Going the Distance

It is more difficult to maintain your privacy if you use the internet, even for something seemingly as benign as email or Google.

Google is more ubiquitous than the  yellow pages and is far more accessible.There are many analytics engines sweeping Google, twitter, Facebook and other social media for statistics and trends in internet use ranging from your network size, who influences you,who you influence, your areas of expertise and other unmentionables.  Klout is one site that you can access to have some idea of what analytics is capable of assessing about your internet usage. Most of these programs are free with limited functionality but for a price a much more invasive biopsy of your presence is available.

Caseblogs, Medical and Dental Health Blog has a check list for you to accomplish at least three or four times a year.

Here is his recipe for minimizing damage to your online self

Connectivity

Real WIMAX, (not  4G that delivers speed but not distance) may deliver on broadband health IT in remote and rural areas of the United States.

The FCC (Federal Communications Commission) is in the process of releasing “white space”, the television analog frequencies abandoned by the fiat of the FCC several  years ago. The white space will be used for ‘Wi-Max”  a wide area VHF wireless technology that has the potential for a 60 mile radius with one or several broadcast points. While the power limitations are very low and the speeds are low, it will enable much better coverage in rural areas at much lower cost. The adapters are simple and quite inexpensive, the first rendition that has been approved is from Koo Technologies.(KTS)  I believe this will enable  rural providers and hospitals to tie into the NHIN easily. The first test markets are in Delaware and Washington, D.C., and rural Virginia. Spectrum Bridge is an early provider for the technology.The technology requires a database  search for unused spectrum so that it does not interfere with other users in that portion of the radio spectrum. More details here (download).

The innovation will have a great effect on healthcare, as much as scientific advances in medicine. Connectivity has been rated in the top 10 of the best advances in medicine by USA News.

Health Train Express Ends 2011

 

No, Health Train Express is not ending in 2011, rather is signals the time for the annual wrap up on 2011’s big news, small news, and no news.

All of this information need not be regurgitated here, but for those of you who automatically check here daily, I than you.

I have posted a number of links that will feed your never ending quest for information:

General News from the U.K.

Social Media in Medicine: The Answer to the Doctor’s Lounge

Best Hospitals 2011-2012 The Methodology

Best Hospitals 2011-2012

Top 10 Medical Breakthroughs: This one is a little more difficult to list. There are a number of determinants, such as basic science, specialization, public health and others which will effect efficiency and cost savings.

Listed in reverse order starting with:

10. Genetically Modified Mosquitoes to Reduce Disease Threat
9. Novel Diabetes Therapy: SGLT2 Inhibitors
8. Harnessing Big Data to Improve Heath Care
7. Active Bionic Prosthesis: Wearable Robotic Devices
6. Implantable Device to Treat Complex Brain Aneurysms
5. Increasing Discovery with Next-Generation Gene Sequencing
4. Medical Apps for Mobile Devices
3. Concussion Management System for Athletes
2. CT Scans for Early Detection of Lung Cancer
1. Catheter-Based Renal Denervation to Control Resistant Hypertension

You are free to chose a list from:

The Top List of Everything from Times Magazine

Social Media in the Health Train

 

It seems no matter where you look on the internet the buzz this year has been about social media. Health care is no exception and there are many beating the band how valuable and perhaps essential it will become in the future.

Much of it will be dependent upon users preferences for efficiently using limited resources, the most important of which is time.

For physicians personally time is the most critical limiting factor. The use of social media is financially negligible unless  one chooses a social media manager to direct it’s operations. The necessity for this is dependent upon how much resource your organization has to handle this task.

The capital investment is close to zero.

Physicians can easily acquire the knowledge on how to limit breaches in privacy and confidentiality, and that can be passed on to workers in training.

There is some reason to believe that social media adoption may be approaching it’s limits due to time constrictions for employed people. And  doctor you fit in to that equation.  Your best income producing time is in the clinic seeing patients, or in the surgery doing procedures.

