Ding,Ding Health Train Express on Track 134

"Arriving on track 134, the Health Train Express bound for Everywhere, USA. Stand back please, and have your boarding pass ready.   This train is a local and will stop at HMO haven,DRG depot, P4P pitstop, JCAH junction, Copay Circle, H&P Place, EMR Exit,  and points beyond!"

The train is late, and overloaded, standing room only and passengers hanging out the windows, on the roof, and swinging from the doors.  The engine speeds by the platform and the cars smoothly glide  to a halt.

Track 134 is a new 'high speed" mag-lev train,

with very limited service, since the infrastructure of new technology, magnetic lev cars and rails are not yet put into place.  America has talked about this new technology for over 25 years, and there has been little  progress.

502 km/h on Japanese Maglev Train
by KumagayaRocks

You board this special health train on your way to work, and have a seat, awaiting your destination......as you work on your laptop, fiddle with your PDA and/or take SMS and phone calls on your IPOD, or new G1 phone, the train leaves the station gliding smoothly on a cushion of air.

As you pick up speed and pass by roads, overpasses, crossings, and small towns now vacant from migration to city centers, suddenly, you are distracted by:

Ding, Ding..... go the strings of my heart

Dr. Wes began this scenario for me in his blog today

* Ding Ding * You get a best practice alert!
Have a patient without an mammogram in the last year?
*Ding Ding* You get a best practice alert!
Haven't had your colostomy and over age 50?
*Ding Ding* You get a best practice alert!
Haven't counselled you patient about their smoking each year?
* Ding Ding * You get a best practice alert!
Haven't had your cholesterol checked?
* Ding Ding * You get a best practice alert!
Didn't screen your patient over 18 for depression?
* Ding Ding * You get a best practice alert!
Didn't know that there 134 potential alerts for 2008?
*Ding Ding * You clearly need a best practice alert!

DING DING GO THE STRINGS OF MY HEART  (be patient while this loads (Chuck Berry)

"Best Practice Alerts" are computer algorithms triggered from diagnosis codes.
"Best Practice Alerts" are an Electronic Medical Record's (EMR) means to assure that the "voluntary" Physicians Quality Reporting Initiative is undertaken. Never mind that failing to comply means certain discrimination between physicians. Just remember, it's voluntary! Really.
"Best Practice Alerts" force doctors to cross tacit specialty treatment boundaries and risk alientating referral doctors.
"Best Practice Alerts" drive testing and procedures, and therefore costs, to our health care system.
"Best Practice Alerts" are encouraged by those with a stake in health care.
"Best Practice Alerts" remove judgement from medical care in favor of mandates.
"Best Practice Alerts" are disruptive to doctor-patient interactions, consuming precious clinic time as "why" or "why not" must accompany each alert response.
"Best Practice Alerts" have not been shown to improve patient outcomes over more conventional care.
So how, then, are we to assume such alerts represent "Best Practice?"

image credit:  Google images

Theme Song from Father Knows Best....opens in player, be patient while it downloads. (click on photo)

Well, it's simple: because

Father knows best.
-Wes

Dr Wes......you are brilliant!! And thanks!!

photo credit: Dr Wes blog photo

Free Pass on the Health Train Express.

Sign up for free government programs for EMR. 

Did you know that right now the state and federal government has programs that you may be eligible for.  You do not have to have a disabiity, nor be a member of a special class.  Our operators are waiting to hear from you for these special programs set up by the government.  Don't wait to sign up for these programs.  If you were born between 1900 and 2000 you are elibigle for one of these little known government subsidies. 

“Because you pay your income taxes on time, you have been awarded a free $12,500 government grant! To get your grant, simply give us your checking account information, and we will direct-deposit the grant into your bank account!” Even if you don't pay taxes on time....our program has a waiver for that requirement.

Our program outlines all the monies that have been allotted for you to purchase and EMR for your  medical practice."

Not withstanding the above  "fantasy financing for EMR", the reality is that the situation remains grim for most providers.

