The Farmer’s Donkey & The Well

One day a farmer's donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn't worth it to retrieve the donkey.
He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone's amazement he quieted down.
A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing. He would shake it off and take a step up.
As the farmer's neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!
MORAL :
Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells just by not stopping, never giving up! Shake it off and take a step up.

 

What is that all about here on the Healthtrain Express? Who is in the well? Patients? Doctors? Bureaucrats? Government?

Perhaps we all are and should be shoveling the dirt underneath us and not at each other.

 

LiveJournal Tags: donkey,patient,doctor,bureaucrat,government

A Lesson from Richard Feynman

 

Some of you may recognize this man, as well you should. Feynman was a well known physicist who often thought out of the box. Feynman was a powerhouse in the world of theoretical physics, During his lifetime, Feynman became one of the best-known scientists in the world.

Feynman was a keen popularizer of physics through both books and lectures, notably a 1959 talk on top-down nanotechnology called There's Plenty of Room at the Bottom and The Feynman Lectures on Physics. Feynman also became known through his semi-autobiographical books (Surely You're Joking, Mr. Feynman! and What Do You Care What Other People Think?) and books written about him, such as Tuva or Bust! (wikipedia)

What does any of this have to do with Health and Medicine and Doctors?

The Map of the Cat Conundrum:

 

Anyways. As any Feynman fan will remember, he decided to drop out of Physics for a while and check out BiologyThe story goes something like this:

“A map of the cat, sir?” she asked, horrified. “You mean a zoological chart!” From then on there were rumors about some dumb biology graduate student who was looking for a “map of the cat.”

When it came time for me to give my talk on the subject, I started off by drawing an outline of the cat and began to name the various muscles.

The other students in the class interrupt me: “We know all that!”

[Now THIS is my favorite part!]

“Oh,” I say, “you do? Then no wonder I can catch up with you so fast after you’ve had four years of biology.” They had wasted all their time memorizing stuff like that, when it could be looked up in fifteen minutes.

This is the harbinger of what is occurring in healthcare and many sciences as well. No longer are we required to fill our cerebral cortices with dribble that will mostly be lost in time. Our efforts will be toward truly cognitive skills developing constructs with analytics. There will be few places without access to terabytes of stored data, tables, charts, algorithms,  transforms, calculus, spreadsheets and the like.

The stigma of referring to a database in front of the patient will turn to “doctor aren’t you going to look that up to be sure it is correct?

        

Referring to a social media hash tag or a Google circle for an instantaneous second opinion from a #hcsm or #ophth or #intmed friend will become common place. 

 

And that my friends is the power of how social medial will transform your daily dabblings in healthcare

 

LiveJournal Tags: Richard Feynman,physics,emr,health,doctors,socialmedia,facebook,twitter lists,G+

Wal-Mart and Your Health Care

 

It’s just a matter of time. As you exit your local Wal-Mart or SuperWalmart notice the Optometrist and the Optical Shop.

Fairly soon you may also see ‘The Medical Clinic”adjacent to the ‘eye department’ with Dr Joe Smith’s name plate inserted in a sliding name holder.

Wal-Mart wants to be the nation’s largest primary care provider. And no doubt, unless the public refuses to use it, that will come about.

At the moment it is easy enough to  walk into any Rite Aid or CVS pharmacy to obtain flu inoculations. They will even bill your insurance. The CVS Urgent care clinic has a better EMR than many primary care physicians.

Have you noticed when calling for a prescription from Rite Aid the telephone voice tree gets in a ten second spot announcement for it’s lineup of immunizations. I have even had an automated telemarketing machine call me at home to get a flu shot scheduled at CVS soon.

Wal-Mart's public comments revolve around lowering their own employees health expenses.  We used to do that in “occupational health”, an internal department of most industries.

“Analysts said Wal-Mart is likely positioning itself to boost store traffic – possibly by expanding the number of, and services offered by, its in-store medical clinics. The move would also capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance.”, so says Julie Appleby and Sarah Varney in The Health Care Blog

Wal-Mart distributed an RFI (Request for Information) recently to determine how vendors could be used to lower health care costs. Wal-Mart's request goes even further, asking possible partners to provide information on how they would oversee patients with complicated chronic conditions, including asthma, HIV, arthritis, depression and sleep apnea.

LiveJournal Tags: cvs,minute clinic,walmart

Occupy Health Care

The  #“Occupiers” of healthcare also need a medical home and/or a primary care physician.  Despite the government (state and/or federal) push to form accountable care organizations (ACOs) this will be very difficult to accomplish.

Ignoring the very real barriers to #ACOs (except for some large healthcare entities like Mayo Clinic, Henry Ford Hospital, Cleveland Clinic and Kaiser Permanente) the shortage of primary care physicians,is the leading challenge for this “homeless person”. i(e GPs Family Doctors and some internists as well as Ob/Gyn and Pediatricians which may also be counted as primary care,)

If this person has a smartphone he can indulge in participatory medicine and social media in medicine #hcsm via facebook, twitter and G+, ask questions of friends and communicate with some care providers.

