Rumblings

 

I hope to be publishing my blog more regularly. The past week I had a major malfunction of my computer.  Always the one to make things better by adding dual monitors (for more screen real estate) I managed to corrupt several drivers, then my hard drive. (at least I had a good backup). After recovering the system (and having one full day of Window Updates (150 or thereabouts) I am considering upgrading to Windows 7.   It can’t be any worse than what I went through this past weekend. My blogging platform has been Windows Live Writer. It’s much  faster than posting on the blogger platform, and the bonus was getting all the new plug-ins. 

So stay tuned for more blogs from The Health Train Express

Holy Cupcakes Batman

“Holy cupcakes Batman”, said Robin the boy wonder. Holy cupcakes is what ran through my mind as I sat through the Superbowl yesterday. It was so bad I couldn't eat my pizza or popcorn (my contribution to the food pyramid)

My biased opinion is not the product of Left Coast thinking since a good friend of mine from the Right Coast who actually lives in the Southeast USA came to a similar conclusion. So all you pickup gun-toting Dixie-landers, listen up. The names and location of my friends will not be disclosed so they are protected from the gun-toting pickup truck types who like to shoot deer with their kids as a right of passage.

Football is not an example of preventive medicine, health or wellness. The only positive things I see are the conditioning of the gladiators in preparation for a season and the “big game'. And I am not certain about that, given the history of anabolic compounds used to produce muscle mass while further diminishing the intellectual capacities of the participants.

Some readers may wish to click away from my blog since some of it will repel the 'next' generation' and football addicts.

Waiver notice: This post will be offensive to some readers with it's non-obscene, anti-pop culture, and politically incorrect opinions, and unspoken thoughts of most watchers (non-scientific, highly biased opinion poll with limited cohort) (my family of five).

A great deal of my post is taken from my documentation and observation of one personal anecdotal story about my son-in-law who won a superbowl ring in 1986. (that makes me an expert.)

First of all, if you like two hours of weekly pain and concussions, it is not a bad life. You are overpaid, the weekly schedule is cool. Work one day a week, train for five and home most of the time except for a weekly trip occassionally to a distant playing field, all paid by your employer...great health insurance and disability coverage. Free access to pain medications, personal trainer, PR person, endorsements, sometimes a free car by your local car dealer for the season and home games.You live in the nicest home in a gated guarded community, your kids wear the best clothes,they have every new most wanted toys, you are well known in town, so you have to go to a place where hopefully no one will recognize you during your extra-curricular activities (maybe a foreign country or carribean island. You have a wide variety of hoodies, and sun glasses which you wear once and throw away. You can always tell your wife, "honey not tonight I have a broken collar bone (nose, ankle, back, or whatever, or all of the aforementioned." Save your strength for those away game “groupies” Wifey gets the house, fur, fashion coutre, BMW or the Escalade (maybe politically correct hybrid car, or most likely all of the aforementioned. If you get really injured you may sit out a whole year of work on the injured list and then be traded to a competitor. (it's always nice to get a new home and a new community to try out.)

I also wonder if human resources of the NFL uses multicultural hiring practices, hiring Asian, Hispanic, African American players (that does not seem to be a problem as to the latter. It's a great exit strategy for escaping from the ghetto. (sorry for the bad taste here) The only people that can use the N word are Ns. Whatever has happened to us Honkies? “N's and “MAs (Mexican-Americans) as well as 'SE' (slant eyes) should use the 'H' phrase too.

It was so bad yesterday that I had to resort to Keith Olbermann's tweets. Keith has been traded to the Tweet network. (but he can work from home now). Actually I laughed harder there than I have ever since my three boys came back to live at home, out of work. The economy is so bad wifey and I had peanut butter and jelly sandwiches watching our old fashioned non digital, non-HD 36 incher with a TV tube, (wifey and I wear binoculars so that we can see the individual players faces and the confetti at the end of the game), whilst my spawn were in their bedroom watching the Superbowl on a 52” HD TV (also recorded on a DVR). “Holy cupcakes” once again.

