How to use Social Media at Meetings

Recent analytics reveal that over 65% of MDs use social media. There remains much controversy about using SM in patient communications. However, SM offers many functionality for socializing online at meetings, and broadcasting events in your area. (meet me at Starbucks, where you are now, conference attendees, and many many others.)  I am a relative newbie and learn things daily. Thousands of application developers add value to each platform, such as Tweet deck, Hoot suite,

 

Twitter is very useful at meetings.  The key ingredient is how to use hash tags.

Hash tags allow users to ‘search’ for relevant tweets. For instance, #aao_ophth will display all tweets about the American Academy of Ophthalmology. The sender must insert #aao_ophth in his tweet along with the rest of the tweet. When sending the tweet if you leave off the @ all your followers will receive it, or if you want one or more recipients add @ with their twitter id. For instance:  @glevin1 #aao_ophth Hey this meeting is great ! will send the tweet to me alone.   Hey this meeting is great #aao_ophth will send it off to everyone on your follow list and to anyone who search with the #aao_ophth hashtag.

Lesson learned:

This week I ‘attended multiple medical  conferences on the same day on opposite coasts, from home, using the following Social media tools and twitter hashtags

Twitter: #mayoragan,  #aao_ophth   #mccsom  #health2.0  #hcsm #hachat #aamc11 

You can also upload pictuers to Yfrog, twitpics.

For a more complete list of medical meetings hashtags:

Google + is the new social media player.  In less than three months the user base went from zero to almost 50 million at last count. There are several key features that I enjoy.  Circles…you can start your own circle according to category.  Hangouts…for me this is a thriller conferencing with up to nine other geeks, girls, meeting attendees, etc.  The hangouts can also be ‘live streamed across the internet on Ustream.

If you use Google Chrome go to the Google Web Store and add the G+.chrome extension. Otherwise try  plus.google.com. It is now open to the public.

Google Plus Tips

Hangouts work well on iPhone and iPads and Android devices.

del.icio.us Tags: G+,hangout,facebook,twitter,socialmedia,#hcsm

Corporate Medicine and HealthCare

 

The Startup Health Roundtable held last Thursday in Mountain View, CA was attended by over 300 people and was watched by hundreds more on the Live Stream Channel . It featured Wired Editor, Thomas Goetz, author of ‘The Decision Tree ‘ Bob Kocher, and Steven Klein.  Each came to the table with ideas about bridging the gap between Health and Wellness Entrepreneurs and Investors.

Business speak is very different from health speak. Many entrepreneurs have flailed at applying investing theory and startup theory to health ventures..

Despite many efforts to corporatize medicine, physicians remain hesitant and unconvinced.

del.icio.us Tags: corporate,medical,entrepeneurs,investors,startup health

The New Networks

 

During the past ten years we have witnessed exponential growth in networking, social media, medical connectivity, remote telemedicine and video-conferencing.

This is only one of the major changes in the business of practicing our ‘craft.Passivity in adopting new technology is never a good thing, except if one is less than five years from retiring in a solo practice, and even then adopting modern technology adds value to a practice sale price, or recruiting young physicians.  Young physicians are trained in EMR and are facile with digital media and communications and wish to practice in an EMR setting.

                                                                 

Soon, not having an EMR will be a bit like still using a rotary telephone. The usual and customary communications will be digital using an EMR, Health Information Exchange and internet for routine tasks. 

For those who have not adopted EMR, there are already portals for eRx, Laboratory results, Remote scheduling, telemedicine.

The human-machine interface is transitioning from keyboards and laptops to tablets,, which are hand held, and use voice recognition. Each iteration of these devices adds more features and more powerful processors.

My analysis is that even solo practitioners need to invest in EMR. It will form a cohesive network between your practice and the rest of medicine, hospitals, and referring sources.

Health Information Exchanges are coming to fruition in many areas, and the combination of EMR users now makes these networks necessary to complete the loop.

It has been a long journey beginning back in 2005, but as the years go by much has happened.

Private medical practice will survive and those who adapt early will insure their survival by doing so.

What is absolutely essential is that physicians become proactive and lead the movement, otherwise we will see what has happened with health care reform will occur with electronic medical records, and health information exchanges.

Governance and interoperability standards and certifying bodies are now in place. Meaningful use is here and now meaningful usability is critical for further adoption. Whatever gain in effectiveness using EMR can be diminished by inefficient software and hindrance of usual and customary workflow.

del.icio.us Tags: emr,hie,hit,tablet pc,laptop,desktop,interoperability,new networks

Enter the Macintosh

This week’s events over the past ten days since Steve Jobs left this earth brought back memories to me during the early years of my private ophthalmology practice (1979-1984).  I had determined that I would become one of the first small practices to use personal computers to manage the business and billing side of my medical practice.  At the time there were a handful of PC based programs and perhaps only one Mac medical application.   If I remember correctly it was called Media-Mac. Today it probably would have been named iMedic.

