Don Berwick Controversy

Dr Don Berwick resigned from his position at CMS this past Thursday.He resigned with little chance of being approved by congress in a long delayed hearing process. President Obama doomed him to failure with the ‘rush’ to appoint him to the position as head of CMS while Congress was not in session. Dr. Berwick is an outstanding physician and analytical expert, His experience and record as President of the Institute of Medicine (I.O.M.) portended significant accomplishments at Medicare and HHS. He is such an individual with strong convictions and integrity. He is now the first to admit the difficulty and challenge of framing and implementing changes in not only HHS,CMS but our entire Federal and State systems of government.

In a world of politics where there are no shades of gray, but only the rigidity of black and white differences of political opinion he was faced with his own unintended skeletons.  In addition to his own opinions he was sabotaged by President Obama,, himself in the manner of his appointment, perceived by congress as a detour around the process. Congress had some serious questions to ask Dr Berwick, and had he the chance to answer critics, Obama may not have faced the intense resistance to implementing Obama care. In return Congress made it clear he would not be permanently appointed.

Deep partisan divides have stopped Congress from confirming Berwick since mid-October 2006, creating instability in the agency that oversees the Medicare and Medicaid programs. Obama installed Berwick in July 2010 as a recess appointment, which was heavily criticized by Republicans who accused the pediatrician of favoring health care rationing -- a charge Democrats dismissed as nonsense. (Senior Journal.com).

 

Those of you who read my opinions know that I was not a Berwick fans. However in his departing commentary he pointed out,

“The extremely high level of waste,” as exemplified by overtreatment of patients, failure to coordinate care, administrative complexity, burdensome rules, and fraud.

• “Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”

• “I came with an agenda, I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

• It’s a complex, complicated law. To explain it takes a while. To understand it takes an investment that I’m not sure the man or woman in the street wants to make or ought to make.”

• “We are a nation headed for justice, for fairness and justice in access to care,”

• “We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that’s compelling.”

• “Government is more complex than I had realized. Government decisions result from the interactions of many internal stakeholders — different agencies and parts of government that, in many cases, have their own world views.”

• “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

• Berwick added, “Republicans have completed distorted my meaning. My point is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

In another ‘interim appointment’ President Barack Obama is nominating Marilyn Tavenner (Washington Post Wonkblog) to succeed Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services.The current political climate on Capitol Hill may mean that Tavenner is just as likely to see her nomination stall.

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My Webcina Story

 

Things my father never taught me about social media…thus HealthTrain Express was born.

I still feel privileged to know I was there at the birth of medical social media. I remember the strange looks I was given when I talked about it at meetings and used it to develop my blog as a form of newsletter (for free) when I was investing time into developing health information technology.

My entrance into social media in 2004 was at a time when only some heard of  social media. At the time there were far fewer bloggers and most had to have some level of nerdiness and geek quality to even know how to blog. The popular platforms such as blogger, wordpress, Drupal, and offline clients like Windows Live Journal were not much in use.  To be a blogger took gumption and significant time. It was more difficult since the smartphone revolution and the iPhone in particular was not available.

Social media allowed my expansion into health organizations from Harvard, where I mixed with the Chief Information Officer of the University, and Patient advocacy groups. It empowered me to be on the patient side of the health care equation. I met artists who used their talent to create artwork at meetings based upon the topic of the meeting. One of my favorites is Regina Holladay, who was unknown at the time. I can see how SM has made her well known.

I have always been one of the USB people…I like to ‘plug and play’ and fortunately I found blogger very early on. It was not sophisticated, and I learned as time went along how to modify templates, themes, insert HTML, videos, images, and how to insert hyperlinks into my text.

My first platform, “ Inland Empire Regional Health Information Organization” blog was a newsletter for a newly forming Health Information Exchange.  The readership was limited to less than 100. It was focused on our fledgling health information exchange as a source of knowledge regarding medicine and electronic medical records, and government grants to fund their implementation. It also served to connect with other HIEs and the California State-wide HIE.  It was read by the Department of HHS and the newly appointed head of the Office of The National Coordinator for Health Information Technology (ONCHIT).  We stimulated vision, education and eventually dug the foundation for the stimulus packages in HITECH and ARRA.

My social media experience with twitter and Facebook were non-existent. About one year ago I began tweeting and learning about hash tags. I began posting on Facebook as well to drive traffic to my blog and other publications.

