HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Governor Brown surprise budget announcements.
Major revisions will be made to California’s health safety net, with reorganization and downsizing big government. No doubt this will be unpopular in some circles. This is further complicated by federal mandates for health insurance exchange formation and proposals to use Medi-Cal as a vehicle for uninsured, uninsurable, and poor.
Expect Chaos
Warning: This post may not be appropriate for readers under the age of six.
The article is not intended to be discriminatory in terms of sexual preferences, race, creed, color or political preferences.
I am expanding upon an article read in the WSJ Health Blog today.
A recent study reported in the WSJ Health blog discusses the overall slight decline in rates of cancer with an uptick in certain types of cancer.
Among the small increases are the incidence of oral cancers (HPV papilloma of the posterior pharynx, malignant melanoma, thyroid cancer, Although the decline in smoking should decrease this incidence it appears that ‘oral sex’ increases the rate for practitioners of this art of karma sutra.
I have given up cigarettes, alcohol, marijuana, meth,cocaine but I will not have oral sex withdrawn (pun intended) from my repertoire of pleasurable activity.
Several important features of the study were missing, male vs. female rates, unprotected vs. protected sex and whether the study was separated into homosexual encounters or heterosexual encounters.
The CDC and Public Health Service have been allotted ten million dollars for this anti-motivational poster, seen on the left below which is somewhat akin to the anti-smoking images seen below as well
P.S Smoking is banned on the Health Train Express, Oral fellatio? That depends….
The entire post is offered (tongue in cheek). Oh there I go again with my oral fixations this morning I am having oatmeal with bananas (cut up for those of you with dirty minds…). Hope you enjoy your coffee !
I have been a proponent of social media and it’s use to improve healthcare and improving accessibility for patients to clinicians and hospital resources, there are certain caveats and precaution are advised when attempting ‘self diagnosis’
In the past ten years innumerable web sites have become available for patients.. Remembered that these sites were never meant to be used in an isolated fashion for self diagnosis. They are meant to be educational and as a supplement to professional office or clinic visits.
Entering or searching for symptoms both physical or emotional into a web site will list many answers, some irrelevant. These sites can be accessed either before a visit or after a visit to assist you in discussing your condition with your health provider.
Today’s both physicians and patients are faced with decreased face-time during the visit. Web sites are a positive influence for both physician and patient when used properly.
They provide the patient an opportunity to ask appropriate questions for the health provider on initial visits, and for follow up education especially if the provider educates his patient as to what sites are credible sources as a supplement to the office visit. Patients should discuss their sources with their doctor.
Social media also provides relevant and usually accurate information about health information technology advances, not only in EMRs, HIEs but the explosion of mobile apps for their use in non clinical settings, home monitoring and accessing insurance information, geolocation services for emergencies, hospital and offiice wait times, and drug information.
2012 promises to be another innovative year of HIT and Health Reform.
Take a look at the Info graphic below…. This is taking place in a single minute — every minute — of most everyday within the digital world….
Still think it’s a passing fad?
Still think you do not need to establish some form of digital presence on the healthcare social media stage?
—Think again —
http://goo.gl/Bwz1d By: Shanghai Web Designers
Howard J Luks M.D. points out the reasons why physicians should participate in the landscape of social media in his recent post via Summify.
Dr Luks message and articulation of the message is so well put that I repeat it here, and give him full credit for this information. It bears repeating in my blog(s).
I happen to agree with him. Issues surrounding health care and health reform have become much more public, open and transparent. Physicians must use the medium which is presently gaining momentum to replace printed and rapidly becoming obsolete magazines, newspapers and other forms of advertisement.
Let’s face it most studies and experience show the decline of ‘established newspapers, and journals. This is even more apparent in the under age 50 demographic.
Dr. Luks points out:
Dr Luks goes on to elaborate:
50% of the mobile Internet traffic in most countries is for Facebook. One on five patients flock to Facebook for healthcare information. Imagine what this means for a bad patient experience? The world has gone digital —social media is here to stay. 1 billion people simply cannot be wrong. 85% of people log onto their Facebook account every single day.
Any news media presently in business already has built or is building a social media presence. Twitter, Facebook and Google + seem to be in the lead of popularity and each has it’s own model which changes almost daily in an effort to capture the most users.
Recently I have been in several hangouts on Google + where people have asked for my medical opinion in the hangout. Each of them has expressed their willingness to “waive their privacy rights'” under current HIPAA laws.
Physicians are entrenched in patient privacy and confidentiality by their own training and ethics long before HIPAA was passed. Despite this restriction, many patients already waive privacy when they allow their story to be told at grand rounds in presentations, for testimonials regarding treatments, in other media and for other purposes. Does this carry forward for social media?
