Free Riders on Health Train Express

 

TGIF.  Many things happened this week which may impact many of us in the world of technology and internet applications.

Hewlett Packard replaced Lou Apotheker with Meg Whitman in the wake of the discontinuance of the HP Touchpad, the announcement of HP disbanding or selling their HP consumer product line (apparently their printer division will still continue, since it is the dominant printer manufacturer, and also  produces significant  revenue for HP. 

The demise of Apotheker comes not so much from his decisions to make strategic changes, but his poor communication and people skills in dealing with his Board of Directors and the Stockholders. It must have seemed heavy-handed and the investors voted with a 50% reduction in stock price as many unloaded their shares in the weeks since the announcement was made.  This came after only 11 months of Apotheker’s  reign (apparently of terror).  Reports were that Apotheker lacked some leadership abilities critical to management of a diverse HP enterprise.

On the internet side and Web 2.0 Social media announced the expansion of SM with Google +, Google Hangouts and several new versions all within the past three months. Google + gained 45 million new users in less than three months and the growth is still exponential. While Facebook states it has over 600 million users it is 6-7 or more  years old.  Analysis shows that FBs growth has stagnated.  Users of both platforms have a diverse opinion of how G+ stacks up against. 

There is a dichotomy of opinion. Many FB fans are intensely loyal and are vocal about G+s failings while some have willingly jumped the FB ship, announcing how ‘lame’ FB has become.

Google + has loosened it’s ban on pseudonyms for user names, but remains a non-commercial platform.FB remains the dominant marketing SM tool. Many enterprises have just adopted SM for marketing and G+ does not as yet have a significant user base (45 million for G+ vs. 600+million for Facebook.

In the past several weeks this writer spent about six hours a day on Google +. Part of it was a learning experience. I learned much about Hangouts.. Health care has much to learn from and use in Hangouts.

I held an ophthalmology video conference based upon a user list serve for ophthalmology which is international in scope well respected and attended daily. Users who usually only communicate in writing and once or less a year at meetings were able to see and talk in real time to discuss interesting cases, display images with the restrictions in place by HIPAA.  I was able to share the HIPAA 18 never say data as a document during the conference.

What are it’s other potentials? Everyone will figure out a way to use it…patient education in small groups seems the first item, and communication of physicians in regard to operations of the practice (business) or associates and other practices. How about a section meeting of  the medical staff. Multiple concurrent Google hangouts can be run with different Gmail addresses. (You will need a high performance graphic card  or multiple display card) or separate PCs.

President Obama hold a five way Hangout (notice Harry Reid’s one finger salute to the Chief)

Google+s hangout offers a 10 way audio-video conference with the capability of sharing documents, screens, and videos. It seems to offer new functionality every day. It runs well in all the browsers. I have used it in Firefox, Chrome and even Safari (on a PC)  Interesting  that Safari which normally loads very slowly and has slower screen web page changes on my PC yields the best video performance on my laptop. Some of this may have to do with how video is rendered with the laptops meager video resources and memory sharing for video graphics.

FB countered in the past weeks with several new applications and major changes to the interface becoming much more visual with alterations in the “white space’ of their web pages. Zuckerberg announces TIMELINE.

HIPAA violations !!

And finally this news.   Neutrino found exceeding the speed limit of light.

See what I mean?  TGIF now maybe I can get back to work !!

del.icio.us Tags: google plus,facebook,google hangout,timeline,hp,hewlett packard,lou apotheker,meg whitman,video conference

Sea-change on Health Train Express

I have read that medical blogging has changed. The bloggers posting clinical cases and clinical information have declined, many (like life imitates art) are retiring, conflicted about HIPAA and privacy requirements.

Caseblog points out the 18 “never say'” items similar to the old bad 8 words of the 70s on television.