Somewhere in the middle of all of this I began to freelance write, it evolved from the fact that I did not think I was a very good writer. My ideas were good, but putting it down on paper lacked the polish I saw in other spaces. I had been spending a great deal of time blogging without compensation. I  decided to discover free lance writing to learn and earn online. I was compensated for researching financial news about mergers and acquisitions in the social media space  publishing on Next.Inc.in . I learned to feed my blog(s)  with twitter, Facebook links and now Google + links. The advent of the Google + Hangout looms large for me. 

My network has  expanded to artists, musicians, videographers, poets, and more, all of which I will integrate into scientific presentations for a change of pace, entertainment and to maintain interest in my audience.  I see social media as a picture book of conversation and social intercourse.

I spent much time surfing blogs, and websites in addition to writing my own blog.

My life as a physician was very interesting although a bit cloistered revolving around patient care, medical technology and research via the internet. Academic search engines such as PubMed, and Web-based data repositories along with specialized references played a large role in the latter years of my surgical practice. I was an early adopter of electronic prescription writing and was a beta tester for a well known eRx program that exists today. It was featured on a now dead platform, the Palm Pilot, the ancestor of the current smartphone (without the phone).

Like social media, the hardware platform evolves with the software platforms. Which comes first? The chicken or the egg? Without a suitable platform software dies unused, and without suitable software hardware quickly becomes a useless 'brick”.

Form and function go hand in hand and in today's world PC ethnology has developed into tablet PCs and smartphones for convenience and mobility. As I predicted in my early blogs the development of EMR and HIT in medicine would lag until the mix of hardware and software allowed for a physician patient encounter face- to- face and not face- to -keyboard/monitor.

The social media millieu has followed this path to it's current position with multiple platforms accessible from a single client API.

My progress in social media has followed this same pathway. My blog at Health Train Express travels my route since 2004. It's been a self taught journey. Writing and producing content is only a small part of the journey.

Social media participants are not static...we evolve. The power of innovation and entrepreneurship has driven many bloggers, Facebook users and twitters' to monetize their publications.

Although I have been tempted to veer off in that direction my main source of income has always been medicine. I never felt the necessity to derive income from social media and enjoyed it for the chance to develop writing skills, learn more about communication and media and the use of internet technology to make my voice and opinions heard. I developed new friends in areas where I had no previous experience. The curiosity was latent, only waiting for social media to shake it into the open.

As time went on I became immersed gradually in social media, first in Facebook, twitter, and by perm linking to other blogger's spaces. Early on the comment box of a blog was a form of chat room for bloggers like me. IM chatting never caught on with me, however Skype video intrigued me early on. We reciprocated our blog popularity with a blog roll banner on our blogs.

 

Medical bloggers developed the “Health Care Code of Ethics for Bloggers”. The code was revised in May 2007 when HIPAA regulations became effective regarding patient privacy and confidentiality matters. The new law also encompassed health information technology electronic medical records, Health Information Exchanges

Awards and Recognition were given  for the best health blog. Some bloggers aggregated other blogs into theirs and offered guest blogger positions. There was pride and esteem in the ranks. The social health blog was a very personal environment with writers respecting one another and their opinions.

Social media websites began to emerge that were limited for physicians only, SERMO, iMedExchange, and Ozmosis exist today. These sites require authentication with a state medical license which must be verified. SERMO boasts of itself as the leading Social Media Platform for doctors. It is even divided into specialty niches.

Social media sites are invaluable to large organizations in healthcare such as the Mayo Clinic and small entities such as small group practices and even solo practitioners.   It is limited only by imagination, and a willingness to step off and possibly receive some criticism. It is buoyed by freedom of speech and a huge collective of supporters who headed in the same direction. It is a place where diversity is magnified and exploited for the best outcomes.

Social media lays bare the ugly side of some issues and the results produce a real electronic freedom of expression and a hope for betterment of our species. Would the Arab Spring  have evolved differently  without social media? 

My blogging and social media content and direction not only served to satisfy me, it also provided a catalytic platform for disruptive technology in a previously “cottage industry’ of healthcare. 

Social media, Health Information Technology, and mobile applications are the “perfect storm”in health related business and medical practice.

Medical bloggers developed the “Health Care Code of Ethics for Bloggers”. The code was revised in May 2007 when HIPAA regulations became effective regarding patient privacy and confidentiality matters. The new law also encompassed health information technology electronic medical records, Health Information Exchanges

Prizes are awarded each year for the best health blog. Some bloggers aggregated other blogs into theirs and offered guest blogger positions. There was pride and esteem in the ranks. The social health blog was a very personal environment with writers respecting one another and their opinions.