Joseph Britto, CEO of Isabel Healthcare writes in The Health Care Blog,

"September 25, 2008, the Certification Commission for Healthcare Information Technology (CCHIT) issued a report that reviewed 90 EMR incentive programs (state, federal, private) with a total funding of $700 million available.

Of course there are some disclaimers.

Many health policy experts believed that “if you subsidize it, they will come.” While that approach has worked in persuading people to take mass transit, it hasn’t lured many physicians into using EMRs. ............................

 Health Industry Insights, a private research firm, reviewing the CCHIT report, estimated that the cost to implement an EMR is roughly $25,000 per physician and that the $700 million currently available would represent only 9% of the expected total national cost  to furnish all physicians in private practice with an EMR. "

With these realistic limitations in mind, it may be time for a new mindset of what the best utiization is for our limited IT resources.

 

"As we endure financially difficult times, we believe it is time for IT leaders at hospitals and medical groups to take second look at a different set of technologies, one which, like EMRs, can align physicians and hospitals in the shared goals of improving patient care and reducing clinical risk. "

"Clinical decision support (CDS) technology is not new, it has been available in various forms since 1986, but as computer hardware has become vastly more powerful, the newer versions of the systems have become faster and more practical for physicians to use. One particular kind of CDS technology, diagnosis decision support (DDS), has been adopted in many hospitals in the past two years, as medical executives realize its value in attracting leading physicians who understand and value medical knowledge tools.  "DDS systems include two key components: a dynamic medical knowledge data base and an inferencing or logic engine to sort and select decision options for clinicians.

There are some skepticism as to the value of CDS, by some physicians

Ira Breite states, "The real reason that internists and other PCPs have been slow to adopt the EHR systems (EMR is sooo 20th century)is that they are not ready for prime time. Data entry is slow to the point of ridiculous, and while "decision support" may work in a hospital where lots of available data can be condensed into an algorithm, its still not real useful for the question of whether to give antibiotics in the case of sinusitis. Yes, I know there is an algorithm for that, but the reality is I don't always follow it and neither do the guys who wrote it (if they actually take care of patients)."

With this in mind.....call 800-FRE-EEMR or run down to the mailbox and send off your application(s) for these  FREE GOVERNMENT GRANTS

Help us Help them

Help us Help them

Don't vote until you see the video

How can we help these people?

Real Stories about Real People

http://www.youtube.com/watch?v=DNHNCScYpX8

Nathan Wilkes

http://www.youtube.com/watch?v=2peGqRrjXek

Cynthia Campbell

http://www.youtube.com/watch?v=McGm00Mvakc

In a stunning turn around, insurance giant CIGNA has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkisyan, a 17-year-old girl in the intensive care unit at UCLA Medical Center. Unfortunately, Nataline passed away yesterday just after six o'clock the same day of the massive protest

http://www.youtube.com/watch?v=Wh0mgiwXzGM

Emily Cannon is a young woman in the prime of life, the daughter of a registered nurse, and a former elementary school teacher whose life has ground to a halt since developing a chronic but treatable illness. She is now being denied care she needs to return to the active life she once enjoyed.

http://www.youtube.com/watch?v=K1uXUgTakk4

Watch this compelling video about a mother and daughter living on a fixed income and having to fight their health insurance provider for coverage.

http://www.youtube.com/watch?v=Q4xcV4bULRQ

Retiree Juanita Anderson doesn't just fear the rare disease that attacks her organs and sends her to the ER,she also fears the insurance companies who can change her coverage at any time and destroy her finances.

http://www.youtube.com/watch?v=TqSshZZMHGA

Linda Peeno-Sicko

http://www.youtube.com/watch?v=itKJRq3NU7s

Michael Moore-Sicko

http://www.youtube.com/watch?v=aC7zI7VXcCA

Andy Bales: Rescue Mission

http://www.youtube.com/watch?v=tqmk3ycTmuY

Deborah Burger—RN

Zorses and The Health Train

If you are wondering what a zorse is, check out my other blog

DNA Train & Bill Gates

 

Arthur Caplan, Ph.D.,a bioethicist at Harvard (2005) espoused a

theoretical scenario regarding Bill Gates.