The concept of “Occupy Wall Street carries over to health care, with the same outrage as those demonstrating in all the cities, where the healthcare issues also reveal huge disparities in healthcare availability and affordability.

The situation now approaches a critical mass with each section of society claiming “I pay enough, not me !)  Unions want more, employers want less, employees circle the wagons with the latest demonstration project, Medical Savings Accounts, HMOs and empty promises by all concerned.

Several aspects of Obama care have already gone into effect, however there remains a real possibility large portions will be rescinded.. The law was written with a non-severability clause,  ie, all or nothing. That’s a huge CATCH 22. 

         

Although many states and others have raised issues, including constitutional law it appears that the judicial branch of the U.S. thus far has offered little if any relief from Obama Care. It will undoubtedly make it’s way to the Supreme Court of the land.

Prominent congressional representatives are offering measure to repeal all of part of the Patient Protection and Affordability Act

LiveJournal Tags: PAPCA,Obamacare,Supreme Court,Repeal Obamacare,Occupy Healthcare

The End of Medicine as We Knew It, R.I.P.

Does the message here operate when we face unwanted or unexpected changes. Do we grieve for that which we use daily and come to ‘love’.

Am I sticking my neck out? Don’t shoot the messengers 

     

Am  I a messenger or a heretic? Perhaps a little of both. I am always open to changes, however my first reaction to a new idea or product is enthusiasm tempered by a bit of hesitancy until I see which way the wind will blow.  My decisions inevitably depend upon a proven technology and adoption. Too many times I have invested in great possibilities that can not or are not self-sustaining, become obsolete, old in short time, or created more problems than are solved.

This applies to technology in diagnostic and therapeutic machines, as well as cost containment, HMOs, PPOs, ACOs Machinations about EMR, HIT, incentives and penalties, deadlines for adoption that are never realistic, and all the machinations of a far distant decision making process inside a ‘beltway’.

Despite serious reservations and outright negative commentary, physicians see some or all of these adopted, and continue to practice medicine, with each change creating more frustration built upon previous layers of negative results, and negative ROI.

Does it really matter? Can medicine as we know it survive or do we just let it R.I.P. ?

Perhaps this is just my Sunday morning ennui

LiveJournal Tags: change,obsolesence,R.I.P.,HMO,ACO,technology,emr,hit

The Integration of Social Media and Participatory Medicine: The Meaning of the ePatient Movement: Part I

 

A key component of cost containment in medicine and healthcare is wellness and compliance with treatments using educational courses, advocacy in groups of specific illness and support organizations to encourage patients with or without devastating illness.  This is particularly true in orphan diseases where a disease is uncommon or even rare, and chronic illnesses such as degenerative neurologic diseases, inherited diseases and cancer.

How can social media platforms such as twitter, blogs, facebook and G+ contribute to this effort?

Hospitals are integrating these functions into their web sites

“As units of analysis, the authors first identified different types of online media formats utilized by each hospital (eg, blogs, instant-messaging, audio clips, and video clips etc.). After identifying media formats, patient health information content (eg, disease information, symptom checkers, and health education) was identified within each media format.”

 

In a recent study of 14 hospitals:

‘The 14 hospitals, ranked in order, include: (1) Johns Hopkins Hospital, Baltimore; (2) Mayo Clinic; Minnesota; (3) Massachusetts General Hospital, Boston; (4) Cleveland Clinic; (5) Ronald Reagan UCLA Medical Center, Los Angeles; (6) New York-Presbyterian University Hospital of Columbia and Cornell; (7) University of California, San Francisco Medical Center; (8) Barnes-Jewish Hospital/Washington University, St. Louis; (9) Hospital of the University of Pennsylvania; Philadelphia; (10) Duke University Medical Center, Durham, N.C.; (11) Brigham and Women’s Hospital, Boston; (12) University of Washington Medical Center, Seattle; (13) UPMC-University of Pittsburgh Medical Center; and (14) University of Michigan Hospitals and Health Centers, Ann Arbor.[13]”

(author)

This study in The Journal of Participatory Medicine is  heavily skewed with major academic hospitals already ranked in the upper echelon of hospitals and all in major metropolitan areas, and the results do not truly indicate the overall adoption rate throughout the country. However since hospital web sites are online the information is easily accessible to the public.

The study also emphasizes the importance and necessity for broadband internet access throughout the country as a major public health imperative. It should also serve as a driver for either federal or state funding from public health agencies as part of their operating budget.  The use of internet media and social media may serve to decrease public health education using other media.

Blogs:

 

Social Media:

Analysis of Social Media Platforms used by surveyed. Hospitals

Broadcast media:

Web Enabled Communications

Mobile Apps

Citation: Gallant LM, Irizarry C, Boone G, Kreps G. Promoting participatory medicine with social media: new media applications on hospital websites that enhance health education and e-patients’ voice . J Participat Med. 2011 Oct 31; 3:e49.

