thus comes full circle, both insurers and consumers make it more expensive.
This raises the question: If not “Obamacare,” what else? Reformers should start by giving consumers the freedom to make their own health care choices. We need to return health insurance to the role of taking care of unpredictable, catastrophic health care expenses, and leave the great majority of everyday health care decisions in the hands of consumers.

We know this works. In the fields of cosmetic surgery,  lasik eye surgery , alternative medicine, and dentistry, the absence, or minimal presence, of government regulation or health insurance has driven prices down, and quality and service up. This has occured due to these procedures being elective, and requirement for out of pocket payment  by the patient.
Doctors can also refuse to take health insurance. More doctors and hospitals are choosing this path. One of my patients did this and saved $17,000 on a single procedure.
Lawmakers should encourage this kind of patient-focused innovation. Instead, they gave us “Obamacare,” which wraps health care in red tape and forces everyone to purchase health insurance. Real reform shouldn’t leave us with a higher bill.
Dr. Jeffrey Singer practices general surgery in Phoenix and is an adjunct scholar at the Cato Institute.

Thursday, June 19, 2014

Disruptive Men in Healthcare

One of my favorite blogs, Disruptive Women in Healthcare, at which I frequently lurk quietly stalking those ladies who are assertive, bright, imaginative, charming ( I have to throw that in) and articulate.

Here is my new blog, DISRUPTIVE MEN IN HEALTH CARE. Perhaps I should name it "Disruptive Persons in HealthCare. In the last several years we have a new culture of 'anger management' in which surgeons, and doctors are not allowed to yell, be polite at all costs, and tolerate dangerous or risky behavior. This will be a forum for polite expressions of our displeasure with the system.

Male and female physicians are accused of being disruptive when their authority is questioned or an order ignored. I am a bit old fashioned, however a brief admonition is within the scope of human relationships. As a physicians' role is minimized and their duty to protect and treat patients is obstructed by well meaning but uninformed para-medical personell, many physicians approach the breaking point of patience.

I will be inviting and encouraging guests to add their own positive remarks, and/or negative observations regarding health care, policy makers, and the insertion of ' personality '  into daily medical business.

I am looking for those who are willing to express their opinions, without regard to political correctness, however profanity is not welcome.

