Out of the Fog

The fog lifted quickly this morning. It burns off in mid morning and things become clearer as I head off , not on call, not worrying about seeing 40 or 50 patients with itchy burning eyes, floaters, flashing lights, computer vision problems, chldren referred for evaluation of dyslexia referred by a  school psychologist for eye exercises. Mixed in with that mix are the retinal detachments, acute narrow angle or undiagnosed chronic glaucoma, the ocassional herpes dendritic keratitis, zoster, macular hemorrhage, vein occlusion and central artery occlusions. and the bread and butter for most ophthalmologists....that cataract !

But as I said I am not going to be doing any of that for awhile.....perhaps never.  I have made my mind up to become 'cognitive' again after several decades of assembly line medicine seeing 50 or more patients a day. I sometimes lie awake at night, and also during the day (between naps). It must be the sleep apnea as well as my antidepressants and meds for bipolar spectrum disorder.  Now that you know the 'truth' about me you will understand the reason(s) for the nature of my writing.

I had always attributed my sense of anxiety and apprehension as well as occassional irritability and impatience to my sense of superiority in all  things medical and surgical. I mean I survived college, med school, internship, residency, military service in a combat zone, with several episodes of moderately severe depression which I always attributed to my meager financial resources,  and family responsibilities and seemingly endless nights on call and moonlighting to survive residency. Early on my anxiety would bring me to a therapist. It felt good to ventilate. So after 30 years or more my last therapist told me that I sounded 'bipolar'.   Well, shit yes...!! How else would any normal human be able to have normal SSRIs with little sleep and staggering hours and workload without a bit of an imbalance in vital neural brainwash.??

Now, I don't know what bipolar sounds like.

There, I have exposed myself.... my hidden vulnerability.

I have not changed, but the world around me has changed. All the things I studied for and worked for are gone. (but not my family) So it's not my fault and it is not my responsibility to adapt anymore.  I now have a new fundamental understanding and gestalt for those 'old eccentric folks' walking around babbling and seemingly inappropriate....

During my 'seeking'  a career transition (a euphemistic saying to cover up boredom, burnout,or whatever) I visited a local Starbucks near a UC campus.  There it was....the future of the world, a lot of Apple Macs (all white) and lots of Asians. (no insult intended).

I  am not certain what the p.c. term is for those of asian descent.  It seems many Asians excel into getting into the UC system.

This is a wonderful that they  move to the U.S.to keep our universities full, since our own public school system cannot keep up feeding the greater University system.  The unemployment of college professors would be much greater without Asian participation.  What goes around in the business world also comes around in education.  So our educational institutions also participate in the global economy I am just concerned that our balance of education is negative. We need to export more students!!

If you haven't applied for a job in the normal workplace in the last ten years, you will be in for a shocker. 

You have to do most or all of it online....No face to face

unless  you can penetrate the software algorithms screening for key words in your resume.

I am even suspicious that you do not have to write coherently, just put the correct keywords, or tags in the appropriate fields.

Guess the correct combination and your resume does not get filtered into some giant resume spam file.....

presto it appears in the 'incoming resume file for some lower level flunkie to bring into the dean's office, or the human resource filter to be forwarded to the appropriate department in whatever business you will be hired to continue your financial plans.

del.icio.us Tags: fog,flashing,keywords,resumes,interview,finances,nest egg,burn out

Health care vs. Health Care

Yesterday's posts were truncated by some other important issues.

Today I am a bit overwhelmed by what to post. The issues are legion.

Our first great event is the State of California being held in contempt regarding funding of Prison Health Reform  The issue is that  the courts are insisting that California write a bad check to initiate planning for the new prisons. (when I do that I get charged for overdrafts, and possible criminal charges.)

Our second great event is the State of California v. the County of Santa Barbara.  The state claims it overpaid Santa Barbara in Medi-cal funds. 

Just what I love...my government using my tax dollars to fight with one another...net gain less than zero...pure stupidity, audit it and report it, and don't make the same mistake again.