Hands on marketing for professionals between professionals is best done hands on face-face, in meetings, making rounds, lecturing for CME, taking an ER patient that is difficult or challenging due to insurance issues. The referring physician will forever be grateful, you will help a patient (even if you have to later refer him to a public facility later) and you may get some patients from the source that is insured or will pay a reduced fee.

So in reality you are already in social media….the difference is social media is also on the internet..digital social media.

Most users already are aware of many forms of social media, the most common ones being twitter, and Facebook. These two are unique and function differently although the same information can be exchanged in different ways.

Twitter has become a means of announcing and reporting medical meetings broadcasting tweets using a hashtag assigned for that particular meeting, as I have previously reported in a previous blog. It may be advisable for those developing annual meetings to assign a # such as AMA11 to designate a 2011 American Medical Association meeting, then changing it to AMA12 for next years meeting. Different Academies may also use their abbreviations as such but should take care to be certain it has not already  been pre-empted or users will receive some unwanted tweets.

So who owns your twitter account? That depends, as revealed in recent case law that is pending

Case in  point. Your employee who has been handling your social media leaves and takes with her social media information which may be proprietary in nature or take with him (her) the following they have developed in your social media stream. Who owns the content? That may depend on the nature of the conversation? Was it friend to friend or was it medical, marketing or financial information belonging to the medical practice.

 

Legal counsel may be advisable and also a clear guideline in your employee manual in regard to content using  your identification on Twitter, Facebook, Google + or any of the social media platforms

Courts Says Employer's Lawsuit Against Ex-Employee Over Retention and Use of Twitter Account can Proceed--PhoneDog v. Kravitz

Jeremiah Owyang ( A Web Strategist) of The Altimeter Group states the golden age of tech blogging may be over.

New models to emerge, long form content not the only way

Bloggers themselves know that relying on a single tool isn’t effective, they need a series of tools to use; “blogging isn’t dead. it may have gotten a LOT more social, and it may be less frequent now for those of us who also use Twitter / Facebook / Tumbler / YouTube for other distribution efforts, but the overall impact from these platforms together is BIGGER than ever before (and i maintain, also EASIER than ever before if you build it right).”

del.icio.us Tags: social media,blogging,twitter,facebook,google plus,social media liability

Health Train Express Enters The Village with Sexuality Discussion and Google Plus Hangout

“It takes a ‘village” to raise a child” according to Hillary Clinton.

Amazing as it seems the latest survey reveals that up to 80% of physicians use one form or another of social media to interact with patients. This despite precautionary warnings about patient privacy and confidentiality.

The study did not reveal what form of social media they use; email, instant messaging, twitter, Skype or secured Google cloud documents. Google Cloud documents can be locked except for the intended readers.

   

 

Business uses the cloud for secure transactions and sensitive data, and there will be no shortage of offerings for medical applications. In fact, the cloud may offer a more cost effective and usable platform for a national health information exchange rather than re-inventing the wheel.

Now there is a new fast growing platform, Google + and even more revolutionary is Google + Hangouts.

Google plus Hangout and Sexual Ambiguity

The following topic was discussed on a public hangout broadcast by a public television station, KOMU TV in Colombia, Mo. Anchorwoman Sarah Hill is a pioneer in the convergent media space. She discusses a personal sensitive issue with Maya Posch born as a hermaphrodite. You will notice the film strip below the large screen of the Hangout participants. The ability to express herself with support from a public audience obviously gives this person hope.

Part I Interview with Maya Posch

Part II Interview with Maya Posch

The scope and power of social media cannot be underestimated among patients who share serious medical issues with like individuals. Caution, the content may be offensive to non-medical viewers. As mentioned in a portion of the video civil rights are part of the challenge in sexual ambiguity.

Please pardon the commercial message at the start of the video.

