Obama on the Health Train

(AP)

Some say;

This is the year that will make or break the health care law  States were supposed to be partners in carrying out the biggest safety net expansion since Medicare and Medicaid, and the White House claims they're making steady progress.

However, Three out of four uninsured Americans live in states that have yet to figure out how to deliver on its promise of affordable medical care.

It reveals a patchwork nation. If it continues, it will mean disparities and delays from state to state in carrying out an immense expansion of health insurance scheduled in the law for 2014. That could happen even if the Supreme Court upholds Obama's law, called the Patient Protection and Affordable Care Act.

 

About half the states are suing to overturn the law. The Obama administration says uninsured patients have nothing to fear. Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the federal Department of Health and Human Services.says “"The fact of states moving at different rates does not create disparities for a particular state's uninsured population,"

That's because the law says that if a state isn't ready, the federal government will step in. Larsen insists the government will be ready,

Easier said than done.  It’s complicated. Some of the necessary steps follow.

Someone has to set up health insurance exchanges, new one-stop supermarkets with online and landline capabilities for those who buy coverage individually. Many states have refused to do this.

A secure infrastructure must be created to verify income, legal residency and other personal information, and smooth enrollment in private insurance plans or Medicaid.(this sounds like a lot of duplication and paperwork. It also  raises the specter of the IRS and State taxation agencies providing data to the HHS or State Health Departments. (or send your W2s to the State HIE, and then they will cross check with the IRS….That sounds very ominous but should be no surprise seeing how Congress passed NDAA and almost did the same with SOPA. note: Secure infrastructure? Does this sound like health care and/or health insurance?

Over half the states are suing the federal government, which will be heard by the Supreme Court this spring. Not much will take place at the state level until there is a decision regarding constitutional issues.  It is pitiful that the states had to resort to quoting the constitution when there are so many other good reasons for not enacting this financially irresponsible mandate..

The startup, re-organization and continuing maintenance of these new bureaucracies will undoubtedly devour any ‘savings” predicted from ACOs, revisions of payment methodology based upon better outcomes and improved quality of care.

The final coup d’ etat  is the state of the economy where job production is poor. These added responsibilities will not foster new businesses, nor jobs.

So be insured, and remain unemployed. Does it have to be one or the other?

How about some sensible moderation and common sense? Is anyone listening in Washington?

del.icio.us Tags: obamacare,health insurance exchange,supreme Court,constitution,ndaa,sopa,pipa

Mobile Technology Is Transforming The Health Industry

 

Mobile Technology Is Transforming The Health Industry, But To What Extent?

Dave Chase

Technology is in the process of bringing change to every piece of the health industry — wellness, fitness, healthcare, medicine — you name it. And as it always seems with introduction of new technologies, it’s awe-inspiring how quickly they can transform entire industries yet, at the same time, make us realize just how far we have to go (or how far behind we really are). The health industry has been touched (and defined) by cutting-edge technology for years, yet its relics, legacy infrastructure, paper-pushing, and archaic procedures are as obvious today as ever before.

Mobile Technology for health  can be classified in two categories:

Physician oriented: Apps designed to access reference materials, calculators, formularies, eRx, EMR remote access, Social Media, Calendaring, email, Video Conferencing, Algorithms

Patient oriented:Health Knowledge Base, Remote monitoring sensors, like Basis’ heart and health tracker,Lark, Fitbit, and Jawbone’s Up.

Some mobile apps interface patient and physician, Mobile devices will also change the way that we communicate with our doctors, as physicians may help describe possible treatments or procedures to patients on an iPad using multimedia, visual cues, genomic/anatomical maps, etc., prescribe post-treatment apps to our smartphones so that treatment doesn’t end once you walk out the door of the hospital, or become a conduit for modern communication platforms, a la Skype, that will facilitate remote checkups, treatments, diagnostics, through the phone, or over video. Got a strange looking rash? Take a picture, or scan it on this app. Telemedicine is there in a pinch!

All this has developed almost spontaneously with the development of competing hardware devices and software which is open source. and at affordable prices given the size of the patient market. The primary ingredient is innovation, entrepreneurial spirit, and with little governmental funding and/or intrusion.