We need more government involvement in healthcare (sarcasm)

 

del.icio.us Tags: prison reform,healthcare lawsuits,santa barbara,Schwarzenegger,medi-cal overpayments

Health Train Express Travels through the Cloud, or should we say Fog??

What's in a name? Is it a cloud or fog? It depends upon your altitude.....and the dew point....

Sublimation....the transformation of a solid directly into a gas, ie dry ice to vapor.

Microsoft has announced it's new "Azure" platform...it's answer to Google's online microsoft look alike solutions available on the internet. They are calling this "Cloud computing".  We'll see if it a cloud or fog (vapor)  soon. Cloud Computing according to Wikipedia

This announcement reveals a major shift in software development applications for health solutions in both business and clinical applications.  Look here for more information at a later date on specifics about cloud computing and healthcare.

Our medical practices have gone from being solid business platforms into vapor at times. Is this sublimation? At one time our medical practices were a sublime portion of our daily lives.

Happy Hospitalist Express

 

from THE HAPPY HOSPITALIST VIA GRUNT DOC

For most of you out there, I will never meet you. You will live long, prosperous, healthy lives. You will raise families, remain gainfully employed, go to church, give back to the community and generally live. You will play by the rules. You will have your ups and downs and life will go on. What I describe in my blog and experience in my life as a hospitalist represents a very skewed representation of America. I am often lambasted by others for being unHappy and distressed with my situation. That couldn't be farther from he truth. What I try and present to you on the Happy Hospitalist is the gross abuse running rampant in our health care system. The abuse, I believe, entirely the result of third party rules and regulations, has become intolerable for many health care providers. Enough to make many quit. The abuse running rampant by the few has also had the effect of driving up prices for everyone looking for health care security.
So I ask the question, what type of patient are you? Are you contributing to the demise of the third party model so ingrained in our current culture.

del.icio.us Tags: health care abuse,patient,hospitalist,third party model

More Medicare Nonsense

 

CMS in it's infinite wisdon has declared war on those of you who are recalcitrant to adopt eRx. AmedNews reports this morning that since the  ''carrot" didn't work as fast as they wanted it to, and eRx adoption is lagging they would up the stakes.

With electronic prescribing still far off the radar screen for many physicians just weeks before new Medicare e-prescribing incentives kick in, the Centers for Medicare & Medicaid Services hosted an event here in October to jump-start an all-out push for widespread adoption of the technology.

(Most of the attendees were vendors, administrators, and a few physicians who have already adopted eRx (1400 attended).

 

Only about 2% of eligible prescriptions nationwide in 2007 were ordered electronically. While physicians in some states used the technology more extensively, few states broke the 3% mark when it came to paperless drug orders.

Prescriptions sent electronically

Massachusetts
13.43%

Rhode Island
9.05%

Nevada
7.06%

Delaware
4.21%

Michigan
4.20%

Maryland
3.17%

North Carolina
3.07%

Arizona
2.89%

Connecticut
2.57%

Washington
2.57%

New Jersey
2.51%

Pennsylvania
2.46%

Ohio
2.46%

New Hampshire
2.34%

Source: RxHub, National ePrescribing Conference, October. RxHub is owned by SureScripts.

Back to top.

---

The power of incentives

In Massachusetts, the number of prescriptions sent electronically surged after the state's Blue Cross Blue Shield plan started offering e-prescribing incentives in 2004. Medicare officials hope to see a similar boost nationwide from the bonuses they will begin offering in January.

 

Electronic prescriptions written

Q4-2003
13,039

Q1-2004
19,288

Q2-2004
51,126

Q3-2004
107,098

Q4-2004
294,272

Q1-2005
454,896

Q2-2005
599,321

Q3-2005
720,138

Q4-2005
958,569

Q1-2006
1,060,402

Q2-2006
1,095,986

Q3-2006
1,064,357

Q4-2006
1,145,295

Q1-2007
1,167,501

Q2-2007
1,156,112

Q3-2007
1,072,824

Q4-2007
1,095,237

Q1-2008
1,122,761

Q2-2008
1,036,784

Note: Incentives took effect in Q1-2004.