Did I mention my middle child bought a car for 'cash' from his savings (he deserves it since he is totally disabled with cystic fibrosis) and he bought it with the lump sump SS benefit which SSA held up for three years, only relenting when we took them to court......the judge slapped SSA in the face, saying only an idiot would not see he is disabled. (spends 5 hours a day doing respiratory treatments and taking 5,000 dollars/month of medications. (you lucky taxpayers are paying for his health care which is probably a lot better than yours or mine). I personally don't begrudge that one ounce. I would not want to live his life. If he has one good day a week we are thankful (maybe he could join the NFL), and get even better care, and not be on the taxpayer's dime. Thank you Uncle Sam for my boy's life. First thing he said when he took the keys and we drove off was, “I can find a job now and work part time, even if its one day a week.”

The trip to the car dealer was our “Pre-Game” show. (it really was a show since my eldest son-in-law harassed the salesman, 'jewing him down' ( I can say that since I am a “J”). Phil almost 'queered' the deal. You guys better not use that phrase or I will take you to federal court.

However, I digress, and back to the sport's section. Tomorrow is another day and I have to face medicare, outcome studies, meaningful use, a deadline to get my EMR or forfeit whatever from medicare. Cheez Batman, Holy cupcakes.

This is a fictitous post that someone else must have posted, since my computer was frazzled by microsoft's latest update.

I hope your team won !

The Medical Conspiracy ?

Paul Levy, formerly the CEO of a large hospital writes in today’s The Health Care Blog’ about conspiracy theories  Here are some excerpts for clarity on my comments which are also posted at the original blog post.

He mentions excerpts from a writing of George Bernard Shaw, and I am not entirely certain which part of his post is the quote or if the entire article is from Shaw’s “The Doctor’s Dilemma, Preface on Doctors”    

George Bernard Shaw (1986-1950), Nobel Prize for Literature (1925-refused),  but accepted it at his wife's behest.  He is the only person to have been awarded both a Nobel Prize for Literature (1925) and an Oscar (1938),

Quotes, to follow

“The truth is, there would never be any public agreement among doctors if they did not agree to agree on the main point of the doctor being always in the right

But for this very reason no doctor dare accuse another of malpractice

That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice.

But the effect of this state of things is to make the medical profession a conspiracy to hide its own shortcomings.

Public ignorance of the laws of evidence and of statistics can hardly be exaggerated.

If I attribute these comments to the wrong person, I  apologize.

It seems to me GBS was wrong about many things.

 

del.icio.us Tags: George Bernard Shaw,Paul Levy,conspiracy theory

Information Explosion

 

Health is not the only space being driven by information. It has received the lion’s share of exposure, however we should not forget the rest of the spaces, government, military, financial, industry, and technology. The amount of recorded data multiplies almost exponentially for each industry, much like a nuclear fission reaction., and there is significant fallout.

Our ability to understand and incorporate into a useful knowledge base overwhelms our capacity to understand the information to frame it into useful form.

The federal government IT efforts, and others have and are continuing to build software to extract and display this deta into images understandable at first glance. Without this the data is useless.

The same limitations apply to medicine, and medical research.  Who has not read a journal article that quotes ad nauseum statistics which only a statistician can interpret?  How many of us skip to the conclusions to ferret out what the article is all about?  That’s me!!

The web site data.gov is a not so secret open source for information ranging from The Open Government Initiative to an almost infinite number of data sets, including open data sets from all the major US Government Departments

The best way to find out what is in there is to explore the  site.  It is pretty amazing !

del.icio.us Tags: data,government,statistics,open source

Health Train Express’ Best for Today

 

 

The California Health Foundation sends a daily eletter ( iHealthBeat)about  topics of interest to medical professionals

 

There are a number of remarkable items in today’s publication.

February 3, 2011 8AM Express News

 

We are going to be reporting on developments on HIT progress that are important news.  Our sources reveal that HIT in healthcare is making progress. There are differing opinions on the rate of growth depending on which side of the argument you lie.  Most physicians are still skeptical that the huge investment will pay the dividend claimed by vendors, CMS, insurers and the pundits, while some who have adopted EMR in their practices say they would never go back. Well, I think not if I had invested between 50 K and 100K  USD and managed to persist through the adoption process successfully, or not I would be happy unless the EMR was a ‘pig in a poke’,  reduced my income, and consumed more of my time being a  data entry clerk.