"Who needs Bill Gates? No, I don’t mean who needs a gazillionaire corporate titan, a man whose company, Microsoft, took in billions of dollars last year by controlling nearly all the software used to run nearly every computer on the planet.

No, I mean,  literally, who needs him?  If you could go back in time and stop the birth of the world’s most famous nerd, would you?

You probably answered my question with a "no.".......he is the father of a computer revolution that has brought much good to many people throughout the world. Add to that achievement his current generous philanthropic activities supporting some very worthy causes, such as vaccine research and a center for autism research in Seattle, and the case for having Bill with us becomes pretty persuasive.  What if I told you it’s possible that Gates has a medical condition that accounts, in part, for both his tremendous achievements and for his "nerdiness?" Gates is widely reported to display many personality traits characteristic of a condition known as Asperger’s syndrome.  Asperger’s is a mild version of autism, a more serious condition that renders many children unable to talk, be touched, communicate or socialize. While I certainly do not know if Gates has Asperger’s, his difficulties in social settings are nearly as legendary as his genius, so it's possible.  That said, if you had been Gates' potential mom or dad 50 years ago, what would you have done if you knew about his abilities and flaws before he was born?

Asperger’s is the least disabling form of autism and research is beginning to show that it may also account for the presence of some special capabilities in areas like mathematics, computer science and engineering. But the same genes may also create a person who is socially awkward, easily distracted, very introspective and in many ways withdrawn and solitary.

The reason I ask these questions is that there is a good chance we will soon have a genetic test for detecting the risk of autism in an embryo or fetus. The development of such a screening tool raises the possibility that parents might one day have the option of preventing the birth of a child with even a mild case of the disorder.

 

DNA. or desoxynucleic acid was postulated and proven over forty years ago. At that time it was heralded as the next penicillin of health care.

Millions, and perhaps billions of dollars (now worth much less) have been invested in learning more about the molecules of our primordial basis for reproduction.

Recently several high profile biomedical companies have begun to promote wide screening of individuals who appear to be healthy as a predictor for degenerative and/or chronic diseases. Is this technology ready for 'prime time'? Several question have arisen.  The state of California with a recent "cease and desist order"  decided it is not ready, under the present format proposed by the three companies who stand to make a fortune if this idea catches on with the public. (Affymetrix, Navigenics). Microsoft seeing a chance to capitalize offers "HealthVault" to store the data for future use by patients and health care providers in this prospective study. 

Will this testing be cost effective, and where is the evidence based "medicine" ??  Will health insurance companies reimburse for this lab test?

"The cost of genetic testing can range from under $100 to more than $2,000, depending on the nature and complexity of the test"

Genetic testing has proven it's worth in predictive pre-natal testing for hereditary chromosomal abnormalities such as trisomy 21, trisomy 18, cystic fibrosis, and other tests not related directly to genetic analysis have predictive value. (Tay-Sachs disease, neural tube defects)

 

A consortium of health care, technology and research leaders have joined forces in a first-of-its-kind research study to assess the behavioral impact of personal genetic testing on people who choose to receive such screenings to identify their potential
risk for developing certain diseases.

    Sponsored by Scripps Translational Science Institute (STSI), and the National Institutes of Health, ie, our tax dollars,  the study aims to find out if participating in personal genomic testing will improve health by motivating people to make positive lifestyle changes, such as exercising, eating healthy and quitting smoking, as well as decisions to seek further medical evaluation and preventive strategies. The study will offer genetic scans to up to 10,000  employees, family members and friends of the nonprofit Scripps Health system in San Diego and will assess changes in participants' behaviors over a 20-year period.