Source: Blue Cross Blue Shield of Massachusetts

 

---

Weblink

"A Clinician's Guide to Electronic Prescribing", October (www.ehealthinitiative.org/erx/clinicians.mspx)

 

In other news from AmedNews:

Caught unaware, doctors get delay in FTC enforcement of ID theft rules

 

When the FTC begins enforcing the rules, failure to comply could mean administrative penalties or up to $2,500 in fines per violation.

According to AmedNews the rules extend to

"If, on a regular basis, a physician allowed a patient to leave knowing they were not going to be paying immediately, even for a co-payment or deductible, the provider would be considered a creditor.

The AMA and other groups won a six-month reprieve for doctors to implement a prevention program originally mandated for Nov. 1.

The so-called "red flag" rules require entities that regularly extend credit, or defer payment for services, to establish a written program for preventing identity theft as well as detecting and responding to warning signs of such thefts. The commission first released the rules last November as directed by the Fair and Accurate Credit Transactions Act of 2003.

• Discuss on Sermo
• Warning signs for physicians
• Links
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• E-mail  -  Print [Ctrl-P if JavaScript off]  -  Write a letter

Until recently, physicians and health care facilities were largely unaware of the regulations, which were thought to pertain mainly to banks and other financial institutions that offer credit in the traditional sense. But in recent weeks, the FTC signaled that the rule was intended to apply more broadly, including to the health care arena.

So, have a nice day.

del.icio.us Tags: cms,identify theft,ftc,copays,credit,AMA,eRx,incentives

Health Train Express & Halloween

I decided to post my Halloween 2006 blogpost here, again. I brought it forward from my original iteration, RiversideHealth

THIS IS HALLOWEEN

Friday, November 03, 2006

Halloween and RHIOs

Several nights ago we participated in the annual ritual of door to door "trick or treating".
It seemed to me there are some analogies between Halloween night and RHIOs.
We are all looking for some "treats" without being "tricked". Some of the takers would shove their whole hand enthusiastically into the candy barrel and come out with a fistful of treats, while some would gingerly pick out one. My wife cautioned me to hand them out one at a time or we would soon run out. The same can be said about enthusiasm for RHIOs. Some are enthusiastic takers, and givers, others are reticent about their choice(s). One thing was for sure, I had to go out and replenish the barrel several times.
We had just moved into a new family neighborhood, and discovered there were literally thousands of children coming to our door. Having been on the far side of the half century mark for some time, we had recently been living in the relative quiet and senior demographics of the desert. There were wonderful fairies, pumpkins, spidermen, supermen, fantastic fours, and even a few dated ninja turtles, coming to our door that evening. In the desert we were lucky if we saw one or two. The future of our country abounds in Riverside neighborhoods.
It came to me that we are not building health IT and/or RHIOs for ourselves but for our children. How critical this need is demonstrated by recent articles about outsourcing not only transcription services but actual health care delivery, such as surgery, and diagnostic testing where these services can be obtained for 10% of what it costs in the United States. A bit shameful for us.
Physicians are now faced with the annual adversarial role with CMS, and it appears, as usual that our fees will be slashed 5.7% on the average. If you do the math, this makes RHIOs and EHRs even more unlikely.
Then there is legislation pending that would mandate EMRs with funding from Congress through a variety of sources. Which is the trick, and what is the treat?
As for me, give me those

little foil wrapped chocolate balls.

HealthVault Express

I was planning a post this AM, and my internet is flaky, fortunately I use Live writer from Microsoft. It's a simple task to write off line and then save a draft and/or upload to the blog.

The internet is a complex "spider" of networks and supposed redundancy. This morning I only have access to google, and whatever is on their servers. The rest of the bilions of sites are unavailable.  I guess Google will save the world. I wonder if HealthVault is up.

This brings to mind the fallibility of all things electronic. Imagine you are at your docs office and he want to pull up your PHR which is stored in Healthvault and/or Google Health. What now?