Social media websites also emerged that were limited to physicians only, SERMO, iMedExchange, and Ozmosis exist today. These sites are password controlled require authentication with a state medical license which must be verified. SERMO boasts of itself as the leading Social Media Platform for doctors. It is even divided into specialty niches.

My discussions developed ”out of the box” ideas and found many shared these ideas and empowered me to share them with anyone who would listen.

My own point of view is not to blog or comment anonymously. My attitude is that anonymity dilutes the writers 'integrity' and the power of the message. Then again I don't have an employer who might look aghast at some negative commentary about the business or attitudes that run contrary to the employer or corporation's interest. Thus far I have not been stalked. However in social media that is a risk.

Google + and Google Hangouts have afforded me the ability to be broadcast on live Television News programs where the anchor person interfaced with other + Hangout-ers, and to watch artists develop paintings, share portfolio, watch and hear new budding musicians form their craft, meet with fellow hobbyists from far and near. I have even  had my caricature drawn live.

Gary M. Levin M.D.

by Cliff Roth

Earlier this month I saw the Webcina offering for a contest about stories in social media. I was not sure I had much to offer, until only tonite less than 24 hours before the deadline on November 30th.

By late afternoon my daily events convinced me that I must share my story.

In my early morning hours I check my gmail accounts. They are linked to comments and posts on Google +. I receive emails from Summify which aggregates many of my networked blog feeds. I use Feedjit which details all those who come to my blog and from which countries. Social Media today sends me a report of aggregated blogs,  and a summary of blogs that I have written and have been networked by Health Works Collective.  I spend about fifteen minutes on tweet deck and search for #hcsm, #meded I look for medical meetings and attempt to find the suitable #tag. I use Tweetdeck and Hootsuite for posting on multiple platforms simultaneously. I find this advanageous rather than repetitive because my audience uses different platforms, few have time to read or post to all. My object is to reach the largest audience. I look at my Klout Score once a month. My progress seems to be measured as improving from a 18 one year ago to a 48, not a world record but reasonable for a single person not into marketing.  (Watch out Britanny Spears and Jolina I am on your heels.

Social media is the electronic version of ‘word of mouth’, powerful and very underestimated in all fields, yet intensely personal and usually credible amongst close friends. It functions as the ‘whisper’ form of the ‘banner ad’.

Currently I am publishing a  directory of #tags for medical meetings and encouraging attendees to tweet, or post on facebook and/or open Google + Hangouts for those who cannot attend important meetings.

Twitter enters Health Care Conferences: For me this is one of the most useful ideas in SM for medicine. You’re attending a healthcare conference and have one of those moments where something of real value to you was said. Or perhaps you’re attending one of these special unconferences that spur incredible creativity and innovating thought. In both cases, two issues often pop up.

“I need to make some good notes of this”, and “more people should have been here right now to hear this stuff”. The conference participants have, perhaps somewhat unconsciously, been functioning as Trojan horses. In their pockets are hidden iPhones and Androids, loaded with Twitter clients, instantly both recording what they perceive are the greatest thoughts from the conference and sharing it to the public. Information wants to be free.

Social media, like the internet in general has become a  relatively free open source of information changing journal publications, and accessibility to expensive closed conferences.” (Foxepractice.com )

Eventually meeting attendees will habitually utilize social media streaming during a meeting for each speaker regarding the high points of their topic.. It will require some pre-meeting organization and direction to assign appropriate hashtags for specific meetings. Some used thus far in 2011 have been #mayoragan  #aao11, #ismppem11. Tweeting and/or Myspace can be used for more than meeting at Starbucks, and/or travel advisories.

I could not have predicted in 1984, 1994 what would happen. What will it be like in 2024?  I hope I am still here. I will only be 87.

I picture me sitting there with several of my great grandchildren, asking me what it was like in 2012…my answer will be “you kids are spoiled, the only things we had were the internet, smartphones, twiitter, facebook, Google + and Mark Zuckerberg. Why I can remember when Steve Jobs started Apple.

Their response: Steve Jobs? Who was that?

Its’ all relative…my parting words.

The uses of social media are only limited by your imagination.

del.icio.us Tags: #webcina,social media,twitter,hashtags,facebook,google plus,google hangouts

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The Rise of Google + and Hangout in Healthcare.

Imagine this if you will (and this is not imaginary).  I am sitting at home quite comfortably on a Google + hangout and suddenly a window appears from a Live newscast in Colombia Mo. 