They are:

List of 18 Identifiers:   (some of these  were new to me)

1. Names;
2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
4. Phone numbers;
5. Fax numbers;
6. Electronic mail addresses;
7. Social Security numbers;
8. Medical record numbers;
9. Health plan beneficiary numbers;
10. Account numbers;
11. Certificate/license numbers;
12. Vehicle identifiers and serial numbers, including license plate numbers;
13. Device identifiers and serial numbers;
14. Web Universal Resource Locators (URLs);
15. Internet Protocol (IP) address numbers;
16. Biometric identifiers, including finger and voice prints;
17. Full face photographic images and any comparable images; and
18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep.

Count them, there are (bleep) 18 !

Are the standards different for small practices and large institutions? Reality suggests this to be true:

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Social Media in Medicine is particularly prevalent in the Emergency Department. Perhaps this is what ED physicians do during a quiet moment, between entries in the EMR.  This should not be surprising since ER medicine reflects reality. The interface of what we plan and what happens in life while we plan it. Dramatic, crises, no one goes to an  ER willingly, to wait, to see an unknown doctor unless uninsured or by other circumstance unable to make it to the doctors office during regular hours, due to transportation problems, and a simple fact that most ERs will see you no matter what to determine if it is safe to send you home. Most ERs are on a public transportation route.

Whether you are a blogger or a reader, perhaps these features will keep you focused on the never say words,  or who is blogging, why and where of it all.

del.icio.us Tags: blogger,social media,emergency department,hipaa

Doctor Only Social Media Sites

 

Kent Bottles gave a presentation at #med2 describing the  deficiencies in medical social media networks. He described them as too complicated and not easy to use.

SM sites are individuals or small groups.

Typical posts:

Do you use Social Media in your practice:?

Answer:

“Angry and probably not the kind of doctor you should go see” (Kent Bottles)

On the other hand  90% of Social Media is just showing up. Here is a bit from 33charts.com  

SM is a great medium for research. Ask questions. Use #tags, Twitter is a great medium for just in time information.

Patient Advocacy:

Other Trends in Healthcare:

Electronics and Medical Monitoring:

Simulated Environments for Psychotherapy with Avatars:

More Trends to Watch:

What do Leaders Do?

Shameless Shout out for Kent Bottles, MD

Some typical professional “Social Medical Networks:

Doctor’s Hangout         MomMD          Doctors Lounge     DocGreet

Ozmosis

Sermo

Facebook, Twitter, and Google + each have their own way of developing lists, groups and circles for groups, however none of them are secured by passwords for healthcare providers. It should also be noted that although the doctor only social networks are not HIPAA compliant….private and confidential patient matters should be de-identified.

del.icio.us Tags: kent bottles,mecical social networks,sermo,ozomosis,socialmd,doctornetworking doctoshangout mommd doctorslounge docgreet

Health IT Confusion and Clarification

                                  

This is National Health IT week, if you did not know that already. It runs from September 12th-16th. President Obama declared it in an official Proclamation and a Senate Resolution (at least they agree on something).

Official Press Release:

ONCHIT is celebrating by announcing a new website for providers and professionals. It’s a bit more readable for both groups.

Health Information Technology and ONCHIT are becoming synonymous as Federal incentives drive electronic medical record adoption by providers..

Anyone reading a government website knows they do not use smart graphics design.  Even HHS admits this since they have started a new website, more oriented to reader understanding.

The old website is still available.

Two Websites, One Message

ONC’s existing website will remain housed at healthIT.hhs.gov. The HHS site will become more policy and program-focused, and HealthIT.gov will serve as a primary resource for providers and patients who are interested in learning more about how health IT can help improve their health and health care. The new website provides access for patients as well as providers .

 

del.icio.us Tags: health information technology,hit,hit.government,hhs,incentives

ICD 10 Craziness

 

Next time you go to see your MD don’t worry about the seemingly inane questions he / she will ask you. If he doesn’t he will be in violation of a new ICD coding initiative installed by HHS in the next two years.

And for you astronauts you are covered  for spacecraft incidents, except for re-entering the atmosphere without a space-ship.