Or how about your front or back office running an EMR on as asp solution?  Nada!!  Although not requiring much hardware investment and offering 24/7 maintenance .asp solutions are not as cheap as you might think.

That's the downside....

The upside is that my internet has never has gone down for more than an hour or so.  But never say never...I live in a fairly metropolitan area of Southern California.

With a client-server configuration, I have personally been the victim of servers, client work stations fizzle out and be down for a day or even up to a week while a part or major component is replaced, along with the software that may have been lost. Not a happy situation either.

More bad news....I called my ISP to see just how long the outage will  be.  I received one of those messages. "We are experiencing an outage in your area"  (how do they know  where I am...must be one of those caller ID thingys.  The voicemail was upgraded to

"If you would like a call when the technical difficulty is fixed, push one.  (how do they know I don't have a rotary phone?_) For you late season "boomers" go to wikipedia or google....  "we will call you back between the hours of blah blah blah...  This does not sound good.  How will they voicemail blast this message?  

BuzzNet Tags: isp,google,boomer,web 2.0,internet,server,client,voicemail

 

Health Train Billboards

Obama Has Spent $113 Million on Health-Themed Ads

My initial reaction was how many uninsured children would benefit from money thrown at TV ads.

PEOPLE WANT MORE PERSONAL, EXPERT “HEALTH ENGAGEMENT,” GLOBAL STUDY REVEALS

October 16, 2008, — New York – A 5,000-person, five-country study released today by Edelman shows that people want more active, trusted, and personal health interaction with companies, organizations and brands, effectively rewriting the “rules of engagement” in health.

 

Health Populi  Jane Sarasohn-Kahn

A majority of employers who don't sponsor health would be unwilling to contribute over $50 per employee per month for coverage

U.S. employer sponsored health system is experiencing some bipolar behavior: there is a cadre of large employers who want to continue sponsoring health benefits as part of overall compensation. But, for at least one in 3 employers, most would not be willing to pay $50 more.......................

 

BuzzNet Tags: campaign ads,politics and healthcare.global,rules of engagement

Health Train Billboards

Obama Has Spent $113 Million on Health-Themed Ads

My initial reaction was how many uninsured children would benefit from money thrown at TV ads.

BuzzNet Tags: campaign ads,politics and healthcare

Gene Train Express

 

Quote of the day:
The effort to understand the universe is one of the very few things that lifts human life a little above the level of farce, and gives it some of the grace of tragedy. - Steven Weinberg

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

The rapid scientific progress in genomics is now translating into almost everyday clinical applications. It becomes obvious,although expensive at this time, that DNA analysis will cause a revolutionary catalytic disruption in how medicine will be practiced.

One-stop' embryo test unveiled

A gene mapping test could tell parents-to-be if embryos are affected by almost any inherited disease, UK scientists have claimed.

The team from London's Bridge Centre say the £1,500 test could detect any of the 15,000 inherited diseases in weeks.  The claims for this new technique, called karyomapping which analyses chromosomes, is that it is a universal 'one size fits all' test. The human genome project has allowed mapping our DNA.

The economics of genetic testing is a double edged sword. Initially this testing will be expensive. Most payers will not pay for this testing, at first.  As the early testing translates into "assembly line" techniques the cost will diminish exponentially.  The upside is that proper testing will allow forecasting and accurate diagnosis of genetic conditions, allowing for targeted specific conditions.  Patients will benefit from designer drugs modeled to prevent allergic and cross reactions in some patients. It may become possible to design antibiotics against drug resistant organisms. 

Health Train at San Francisco

By now those of you who read my blog regularly realize that I did not go on a media fast.  It didn't seem quite right in the middle of the Health 2.0 ver 3.0 in San Francisco. If Matt, Sarah, Michael are working, who am I  to be a slack? So I am monitoring Health 2.0 from afar.

I received an email from Wellsphere asking if they could link to my blog here at Health Train Express.  The "train" is getting new routes.