KOMU Live Stream Hangout Video

The New Google Health Village

Health care is now much like a village, or perhaps a group of villages which need to communicate. The convergence of the internet and  television, have created a new milieu. Internet or streaming video may replace classical Television much like over the air TV was replaced by satellite or cable.80% of cable television  users also hold a hand held device in their hands while viewing news or entertainment programs. They are frequently polled while watching, straw votes are taken during election campaigns.

The potential is great for social media for two way interaction with doctor and patient  using interactive teaching sessions for patients from your office, or clinic regarding diagnoses, treatment course and for  monitoring patient compliance.

With the support of Health Train Express Google product developers will develop a new platform, an API dedicated to a Google Medical Application, yet to be named.

Google, in it’s infinite wisdom designed the Google+ platform to be secure on a one to one circle share. It is possible to telehealth one to one. Images are of high quality. The medium is extremely cost effective, free for the moment.

The project will take several months to complete, and you may read about  it here when it is ready for a beta release.  Please subscribe to Health Train Express or use an RSS feed to see the announcement.

We are looking for suggestions and contributions about what functionality you would like to see in the new Google Medical API. Please tweet me @glevin1 or email me at riversideeyemd@gmail.com

del.icio.us Tags: social media,#hcsm,#healthit,#healthreform,hangouts,sexuality

Window’s Notification Alert !! bong!

 

Today’s wake-up alert from The Washington Post

“The Obama administration Monday named 32 health care systems across the country as “Pioneer” ACOs. These will be the first places to test out the new payment model; they’ll provide a bit of a sneak peak at what it could mean for the rest of the country. In other words, we may soon see our first unicorns.

Unicorn, or not it is interesting that they chose 30 health systems which are already business entities and well integrated health systems. They are also located in unique health care markets.

Jim Hinton, President and CEO of Presbyterian Health System (one of the lucky 30 chosen makes these remarks in the Washington Post article authored by Sarah Klif.

“Jim Hinton: Health care has grown up in a fee-for-service system, and it’s also grown up with a system where the primary unit is an individual doctor taking care of an individual patient. At Presbyterian, we’ve been working on making care more integrated for 20 or so years now and have been able to do a lot by operating our own health plan..

A lot of what [the Accountable Care Organization model] does is build a system of care where there’s a safety net and we can help advocate for the patient. We’re looking at how can we do more with nurses and other advance practice professionals. How can we use technology? How can we change the visit model so its not one patient with one doctor every 15 minutes?

He offers some creative solutions for extending benefits such as home health care by up regulating it to a ‘home hospital’, reducing the cost of in patient hospitalization, but increasing the amount of home health care. To me this just seems to be cost shifting and would require major re-designs of accounting for the ACO.

All of these proposals are well hidden in the PPACA and the net effect is going to take a decade or more to be studied.

We’re experimenting with some group visits with doctors, and also another program where we hospitalize people in their homes. One good metaphor is thinking about it as if you were going to remodel your house. If you had a plumber, carpet-layer and someone putting down tiles not talking to each other, the house might not turn out very well. The idea is to anchor all the care in one place, where there’s a lot of coordination.

Mr Hinton summarizes it well for the rest of medicine.

““SK: As you mentioned earlier, your health system has been working on moving toward more integrated care for over 25 years now. What about the health care providers that haven’t been working on this stuff? How well do you think they’ll be able to use these new incentives?

JH: My colleagues who come from systems that have not owned managed care organizations are trying to assess how they can accelerate into this mindset. Most hospital systems today have some experience employing physicians but I think there are still two big barriers in going towards more integrated care. One is bringing an insurance perspective to populations, where you’re managing care and managing risk. The second is a cultural one. Many health care providers have fee-for-service as one of their core business models. It’s hard to get away from this notion that doing more health care means earning more money”

I do not see ACOs catching fire in much of medicine. In fact I predict that smaller towns will continue on their current merry way. Some ACOs may very well have to contract out some professional services depending on the willingness of the physician community to forfeit freedom and independence. This will invoked the laws of secondary consequences with it’s attendant unforeseen challenges.