I would like to ask the readership their opinions and experience in this matter? How many of you have been asked this same question, and what have you advised? Would a verbal waiver be adequate or would you require it to be in writing?
.
What most physicians recognize is that access to a physician (and almost any physician) is restricted by time and distance. Patient abhor our new systems of telephone trees and triage. Numerous times potential patients express their desire to interact on social media or email with their physician even preferring to leave a ‘message’ via email, twitter or Google plus.
With the enormous increase in ‘Boomers’ our system is about to be stressed beyond it’s limits unless some creative steps are taken by universal acclaim. We cannot wait for governments to solve problems that physicians and patients are able to address together. The perfect storm of limiting reimbursements, and increasing benefits, and access threaten our health system. The first step has already taken place by eliminating pre-existing conditions, and extending eligibility of children under the age of 25 under their parent’s policies.
Physicians should start thinking about setting aside fifteen to thirty minutes a day to devote to patient care via social media. Some are already doing this via secure email or built in secure messaging in their electronic medical record systems. However not all EMRs are created equal and most do not afford this feature.
Most patients no longer find a physician through the yellow pages..they search on Google. Google also indexes social media, and blogs. Their entrance to your practice (other than an insurance roster) is already via a search engine, be it BING, YAHOO, or GOOGLE, Twitter and Facebook. Patients can even invite you to a Google Plus Hangout. And these can be one on one.
Internet social media is only beginning and will be adapted in ways we cannot yet even imagine. It has already become a commonplace feature of broadcast television, anchor news, and international links between non major news sources for direct news bypassing conventional syndicated news sources such as CNN, FOX, ABC and NBC. It may become a primary source for professional journal news releases.
The American Medical Association has published a statement regarding physicians’ use of Social Media
Stay tuned…different place, different station and at any time.
New Year's Resolution(s)
The words I will try to never use in 2012.
Transparent,Open Source,Actionable,Ground breaking,Serial entrepreneur,Pioneer,Visionary, Futurist, Venture Capitalist, Killer-App, G4,LTE, Cloud, Outsourcing, iOS, WebOS, Apple, Microsoft, Windows 8, Virus, Trojan, Worm, Ver.n, Friend-unFriend, Timeline, Circle-Uncircle, Social Media, Klout Score, Mashable, Scobleizer, Timeline, Google, Facebook, Twitter, IPO, Start-up, Kindle, Kindle-fire, I (anything),Smartphone, QR codes, Work from Home, Tablet PC, Groupon, Virtual Machine, Wireless, Youtube, Online/Offline, Chrome, Extensions, Add-ons, Hot Tech Trends,
Outcomes, Meaningful Use, Incentives, ICD-10, SGR, Disruptive innovation, Physician pioneer, :Physician champion, ONCHIT, HIE, RHIO,
Things I will try to do:
No more than 6 #tags, No more than 5 @s, No more than 3 hyperlinks/blog post, Clean my gmail archives, review my Facebook app authorizations, Defragment my hard drives, Not update Windows 7 to Windows 8 for at least one year after it is released. Replace my aging router. Replace my aging laptop. And add an iSomething or other.
Spread cheer, humor, understanding and humility to all friends, love my enemies, obey my spouse, try to understand my children (now young adults) and remember that was me 40 years ago.
There are many more do not does and does, but I have a hand cramp.
I declare tomorrow December 31, 2011 as the last day of 2011 (by the powers vested in me?)
Facebook study reveals deeper penetration of social media into healthcare than most would have predicted.
Patients seem more willing to adopt social media platforms that healthcare professionals.
It seems that patients will classify certain health related problems according to social acceptability, fears of retribution by friends, or employers or merely embarrassment.
STDs appear to be highest on the list followed by cancer, neurologic problems such as aging, dementia, or mild strokes and/or memory loss. Some parents do not want their children to know about serious or potentially fatal illnesses..
During my own social media contact with people (not my own patients) they will often inquire about their illnesses and express a desire to contact their physicians office for an initial encounter, even before a telephone contact.
Their may be several factors operating.
1. It offers bypassing clerical personnel, either by shortcutting a wait on the telephone, via telephone triage. It also offers after hours communications.
2. It depersonalizes the initial contact with a non-medical person, who they do not want to know about a personal problem.
3. Some have expressed a brief social media contact with the doctor would alleviate anxiety while waiting for an appointment.
4. Some perceive a professional social media contact as an act of caring and would offer a means of expressing anxiety, which might facilitate an earlier office visit.
5. The acceptance of these forms of communication have been limited by the feds. Ethics have been replaced with law.
6..Google + hangouts it turns out is not a secure platform, nor would an application on top of it be secure.
7.others
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.
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:
Social Media in Medicine: The Answer to the Doctor’s Lounge
Best Hospitals 2011-2012 The Methodology
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:
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
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).”
“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.
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
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.
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”
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