I must admit as I have extracted myself from all the 'wonderful' things of patient care,

the only thing I miss is the personal  interactions between myself and patients.  I always aimed for the best outcomes, and was disappointed and somehow always felt guilty when the outcome of an eye surgery was not what I assumed to be perfect. I always had to go back and review what I might have done wrong, and discussed it with colleagues. I tried to keep my 'ego' out of the equation.

I am now a 'voyeur' enjoying academic discussions, patient care, and via several listservs, Sermo, iMedexchange focused on deep thought and practical questions with not only ophthalmologists from Brazil, Thailand, Hong Kong, Australia, Iceland and beyond. 

Nancy Turett in her blog shares her excitement about Health 2.0 and I can see why. These gatherings are educational but also are the physical manifestation of 'blogging'. It is the real world of virtual social blogging.  Friendships are made, and lost in a virtual world...a good deal like having a pen pal who sometimes answers your letter.  Putting a face and a voice on the blog seals the deal.

At Health 2.0  Gary Karr lists  Seven Great Health Care Policy  Blogs.

I expect to see some  updates on your flights back home.

gml

43 Things Tags: eye surgery,health 2.0,outcomes,pen pal,wellsphere

Health Train Genetic Transcription

John Hamlaka, M.D. the Chief Information Officer at Harvard Medical School and the Beth Israel Deaconess Hospital  has "donated"  his genome for the PGP (personal genome project.

It is now in a public space, accessible to anyone who can read AGTC code.

Audio transcript--John Hamlaka M.D.

Thought Leader #1

Thought Leader #2--David Altshuler

Thought Leader #3

I took a wrong turn surfing looking for blog material and happened upon these wonderfully informative daring innovators

Listen to the podcasts...you will need either iTune or Windows media player.

from Harvard Medical Labs

Episode 1- The Science of Social Networks--Audio

Episode 2- The Secrets of Aging--Audio

Episode 3- The Art of Perception--Audio

Episode 4-  And Coverage for all ? --Audio

Episode 5- Striving for Global Health--Audio

Episode 6-  Your Genome, Your Future--Audio

You may find the accompanying text from Harvard Medical Labs here.

Successful Health Train Reform

In many ways healthcare and education have taken a similar path. Education has endeavoured to equalize the playing field by increasing the number of pe0ple who are educated, thereby elevating them from impoverished lives, both economically and socially.

Despite increased spending in education, and a number of 'innovative' techniques' some of which have suceeded in their own relaively narrow segment, the effort has largely failed....left behind.

Max Ladner and Dan Lips write about the Heritage Foundation and about "A  successful model for education reform."

Parallels can certainly be drawn between our educational system and our health care non system.There  remains a large number of uninsured.

Obesity and dys nutrition abound fueling chronic diseases.

Florida has excelled in education outcomes. The tools have been a liberal use of charter schools, (300)......

— Standards and Accountability

— Ending Social Promotion

— Focusing on Reading

— Expanding School Choice Options

— Improving Teacher Quality

The Goldwater Institute elaborates further on the report from the Heritage Foundation.

Does this sound familiar?  Our government and payors have thrown more and more money at these issues in medicine, the underinsured, the medically indigent, the lack of physical fitness, and malnutrition without measurable success over the past ten years, except for some improvement in heart diseases. 

We physician leaders need to step back, out of the box, and ponder if some of education successes and failures apply to health care as well.

Health and wellness education and training needs to begin in elementary school.

M.D. O.D. also relates public education and public health issues in his recent blog, a guest editorial from ACEP by David Baehren M.D.

Evan Madianso likewise associates "affordable housing"  and "affordable health care  (brought to you by the feds. 

See   Freddie Mac  and    Fannie Mae. and yes they are still in business, have a web site and 'doing well' Thank you very much!!!

Health care needs a bailout, but we do not want it from the feds, for all the obvious reasons.

 

delicious Tags: affordable housing, affordable health, freddie mac, fannie mae, medically indigent, uninsured, heritage foundation, education reform, goldwater institute