Contrast this with the stuttering acceptance of EMRs and HIEs with government mandates, artificial support with incentive subsidies to support the HIT vendor market. The real beneficiary for CMS’ incentive program are the HIT vendors, not patients, not doctors nor insurers. The data collectors will benefit from the system which will be mined for the benefit of cost containment and perhaps better outcomes.

del.icio.us Tags: health 20,mobile apps,mobile technology,emr,hie,hit

Social Media in a Hospital Bed

 

No this post is not about pubescent hormonal hyper sexuality nor the story about the sex life of fan boys or fan girls,  G+strings,, or tantalizing twitter tweepes. It is a story about Fred and Regina Holladay and their experience (bad) when Fred was diagnosed with advanced Renal Cancer.

Dr. to Dr.

View more presentations from Regina Holliday

The program is self-explanatory and does not require expansion here.

del.icio.us Tags: hospitals,social media,healthcare,cancer,twitter,facebook,Google plus

Bold New Approach to Funding Medical School Tuition

 

Over the past ten years both college and medical school tuitions have increased in some cases four times. This has effected college graduates and physicians. Tuition at the state run UC system in 2001-2002 was $ 3429 and has risen to  $13,200 per year. This places an extraordinary debt burden on students at a time when they have little income.

In California which has faced the perfect storm of decreasing revenues in the face of economic distress Chris Occasion, President of the FixUCR movement at the University of California presented a manifesto

Their manifesto is the UC Student Investment Proposal, which calls for eliminating the upfront costs of college and having working graduates pay 5 percent of their salary back to the system for 20 years.

The idea was conceived by students, and although designed for the UC system could very well be adapted to  other states and private universities.

The investment proposal concept has captured the attention of the Board of Regents of the UC system and was a concept previously studied and discussed by Robert Reich former Secretary of Labor under the Clinton Administration. He presented a similar idea in 2008 for California’s  mounting fiscal stresses. Economists at the time termed the financial plan feasible however it was deemed politically undoable. This would not be the same for privately funded schools of higher education.

A similar perfect storm has developed in health care and medical education which is even more expensive and extended eight years up to twelve years. And while college graduates may complete undergraduate education with a $100,000 debt load, some physicians will  exit from medical student and

training with up to $ 250,000 debt.

Health reform promises two events, more insured patients, decreased reimbursements and a shortage of primary care physicians (family physicians).This will decrease ability for  physician graduates to repay  education loans. Adjusting payment rates as a percentage of income adjusts for future changes in income.

Many well qualified students rule out medicine as a career because of it’ prospect of prolonged poverty and what often appears to be insurmountable debt. Some highly qualified  students will change career goals

ref: Zimmerman, Riverside Press Enterprise.com

del.icio.us Tags: college,tuition,loans,debt,primary care,physician shortage,education loans

5% of patients account for half of health care spending

USA TODAY reports that 22 % of healthcare spending is from less than 1% of patients.(2009).

That's about $90,000 per person, according to the Agency for Healthcare Research and Quality. U.S. residents spent $1.26 trillion that year on health care.

Five percent accounted for 50% of health care costs, about $36,000 each, the report said.

Why is this number so important? According to AHRQ the report showed how a tiny segment of the population can drive health care spending and that efforts to control cost should focus on this segment to improve efficiency using new technology, outcome studies,

About one in five health care consumers remained in the top 1% of spenders for at least two consecutive years, the report showed. They tended to be white, non-Hispanic women in poor health; the elderly; and users of publicly funded health care.

•Sixty percent were women

•Forty percent were 65 or older.

•Only 3% were ages 18 to 29.

•Eighty percent were white.

•Only 2% were Asian.

The  found that Hispanics, 16% of the population in 2009, spent less on health care. Twenty-five percent of Hispanics were in the bottom half of health care spenders, the report showed, while only 7% of Hispanics were in the top 10% of spenders.

Next, Cohen plans to look at whether cost-cutting measures make a difference. Beginning in October 2012, the government has told hospitals with Medicare patients that it will no longer pay for patients who are readmitted to hospitals for the same condition soon after being released. Cohen said he'll look at whether that will change the spending averages for people in the top health care cost brackets.

Another way of stating this is, “unmarried women” (uninsured) (or Medicaid)  and  old people on Medicare

del.icio.us Tags: health consumer,medicare reform,medicaid,usa today

C.E.S. & Health Train Express in Vegas

 

Monday January 9 2012 marked the opening of the Consumer Entertainment Show in Las Vegas.