Physicians resistant to ACOs may very well  boycott a local ACO if given that alternative.

Nothing for sure is certain.

del.icio.us Tags: aco,accountable care organization,incentives,outcomes,hhs,medicare reform,ppaca,integrated health systems

The Issue in Health Care is NOT Money

 

Contrary to what poor or affluent people think, money does not solve all problems of health care,  and it will never stop the issues of caring for one another in a health system.

I believe the entire national budget could be thrown at health care and there would still be a problem of ‘not enough money’.  There is more than enough funding to maintain good health, wellness and treat those who are no longer healthy and/or well.

Precious resources are expended on studies, fighting fraud and abuse, having analysts draw graphs that either intersect dangerously at some time in the future, or have in the past. My favorite one is the exponential graph rising vertically into infinity.

The issues are much like the impasse about the debt ceiling. Political expediency and prostituting opinions for votes.  We ask politicians to make decisions from false economics, and figures that may be highly inaccurate, against a setting of voting on issues they know nothing about except how it affects a state or federal government.

Case in point is the current conflict about mandated insurance coverage.

Much has been said about using the current medi-caid system to fill in the blanks.  This is a more than stupid idea for many reasons.

1 The current system is not designed nor can it accommodate  more patients. 

2. The current system in many states do not have enough providers to service the huge increase in patients.

3.. The current system is not designed to care for patients. It is cumbersome and designed to deny care for any possible reason, financial, missing paperwork, or a vacant modifier in the billing codes.

4. The current system does not respond to market indicators, and reimbursement methodology is byzantine.

5. The current system needs to be “occupied”

del.icio.us Tags: reimbursement,money,occupy

Ticket Price Increases on the Health Train Express in a Time Calling for Austerity

 

Like the airlines, who are not too big to fail, medical practices will need to find ways to increase revenues. It’s too bad our patients don’t carry  baggage  into our offices so that we could have a surcharge modifier such as –0000 for each item.

However physicians can emit a sigh of relief with the announcement from on high at HHS, as brought to us by the American Medical Association, in AMED News.  Included in that news are:

Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses. The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. ( Who cares what Obama thinks about goodwill? The AMA ?)

True to form modifications are being made to the calendar for implementation-incentive reward-penalty dates because the initial proclamations and mandates were poorly planned. What we have in  the federal government is a group of “cheerleaders’ encouraging the workers how much health IT will improve patient care. Even the AMA buys into that.

No Doctor Left Behind ?  This sounds much like the Bush Plan of No child left behind.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

It takes a lawyer to make the following statement,

“

“There are several takeaways for physicians from Sibelius' announcement,” said Stephen Bernstein, an attorney who is the international head of the health industry practice group at McDermott Will & Emery in Boston. In general, more physicians are adopting EMRs and using the technology to improve their practices.

“HHS also is sending a message to physicians who are undecided about whether they should make a significant investment in electronic recordkeeping”, Bernstein said. “The agency will work with physicians to help them adopt EMRs”. He suggested that doctors get in touch with one of 62 federal regional extension centers that have been established to help physicians, in particular small primary care practices, adopt EMRs.

"The main message is that there are federal government programs out there to help physicians, and the federal government isn't going to stop offering help," he said.

“It’s okay, we are here from the government to help you.” (author)

Bernstein added that a robust EMR system is needed to participate in new Medicare payment models, such as accountable care organizations. If CMS wants physicians to participate in these initiatives as well, it must do everything it can to encourage doctors to use EMRs, he said.

It’s a bundled plan, just like reimbursements. Step C is dependent on steps A and B. (If they work in the first place)

Clearly it is disruption disrupting disruption. Even chaos theory fails to keep up with these advances in advanced health care physics.

The incentive program is clearly aimed at primary care MDs, and the recent statistics reveal it.

