Health Train Express--2008

The end of 2008 seems a good time to review the state of health information technology and the progress of Electronic Medical Record implementation.

Much has not occured since 2003 when GWB appointed David Brailer MD as the National Coordinator for Health Information Technology (ONCHIT). Initially, like all new things, ONCHIT attracted a great deal of publicity.  It stimulated the organization of CCHIT, a national certifying authority for producing interoperable information systems, assuring the compatibilty of different vendor offerings to move toward a goal of the National Health Information Network.

During the ensuing years, the most successful vendors became CCHIT certified, but now without annual costs paid for by the vendorss themselves to become certified each year.  These applications also are the largest companies and the most expensive software.  While bolstering interoperability, at the same time many vendors have disappeared because of  the CCHIT requirement.  The industry consolidated leaving fewer vendors.

All of the media excitement and cheerleading is now led by promises (mostly empty) of bailout funding.  Admittedly some states have ponied up to the bar with funding for EMRs. However, these 'integrated systems and EMR are limited to mostly public sector agencies. Little money has trickled over to private practice.  And this group needs it  most.

MRI (The Medical Records Institute) released it's Status Report, 2008, by it's  CEO C. Peter Waegmann.

iHealthbeat regularly charts the progress and adoption of EMRs several times each year.  It is my estimation that these figures are biased.   Many users report the use of EMRs which do not offer many functionalities which should be inherent in an EMR.

It is true that some practices have adopted electronic prescribing. and one or two other functionality.

The Chart below is taken from National Health Care Surveys done by the CDC.

The fact that EMR adoption has lagged does not take into  account the adoption of health information technology available via the internet and other sources.  The parallel development of Health 2.0 online services and mobile devices, such as smartphones, Personal digital assistants, and others hand held devices reflect the interest and willingness of physicians to utilize IT when cost effective. Adding to this strong trend is the deployment of high speed 3G cellular technology which empowers internet use almost anywhere.

A new survey found that 58% of U.S. physicians surveyed go online for clinical information at least two times per day. More than three out of four respondents said they go online for clinical information more often now than they did a year ago, according to the survey.

By now, most providers are familiar with software offered by third  parties as downloadable applications.

In 2008, 84% of physicians surveyed reported using the Internet and other technology to find information about pharmaceuticals, biotechnology and medical devices, up from 64% in 2004, according to a survey

 

Utilization of Health IT by Patients

A new survey found that 31% of non-elderly Americans with private health insurance and Internet access have used an online physician or facility finder. Meanwhile, 16% reported using an online health plan selection tool and 10% have used an online health care cost information tool.

Privacy Issues

In 2008, 62% of U.S. adults age 21 and older said they were not too or not at all confident that electronic health records would remain confidential, while 12% of survey respondents said they were extremely or very confident that EHRs would remain confidential

The area of explosive growth of health IT is in electronic prescribing. 

Fueling this growth is CMS's indication that users will receive a 2% bonus for using ePrescribing.

What does 2009 have in store?

iHealthbeat reports:

Nearly half of health IT professionals surveyed said that Democratic control of the White House and Congress will strengthen efforts to promote patient safety and the use of health IT, according to a new survey from the Healthcare Information and Management Systems Society.

Fourteen percent of respondents said that Democratic control of the White House and Congress will weaken efforts to promote patient safety and the use of health IT, while 29% said that it would have no impact and 9% said that they did not know what kind of effect it would have, according to the survey.

Meanwhile, 20% of respondents said that President-elect Barack Obama's proposal to spend $50 billion over five years on health IT is sufficient to advance health IT adoption, while 46% said that the funding would advance health IT adoption but that additional funding would be required to truly accelerate adoption. Fifteen percent of respondents said that Obama's proposed health IT funding is insufficient.

Results are based on a November survey of 622 health care IT professionals.

Source: HIMSS, "2008 Presidential Election"

 

This appraisal is based upon uncertain funding, intense competition for federal dollars, an exploding federal deficit, and many other unknowns. 

 

del.icio.us Tags: privacy issues,onchit,obama health proposals,medical records institute,cchit,health it utilization by patients,health it utilization by providers,emr adoption,pda,smartphone

Health Train Express--Denoument

Today we are changing from the train to an airliner. I do my best 'creative thinking', or perhaps I become a bit delusional at 40,000 feet. Perhaps it is the reduced atmospheric pressure or  decrease in oxygen.  No matter...it is the end result here that is important rather than the science.