Among the carnival-like presentations both on the exhibit floor and in conference were many medical applications in hardware and software.  After all,, medical practices and physicians are consumers.

Connectivity is high on the list of presentations.. Physical security of the mobile hand held devices was important, however the real value is the software and data in the device.

Consumer oriented health monitors were also on the list:

This one is from Zensorium. and intended for iOS. (iPhone)

RFID for security is available with small tags on laptop cases, smartphones, iPads and the like “Tags” are available for pets and even children to keep them from wandering off. It could even be used for ‘colleagues’ and peers to keep from losing each other even significant others or spouses.  (in an extreme case).The potential for use in hospitals is great to locate patients who may be roaming to special testing. Physicians hate going to an empty room when they expect to see the patient.

Digital healthcare was no stranger at the CES. From Panasonic to Allscripts medical applications are being mainstreamed even in the consumer retail market place.  COSTCO offers the  Allscripts My Way EMR which can be purchased at any Costco warehouse.

In addition to mobile apps and advances in display technology the merger of automobile connectivity within the vehicle and also externally for safety features are being emphasized as selling points for vehicles

Ford, Microsoft, Healthrageous and BlueMetal Architects announced an alliance to research technology to help people monitor and maintain health and wellness while on the move during the “Doctor in Your Car” keynote address at the Digital Health Summit at the 2012 International Consumer Electronics Show (CES).

An interesting statistic (Pew)

More people now visit online health sites than go to the doctor’s office, making health and wellness the most popular activity on the Web after email and general searches.

Social media was also a large component of the CES. Reporters, presenters, and observers were all well connected via email, im, twitter, FB and Google +. Multi-tasking was a necessity on the floor and in the booths. The infrastructure to support this seemed to be better than in most previous CES’ The learning curve from previous event was obvious and the ‘show’ ran smoothly There appeared to be little difficulty with broadband access nor bandwidth. Convention centers seem to have caught up with the never ending growth of demand for wider ‘pipes’.. I watched much of #CES from the comfort of my desk , at  C-net, Ustream.tv and Techcrunch,and Twit.tv .

It eliminated the challenges of air travel, TSA and DHS.

del.icio.us Tags: #hcsm #fordsync,#digitalhealth #healthit #ces

Senior Citizens on the Health Train

1. GeriPal (blog)
2. POGOe – Portal of Geriatric Online Education (clinical resource)
3. Geriatric Nursing (podcast)
4. CareGiving (community site)
5. The American Geriatrics Society Like (Facebook group)
6. Wen Dombrowski MD (Twitter)
7. American Geriatrics (Twitter)
8. GeriPsych Consult (mobile app)
9. Health AGEnda (blog)
10. John A. Hartford Foundation (Youtube)

Senior citizens are getting much attention from politicians and health care professionals. Deservedly so since they are the unfortunate who are involuntarily ‘consuming’ health care. It’s the nature of aging and human life.

No one wants to be ill or infirm. The term “consumers of health care’ implies that healthcare is produced, or that health itself is produced. Perhaps that is what preventive medicine, healthy diets, exercise, stressful living and a good quality of lifestyle is all about.

The list of links at the start of the article is for mature adults and their caregivers. (credits to Bertalan Mesko MD and Webcina.  I recommend giving it to  you patients.

del.icio.us Tags: medicare reform,seniors,webcina,healthtrain express,mesko,geriatrics,nursing

Is 2012 The New Era for Health Train Express?

Val Jones MD, perhaps the empress of health social media, and Better Health has announced her discontinuation of posting blogs on Better Health LLC. She however indicated the continuation of the brand as a platform for Grand Rounds and for her use of it as her personal consulting platform.

Dr Jones, along with others, has been a visionary and developed considerable credibility with early backing from Revolution Health and Steve Case’s interest in health reform.  Her success required considerable investment of time, resources and the generous support of many silent investors, physicians, nurses and medical journalists.   She innovated aggregation of gifted medical writers into a visible public platform for medical news.

There were and are a central core of respected experts contributing to Better Health and these contributors will continue to create content in their own spaces.

Thank you to Val Jones M.D. for her effort and success in opening a new vista in communication for patients and providers. I will miss her cartoons.