Specialty               # Participating in   Bonus

Family practice     1,216

Internal medicine  1,198

Cardiology               517

Podiatry                   378

Gastroenterology    232

Orthopedic surgery 201

General surgery      197

Urology                    197

Nephrology              174

Neurology                148

Other                    1,347

What Medicaid Paid for EMR Bonuses

Physician               6,609             $138.5 million

Nurse practitioner  1,463               $31.1 million

Acute care hospital   607             $483.9 million

Dentist                      333                 $7.1 million

Certified nurse midwife  172             $3.7 million

Physician assistant        107             $2.3 million

Children's hospital           15           $45.1 million

What is even more worrisome is the profound recession we are experiencing, the HHS emphasizes the ARRA and Hitech have produced 50,000 job…a mere drop in the bucket. Our budget deficit is crippling planning at the federal and state level….

More than incentives we need austerity.

Stay tuned for more modifications

del.icio.us Tags: medicare reform,incentives,primary care,hitech,arra,papca,sibelius,hhs,obamacare,ama,amednews

Touchfire with Health Train Express

 

Another bold innovation (and why didn’t I think of this before?) The beauty of this is that it offers another functionality to the iPad form factor. without the burden of extra parts.  Although the iPad offers a keypad feature, users complain there is no tactile feedback which touch typists use unconsciously to type. And the addition of an external keyboard adds to more clutter.

This flexible plastiform rubberized overlay is held in place by magnets which attack to the border of the iPad’s frontface. It gives the user tactile feedback much like a normal keyboard. It also has other features attaching it to iPads official cover.

All in all a dandy device for the  clinic, by the bedside or in the hospital.

Health 2.0 in Social Media

 

Monitoring the social media stream today in #hcsm #medicine #healthreform and find that Facebook will offer a page and/or referral to FBers who are depressed and suicidal. Is this the first step into Health 2.0 and is social media going to bypass formal developments in the Health 2.0 Challenge?

Mobile apps already support API for all the social media platforms, twitter, facebook, and Google +. Twitter is very restrictive as to which APIs can use twitter’s API however health 2.0 would gain them many more users that do not compete with Twitter’s plans.

I predict that Social media will bypass the present vision for formal  health 2.0 apps, and developers should re-think their game plans or be left behind even before it happens.

G+ offers the potential for telehealth with video and it should not be hard for programmers to build a secure encrypted API to comply with HIPAA. It is accessible on smartphones, iPads and many tablet PCs.

I held a G+ hangout on Tuesday night at 6PM. The attendance was zero. A big disappointment but not a surprise at all. Not many MDs and few #hcsm users are on Google + Experience reveals it takes about one month for the stream to capture interested social media participants.

Google + has a predominance of artists, performers, and photographers. Even if you don’t want to hangout in health care…it is a broadening experience and revealing as to how much talent there is besides American Idol and the network cable offerings.

Health Train is the most prominent MD and health related +er on Google.

You can find Health Train’s profile on Google + at the Google ID.  Join and put me in one of your circles.   Hope to see you all there.

del.icio.us Tags: social media,#hcsm,#medicine 2.0 conference,Google +,twitter +,Facebook,Google+hangouts,telehealth,health 2.0

And The Webcina Winners are:

 

Webcina announced it’s winners for their contest for social media participants. Although Healthtrain Express failed to make it to the podium I enjoyed participating and ‘spilling my beans”. My reward was to be able to read these fine stories..Stories that should excite all of us in social media.

I read the winning blog posts, and found them all to be far better in appeal and content than my illiterate meanderings.

Here they are:

The Tap Code by Katherine Leon

Transient Global Amnesia and Social Media by Susan McKinnon

Suzanne Ezekiel’s Journey  Her contribution includes her vivid youtube video portraying the effects of her disease. It is one of the most telling and vivid descriptions that leaves the observer breathless and battered.  It probably should receive some type of award in videography and story content.