I went the PC way and my partner decided to go Medi-Mac.  My associate was not a techie kind of doctor, he just knew it was intuitive to use and got the job done. Many of my doctor friends used Macs at home, for teaching, and giving presentations. It was great for graphics, photo cataloguing from the get-go. I don’t know if his system ever crashed.

I started off with a system from vector graphics (Z80 Vector 3) using CPM and later MSDOS when I switched to a PC from my older system which ran on a Z80 (8 bit system, if I remember correctly.

My first iteration was a single user system. The Vectorgraphic 3

 

Eventually  I needed multiple workstations and found a vendor that set up some type of multi-user system with dumb Wyse terminals. The really dumb thing was that I tried to use a terrible system. It cost me dearly over the next several years.

Apple’s designs and their software apps were intuitive, and just worked out of the box…almost forever, or until a new version was introduced not because of problems with the older version, but because Steve Jobs found a better way to do the same thing.

It’s been awhile so I had to do some research on wikipedia and also found the original vector web-site. Looking back I actually made a wise technical choice for the times, but had no prescience for what would come with Apple, IBM, and the explosion of PC clones (as non-IBM machines would come to be known). Steve had forged an agreement at the time with IBM to produce the original IBM PC’s OS known as PC-OS.

In those days main frame computers were the pinnacle of the art. Numerous iterations of PCs, and networking systems, like Novelle, Windows Server,and others would gradually chip  away at mainframes, replacing them with larger and larger networks, eventually coming around full circle to today’s  Cloud Computing with huge server centers dwarfing mainframe facilities.

What goes around come around.

del.icio.us Tags: vectorgraphic,z80,cpm,msdos ibm,emr

Retraction Attraction on HealthTrain Express

 

Not much of what I write about is original, rather I hope to select important blogs and select items of interest to my readers for a fresh perspective and change of pace.

Such is today’s topic

RETRACTION WATCH is such a blog written by respected journalists. There are more instances of scientific publishing gone awry, and this site purports to alert us of these happenings.

The Logo stands for :  ‘Natural Sciences and Engineering Research Council (NSERC)

I know of no related sites for medical research.

Why write a blog about retractions?

For that answer we must listen to Adam  Marcus and Ivan Oransky and listen to what people are saying about Retraction Watch.

Your physician may have been treating you with misinformation for five years until the deficiency is noted. Perhaps he is still treating you with misinformation….What we need is a watchdog registry as a central reference for disproven health and/or scientific publications.

del.icio.us Tags: retraction blog,nserc crsng

The Threat to Legalized Cannabis

 

The Threat to Legalized Marijuana:

   

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Associated Press writers Lisa Leff in San Francisco and Catherine Tsai in Denver contributed to this report.

Some states have legalized the growth of marijuana for medical purposes. Other states have bills proposing the same laws.

Sources, including the AP are reporting the Department of Justice plan to shut down many growing and sales operations of Marijuana Dispensaries in California. In some cases the process has begun with warning letters sent to landlords threatening seizure of property (forfeiture) in an effort to dissuade owners from renting to marijuana businesses.

The marijuana businesses operate within the limits of California law, employing people, paying taxes, renting property that would likely be empty in the current economy. Estimates are that California's Marijuana industry supplies the nation

This is a never ending story (much like 'right to life') issues, homosexuality laws as a civil rights issue, and abortion. The pendulum swings both ways.

There are many arguments on both sides regarding the issues of whether marijuana should be legalized.

 

 

 

1. The California Board of Equalization has estimated medical marijuana generates between $53 million and $104 million in annual sales taxes on sales of between $700 million and $1.3 billion. This is a significant cash flow and tax base for California sales taxs. and the Federal government in the form of income tax. And this in a state where the economy is terrible and the state is bankrupt.

2. There are no facts given by federal officials regarding whether or not the sale of medical marijuana has resulted in an increase in serious crime or even misdemeanors.

3. Obtaining a medical marijuana card is very easy. While it does require a doctors authorization for a referral to a dispensary there are no specifics in regard to documentation of a reason for this treatment. Merely a prescription for the individual to obtain medical marijuana (there is no such thing). There are no laws or regulations certifying strength of the marijuana. Most users are sophisticated and recognize plant types, such as and chose accordingly. Dispensaries have these plant species separated and are sold according to the client's needs and their effects, which differ significantly from patient to patient.

