HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Sorry guys, I could not pass this one up. Donated to the blog cause by none other than The Happy Hospitalist.
Happy recently has had some very interesting and some controversial episodes that he reports.
Haybayles, Hijacked Medical Practice, Medicaid Insurance or Insult? The ten year cycle for new drugs, Sex with a Fat Woman who is dying.
Okay I was a bit syrup, and emotional yesterday, but we all have our days.
Today we will feast upon a round of the health blogosphere. We will go where no man has gone before, and perhaps discover new forms of life and brave new worlds. Buckle up buddy, and prepare! I also issue a disclaimer that these opinions are not that of Blogger, Microsoft, Apple, no myself. I am not certain that Intel and AMD were not involved in this opinion.
I' ll start today at Dr J's Housecalls, a physician who seems to be trapped in rural North Carolina. This blogger has a real fixation on events some years ago which terminated her dream of serving her birthplace; a bit like Don Quixote and his windmills. Although her enemies do seem real and the events quite probable, her intensity remains unaltered. I genuinely feel her pain having been through similar but less intense events in my career.
On to a more positive blog by "The Happy Hospitalist" who seems to live a balanced life despite being a hospitalist. Perhaps the regular hours offset working for a hospital and/or administrators. He also most likely has good relationships with his referring physicians who also most likely thank their stars for his help whilst they attend to their offices and/or clinics. I like his Italian greyhounds, Marty and Cooper...Mrs Happy must be a happy camper.
Buckeye Surgeon is also one of my favorites, although he seems to write in spurts, and Surgeon's Blog has mostly been replaced by Cutting Through The Crap. Surgeon's blog is worth reading through the archives, because a great deal of Sid's writing are timeless (but not odorless).
Dr Wes corresponds on a varietyof topics, ranging from cardiac electrophysiology, to reimbursement issues as well as his thoughts, and opinions ranging from The Vanishing Oath, Computer hijinx, to The Top Ten Reasons to be a Doctor.
Edwin Leap is a nice blend of spirituality, life in the ER with bizarre patients, family vacations, and his 'formophobia'. NPs, PAs and RN PhDs beware...sign your own charts.
The Health Care Blog written by Matt Holt is always a great combination of writing by consultants, insurers, doctors, and I envy his traveling to international Health 2.0 conferences. on everyone else's dime. What a great scheme; and all concerned get to write it off.
KevinMD likewise alternates between interesting medical cases, doctor attitudes and philosophies and also g uest bloggers. Kevin Pho has a long following and is one of the original well known and often quoted bloggers in other venues.
Musings of a Distractible Mind carries with it a dose of humor, Zippy, the Golden Llama Award (which has not been seen lately) and the author of The House Call Doctor
Placebo Journal Blog, Medical Humor with a Purpose a video musical production blending the best of new media, cartoon humor and vaudeville....carry on PlaceboJournal.
And last but not least; Medinnovation Blog the musings of a retired pathologist, who really does understand primary care.
I could go on and on, and don't be offended if I did not include your wonderful blog.......but duty calls.
This past month I turned 67 years old. Today is Mother’s day in America. Mother’s are the strongest and deepest bonds we experience in life. They are our first and lasting imprint on our minds, auditory, visual and sensory. Fathers are important, however Mothers are crucial to sons, and daughters.
My mother passed away five years ago at age 89. Her last three years were spent in an assisted living facility and towards the end she knew not my brother or myself. She became less lucid as the end approached. My brother lived near her and made sure her needs were met as to where she lived and he became the executor for her personal financial affairs. I lived some distance from her and had many of my own responsibilities, a disabled wife and very ill son. I will never forgive myself for not making time for her.
During the last few years of her life I would speak with her on Mother’s day and apologize for not being there with her. She would respond saying it’s okay you have your own family now, it’s enough you remembered me…it’s enough…..
It’s enough rings in my ears to this day. No, it was never enough and that clarified itself on these past mother’s day when my first and lasting thought was to call her. It was not a thought, it was a deep emotional reflex, lingering throughout the day.
So Happy Mother's Day to all you Mom's....and boys and girls don't forget 'the mom".
I was up very early this AM and set off on my daily surfing of health blogs. There seems to be a division of those who focus on patient encounters and clincal care isssue, both humorous, commonplace and very sad stories. The other end of the axis are those blogs focusing on health IT, health policy and reform.
Matthew Hold on the Health Care Blog always seems to have a reservoir of important health policy wonks emoting good stuff.
I envy the guy for creating Health 2.0 meetings all over the world. What a gig!!