    Co-sponsors of the study include Navigenics Inc. of Redwood Shores, Calif.; Affymetrix of Santa Clara, Calif.; and Microsoft Corp. of Redmond, Wash. Study participants age 18 and older can receive a scan of their genome and a detailed analysis of their genetic risk for more than 20 health conditions that may be changed by lifestyle, including diabetes, obesity, heart attack and some forms of cancer. Other companies such as 23andme will offer the range of tests (using a small sample of saliva) for $399.00 through  the internet ( secure)
  

"Genome scans give people considerable information about their DNA and risk of disease, yet questions have been raised if these tests are ready for widespread public use," said Eric J. Topol, M.D., director of STSI and principal investigator of the study. "Our study will prospectively evaluate the effect that state-of-the-art gene scans have on people's lifestyles, behaviors, diets and psyches."

    Affymetrix will scan each participant's genome and Navigenics(TM) will interpret the scan results and offer personalized guidance on steps to lessen the chances of negative health impact. This information will be available to participants on Navigenics' secure Web site. Each participant will be able to enter and store clinical and lifestyle information in an individual Microsoft HealthVault(TM) account, allowing the participant to manage his or her personal health information in one location and share it,
as desired, with health care providers or others they trust to help make more informed health care decisions. (ref: PR Newswire)

It's a brave new world out there!!!

The Train Station

Dr Val  www.getbetterhealth.com

Last night I had a chance to join Dr Anonymous on his world famous Thursday evening show. It was great to hook up with fellow bloggers, Dr A, Dr. Val, Dr Rob and many others in the health train station.

For those of you who have not heard, Dr Val has changed 'networks'. Her new blog, which I call  'soft & fluffy' , address is www.getbetterhealth.com   .

Dr Val  has interview posts from Mike Huckabee, Grant Hill, Maria Menounos, Bob Schieffer,Phylicia Rashad, and Dr.

Richard Carmona.

Here is your chance to learn from "Bones" of Star Trek fame. It seems he had troubles with reimbursements as well.

As usual Dr. Val shows her creative flare....this is going to be a great blog and web site...Watch out Oprah and The View..

Congratulations to Dr. Val!!!!  You are no longer homeless.

Dr. L

Health Train Calclulator

Quote of the day:

Reading is to the mind what exercise is to the body. - Sir Richard Steele

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Located at number 92 in the list of the most popular Health2.0 blogs is 'Stayin Alive'  Clicking on this link takes you to the blog, and in the posting today (October 9,2008) is a link which takes you to the "Health and Education Calculator" .  The web site is self-explanatory. It's a fun thing to tinker around with.

Wealth Train Express

I'll take a right hand turn here (not politically) to share with the readers....we are in the wrong profession.

Some new definitions in the world of business. This guy's blog was bought for  15 million buckaroos!

Revised Financial Terminology for 2008

Posted in Banking News by Johns Wu
October 8, 2008 09:34 AM - 15 Comments

Hat tip to The Big Picture for posting up this bit of Wednesday humor.

CEO –Chief Embezzlement Officer.

CFO– Corporate Fraud Officer.

BULL MARKET — A random market movement causing an investor to mistake himself for a financial genius.

BEAR MARKET — A 6 to 18 month period when the kids get no allowance, the wife gets no jewelry, and the husband gets no sex.

VALUE INVESTING — The art of buying low and selling lower.

P/E RATIO — The percentage of investors wetting their pants as the market keeps crashing.

BROKER — What my broker has made me.

STANDARD & POOR — Your life in a nutshell.

STOCK ANALYST — Idiot who just downgraded your stock.

STOCK SPLIT — When your ex-wife and her lawyer split your assets equally between themselves.

FINANCIAL PLANNER — A guy whose phone has been disconnected.

MARKET CORRECTION — The day after you buy stocks.

CASH FLOW — The movement your money makes as it disappears down the toilet.

YAHOO — What you yell after selling it to some poor sucker for $240 per share.

WINDOWS — What you jump out of when you’re the sucker who bought Yahoo @ $240 per share.

INSTITUTIONAL INVESTOR — Past year investor who’s now locked up in a nuthouse.