4.  

5. 

6.  

7. Some (most) physicians who prescribe marijuana do so without documentation of a proper medical history and/or physical examination. And there are adequate laws in that regard to enforce more restrictions in the sale of marijuana. Most physicians have little background or experience in prescribing marijuana. The Board of Medical Quality Assurance has strict rules in regard to prescribing which include examinations and documentation and continuing follow-up of patients prescribed medications. Many physicians have had their medical license suspended and/or revoked for violation of those requirements. Physicians must take a proportional responsibility for this situation. If current regulations were enforced the prescription rate would drop precipitously due to the increased time and effort required for physicians to comply with the law.

                   

1. Physicians such as oncologists and some pain specialists will resort to marijuana to control nausea, pain, anxiety, and anorexia. A new specialty has developed. The marijuana doctor who hands out prescriptions for marijuana to almost whoever enters their office asking for one. The users know well who these physicians are in their community. It is also a well known fact that some physicians will work part time in a marijuana clinic, employed by the growers and/or dispensary.

The marijuana business is  'cash and carry'. and it cannot be regulated through the customary process of insurance restrictions.

In most cases an ethical physician will refer a patient to a dispensary after attempting to control symptoms with accepted medications, acupuncture, physical therapy or other mode. Marijuana now is accepted as an alternative treatment method, however regulations are side-stepped and ignored in regard to customary medical practice guidelines.

Demand is no excuse for not enforcing regulations, and this falls at the foot of organized medicine, peer pressure and the State Medical Board of California.

If medical marijuana is a controlled substance tracked by DEA numbers on prescriptions prescribers can be tracked, identified and enforcement can proceed through the established methods used for over prescribing of any controlled substance such as Vicodin, or Demerol.

Current law allows for revocation of a DEA license and Medical license, and provides for a very significant ability to control this issue at the source.

The Justice Department's enforcement “nuclear option” is a poorly conceived method when a tactical strike with a smart bomb targeted at the source....physicians who are breaking the law set forth by medical boards.

Assemblyman Tom Ammiano said the crackdown "means that Obama's medical marijuana policies are worse than Bush and Clinton. It's a tragic return to failed policies that will cost the state millions in tax revenue and harm countless lives."  Once again Obama does a one-eighty on his policy toward marijuana since election.

"I don't understand the politics of it, and certainly if we haven't learned anything over the past century, it's that Prohibition does not work," added State Sen. Mark Leno, who has worked to safeguard and regulate medical marijuana in California.

del.icio.us Tags: marijuana,cannabis,california law,obama,justice department,dea,state medical board,marijuana dispensary

Apple on the Health Train

Steve Job’s life and death have had a deep impact here on earth. His accomplishments rival those of  Thomas Edison, Henry Ford, Andrew Carnegie, Richard B. Mellon, Rockefeller, Harvey Firestone, John D. Rockefeller, J.P. Getty,

Who would have known what transpired between these two photos of Steve Jobs at the extremes of our lives. It is almost as if his physical being was transformed into his inventions.

Bloomberg’s Business Weekly tells the story of Jobs from 1955-1985.

ABC News perhaps gives the best video-documentary of Job’s Professional Career.

As his life progressed he gave much of himself, 101 % to his family and community and will leave a legacy to the city of Cupertino with the new Apple Campus.

Steve Jobs will be remembered for many things His famous quote at Stanford University's commencement address in 2007, “Stay hungry, stay foolish”. will most likely go down as the most memorable spoken word of Jobs. 

Steve was an artist in  form and function for his numerous devices. He was the master of ceremonies for each introduction of a new revolutionary gee- whiz device, each one of which changed millions of lives, and spun off new companies, fueling entrepreneurship.

Steve (many felt comfortable enough with him, to call him that) even if they were not close friends.

Job’s impact on healthcare is now becoming apparent and although Apple was a late entrant into HIT, the iPhone and iPad have produced the most useful human-machine interface to work flow in medical practice at the bedside, office, and for remote work from home, in a car, on a lake, and at times in the air. Numerous medical calculators, Medical search engines, journals,   Continuing medical education podcasts also are readily available from iTunes.

Jobs left a legacy for healthcare, in a cost effective IT device. The iPhone and IPad have spawned a niche for remote monitoring, imaging, and Facetime has a secure video capability that will stimulate remote office visits.

The R&D at Apple must have been enormous. Jobs was a revolutionary at project management, coordinating production and manufacturing and assembly of Apple’s devices. Steve recognized the time involved in product development, working on many devices, many of which we probably will never know about.