Wednesday, June 18, 2014


americans-health-reports.jpgArticle attributed to:  New Yorker Magazine

Many Americans are aware that the United States spends much more on health care than any other country in the world. But fewer people know that the health of Americans—by many different measures—is actually worse than the health of citizens in other wealthy countries.
Two major reports, both released last year, provide further elaboration of this apparent paradox. The first, The State of US Health, 1990-2010,” documented trends in mortality and morbidity across the thirty-four member countries of the Organization for Economic Cooperation and Development (O.E.C.D.). The study, published in The Journal of the American Medical Association (to which I am a contributing writer), showed that both life expectancy and healthy-life expectancy improved in the United States over two decades. But the pace of those improvements was considerably slower in the United States: in 1990, the U.S. ranked twentieth among O.E.C.D. countries for life expectancy, and fourteenth for healthy-life expectancy; by 2010, it had fallen to twenty-seventh and twenty-sixth, respectively. The other charts and tables in the report—about heart, lung, and kidney disease; diabetes; injuries and homicides; depression; and drug abuse—all show Americans suffering poorer health.
The second report, commissioned by the National Institutes of Health, and conducted by the National Research Council (NRC) and the Institute of Medicine (IOM), convened a panel of experts to examine health indicators in seventeen high-income countries. It found the United States in a similarly poor position: American men had the lowest life expectancy, and American women the second-lowest. In some ways, these reports were not news. As early as the nineteen-seventies, a group of leading health analysts had noted the discrepancy between American health spending and outcomes in a book called “Doing Better and Feeling Worse: Health in the United States.” From this perspective, the U.S. has been doing something wrong for a long time. But, as the first of these two reports shows, the gap is widening; despite spending more than any other country, America ranks very poorly in international comparisons of health. The second report may provide an answer—supporting the intuition long held by researchers that social circumstances, especially income, have a significant effect on health outcomes.
Americans’ health disadvantage actually begins at birth: the U.S. has the highest rates of infant mortality among high-income countries, and ranks poorly on other indicators such as low birth weight. In fact, children born in the United States have a lower chance of surviving to the age of five than children born in any other wealthy nation—a fact that will almost certainly come as a shock to most Americans. But what causes such poor health outcomes among American children, and how can those outcomes be improved? Public-health experts focus on the “social determinants of health”—factors that shape people’s health beyond their lifestyle choices and medical treatments. These include education, income, job security, working conditions, early-childhood development, food insecurity, housing, and the social safety net.
Steven Schroeder, the former president of the Robert Wood Johnson Foundation—the largest philanthropic organization in the United States devoted to health issues—had a definitive answer to my question about why Americans might be less healthy than their developed-country counterparts. “Poverty,” he said. “The United States has proportionately more poor people, and the gap between rich and poor is widening.” Seventeen per cent of Americans live in poverty; the median figure for other O.E.C.D. countries is only nine percent. For three decades, America has had the highest rate of child poverty of any wealthy nation.
Steven Woolf, of Virginia Commonwealth University, who chaired the panel that produced the NRC-IOM report, also pointed to poverty when I asked him to explain the causes of America’s health disadvantage. “Could there possibly be a common thread that leads Americans to have higher rates of infant mortality, more deaths from car crashes and gun violence, more heart disease, more AIDS, and more premature deaths from drugs and alcohol? Is there some common denominator?” he asked. “One possibility is the way Americans, as a society, manage their affairs. Many Americans embrace rugged individualism and reject restrictions on behaviors that pose risks to health. There is less of a sense of solidarity, especially with vulnerable populations.” As a percentage of G.D.P., Woolf observed, the U.S. invests less than other wealthy countries in social programs like parental leave and early-childhood education, and there is strong resistance to paying taxes to finance such programs. The U.S. ranks first among O.E.C.D. countries in health-care expenditures, but as Elizabeth Bradley, a researcher at Yale, has documented, it ranks twenty-fifth in spending on social services.
The NRC-IOM report emphasized the effect of social forces on children and how those forces carry over to affect the health of adults, noting that American children are “more likely than children in peer countries to grow up in poverty” and that “poor social conditions during childhood precipitate a chain of adverse life events.” For example, of the seventeen wealthy democracies included in the report, the U.S. has the highest rates of adolescent pregnancy and sexually transmitted diseases, and the second-highest prevalence of H.I.V. This platform of adverse health influences in childhood sets up the health disadvantage that remains pervasive for all age groups under seventy-five in the United States.
It seems likely that many Americans would respond to these figures—and to the role poverty plays in poor health outcomes—by assuming that the data for all Americans is being skewed downward by the health of the poorest. That is, they understand that poor Americans have worse health, and presume that, because the United States has more poor people than other wealthy countries, the average health looks worse. But one of the most interesting findings in the NRC-IOM report is that even white, college-educated, high-income Americans with healthy behaviors have worse health than their counterparts in other wealthy countries.
Woolf explained this disparity by citing the work of the British social epidemiologist Richard Wilkinson, who has proposed that income inequality generates adverse health effects even among the affluent. Wide gaps in income, Wilkinson argues, diminish our trust in others and our sense of community, producing, among other things, a tendency to underinvest in social infrastructure. Furthermore, Woolf told me, even wealthy Americans are not isolated from a lifestyle filled with oversized food portions, physical inactivity, and stress. Consider the example of paid parental leave, for which the United States ranks dead last among O.E.C.D. countries. It’s not hard to see how such policies might have implications for infant and child health.
Other countries have used their governments as instruments to improve health—including, but not limited to, the development of universal health insurance. Health-policy analysts have therefore considered the effect that different political systems have on public health. Most O.E.C.D. countries, for example, have parliamentary systems, where the party that wins the majority of seats in the legislature forms the government. Because of this overlap of the legislative and executive branches, parliamentary systems have fewer checks and balances—fewer of what Victor Fuchs, a health economist at Stanford, calls “choke points for special interests to block or reshape legislation,” such as filibusters or Presidential vetoes. In a parliamentary system, change can be enacted without extensive political negotiation—whereas the American system was designed, at least in part, to avoid the concentration of power that can produce such swift changes.
Whatever the political obstacles, a major explanation for America’s persistent health disadvantage is simply a lack of public awareness. “Little is likely to happen until the American public is informed about this issue,” the authors of the NRC-IOM report noted. “Why don’t Americans know that children born here are less likely to reach the age of five than children born in other high income countries?” Woolf asked. I suggested that perhaps people believe that the problem is restricted to other people’s children. He said, “We are talking about their children and their health too.”
The superior health outcomes achieved by other wealthy countries demonstrate that Americans are—to use the language of negotiators—“leaving years of life on the table.” The causes of this problem are many: poverty, widening income disparity, underinvestment in social infrastructure, lack of health insurance coverage and access to health care. Expanding insurance coverage under the Affordable Care Act will help, but pouring more money into health care is not the only answer. Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.
Self-interest may be a natural human trait, but when it comes to public health other countries are showing the U.S. that what appears at first to be an altruistic concern for the health and care of the most vulnerable—especially children—may well result in improved health for all members of a society, including the affluent. Until Americans find their way to understanding this dynamic, and figure out how to mobilize public opinion in its favor, they will all continue to lose out on better health and longer lives.
Allan S. Detsky (M.D., Ph.D.) is a general internist and a professor of Health Policy Management and Evaluation and of Medicine at the University of Toronto, where he was formerly physician-in-chief at Mount Sinai Hospital. He is a contributing writer for The Journal of the American Medical Association.
Photograph by Ashley Gilbertson /VII.