An economic survey, or just reading the news tells us that financial institutions have failed.  Our industrial production base has changed, and what was once the bastion of middle class attainment, the automobile companies in the United States have tanked.

As I fly over the United States I see Wall Street in ruin, empty houses, unfinished home construction, and

a hole in the ground where the world trade center used to stand, the midwest where steel factories and other heavy manufacturing plants lay rusting in the cold damp winters, and in the warm humid summers.

We in health care bemoan our sad state of affairs as health  care costs have risen seemingly without end and naysayers who say most of our money is 'wasted' with little evidence for better outcomes and better health. 

Actual facts dispute this. Evidence and statistics show that mortality has changed. Fewer heart disease deaths, a drop in mortality from infectious diseases, and relatively more deaths from cancer. The increase in death and morbidity from cancers may more be a reflection of  increasing survival .

Despite these facts healthcare has now become a major backbone of  financial flow....health care provides employment for millions of Americans. 

The economicengines of the United States are service industry,  healthcare, education,  government (at all levels), regulatory agencies,public safety,the judicial system, technology, and communications. ( I leave entertainment as another driving force)

My previous post relates to the merger of health, prevention and entertainment.

Stepping back from all of this I think, what better use of our resources is there than keeping one another healthy.  What finer product is there than the human body?  What product grows and maintains itself automatically for up to 75 to 85 years?

 

del.icio.us Tags: entertainment,wall street,industry,automobile,world trade center,midwest,healthcare,economic crisis,technologoy,education reform,mortality,cancer,heart disease

Brain Train Express

For those of you who have not noticed videogaming is a 3 billion dollar industry, and is fluorishing during hard times.  For one thing it has a lot of 'bang for the buck',  compared to theme parks, movies, and does not use any fuel.

It also turns out that 16% of the gaming market has to do with health and fitness.  Yes,that's correct, you couch potatoes can use brain power as well as fitness training with interactive Wii (Nintendo) games.

Here are some examples:

Flaghouse  

PE & RECREATION

SPECIAL POPULATIONS

ACTIVITIES FOR LIFE

SENSORY SOLUTIONS

FITBRAINS

PHYSICAL FITNESS VIDEO TRAINING

POSIT SCIENCE BRAIN FITNESS PROGRAM CLASSIC

TRY AN INTERACTIVE DEMO HERE

EXERCISE IN A BOX

DANCE  DANCE REVOLUTION

 

BEFORE

 

AFTER

EVIDENCE BASED MEDICINE

del.icio.us Tags: excercise based medicine,evidence based medicine,health video games,brain fitness video games

Brain Train Express

For those of you who have not noticed videogaming is a 3 billion dollar industry, and is fluorishing during hard times.  For one thing it has a lot of 'bang for the buck',  compared to theme parks, movies, and does not use any fuel.

It also turns out that 16% of the gaming market has to do with health and fitness.  Yes,that's correct, you couch potatoes can use brain power as well as fitness training with interactive Wii (Nintendo) games.

Here are some examples:

Flaghouse  

PE & RECREATION

SPECIAL POPULATIONS

ACTIVITIES FOR LIFE

SENSORY SOLUTIONS

FITBRAINS

PHYSICAL FITNESS VIDEO TRAINING

POSIT SCIENCE BRAIN FITNESS PROGRAM CLASSIC

TRY AN INTERACTIVE DEMO HERE

EXERCISE IN A BOX

DANCE  DANCE REVOLUTION

 

BEFORE

 

AFTER

EVIDENCE BASED MEDICINE

Health Train Express Transition

The gulf between the macrocosm of health policy planners and the microcosm of health care providers, ie physicians, grows wider day by day.

Evidence of this abounds as other participants in the health process compete for a seat at the table of transition teams for the new Obama administration.  

What does Tom Daschle really know about providing healthcare to that patient on the exam table?

His choice was as an arbiter for political disagreements and an attempt to create the coalition to pass some type of health care legislation.  One cannot even begin to predict the outcome....whether it will call for a universal payor plan or another throwing of the dice in regard to reimbursement plans, or another game of insuring the uninsured by shuffling the deck of poker cards.