EMRs are only going to make it easier for those who read our reports, clerks, utilization reviewers, and audits. 

80 % of Internet Users Seek Health Care Information Online

Judge's Health Reform Law Ruling Could Affect Several IT Provisions

Stakeholders React to GOP Bill That Could Cut Meaningful Use Funding

Judge Voids Health Reform Law on Basis of Individual Mandate

Study Suggests Some Health Providers Lag in New Coding Transition

Job Growth in California's Health Care Sector Slowing to a Crawl Amid Ongoing Recession

Report Finds Doctors and Public Agree on Many Health IT priorities

VA seeking advice to Upgrade Health IT to Open Source Software to Upgrade Legacy Systems

States Line Up for Grants from ONC’s Health Information Exchange Challenge Program

Health IT Tools Do Not Improve Care Quality, According to Study

Publisher of Wall Street Journal Sues for Access to Medicare Data

 

Obama Cites Importance of Health IT in State of the Union Address

Disruptive Women in Health Care  Health Care Roundup features Hope Ditto and the state of the world…disruption seems to be the key word for 2011 thus far. Health care is not alone. It is a good read!

Are We There Yet?

 

 

Are you waiting for Health Train Express on the train platform? Have a seat and call  911.

If you are at all wondering if your doctor will be there next time  you call,  you are operating in reality. In a recent survey sponsored by a well known EMR vendor the results are stunning.  Practice Fusion’s independent consultants found the following:

Key findings:
* 41 percent of doctors report that their practice is doing worse this year compared to last year. Compared to 26 percent who report their practice doing better and 31 percent report no change.
* 59 percent report that new technology has made things easier for their medical practice.
* 73 percent report that the computers in their practice are over three years old on average (21 percent in the five to six-year-old range).
* 69 percent of doctors report being satisfied to extremely satisfied with their career despite these challenges.
* Doctors were also asked to report their practice's top negative pressures and positive trends in a series of open ended questions.
* Issues relating to practice administration (31 percent), insurance and reimbursement (26 percent) and difficult patients (11 percent) are the top negative pressures on the practices.
* Positive trends are led by advancements in medicine (22 percent), patient quality (19 percent) and improvement in the healthcare workforce (15 percent).
* 80% of US physicians practice in groups of 9 or less according to the AMA.

View Practice Fusion's 2011 State of the Small Practice info graphic. Raw data from the survey is available free upon request. Practice Fusion is also offering physician sources across the country to talk about their own experiences managing a small practice.
Survey Methodology
The Practice Fusion State of the Small Practice study was conducted by internet survey in December 2010 with MDLinx. Responses to 10 questions were collected from a national sample of 100 physicians. The majority of respondents were primary care providers in practices with fewer than six providers.

Admittedly this was not a very scientific study, nor was their any indication of the demographic of the study group, not taking into account the geographic location, age of the physician, or medical practice. The statistic lumped all small practices from 1-9 physicians.   That is quite a spread. The resources of a one or two man group are far different than  three or more individual practitioners.

"Small primary care medical practices are the backbone of the US healthcare system," said Ryan Howard, CEO of Practice Fusion. "These are family doctors on the front lines, they're passionate about caring for their patients and our survey indicates  that they're struggling. “

EMR vendors as part of their service will evaluate a medical practice for implementing a system. This includes a thorough analysis of costs and return on investment.  They know the financials  within which physicians operate.  If anything they are biased toward selling their system,, and having a client be able to purchase and pay for it.

This survey by Practice Fusion (which offers a totally free EMR which operates in the cloud) points out that even with a ‘free EMR”  practices cannot afford the down time or the cost of minimal hardware investment.

Most small practices, and larger ones are operated with less than optimal physician/staff ratios.  The staff has to be multi-tasking in their job description. This is not always possible.

