Commodization of EMR

 

EMR has reached the point of retail commodity. Costco’s online website is offering the Allscripts My Way and PHR for $499 /  month.  It was not clear if this was a ‘cloud’ solution, although it did state it was a ‘hosted’  EMR.

Costco has teamed up with Etransmedia, a Premier Plus Allscripts Partner, allowing them to offer this EHR and PM solution to Costco members.

My Way is the product of the purchase of Misys, a former competitor of Allscript, and is not truly the Allscripts EMR.

The COSTCO web site elaborates further on federal incentives of $44,000 dollars for adopting EMR.

The advertisement appears on a ‘redirect’ to Etransmedia’s website, not an uncommon practice for Costco Online offers.

No mention is made of whether the offer applies to in store  purchase.

Algos in the Health Care Equation

 

“Many problems in society are just poorly designed algorithms”

According to Bill Gates at a recent University of Washington talk, He posits that: 

“The Miracle Of Availability” And Applying Computer Science To The World” 

is certainly the case now with mHealth in all shapes and forms, Android devices iOS devices and Windows 7 phones.

He admits to not being able to think in terms of terabytes and petabytes in this age as compared to his boyhood days of being happy with kilobytes and rarely a megabyte.  Programmers were spartans in that age, and there was no room for ‘bloat’. Gates admitted that he simply isn’t ideologically suited for allocating terabytes and petabytes.

His comments regarding health care:

When the most controversial bill of a political era (Obama’s health care bill) is over four thousand pages long and totally unreadable by the average voter, how is that effective?

“I like hash tables and I dislike malaria”

He then moved on to the question of poverty and disease. His primary insight came when he was working with researchers to create a stochastic model of “one of my reactors.” It was immensely complicated but the computing power at their disposal made it possible. He thought, if we can model a reactor, with all these forces and materials, why can’t we model disease, including the mosquitos, the people, the environment, the solutions?

So they worked at it and eventually came up with an immensely complex model for disease vectors, weather, vaccines, life cycles, seasons, and everything else. They compared it with real statistics and it checked out. He said with confidence: “The world effort to get rid of malaria will be based on this model.” And the modeling approach to problems, now that we have the computing power to simulate the world with some precision, is just as important to apply elsewhere. Whether it’s malaria, polio, crops, nuclear reactors, sanitation, or education, “it makes you so much more rational in terms of what you do.”

Statements such as these empowers those in healthcare who want more algos and clinical decision support. The question arises as to who is going to be the testing and certifying authority for these systems? Will it be a subcommittee of the medical board in the department of consumer affairs, or perhaps a new ANSI board. Will there be a liason between these disjointed organizatons?

del.icio.us Tags: algorithms,ansi,models,mhealth,gates

Weight Loss on the Health Train Express

 

According to the California Health Care Foundation which publishes California Healthline,

The number of weight-loss surgeries performed at California hospitals increased by nearly 7% from 2005 to 2009, but deaths associated with the procedure have remained relatively low, according to a report by the Office of Statewide Health Planning and Development, the Riverside Press-Enterprise reports.

OSHPD examined five types of weight-loss -- or bariatric -- surgery, the safety of the procedures and the number of surgeries carried out at hospitals (Hines, Riverside Press-Enterprise, 10/26).

The report found that 94 hospitals in the state performed weight-loss surgeries in 2009.

Hospitals performed 13,500 procedures that year, up by 6.8% since 2005, the report found.

Mortality rates associated with the procedures remained low, according to the data. Between 2005 and 2009, 40 patients died in surgery and 79 died within 30 days of surgery.

Researchers found that the lowest-risk surgery was laparoscopic adjustable gastric banding -- or Lap-Band surgery -- which involves inserting an inflatable ring at the top of the stomach.

The highest-risk procedure was biliopancreatic diversion, which involves bypassing the small intestine and removing part of the stomach. This procedure usually is used for morbidly obese patients who have not had success with other surgeries, according to state officials.

Rather than becoming an elective surgery it is now on the list of acceptable alternative treatment methods for morbid obesity

Public health proponents and scientific data corroborate higher rates of breast cancer, heart disease, hypertension, osteoarthritis, hip disease, and other chronic diseases which increase the financial burden on health plans, medicare and private insurers. Insurers are now much more likely to pay for these procedures if less drastic measures such as exercise (often very difficult for morbidly obese patients) and nutritional modification.  The lap band procedure gives the patient satiety after only eating a small amount of food.

Faced with increasing medical expenses the elimination of treatable disease with proactive preventive measures such as weight loss, control of hyperlipidemia, and consumption of highly processed food becomes essential as the population ages.