ICD 10 Search

ICD 10 Codes:  Search

My favorites are:

Bitten by Shark, Bitten by Shark, Second Encounter

Whale encounter cannot be found

Injury or Death from encounter with sting ray….could not be found, nor a code for second encounter…..What would the late “crocodile hunter’ say, may he rest in peace.

Jelly Fish are included, however, only show up if you search for Jelly and do not if you search for Jelly Fish.

Try it yourself, it’s a bit of a game show….probably good for an evening of after dinner socializing.

Wait one, my spouse is calling me to dinner:  She got my attention with an ICD Code:  W274XXA, followed by a W274XXD with a  modifier Y92010.

In trying to escape I further was injured by a: W541XXS at which point, I W134XXA.

    

I just hope I don’t get: W2111XA.

Did you get all of that? Don’t ask me to repeat it..

del.icio.us Tags: ICD10,shark,bite,kitchen,jellyfish,macaws,water ski chickens,things that bite,struck by,turtles,crochet

Federal HIT final Strategic Plan Released

Like it or not, the feds have released their ‘edict’ for adopting the digital age for EMR, and HIEs.(Office of the National Coordinator for Health Information Technology).

Anyone reading my blog knows that I am not a luddite,, and I  tend to err on the side of caution.  Like most surgeons my first thoughts are ‘primum non nocere’.  (first do no harm).

For all physicians and leaders this is a must read, It was developed after a 90 day period of public comment, and the document states it is still subject to revision(s).

The document includes the following information:

“Request for More Information on Outreach and Education to Providers and Consumers
In order to achieve the highest participation possible in the Medicare and Medicaid EHR Incentive Programs, ONC and CMS are working together on a coordinated outreach and education campaign directed at providers and hospitals. Our approach is two-pronged and involves distributing critical information and materials nationally, while focusing on local communities to engage audiences where they live and work.  We’ve already started collaborating with stakeholders and the media to distribute materials and established a strong online presence through social media.

In addition, ONC and the Office for Civil Rights are gearing up to launch a national campaign this month, designed to increase consumers’ awareness about:

• The transition to health IT;
• How to access their health information;
• The benefits of leveraging health IT tools to better manage their health; and
• Privacy rights to access and protect their health information.

Does this mean HIT is now a ‘civil right’?  Will it be subject to enforcement if a provider does NOT provide an EMR, or is this the way our bloated government deals with publicizing items for public consumption? Perhaps I am over-reacting here…I will have to call Glenn Beck and get his opinion.

BTW Glenn now has his own Internet TV network at  GBTV.com (Unashamed promotional material given without financial compensation (my charitable donation to freedom )

The revised Plan is available

Read the Federal Health IT Strategic Plan [PDF - 1 MB]

Your tax dollars at work….

Comments are welcome here. HealthTrain posts are announced on Twitter, Facebook and Google +. Readers may also comment on my blog @glevin1.

 

del.icio.us Tags: ONC,HIT,Civil Right,Strategic plan,Glenn Beck

Physician Leadership-What should We Expect?

 

Kevin Pho MD in his blog KevinMD  has a guest post by Stephen C. Schimpff, MD who asks   “What should we expect of a physician leader today? “ 

Dr.Schimpff’s bio is very impressive, and perhaps the  most interesting feature is that he is now ‘retired’.  When I first started to  read Dr. Schimpff’s blog post I thought to myself.  ‘Who has time to lead, when one is fully engaged in the daily care of patients, administration, meetings, lectures, CME and the business of your medical practice (s)?’  . Very few indeed !

It is not enough for us to talk to ourselves, go to medical society meetings and trump the latest talking point from organized medicine.

Today we have a new means of leadership, the ultimate tool of democracy, a leader in revolutionary thought and a means of aggregating opinion, visible to all. Social Media, whether it is Facebook, Google +, Twitter Tumblr, Stumpleupon, or whatever.