Anyway today he has
all well known writers on a number of health blogs, discussing disruptive changes in health care.
ePatient Dave brings this approach to our challenge:
"It’s possible to look at the patients issue from a moral or ethical perspective, or from a business planner’s ecosystem perspective. In this post we’ll simply look at it pragmatically: is our approach going to work? It’s our thesis that although you won’t see it written anywhere, the stage is being set for a kind of disruption that’s in no healthcare book: patient-driven disruptive innovation."
ePatient Dave's comments at the Meaningful Use Workgroup of the HIT Policy Committee revolve about the potential for Consumer and Patient Involvement
We assert that to disrupt within a non-working system is to bark up a pointless tree: even if you win, you haven’t altered what matters. Business planners and policy people who do this will miss the mark. Here’s what we see when we step back and look anew from the consumer’s view:
If you view your health data as a modular component in the “health web of the future,” you see that today it’s tightly integrated – with your provider. That prevents you from seeking care elsewhere, and it prevents you from adding value to your own data by applying innovative tools. To us that’s harm. It’s not just restraint of trade, it’s restraint of health.
At one time in the not so distant past it was posssible for the patient and the provider to get the consultation from whomever the consumer and provider wanted.
Raw Data Now: Give us the information and the game changes.
People often ask, “If we give you your data, what are you going to do with it?” We don’t know – that’s the point: innovators haven’t gotten their hands on it yet!
Twenty years ago Tim Berners-Lee invented the Web. In his TED talk a year ago
It can be hard to see huge potential in a simple change. After Tim’s boss died, the original proposal was found in his papers. In the corner he’d written, “Vague, but exciting.”
Tim’s next big vision says today’s internet stops short: it lets us see other people’s interpretations of datasets, not the data itself. So his 2009 TED talk agitates for change. By the end of the talk he had people chanting,
“Raw Data Now.”
The playing field in health information data exchanges amongst vendors is beginning to look a lot like EMR offerings several years ago. However, today there appears to be a de-facto standard set by CCHIT. It remains to be seen if the feds will mess this up, too in their quest for 'higher standards' such as NIST.
The recent offerings were displayed and discussed at HIMSS 2010, which can be found here...............
As the marketplace continues to gain calories, a number of vendors in EMR, and even mobile platforms are jumping into the fray
You can take at some of these offerings here:
Systems Healthshare
KLAS is a reputable consulting company that evaluates software and certification standards. They offer a white paper regarding EMRs and HIE offering for both providers, consultants and vendors. They offer an overview and analysis of the current state of data exchanges throughout the United States.
The date has passed for states to notify the Feds whether they will accept additional responsibilities for uninsured patients.
The New York Times reported on Friday,
"Friday is the deadline for states to tell the Obama administration whether they want to run the high-risk insurance pool for uninsured people with pre-existing conditions, or whether they will leave the task to Kathleen Sebelius, the secretary of health and human services."
Some states such as California already have a Major Risk Insurance Board, and some funding for the uninsured through the Major Risk Insurance Program. The coverage is not inexpensive, has a low cap, but does subsdize the plan using not Medi-cal, but programs such as Kaiser Permanente, Bllue Shield, and others depending on the region of California. If one can afford it, it does work well, and is transparent to providers. ie, it looks like private insurance. (meaning the provider does not have to be a medi-cal provider.
"Democratic officials in Montana, Pennsylvania, Washington and Wisconsin, among other states, said they intended to operate the program under contract with the federal government. They were joined by Gov. Arnold Schwarzenegger of California, a Republican, who gave a rousing endorsement of President Obama’s health plan at a news conference."
"But Republican officials in Georgia, Indiana, Nebraska and Nevada turned down the opportunity to run the high-risk pool, as did at least one Democratic governor, Dave Freudenthal of Wyoming."
Now that health care reform has been passed, attention is being given to the shortage of 'primary care'. What is the problem?
1. The new "politically correct term 'Primary Care' Provider,rather than family physician, or general practitioner. This lumps MDs in with NPs. PAs, MedicalCorpsmen, and who knows what else. (would you go through 4 years of college, 4 years of medical school, and 3 or 4 years of serfdom as a resident to be 'lumped in '
2. The enormous amount of non clinically related administrative tasks and secretarial work to be done each day. A recent article by Richard Baron MD in the NEJM chronicles the day in the life of an internist. This publication is a MUST READ for anyone in pre-med. It gives an accurate appraisal of what to expect if one selects to become a general internist or family physician.
In addition to the daily acts of diagnosis, treatments, and minor procedures, these generalist internists did the followng:
I would say that the number of patients these physicians see is very very conservative. From my experience it is much more like 25-30 patient encounters a day.