Health care unfortunately has become a game of chance.

Will you have a job?  Will you become disabled?  Will you become uninsurable? Will you be able to find a family physician? Will you, will you , will you?

Medicine and Politics seem to be following a new course of increased transparency of their own process. The internet has led to this development but still lacks user friendly search engines and other health 2.0 applications to find, organize and interpret raw data and commentary.  If one visits the Obama Transition Web site,  and searches you will find numerous sources and opportunities to participate .

 

Senator Tom Daschle is now the designated head of Health and Human Services.

The issues are complex and the economy has now complicated it further.  A bailout and stimulus package is a false hope. The  real problems are systemic.  Throwing money at our failed health care system is almost as bad as giving it to the IRS.

del.icio.us Tags: daschle,hhs,bailout,failed health system,obama transition web site,family physician,disabled,unemplloyed

Health Care Transparency and others

New buzz word "Transparency" is upon us all.  Wikipedia lists a number of industries, and uses for this term, however it does not list 'healthcare".  I am not sure what that means.

Much of today's post will not relate to health train express, so I will link you to my posts over "there".

Health Train Express Bailout 2018

Medpolitics has an  article written by  Paul Hseih MD regarding parallels between the home mortgage crisis created by 'universal home ownership' encouraged by not so wise financial market manipulations, and 'universal health care" as is being currently proposed by the Obama administration.

Paul Hsieh, MD is the co-founder of Freedom and Individual Rights in Medicine.

Are we at the beginning of a "Health Care Bubble"  destined to failure?

More bubbles please!!

del.icio.us Tags: health care bubble,obama health care,universal payer

Cool Down the Health Train Express

How would you like to become a popsicle?

A cardiologist in Louisiana has developed a non invasive technique to cool down the body of patients with strokes, acute myocardial infarction, for any disease whose body temperature can rapidly be cooled (ie, within six to ten minutes) to produce hypothermia. 

It has long been recognized that hypothermia slows down the metabolic processes and improves the liklihood of healing without further damage to vital organs such as the brain, heart, kidneys, and liver.

This technique has been in use for decades for transporting donor organ tissues.

The device, is demonstrated by Paul McMullen M.D., cardiologist at the Ochsner Clinic, named "THERMOSUIT HYPOTHERMIA THERAPY.  It is currently undergoing clinical trials at a number of Universitys and Heart Centers.  

The therapeutic modality is already in use in Europe and approved by CE (Conformite Europeene). for use in hospitals

"Way cool"  Pick your flavor(s).

del.icio.us Tags: hypothermia,cardiac arrest,myocardial infarction,stroke,clinical trial

Throwing Money at the Health Train

As long as we are at it, how about throwing  50 or 100 billion toward those underpriveleged hospitals and doctors.  This is a national crisis which undermines  the health and welfare of all.   Get it while the spigot is flowing.  Do we want cars or health??

iHealthbeat reports: 

Lawmakers Consider Adding Health IT to Stimulus Package

Congressional health care leaders are considering adding health IT provisions to an economic stimulus package being developed by aides to President-elect Barack Obama and congressional staff, Government Health IT reports.

Congressional sources say that one strategy would be to attach the Wired for Health Care Quality Act to the economic stimulus legislation (McCloskey, Government Health IT, 12/4).

Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and ranking member Mike Enzi (R-Wyo.) introduced the bill (S 1693) to create a national electronic health record system more than a year ago, but privacy issues and funding concerns prevented the legislation from reaching the floor.

On Thursday, an aide to Enzi said the senator has not seen enough details of the economic proposal to know whether adding health IT to it would "blow the budget."

Blow the budget??  You mean if all this stimulus package fails it will be the providers and hospitals that caused it all.

Health Policy Experts Urge Caution

At this week's annual e-Health Initiative conference in Washington, D.C., health policy experts raised concerns about driving health IT adoption through a financial stimulus program.

Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said that efforts to finance health IT would be most effective if they are linked to specific standards or functional and performance requirements focused on health outcomes.

He said that although direct financing could increase health IT adoption, he is "not sure that by itself, it would lead to better care."

Democratic National Committee Chair Howard Dean, a physician and former governor of Vermont, cautioned that standards and uses of systems underwritten by a stimulus would have to be widely tested and accepted prior to purchasing (Government Health IT,

Unlike the financial world and credit fiasco, as well as the impending demise of the big 3 (not so big anymore), throwing money at the healthcare system will not cure the problems..