Taxpayers subsidizing 76% of premium under health care law Associated Press  If you missed signing up, here are some other alternatives

People who signed up for coverage under President Obama's health care law are paying about $80 a month in premiums on average, the administration reported Wednesday.

The new numbers from the Health and Human Services Department cover only the 36 states where the federal government took the lead in setting up new insurance markets, accounting for about 5.4 million of the 8 million people who signed up nationally.

-- Taxpayers are subsidizing 76 percent of the average monthly premium in the 36 federally administered markets.
-- The average premium is $346 a month, but the typical enrollee pays just $82. Tax credits averaging $264 a month cover the difference. The government pays the subsidy directly to insurers.
-- After tax credits, Mississippians paid the least for coverage - averaging just $23 a month on average premiums of $438. Among people in the 36 states, New Jersey residents paid the most - an average of $148 on premiums averaging $465 a month.
-- For this year, the average consumer could pick from five insurance companies and 47 different plans, although choice was more limited in a small number of states. From a range of platinum, gold, silver and bronze plans, most people picked silver.
-- There was a link between greater competition and lower premiums. For each additional insurer in a local market, premiums for the benchmark silver plan declined by 4 percent.
-- Premiums varied widely between states, ranging from an average of $536 in Wyoming to $243 in Utah.
Federal officials say they don't yet have complete data on the 14 states running their own markets.

Monday, June 16, 2014

Processed red meat harmful to heart

Processed red meat harmful to heart

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Processed red meat harmful to heart
In general, red meat is not considered as healthy. A Swedish study, which was published in "Circulation", now indicates an increased risk of heart failure and related deaths when processed red meat is consumed.
Researchers from the Karolinska Institutet in Stockholm studied eating habits in a cohort of 37,035 men (aged between 45 and 79 years) over the course of twelve years. The study differentiated between consuming unprocessed and processed red meat. The latter included cold cuts, sausage, pies and black pudding.
During the course of the study, 2,891 men were diagnosed with heart failure and 266 died from it. The risk of heart failure was 28 per cent higher for men who ate the most processed red meat (more than 75 grams per day) compared to men who ate the least (less than 25 grams per day). People who ate the most processed meat also had double the risk of death from heart failure than people with the least consumption.
For each 50 gram increase per day, the risk of heart failure increased by eight per cent and that of death from heart failure by 38 per cent. In contrast, eating unprocessed red meat had no effect on the risk.
"To reduce your risk of heart failure and other cardiovascular diseases we suggest avoiding processed red meat in your diet, and limiting the amount of unprocessed red meat to one to two servings per week or less", said study author Joanna Kaluza from the University of Warsaw. It was assumed that the results would be similar for women.

Thursday, June 12, 2014

Google Glass and Health Care

If you are a practicing physician, it woul be hard to miss all the changes due to EHR adoption, and Health Information Exchanges.

The HIT space is also being invaded by other applications and consumer hardware/software platforms easily adapted to medical practice.  Some innovator surgeons and medical physicians also have taken available platforms and adapting them to patient care.  HIPAA has prepared the innovators for security and privacy of patient medical information.

Google has many apps that can be used in a medical environment.

Google glass has been used by  some surgeons to teach and/or get consultations in real time.

Google Glass has been of interest to the healthcare industry for a while, and while performing surgery with Glass is nothing new, complying with HIPAA standards while doing it is.

We go into this in more detail at:  Digital Health Space.