Now I am NOT saying this is a bad thing. Many young aspiring students go into medicine for this vision of their careers. In fact most go into medical school, either undecided, or want to become a family physician either because of a personal experience with their own family's physicians or a personal life experience from an illness or that of a family member.
3. The fatal flaw of the CPT procedural coding system aligned with performing procedures rather than the extent of complexity and cognitive work for the event. This results in an enormous disparity of income for generalists and specialistss.
4.
Continuing this week's summary news Better Health created a series of video interviews at HIMSS. You will find it here. Thanks to Val Jones, MD and Dr. Anonymous. The range of interviewees extends from Sprint to Epocrates.
Increases in Health-Care Costs Even Worse in Military
The military’s latest enemy: rising health-care costs.
How Smartphones are Changing Healthcare for Physicians and Providers
from today's iHealthbeat:
Regional extension centers might be too understaffed and underfunded to provide the help health care providers need in adopting electronic health record systems, according to a recent study in the journal Health Affairs, American Medical News reports.
The 2009 federal stimulus package includes about $640 million to establish regional extension centers to help small health care practices become meaningful users of health IT.
HHS has awarded funding to establish a total of 60 centers throughout the U.S.
Study Findings
The study, funded by the Commonwealth Foundation, reviewed 29 existing programs that aim to help health providers with EHR adoption.
The study authors concluded that those working at the extension centers should have direct experience with small practices and technical knowledge -- a combination they say is difficult to find.
The researchers noted that many health care practices have difficulty selecting an EHR system and that extension centers are not providing adequate assistance in that area.
Researchers also warned that regional extension centers might be unsustainable due to inadequate funding. They noted that similar projects in Massachusetts and New York spent on average 10 times as much per targeted physician than the stimulus package funding provides (Lewis Dolan, American Medical News, 4/28).
Is it possible that this will be an unfunded mandate? Will state governments or university systems have to foot the rest of the bill, and will they? Certainly this may fuel a new wave of employees, but who will pay them? The 40,000 dollar incentive per physcian says nothing about the cost of selection, implementation, or operational and maintenace costs.
The infusion of information technology is not unique to health care. Technology is not a standalone black box sitting in the corner of the office or in a closet. Those in the technology industry are now recognizing the importance of integration and to bring 'game changing ideas' to the market place.
Is technology a noun or a verb? I think you will find this speech by Anish Chopra, the Chief Technology Officer for the United States. interesting.
Does eHealth technology such as email lighten the burden for physicians or does it impose additional responsibility upon them whether they are reimbursed or not?
A study published in the New England Journal reveals this counterintuitive finding. Simple is as simple does; More time on EMR or EHR, less time with patients, not the reverse. Tell that one to the policy makers. Okay I can spend an additional 90 minutes a day filling in the boxes and checking off the drop down menus and see 6 or 7 fewer patients. That will really increase the shortage of PCPs. And what about the nonsense of coding for email and telephone calls. Please, how is
the nation going to pay for that, not that MDs do not deserve to be reimbursed for their time.
The leaders of our government have a very strange thought process, or they are liars and have a hidden agenda.
And now something we as MDs have always realized, the not so hidden cost of sending a bill to the patient and the payor.
Another study performed at the Massachussetts General Hospital and published in Health Affairs (abstract) (full pdf article), explains how " The U.S. system of billing third parties for health care services is complex, expensive, and inefficient. Physicians end up using nearly 12 percent of their net patient service revenue to cover the costs of excessive administrative complexity"
Table 1: Financial Cost of Administrative Complexity
Table 2:
Administrative Complexity Burden In A Physician Organization’s Professional Billing Office
Today's offering is a collection of web reference sources, and video keynotes regarding the Office of The National Coordinator for Information Technology.
Electronic Health Records Critical to Effective Reporting of Quality Measures Says ACP
A Parallel Universe David Hesse, CEO Sprint/Nextel
Dramatic Challenges and Changes in Health Communications
Mobility Technology and it's use at the Point of Care
Compelling Health Information Solutions
HITECH ACT------THE BILL-----PHYSICIAN INCENTIVES
There is much buried in this legislation....a worthwile read, even if only a quick scan
Competition for Certification Authority
???? During the last four years EHR vendors have formed the alliance called CCHIT, to establish the standards for interoperability of disparate electronic health records. A large number of vendors have already complied with this standard. In fact many potential users have taken a wait and see attitude because of the lack of a standard.