How many times do  you receive an answering machine when you call the  doctor’s office?  My observation is it occurs a great deal of the time. The message is ‘if it is a medical emergency to call 911 or go to the emergency room.” 

How about that for improved quality of care?  Government studies do not measure that metric, “the first mile to the health care system”.

Let me have your thoughts on this matter.

You can tweet me @anophthalmus, or leave a message on facebook/garylevin

del.icio.us Tags: doctors offices,waiting time,911,health train express

Monday Digest for Health Train Express

And here is the top of the blogosphere news for Monday, January 31, 2011

Dr Val   5 million dollar fine for Doctors asking questions about Guns in the home

The Health Care Blog  A Medical Student’s Dilemma

Dr Wes   Carding Doctors?

Dr A  Social Media to Traditional Media, or why you should participate

Health Policy and Communications Blog Rise of the Tea Party Machine

Life as a Healthcare CIO   Cool Technology of the Week

Medinnovation   Health Reform and Pay-for Performance,Not So Fast, Macduff !

Wall Street Journal Health Blog   Six Health-Care IPOs Planned For This Week

Disruptive Women in Health Care   Who’s a Medical Doctor?

Kevin MD   Marcus Welby and the relentless growth of specialization

Edwin Leap   The Physician Exodus

iHealthbeat  Report Says Health IT Has Potential To Advance Personalized Medicine (report from the Brookings Institute

                                                  

 

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del.icio.us Tags: kevinmd,edwin leap,iHealthbeat,disruptive women,health cio,wsj blog,medinnovation,health policy,Dr A,Dr Wes,THCB,Dr Val

Health Reform—The Nail on the Head

 

Richard Reeces, author of Medinnovation reveals that two Democrats his the health reform nail on the head.

In his blog Reece elaborates:  “Patrick Caddell, former pollster for Jimmy Carter, and Douglas Schoen, Democrat pollster, strategist, and author of The Political Fix: Changing the Game of American Democracy, say bluntly and succinctly give three cogent reasons why the health reform law has failed to impress the American people.”

Number One, the law is “anti-democratic.” It received no Republican votes, and three sneaky deals – the Louisiana Purchase, the Cornhusker Kickback, and the Connecticut U Con – made it possible. Its passage did not pass the smell test. If you believe in democratic bipartisanship and consensus, the law emits an unpleasant odor.

Number Two, the law fails flat on two false promises,
a. That everybody can keep their current policies, while in reality , employers are quickly dropping employees like flies from employer plans because it is now cheaper to do so.
b. That the individual mandate was a regulation of commercial activity and was not a tax, yet Democrats are defending it as a tax in the courts now that 28 states are challenging its constitutionality.

Number Three, the law does not deliver what the reform package the public wants,
a. Purchase insurance across state lines
b. Coverage pre-existing conditions (this being the one exception)
c. Portability from job to job
d. Support of malpractice reform
e. Incremental introduction of reform
f. Believable initiatives to hold down costs

The health reform law, in short, is a pig in a poke, an idiom referring to someone buying a low-quality pig in a bag because he or she did not carefully check what was in the bag. Now that the public is learning what’s in the law, they dislike it more than ever.

del.icio.us Tags: health reform,flaws,pig in a poke

Health Train is changing Tracks

 

The Big Switch

I spent the past several days reviewing the content of my blog over the past six years.  It amazed me that I don’t remember writing a lot of what I read.  It seemed unfamiliar and I wondered who wrote that stuff. Perhaps some other writers experience this phenomenon whereby one does not want to own what one wrote some time ago. My blogs have changed considerably and I estimate most of it is not really original, much is cut and pasted, some is repeated with attribution.

The most I have to offer to my readers is my time. I am not seeing patients anymore and have a volume of time to read many things, sit back ponder, pontificate.  Those who can do, and those who can’t either teach or write. Both of those avocations take inordinately large amounts of time, to do well. And so does keeping a medical record, hand written or via an EMR.

For those of you in practice your time is very limited and one of the things you don’t have time to do much of is read and/or surf news articles about anything.