I have a weekly Google + Hangout on Wednesday evenings at 6PM. Frequently there are several MDs, HIT  people, and a number of Googlers unrelated to health, but with many questions, and I am asked questions that surprise me. I take for granted everyone knows details of the impending Health Reform. Well, they do not. The questions are good ones, and it is a chance for me to give my own opinion, and knowledge with the filtering of organized medicine.

There is another option for Health Reform, and I have my own special forces team working on the mission.

del.icio.us Tags: google hangout,health reform,secret agent,physician leaders,kevinmd

A New Blogroll

 

Health train Express felt it was a good time to review what some think are the best medical blogs.

Some view blogging as passé and moribund since social media seems to have surpassed blogging as a medium.  I disagree. I find social media as a way of driving traffic to my blogs. 

There are several sources, and without further ado, here they are:

Sponsored by Lenovo and Epocrates

Top Ten Clinical Medicine Blogs from blogs.com

Ten Top Healthcare Blogs (Medical Billing and Coding)

Life in the FastLane.com’

Meducation (Technology)

Top Health & Medical Bloggers (& Their Twitter Names

This list should keep you busy. Each of them brings something else to the table.  I found Top Health & Medical Bloggers and their twitter names the most interesting. This list should allow us to expand our social media networking.

I am wondering if my international readers would like to comment here or twitter me @glevin1 with their regional ‘Hot Blogs’ ?

Our next Google Hangout will be on

September 14, 2011

6 PM PDT

Invites will be sent out during this coming week. Watch for it on twitter, G+, or by email. Put Gary Levin in  your circles on G+ to be sure your Google Hangout Invitation arrives.

del.icio.us Tags: google hangout,top health blogs

 

 

Primary Care Reimbursement

Quote of the Day:
God looks at the clean hands, not the full ones.
--Publilius Syrus

A hot button topic for primary care doctors has been about the imbalance of  RVUs allotted for patient visits to a primary care doctor, and the lack of procedure codes. Unlike specialists who have a potpourri of procedures, codes, modifiers to up regulate their fees (all legal and proper), the PCPs are left with  few to chose from.

One fear that specialists verbalize is that the ‘Medicare pie’ is only so big, and CMS is not going to increase it, so that if PCP gets more specialists will get less.

This is a strategic move on the part of CMS and HHS. It has always been this way, and that is why specialists want to continue to control the RVU process. Divide and conquer weakens our voices.

 

My opinion is that specialists must support their PCP referral base. If we do not then

1. Your referral base will disappear if your PCPs get wind of  your opposition

2. It is foolhardy to enjoy the fruits of medicine no matter what specialty you are in, while other MDs are suffering from disparate incomes. Any health reform must equilibrate the work/reimbursement ratios.

3. PCPs now must have at least three years of postgraduate training, unlike years ago when one year of postgraduate training made one qualified to practice general medicine

In addition to that the AMA has the copyright to CPT coding, something that every physician uses everyday. In fact that is one reason why only 165,000 licensed MDs belong to the venerable AMA.

The AAFP has begun a campaign to change the system. An article in the Wall Street Journal by Anna Wilde Matthews elaborates,

“Primary-care physicians are pressing the agency that oversees Medicare to change a payment system they say places a higher value on work done by specialists.

The American Academy of Family Physicians has sent a letter demanding changes to a committee that plays a key role in Medicare's process for setting physician payments. The academy wants the panel to add more members representing primary-care groups, among other adjustments.

The academy also has set up a task force to propose new methods for calculating Medicare reimbursement for many of the services provided by primary-care doctors.”

In an article published in 2005 by the Dean’s Newsletter at Stanford School of Medicine, the issues about CPT codes and RVUs points out the added complexity of valuing CPT codes.

Stanford University uses a “Funds Flow Work Group” . If ACOs come to pass, this may be the model for distributing income allotted to physicians. No matter what it is going to be a very interesting and challenging time.

del.icio.us Tags: primary care,specialty care,cpt,rvu,Stanford,aafp,ama