Present projections of ‘bankruptcy of the Medicare system’ do not factor in improved general health and wellness, and lower incidences of these chronic ailments. The projections also do not factor in upcoming radical advances in chemotherapy, immune diseases, nor the possibility of an early detection and/or treatment of Alzheimer’s Disease (TEDMED presentation, 2010 David Kamen)

del.icio.us Tags: lapband surgery,bariatric,public health,obesity,tedmed

Health Train Express 2011

 

 

The time of year is approaching when change and snow are in the air. We are approaching Health Train’s 7th Anniversary. During the next several weeks Health Train Express will be redesigned with new cars, engine and perhaps add a caboose. We are eliminating the many distractions on the side banners and also eliminating our blog roll. Readers will be left with social media buttons for Facebook, twitter and G+

Gone will be the other links such as   These were far more useful in past years prior to the explosion and common use of social media.  Health Train is based upon fact and opinion. Our mission is to put it out there, and there are better internet businesses that focus on distribution, networking and building a following.

With that the  Health Train Express Design Template will also change.

A helpful effect will be faster  page loading times.

In a continuing effort to make the pages attractive, capture attention and readable I will continue to include links to videos, and some images, although there will be far fewer to keep loading times to a minimal amount.

I will continue to include appropriate links for those who wish to deep dyve into a particular section.

 

Thanks for travelling thus far with me on the train..

LOL

del.icio.us Tags: social media,blogs,healthtrain express

Social Media TEDMED and Health Train Express

 

TEDMED

“ Intellectuals solve problems… geniuses prevent them “ (Albert Einstein)

One of my favorite pastimes is reviewing TEDMED’s videos. Frankly it is not cost-effect to attend these meetings at a cost of 4-5,000 per TEDMED.

However in the scheme of things a delay of several months or even year (in the scheme of things) is not terribly significant.  In fact the delay serves to allow the ideas and projections to mature with the curing effects of time.

One of my favorite TEDMED presentations is from Dean Kamen who invented the original infusion pump, the Segway, and now works on cyborg-like prosthetics, as well as cost-effective water purification equipment usable in third world countries.

Dean Kamen and TEDMED

This presentation is from TEDMED 2010.  It comes at an opportune time since TEDMED 2011 has just begun.

In addition to the ‘science” and/or innovative ideas one comes away from a “TEDMED” with the excitement and ‘prescient; feeling that humanity will survive and overcome obstacles to better itself.

Physicians usually emphasize prevention and Dean Kamen is high on prevention. He points out that the current mindset about healthcare costs bankrupting our system are faulty because measures such as improved diet, healthier life styles, prevention of diabetes and chronic heart disease and perhaps prevention of Alzheimer’s disease will result in reduced health spending.  Hopefully fewer people will require expensive chronic disease care. The gradual increase in preventive measures will ‘bend the cost curve” in a way much more effectively than all the information technology in which we are now investing.

He correctly points out that some of the most destructive industries can offer ways of delivering beneficial products. He tells the story of how inventing his purification system was the simple side of developing and distributing it to the world.

Coca-Cola a company that thrives on the demand for a processed sugar drink that increases the risks of poor health, obesity, diabetes also has the largest distribution system in the world for it’s products, and a means of delivering the drinks. Dean coupled his invention with the Coca-Cola soda dispensing appliance (that you see in almost every fast food restaurant) with his water purification system, and the means to deliver his water purification system to third world countries such as Bangladesh, India, where a simple thing such as clean water actually is a medical device to prevent infectious disease and/or toxic contaminants  in the water system.

The use of social media in health care may have the same outcome if it’s utility as a communication system is linked to the messages of preventive health. Social media serves the youngest portion of our demographic in many ways previously not possible.

Here is a “springboard” of Social Media’s rapidly growing potential for good in healthcare.

Health Care and Social Media

del.icio.us Tags: social media,healthcarebluebook,facebook,twitter lists,G+,TEDMED,Dean Kamen

Google + and Health Train Express

 

Health Train Express will soon have a direct link with Google +. The link is in place but not yet functional.

For those familiar with Google + the functionality will be identical to G+ that you now access, including social groups (Circles) over which you have complete control. Our readers will be encouraged to set up a “Circle” named “Health Train Express” There you may ‘friend’ others who read our blog and/or other social media in medicine. The site has the capability of back linking to any of our archived and current posts. Images can be uploaded and you will also be placed in our circle of readers. A key feature is Google Hangout where uses can video conference with nine other readers for discussions on Health Care and Social Media #HCSM.

Google + readership now exceeds 50 million individual users, growing from zero to it’s present size in only 90 days.

Readers will notice that Health Train has shifted it’s focus recently to social media. The reasons are obvious because Social Media has become an influencer of the healthcare community. #hcsm now links to many websites, patient education products, links to other medical professionals and a form of communication between medical conference participants. Google hangouts offer an unsurpassed window to online video conferences with up to ten participants.

Health Train will utilize #hcsm to convey and make relevant announcements as well as hosting Google Hangouts which will be announced here.

Google + like Twitter offers a search engine like feature using hash tags.

 Gunter D.Fuchs, Senior Partner, The Fox Group

Foxe practice.com/healthcare-hash tags offers a directory of # tags. It is regularly updated and a good starting point for research.

Physicians would be advised to open a Google + account, which does not require a profile. This allows user access to all of it’s functionality. It requires an email account on Gmail.com 

Our next post will revert to healthcare policy, HIT, EMR or other topics in health care.

del.icio.us Tags: social media,#hcsm,Google plus

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:

   

.

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