In the next week or so my blog design will change as well as it’s content.  Stay on this ‘channel’

Also follow me @anophthalmus for interesting news, some medical, some political, some humorous, some sad. (all in a day).

World Economic Forum

 

  The World Economic Forum is live today via video streaming from Davos,Switzerland.  Many health care related interviews with Bill Gates, Tony Blair and others.   http://www.weforum.org/    Other issues regarding Information Technology, and World Health, Global Social Media Networking.

 

LIVE STREAM

Observations

 

The Medicare web site,  Medicare.gov offers a “Physician Compare” section.  The stated goal is to be ‘patient centric’ to meet consumer needs.  This section supposedly  offers a means to search for physicians to compare their demographics and expertise as well as certifications.

 

I researched the site extensively for multiple providers who I know personally. 

The amount of information was minimalistic, demographics, specialty and degrees, ( no mention of subspecialty) medical group name (if any) with no mention of hospital affiliations. There was no mention of re-certification status, when licensed. The main features most notably displayed was if the provider accepted assignment. (apparently an indicator of ‘quality”)

It is highly inaccurate. I did a search for a physician within 15 miles of my location and came up with one that had over 100 locations listed (not in a group).

I would label this web site as dangerous !!!

Hard to believe whoever was in charge of this let it slip through. Well intentioned  but poorly implemented.

The Health Care Blog also has a post today by Micihael Millenson. Thanks to him.  I will write Czar Berwick about this one.  Suggest all of us do the same. 

 

del.icio.us Tags: CMS,WEB SEARCH,PHYSICIAN COMPARE

Pharma Crisis ??

 

Today’s WSJ reports that Pharma is being squeezed from all sides.

2011 Looks Tough For Drug Companies  (clickable)

 

Despite past news of huge billion dollar profits for Pharma, the ecosystem for pharmaceuticals has gradually eroded leaving   pharma in a less tenable position.  Pressure is mounting with health reform measures, while pharma has been hit hard by restrictive formulas, and the emergence of ‘generics’.  Generics, once looked upon with suspicion and doubt have take over a large part of doctor prescribing habits.  Doctors have been forced to prescribe generics by limitations of their patient’s plans and their formularies.  Most generics are tier 1 (a classification of drugs in each formulary). It does not take long if you gaze at a typical plans formulary to see how much less the copay is for a generic drug. Specific drug formularies are easily found on plan websites. 

Pharmaceutical R &  D is expensive, as well as the FDA approval process,   The previous model of marketing a new  generation  or modification of an older drug with attendant new  patents (at a much higher price) will not work today. We have and will see a marked increase in new drug cycle times.

So bad is the situation that this documentary was written by the Bureau of Investigative Journalism (clickable link) 

 

NYSE Floor

 

The NIH National Center for Drug Research (clickable)

“The National Institutes of Health has approved Obama’s decision to assist with funding for drug research and development through a Federal Research Center.

 

                  

Federal officials concerned about the slowing pace of new drugs coming out of the pharmaceutical industry have decided to start a billion-dollar government drug development center to help create medicines.”

The New York Times reported on its website Saturday about the new effort that comes as many large drug makers, unable to find enough new drugs, are trimming back research

“ NIH chief Francis Collins is pushing ahead with ambitious plans to create a new center for translational medicine that will do some of the early-stage work for the drug development industry.

Collins' plan, endorsed by HHS Secretary Kathleen Sebelius and outlined over the weekend by the New York Times, is to bring together $700 million in R&D work under one roof at the National Center for Advancing Translational Sciences, where government scientists will pursue a billion dollars in funding to push the projects through the Valley of Death. Collins' blueprint calls for scientists to get enough proof-of-concept data in hand to whet pharma's appetite, spurring them to step in and finish the discovery work needed to obtain an approval.”

If I read this correctly, the FDA will have one arm to assess the safety of new drugs, and     it’s sister  NIH will be dueling.

There is some opinion  the NIH has no business  in pharma other than to provide basic science and early translational work.  It may be a different story for Orphan disease and Orphan Drugs  (clickable)

 

del.icio.us Tags: orphan drugs,orphan diseases,nih,francis collins,national center for drug development,pharma