PROFIT — An archaic word no longer in use.

I know, I know, we still get our jollies out of helping these people.

Health Train addendum

It seems that no sooner do I ask a question, that the answer appears on other blogs. Thank you Matt Holt, and others.

 

 

Candleglance provides some stellar graphics. More comments later.

Answers to the Health Train Questions

Edwin and Kevin, I have found the answer to my questions about symptoms at the  E.D.

From the WSJ

The grim economy and quaking stock market are driving masters of the financial universe to seek professional help for anxiety, and eroding sense of identity or tips on how to deal with angry clients, the Boston Globe reports.

Therapists are seeing an 15% to 20% uptick in business from affluent clients around Boston, psychologist Jim Grubman told the Globe.

The financial crisis bruises the psyches of the wealthiest in particular because their sense of self can be so focused on making money, therapists say.

“It’s something that I call identity dissolution, their sense of identity dissolves,” Dennis Pearne, another Massachusetts psychologist, told the Globe. “The primary way they defined themselves and who they were and their values - what they can and can’t do in this world - disintegrates.”

In counseling, the rich (or formerly rich) may need to learn that who they are is more than raw purchasing power. Therapy may explore the idea of a different career or, alternatively, how to renew the patient’s motivation to compete again in the market. Grrrrr.

Kick your Apps off the Health Train

I don't know about you, but I have heard, written, and seen about enough of gloom, doom, and problems.  I turn our attention to some fun stuff.

Today we are offering a number of innovative applications to benefit you and your patients.

First, I would like to invite the readers to join an internet site which is a unique central control for all your social networking sites. For those of you who are of an entrepenurial bent, or those who have internet savy and web sites, this is a site with a myriad of tools to promote your web site and integrate it into multiple social networking sites. Kickapps is a user friendly site offering multiple venues for publicizing  your enterprise.  Some of the companies that are represented include: National media, Local media, Blogs, Magazines,Newspapers,Lifestyle,Not for Profit,League and Associates, Community Associations, Local and National Televison, Local and National Radio, NPR.....and more.  There is even a site that will take you to Concierge Medicine.

The site is supported by advertising, and a host of interesting links.  There are multiple tutorials for idiots like me. Exploring this site may give you ideas for your interests. My site gmlevinmd123 is there in it's infancy.  See you there at Kickapps

Warning, this is an unabashedly commercial marketing site.  I make no claims regarding it's veracity and I have no financial interests in the site, nor any of it's participants, other than my own link.

Health Train Collision

Harry Truman

"I never did give them hell. I just told the truth, and they thought it was hell."

************************************************

The past two weeks have hammered

all segments of the economy, from the housing markets, banking institutions, small and large businesses, and soon into healthcare.  Unless the credit markets resume functioning very soon we will witness payless paydays in provider groups, elimination of health information technology projects and the abrupt decrease in adoption of EMRs.  The Feds have shot themselves in the foot, quite nicely.

AIG crashed several weeks ago, and we have heard nada from health insurers, their reserves, nor the state of their investments in the market and/or real estate. I am naturally suspicious and it has been eerily quiet from those corners.

Ignoring Crisis has a price  (from the New York Times)

After 14 months of crisis, the federal government — meaning you and me — has put serious money on the line. As a point of comparison, the entire annual federal budget is about $3 trillion.

Despite everything, the biggest fiscal problem remains, far and away, health care. Based on the rate that medical spending has been rising, the Congressional Budget Office forecasts that Medicare and Medicaid will take up 10 percent of G.D.P. within two decades, up from about 4 percent now. In today’s terms, that would be the equivalent of adding at least $900 billion to the deficit every single year, in perpetuity. It makes the cost of the bailouts look like a rounding error.

When it comes to health care, we have a situation that is blatantly unsustainable. With the right choices, we can prevent that. But so far, we instead seem to be hoping that the situation will magically resolve itself, which is a recipe for big problems and perhaps even a crisis.  Will health care bomb out?

Let’s see. That doesn’t sound familiar, does it?