Physicians should note that Social Media is here, and most likely will stay. The APIs (Application Platform Interfaces) are designed for users to layer their own specific software needs over the social media websites. It would seem that hospitals and physicians can easily integrate a social media site into their EMR. EMR vendors may choose to integrate SM into their products as well, with special attention to HIPAA regulations.

Next on Health Train Express:

All about ePatientDave

LiveJournal Tags: dalai lama,epatientdave,social media,participatory medicine

Social Media? The Answer to the Doctor’s Lounge

Patients and hospital staffs alike, as they walk by the Doctors lounge must wonder what transpires in those cloistered spaces, somewhat akin to boardrooms, VIP lounges, and even without “Private” or “Do not Enter” signs, the unwritten social understanding is this is a special place for a select few.

Social media is the opposite, where anyone can enter unless a specific block is used for a message. Pandora’s box has been opened, and not all the things which come out are bad.

Humans have a primitive need for social contact.  We even see this in higher species of the animal kingdom, grooming, verbalization, family groups, mourning, hunting and more.

In fact when denied this contact humans undergo mental and behavioral changes that become destructive. Studies have shown that restricted social contact and/or isolation at critical stages of development create the inability to relate to others.

There appears to be no danger of social isolation among twitter, FB and G+ fans. The phenomenon carries over to medical meetings and the use of smartphones for mHealth apps

It is just about time for the annual mHealth Summit near Washington, D.C. The event will feature keynote speakers, such as John Stratton COO of Verizon Wireless and Qualcomm CEO Paul Jacobs

The inclusion of these notable executives illuminates the importance of reliable mobile access and the improvement of smartphone speed such as LTE and 4G to facilitate the transmission of medical images. Because cellular phone technology is not secure this will require new encryption software, possibly similar to that used by the military to ensure compliance with HIPAA regulations.

del.icio.us Tags: twitter,facebook,google +,verizon,qualcomm,mhealth

Public Health and Nutritional Supplements

 

del.icio.us Tags: public health,apha11,nutritonal supplements,pom,weight loss,youth,celebrities

The American Public Health Association is meeting today in Washington, D.C. Public health has taken on a new meaning, with much more visibility and a proactive campaign which has captured the market place. Many entrepreneurs see the opportunity for profit in marketing healthy foods.

Nutritional supplements are one area of much controversy. For healthy people there are few dangers except for overdoses of Vitamin A and Vitamin D.Nutritional supplements are very loosely regulated and patients cannot be certain of what or how much “active ingredient” is present in a dose.

One spin off that is beneficial is the mindset of those using supplements and the associated discipline of a healthier life style, exercise and weight loss. One cannot rule out the psychological factors in operation by using a supplement.  Is this a form of hypnosis?

Some celebrities offer this as their recipe for youth, good looks, or weight loss, muscle building, and increased stamina. Their ‘celebrity’ often increases their reach and ‘credibility’ no matter if they are an actor, sports figure or successful entrepreneur.

You can follow the tweets from the meeting at #apha11.

Me, I am going to drink my carrot juice, and later have a POM wonderful !

 

 

Healthy People.go offers this list of Leading Health Indicators

Valley of The Dry Bones

 

The View From Here

Valley of the Dry Bones??

Today I am redirecting Health Train Express to “The View from Here”, another web site which I reserve for opinion on current events in medicine and in other socio-political controversy. Join me in a different kind of rant.

The fork in the road leads us the choice of which desert landscape we will proceed to from here.  In the far distance lies the mountain,

This photograph was taken in 2003 while residing near Palm Springs in Desert Hot Springs.  It was a unique time in my life while recovering from a heart surgery and a spine problem.

Disconnected from most concerns of modern times it brought me back to pioneer times. There were several old abandoned miner communities where we lived in a primitive cement block house on a sand dune.

Dry Gulch Road  Desert Hot Springs, CA 2003      Lower House

The View From Here

My spouse called this place “The Valley of The Dry Bones” (Ezekiel, 37:1-14)

Is America, like Israel in the Valley of the Dry Bones ? 

No one can quite explain why we are in this place of dysfunction and chaos despite what some of the supposedly brightest men who speak without wisdom tell us.

The problems are deeper than financial balance sheets, or political correctness. The Occupiers on Wall Street seem to know this to be true. So our educational system despite critics must be doing something right, or perhaps they are so ineffective in brainwashing our young people that their common sense can tell them right from wrong.

Health Train Express cannot exist in the present economic morass and social upheaval of “Occupy Wall Street” and the events of the past decade leading to our present stagnant economy and our morale, without rendering an opinion of an ‘old physician"’

The opportunity to introduce and give a head start to my other blog from Health Train Express is important because regardless of mandates by Obama care it is doubtful the mandates can or will be implemented in full.

Today I am redirecting Health Train Express to “The View from Here”, another web site which I reserve for opinion on current events in medicine and in other socio-political controversy.  Join me in a different kind of rant.

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