Health Train Express Consensus

While most folks have been tuned to the recent financial crises, industry bailouts, mortgage melt downs, there have been significant proposals from the health insurance industry, set forth by the American Health Insurance Plans (AHIP),

The Wall Street Journal reports:

Ideas about how the U.S. can achieve universal health care are coming thick and fast. The insurance industry itself is stepping up to the nation’s suggestion box with another proposal.

The trade group America’s Health Insurance Plans, or AHIP, called for universal coverage, a more centralized insurance market and cost-reduction that would slow the growth of the nation’s ballooning health-care spending by 30% in five years.

Consensus is emerging on universal healthcare, as reported in the New York Times

del.icio.us Tags: AHIP,universal health care,consensus,wall street journal,health savings

President Obama's Healthcare Transition Team

Every physician and almost every potential patient has dealt with the chaos and inequity of our current non-system. It takes an enormous effort to navigate to and from a medical clinic, hospital, navigate forms, bills, and payments, what is covered, and what is not covered.  What used to be  a rather simple transaction between doctor and patient has degenerated into a blizzard of paperwork, information technology and more. While HIT is promoted as a 'cure' it also raises many questions as to expense, privacy and converting healthcare providers into data entry clerks who will utilize more time entering data than caring for patients.

Healthcare transparency is upon us, and also health care policy planning.  Tom Daschle has the following to offer.  All of us should 'bury' him with our ideas.

Health Train Express applauds this relatively new approach

del.icio.us Tags: health transition team,Tom Daschle,you tube video

Arrogant,Abusive, and Disruptive on the Health Train Express

In today's email newsletters one from the New York Times caught my eye.

This is old, but still disturbing news. The article fails to mention what steps hospitals, medical staffs, and others have initiated to curb these episodes.  Human behavior is at times unpredictable. What is also not mentioned is the disciplinary process, nor the response of the attending surgeon in their example.

It is also very interesting the article mentions (as an afterthought) that the incidence of these 'outbursts' have diminished recently. Could this be attributed to the mandate of decreased hours for residents in training.

It also does not attribute what the support staff did ,if anything, to enable this type of behavior.  Does the nursing supervisors, and hospital administration have an avenue and procedure when this occurs.

This article is entirely one sided. How about this picture?

We have surgeons in the operating room, who bear total responsibility morally, ethically, and legally who may have been up for 24 hours or more, may have had their office hours disrupted to be in the operating room, at times at night with unfamilar and at times untrained personnel doing a procedure.  Thrown into a life and death situation under these circumstances can tip an otherwise 'balanced surgeon' into 'anger'....Throwing a scalpel can be construed as assault with a  deadly weapon.  There are legal means of dealing with this situation, far beyond hospital discipline.

The New York Times lumps all episodes of surgeon unhappiness or anger into one category.  Do they include a loud admonition to nurses that are talking, or an anesthesiologist playing loud rap music or  even playing music without the consent of the operating surgeon?  Is blood squirting up to the ceiling because a nurse or assistant was not paying attention to the operation?  Did a critical piece of equipment fail causing irreparable damage?

None of these episodes can be lumped into one category, and each must be addressed individually.  All hospitals  now have procedures and mechanisms to avert this behavior. 

Compared to other issues in our health care system, the uninsured, the inaccesiblity and unfunded mandates, this is a miniscule problem for American Health Care.  There must be other issues the NY Times can print to fill up their space.

 

del.icio.us Tags: rage,nurse abuse,arrogance,disciplinary action,physician anger,healthcare,uninsured

Hypoprimarenia

Post  tryptophane tremors

Why are there  not enough

Primary Careologists?

This sounds very familiar. The problem with medical school begins in the first year. Most of the two preclinical years have little to do with practicing medicine. Those trained in some basic science in the last several years of college realize very quickly that medicine has little to do with science or curiosity about science and/or health. It is more like elementary school for doctors…just like you learned reading, writing and rythmatic to prepare you for middle school, and high school to learn trig, algebra and calculus. What you learn during those first two years is nomenclature, and linguisitics…much like any vocation which has specific terms. Lawyers learn how to speak ‘lawyerese’, computer scientists learn ‘geekology’. These first two years expand your vocabulary, which few other people can or will understand.