Suddenly I am in the midst of a live news program where I am asked a number of questions about medicine, health and reform.. Sarah Hill (an Emmy Award Winning News Person is one of a few broadcasters who use Google + Hangouts regularly during their broadcast day to obtain opinion and comments from viewers like you and me. My sense this is just the beginning of a new iteration of social media.

Social media in general and healthcare in particular has reached a significant audience, and even more important, active participants. The rise of the hash tag and understanding of how it works and is used makes the millions of seemingly endless tweets somewhat more organized according to readers’ interests.

Hash tags are really quite simple and they allow a selective view of recent tweets according to your interest. The challenge is identifying the best one(s)  for your search. There are some directories available. In healthcare the Foxegroup has a good resource for #hcsm (healthcare in social media). A Google search for hash tag ((N) where N is the area you are interested in will bring up some other resources. That is for the incoming stream you read.

When posting you can also identify the general group you target in addition to using the @ sign. You can use multiple hash tags. It is also possible to search for an individual twitter stream such as #glevin1.  Try that to follow my stream of unconsciousness on twitter.

I have been accused of being a hash tag scrambler using multiple tags. One must be cautious to leave a space between the tags otherwise the software will  concatenate your hash tags into a meaningless string of words.

Hash tags can also be added to Facebook entries, Google+ entries as well as tweets.

Each week I read more and more about the growth of social media in healthcare and medicine.

The addition of Google + and the Google + Hangout adds a new dimension to social media in terms of intimacy and face-to-face-time in a way that Facebook failed to capitalize upon.

My Google + Stream will soon offer the “Medical Hangout” on Thursday evenings, 6PM PST. I am looking for outgoing visionaries in the Health 2.0 space from an international audience. I am certain you have something to offer, even if it is a negative opinion.

If you are reading this, place me in your Google + circles to receive an invite to my hangouts.

Meanwhile I have just realized it’s time for me to submit my social media story to Webinar. I might win a prize if I win the contest.

LiveJournal Tags: blogs,twitter,facebook,webcina,G+ #hcsm

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Social Media Update for HTE

 

Update on the Blog Format and Widget Add-ons:

Readers may notice I have re-instituted the “Feedjit” feed. I did not realize how useful it was in tracking who tracks me. I have missed it. It opens a new social media tool for true personal communications with those with similar interests.  I do attempt to reply to all who email, tweet, friend, circle me on G+. During December I will be filtering my responses to those who have not responded to  me in the past year. I know how busy you all are, and I am sure those readers will not miss me. If  you have followed me in the past six months and want to be retained contact me. 

2011 has been an eventful year, like 2010,2009, and beyond. For those of you who blog and/or do SM it is never a dull moment. For me it is a breath of fresh air to belong to the SM stream. (it saves a lot on gas). Look for me on my favorite venue, Google Hangouts.  I can be found almost at any time between patients, surgeries, and my regular time is at 6PM PDT Thursdays.

Googlel + Hangout Example: Live Stream from KOMU Lecture at University Journalism Class

 

I can also be found frequently on KOMU’s NBCs news casts with Sarah Hill each morning. Circle Sarah Hill or Me on Google + and receive an invite to attend and/or participate. (only 9 get in so join early as soon as you see the invite.  I try to post the hangout a few minutes early on  twitter. Search for my tweet at #glevin1 If you cannot join the hangout there is often a live stream on #glevin1 

This year I will continue my ‘rants” on healthcare reform, and introduce new media for bloggers, a series of Google + hangouts which will include several prominent health bloggers. I also invite you to apply to participate in this ground breaking  health cares social media #chasm on twitter.

Topics may range from health reform to expert opinions on patient advocacy, participatory medicine,  and we also may introduce a ‘TED SM

In all it will be another exciting year in #chasm. I am looking for a global presence in participation.

del.icio.us Tags: social media,google hangout,G+,#hcsm

LiveJournal Tags: social media,google hangout,G+ #hcsm

Happy Thanksgiving Health Train Express

 

       

It is a Happy Afternoon here after Tom Turkey has donated a mega-dose of tryptophan to me and I descend into an endorphin sea of pre-somnolent horizontal meditation. As I pass from consciousness a stream of thought occurs about the past years blogs, social media and how to wrap up 2011, and worse what planned and unplanned revolts, reforms, recalls, and revolting decisions will affect medicine and health care.zzzzzz in 2012.

Wake me up when the pie is ready.

Tomorrow the “Elephants” and “Asses” can resume hostilities while the country burns.

LiveJournal Tags: gop,democrats,congress,thanksgiving,deserts,elephant in the room,turkey

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