Steve Jobs had the next two generations of inventions’ already planned and designed when he launched any Apple product.

His designers not only designed functional electronics, but delivered them in a unique refined manner, much like a piece of  expensive jewelry or perfume. The interior design of the package was designed and produced as carefully as the internal electronics. Much of the joy of buying an Apple Product was the artistry and almost magical process of unpacking “the Apple”. Whenever you bought an Apple Product…it was Christmas time. The “fruit” of his inventions was the apple, the much maligned object of man’s downfall. However this Apple was not denigrated as the one in the Garden of Eden.

Apple is a  huge company, yet he somehow managed to inspire complete secrecy in his employees, going far beyond the written contract between him and employees. Not much detail was known about the final release of a product until the day of launch. It is safe to say that if the U.S. government could keep a secret, Jobs could do it one better.

At the same time as we idolize and perhaps magnify his life,  Steve Jobs was loved by his wife Lauren and their three children Eve, Erin and Reed. They supported him and stood by him as he battled cancer and though they no longer have a father, they'll always have his legacy. and children must share a deep personal loss sharing his end.

His personal life had the normal ‘tragedies’ of any life, which fade into ghostly events as life goes on.

R.I.P. Steve Jobs

del.icio.us Tags: Apple Inc,Steve Jobs,iPod,iPhone,iPad,HIT,EMR

In Training for Health Train Express

 

The Enterprise Medical Center announces new EBM guidelines, questionable guidelines for outcomes and failure to meet JCAH standards.

EMC also failed to qualify for incentive payments because EMC did not meet meaningful use requirements.

Health Train Express thanks ZdoggMD for his intepretive potentially Emmy award winning video on the pitfalls of medicine in the space age.

In space, no one can hear you code. We boldly probe where no finger has probed before

Something smells bad here.

del.icio.us Tags: zdogg,space age,meaningful use

Social Media for Hospitals and Clinics

Mayo Clinic has established a formal Social Media Department to enhance patient care and educational needs.

Lee Aase (@LeeAase) created this slide share presentation which is also available online  There is also a presentation transcript, if one scrolls down the page.

Lee Aase is the Director, Mayo Clinic Center for Social Media. (#MCCSM) THIS IS THE EPONYM FOR TWITTER SEARCHES

5-plan-1050-Aase

 

View more presentations from med20su

For those of you who could not attend, Click Stanford Summit + Medicine 2.0 @Stanford. for the agenda.

Health Train continues to believe that social media will expand and flourish not only in the business world but also will change the game in healthcare, as much as EMR and HIE, and in a much more effective manner as it builds from the ground up.

Next Healthtrain will be  Google +, a fast moving high speed maglev vehicle with enormous potential for health institutions and clinic communication.

del.icio.us Tags: mayo clinic,social media,google +,hangout,lee aase,health2.0con,asco,robert miller,medicine 2.0 conference,Stanford,Larry Chu

Who Came First on the Health Train? The Chicken or The Egg

Caution Lights down the Track

 

A troubling report from the U.K.

Trouble Down the Tracks

U.K. Health Service To Dismantle Nationwide Health IT Program
Read more:

Health Secretary Andrew Lansley said that the National Programme for Health IT, which launched in 2002, "let down the NHS and wasted taxpayers' money" (Press Association, 9/22)

iHealthBeat:

It is now almost ten  years since beginning their National HIE in a country much smaller than the U.S. Certainly their software designs are obsolete and not industry current.

Lansley said, "We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernized NHS" (Beckford, London Telegraph, 9/22).

Because most healthcare transactions take place in regions and not nationally it seems reasonable that the nationwide network should be built last. The interoperability standards have been set…things may evolve and what is the rush?  How many patients receive treatment in LA, Chicago, and NY?  Few travel that distance for routine treatments. The number of patiens who can afford national expeditions for treatment are limited.

So far HHS has dispensed over $ 600 million dollars in incentives, according to

The Federal Government Has Distributed $653M in EHR Incentive Pay

Read more:

The CMS data also show that:

• $262.2 million in Medicaid incentives have been paid to 294 hospitals registered as eligible for both the Medicare and Medicaid incentive programs;
• $226 million in Medicare incentives have been paid to 114 hospitals registered for the Medicare incentive program;
• $93.9 million in Medicaid incentives have been paid to 4,463 physicians and eligible health care professionals;
• $38.3 million in Medicare incentives have been paid to 2,129 physicians and eligible health care professionals; and
• $32.9 million in incentives have been paid to 15 hospitals registered solely under state-administered Medicaid incentive
• 

del.icio.us Tags: emr,hie,incentives,cms,medicare,medicaid

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