The second two years of medical school expose medical students to some clinical work, which they will perform only if the intern and resident are overwhelmed with their duties, don't want to be bothered, since they consider it 'scut work'. If the clinical material is scarce it will be monopolized by the intern/resident. Actually the medical student rotation may bear little resemblance to the actual clinical work that a mature physician will do in his practice. Ordinary medical stuff is usually lacking in a university or tertiary medical center where formal training takes place.

So what actually occurs is that each medical student must make a choice of what he will do with very little chance to experience a specialty or general practice prior to having to select a specialty or match for postgraduate training. In addition to this major shortcoming, the free standing postgraduate year of what used to be called internship is now called pgy 0, or 1, whatever the term is these days. This is also another reason why PCP, or primary care providers are so rare. (this used to be called general practice or family practice for you really young guys.) Many young doctors used to take an internship, then go out and practice general medicine for a few years to get a real taste of what they like or don’t like about each brand of medicine. Yes, Johnny it is possible to do this, and quite safely if apprenticed with an older physician. I did it in the U.S. Navy aboard a floating naval ship LPD-10  in the middle of a war.

Primary Care Can  Be Fun

LPD-10 U.S.S. JUNEAU

The Well  Deck (partially submerged) on LPD 10 

U.S.S. JUNEAU (L)    SUPPLY SHIP (R) underway refueling, and  transfer of doctor as well.  (not for the squeamish)..the cable goes up and down about 50 feet as the ships ride the waves.

 

I was able to do so because of my strong general medicine training in med school and INTERNSHIP. This is because the internship required and demanded competency in general medical,pediatric, surgical and OB/GYN.( I and my classmates delivered over 100 babies during our senior year of med school. Those who had OB in their third year also did the same.) After the navy experience I chose to do general medicine and even became medical director of an emergency department…. It was 6 years before I specialized, some by choice and others by necessity.

Early on I was not sure what I liked or disliked. The clinical part of medicine bears little if any relationship to the science of what you study in the first two years of medical school. You may love endocrinology, or cardiac physiology, but find the clinical aspects of gyn, proctology, or cardiac resuscitation, or surgery revolting. You may like ENT but the thought of treating nosebleeds at 2AM a turn off.

The bread and butter of medicine has little to do with what you see or do at University Tertiary Medical School.

And you are being trained by a guy with one more year of training than you have experienced. Not only that, but he or she will be ranking you, in many cases. Those ‘professors’ who run the department are off giving lectures, writing speeches, or patting some other professor from eithr your institution or another one, on the back.

Being on call every other night, or dealing with very sick patients has little resemblance in internship to practicing general medicine, pediatrics, or other specialties. The journey through med school and internship may be more a journey of avoidance rather than seeking fulfillment.

Sometimes doctors near or at the end of their formal training are uncomfortable entering the ‘real world’. Some chose to go on because of this and subspecialize, some even do multiple fellowships, in neurology, ophthalmology, oculoplastic surgery or other areas.

Some even decide to avoid ‘real medicine’ by becoming academicians. (which is another whole story on dysfunctional adult behavior)

When you reach the pinnacle of success in your own practice and look outward at your colleagues you will find clusters of physicians in a group who trained at one particular institution or another…the Harvard guys, the Yale guys, the UCLA guys…

all self selected into their own tier. My experience is that they are neither smarter or dumber that the rest. Only some patients think that is really important. I often times would have to ‘bail them out or show them some ‘ordinary thing’ that they never saw at the IVORY tower university. Perhaps they saw 100 cases of Sarcoid or Wegener’s granulomatosis, but never managed an Alzheimer patient, or chronic congestive heart failure,nor managed a new diabetic that was not in severe ketoacidosis

And finally our realm of medicine has been invaded by nurse practitioners, physician assistants, retail health clinics, and more.........Why go to school to study over 15 years to do a job that a nurse can be trained to do.  No, the won't have the depth of knowledge or experience....but the insurers, and payors could care less.  The only ones hassled for credentials are the MDs and specialists.....

Most young doctors don't realize that 90% of what they will  do is in an outpatient setting, so who really needs a hospital unless your insurer requires it, and then you can find either a hospitalist or specialist to do all the hospital or paperwork...