Take My Body Away

Thank you Webcina !!

del.icio.us Tags: webcina,motor neuron disease

G+ Hangout with Health Train Express

 

At 6 PM PST/ 9PM EST on Google + Hangout please join us tonight December 12, 2011 for a discussion on health care and reform.

Proposed agenda:

1. Effect of social media on medical  practice and business. Do you use it for;  marketing, communication, patient care.

2. Will Obama care be repealed? totally or partially

3. Will SGR formula be enacted or put on hold again this year?

4. Will you become part of an accountable care organization

5. Bring your own topics.

6. Discuss selection of special invited guest as ‘keynote speaker”  for next week’s hangout to be held on Tuesday December 20 2011 at 6PM PST.

BruceGarber.tv

On next Tuesday we will host a special invited guest, +Bruce Garber, whose interests are in video production and the use of Google hangout for medical conferencing and telemedicine.

Link to my stream to join hangout:

Join HealthTrain Express Google+ Hangout December 12, 2011 6 PM Pacific time  9 PM Eastern time.

Accessible with iPhone  iPad  as well as desktop or laptop.

See you then:

No Ticket Required on Health Train Express

Just like my office walk ins are always accepted. The same here on the Health Train Express….my plan for a subject often changes drastically when I surf the web, check my tweet box, Facebook, and Google +.

Healthcare is not all that unique. I find similar challenges in business  on Google +, Facebook, LinkedIn and Twitter. Business is also perplexed just what to do with social media. In healthcare there remains a large part of the workforce that are neophytes with health information technology and  how to use it. Questions arise about return on investment with EMRs, Health Information Exchanges, Outcome studies, and Analytics. The jury will be out for several or more years for many reasons. Statistics have a way of flowing in slowly however with the modernization of systems and new software that will take a set of tables, and charts and transform them into an easily understood graphic understanding sheer numbers may turn into a video-game like presentation.

As in healthcare business is challenged as to what portion of social media to exploit, where, and how much. Like electronic medical records the work force must be trained in social media.

del.icio.us Tags: hcsm,social media,google+,twitter,facebook,linkedin,urgent care

Health Train Conductor

Do you remember in days of old the train conductor would come by and punch your ticket. The shape of the punch hole looked quite a bit like # .

# now represents the hashtag on twitter as well as other social media platforms.. Speaking from my anecdotal story of one in the cohort, I found them to be confusing at first, especially if there was a hashtag salad of multiple #s.

The  Hashtag Project. Hashtag Project is organized and administered by the Foxepractice.com Consulting Firm.  In addition to their epractice modules and advice on Web 2.0 they provide a full menu of services. If you don’t have time yourself to dive into social media (and few doctors do) they can set you up and your staff can do the daily operations. Put your efforts into your own area of expertise.

The proper use of a hashtag allows others to search the twitter stream for your subject, #hcsm is the most often used tag for medical issues, and there are also specific hashtags for medical meetings. ( a topic I covered in one of my recent blog posts).

Recent analysis of social media in medicine reveals some positive dividends and a return on investment, according to FiercePractice Management. One primary care physician attributes 30 new patients/month from social media engagement prior to an office visit, conservatively estimating a $125,000 annual return on his $60 investment.

According to the update from online physician learning collaborative QuantiaMD, 87 percent of physicians make personal use of social media, while 67 percent use it professionally.

The QuantiaMD report also indicates that most physicians using social media are heeding to best practices, with 75 percent of those who've received friend requests from patients saying they declined. While challenges persist in navigating the best ways for physicians to use sites such as Facebook, Twitter, Google+ and the like, some doctors who've dipped a toe in the water report unexpected advantages.

Natasha Burgert MD, a pediatrician committed to one year of social media with surprising results as published at Pediatric Inc

On Monday evening, 6PM PST December 12, 2011 there will be a Google + Medical  Hangout. If you would like to attend send me an email gmlevinmd@gmail.com or tweet @glevin1 

 

del.icio.us Tags: social media #hcsm,quantiaMD,hashtag