ONCHIT had recently announced that it would seek out other potential certifying bodys (ie, COMPETITORS) before adopting one standard. Thus far there has been only one other competitor (THE DRUMMOND GROUP).
The passage of the ARRA and HITECH Act creates a mandate of 19 billion dollars to the health IT industry. This creates fierce competiton amongst HIT vendors for these dollars. Mandates are not the same as actual funding. We see this in many other situations. Let's hope the government will be capable of following through on the congressional mandate. It's a bit like California's situation, or the year end delayed or non payment of medicaid bills each year. The government is free to back out of mandates from congress unless all hell breaks loose.
Vendors will be quick to offer their solutions, even if deficient, inefficient for physicians to implement and use. Feedback from physicians remains critical, otherwise solutions will remain stagnant if they can continue to market and sell poor software. There will be no driving force to improve with research and development.
Physicians and hospitals must vote with their pocketbooks, rather than aceeding to government mandate to 'buy something' whether it suits our needs or not. In my opinion if caution and deliberation are bypassed much of the investment will be a total waste. The time frame for implementation fits someone elses needs not that of the health care industry.
Austin Merritt points out the current state of affairs amongst the software companies .
Sorry for the absence. It's been a bit hectic while the Health Train travelled from Georgia to Southern California. (from green to brown)....from bugs to lizards and snakes.
I am on a sabbatical and expect to post much more from here.
I now have an internet connection and am able to catch up on some of my favorite bloggers, KevinMD, Dr Wes, Edwin Leap, Medinnovation, and more, most of whom are listed on sidebar, with their links.
I admit I have been blog and healthcare reform fasting. I am not totally in 'remission' yet. I am weighing whether to continue my avid interest and advocacy for continuing health reform. I feel I need to contribute to bettering our health system.
The next ten years will see radical changes in health care delivery.
Some of what was once thought of as 'unethical' by practitioners will become commonplace.
The rise of retail medical clinics will continue unabated, and the scope of their practice will extend to management of hypertension, diabetes mellitus in addtion to other common maladies of body and spirit.
To survive, primary care practices will need to adopt electronic information systems, not just to increase efficiency, but to satisfy insurance and governmental requirements to obtain complete reimbursements, without penalties.
Retail medical clinics already employ these systems and are an integral part of their operations.
Physicians will either adapt or be swept aside. We must prepare the next generation for what they will deal with once they are finished with medical school.
Medical education itself is undergoing a transformation in funding. The federal government has bypassed private banks for funding undergraduate medical education. This will allow the federal government to specify who will get financial assistance,as well as possible later waivers on loan repayment. Medical students may be required to sign a contract agreeing to serve in underserved communities or less desirable practice locations. Perhaps it may be year for year. These students will become civil servants. They will be required to develop multi-cultural skills, and to demonstrate their literacy and verbal skills in Spanish.
The lack of enrolling minority groups, African American and/or Latino will encourage the federal government to aid schools by forcing them to accept lesser qualified candidates for acceptance to medical schools. This does not appear to be a problem for Asian students who mostly excel in secondary and undergraduate colleges.
The "cell" generation will generate a strong market pressure to allow developers to build EMRs that will run on smartphone, such as the iPod. These systems will integrate almost seamlessly with the office EMR and/ PM systems.
Patients will no longer use a yellow page listing to find providers, they will utilize the internet, and at times find poor providers. Ths will drive state and federal officials to require documentation to be listed on internet search engines. Commercial web sites such as healthgrades will not be a credible source for paid listings.
Despite the evolution EMR and Health IT, it will be found to not save money or enable providers. In fact it will reduce provider efficiency unless they are radically designed to be user friendly as a priority over meaningful use. The term meaningful use will have been discarded, to be replaced with "Specialty specific Design. Meaningful use with be specific for each specialty.
Remote telemedicine and monitoring will become commonplace. The Federal and State governments will adapt their reimbursement method to pay for most of these costs when an analysis reveals that remote monitoring reduces inpatient admissions drastically, and reduces the number of outpatient visits.
All of the home devices will be wireless and connect automatically to the home network and the specified instrument monitoring service. For those without broadband, dial up will be an alternative. Just as providers now are required to have a national provider identification number, patients will also be assigned one at birth or on the occassion of their next birthday. The number will be unique to the medical system for a number of important security issues, and prevention of fraud.
Written signatures for consents, hospital admission and discharge and medical office registraton will be supplanted by biometric identification, either infrared fingerprint recognition or iris recognition. It will no longer be necessary to provide an insurance identification card to a provider or hospital.
Freedom of choice will be reduced for most patients.