The range of contributors to Better Health include:

David Harlow, Dr Wes, Dr. Mike Sevilla, Kevin Pho MD,Lucy Hornstein M.D.,Nicholas Genes M.D.,Steve Novella M.D.,, Tony Brayer M.D., Jeffrey Benabio M..D.,

Better Health was and is more than a blog. It matured into a digital form of a medical journal, branding itself as an online media company. It has served it’s purpose and will continue in the digital health space, not to be left behind.

Many new entities are evolving, such as Social Media Today, Health Works Collective, and many others as the niche matures.these follow the early leadership of iHealthBeat, and California Healthline.

Social media in medicine is evolving quickly and in order to continue our success we must all evolve as it morphs into new delivery methods.

I am sure we will hear much more from Val Jones MD

Thanks Val.

Health Train in the Sunlight

 

The Health Benefits of Sunlight

Researchers have started recognizing the importance of sunlight for a healthy lifestyle, recent studies reveal that sunlight renders many health benefits. Apart from Sunlight maintaining temperature and humidity, sunlight plays a significant role in nourishing and energizing the human body. It is also vital in order to get the full nutritional value from food that you consume and it has been proven that getting sufficient sunlight aids in preventing chronic ailments such as seasonal affective disorder (SAD), osteoporosis, mental depression, type 2 diabetes, and cancers affecting the bladder, breasts, cervix, colon, ovaries, prostrate, and the stomach. To put it more succinctly, sunlight serves as the perfect medicinal pill in promoting a healthy lifestyle.

One of the prime benefits of sunlight is that it supplies the body with Vitamin D, which not only promotes the absorption of calcium in the gut but also transfers calcium across the cell membranes. This in turn provides strength to the bones as well as contributes for a healthy nervous system by increasing the production of endorphins in the brain. Usually, deposits of cholesterol-like substances known as ergosterol can be found beneath the skin, which gets converted into Vitamin D hormones when the sunlight penetrates the skin.

Vitamin D also helps to lower the level of cholesterol in blood, and sunlight can even prevent the growth of cancerous tumors. Studies show that exposing your face to sunlight for 10 minutes every day can provide your body with the Vitamin D that is required for the day. A lack of Vitamin D is associated with a host of autoimmune ailments such as Crohn’s disease, multiple sclerosis, rheumatoid arthritis, and thyroditis.

Another significant benefit of sunlight is that it helps in the prevention of infections resulting from bacteria, molds, and viruses. The health benefits of sunlight include the enhancement of the immune system by increasing the count of white blood cells as well as gamma globulin, which is beneficial in warding off viruses and germs and it enhances the capacity of red blood cells in carrying oxygen.

According to certain studies, getting adequate sunlight serves as the perfect exercise for the heart, as it enables the body to lower the resting pulse rate and decreasing hypertension, thereby making the heart healthier. Sunlight also provides resistance power to the skin, by avoiding skin diseases such as psoriasis, eczema, and acne problems. Further, getting sunlight is also correlated with the stimulation of the pineal gland, which produces such vital chemicals as tryptamines.

Other health benefits derived through the exposure of sunlight are:

• Strengthening of cardiovascular system

• Normalizing blood pressure as well as blood sugar

• Increased metabolism

• Aiding in weight loss

• Ensuring proper functioning of kidneys by eliminating wastes

• Enhanced liver function

• Improved digestion

• Above all, sunshine has that magical power to alter your moods and cheer you up, thereby preventing anxiety and depression

Despite its advantages, excess exposure to sunlight may be sometimes destructive, as it can lead to ailments such as eye damage, melanomas, and skin cancer. Likewise, over exposure to sunlight may sometimes result in a change in the color as well as the size of the skin, appearance of irregular spots on the face, and itchiness or tenderness to the skin.

In other words, benefits derived from the sunlight depend upon its usage. Methods such as sunbathing and sun tanning are considered effective for getting adequate sunshine, but make sure that you are using a quality after-sun lotion in order to moisturize your skin after sun tanning. Likewise, put on such clothes that cover your arms as well as legs after sunbathing, which in turn safeguard you from further exposure. However the most important thing to remember that an excess of anything, including sunlight, can be damaging to your health.

del.icio.us Tags: vitamin d,sunlight,cholesterol,hormones

Health Train and Winter

Mobile apps are the big items this year, not only in health care, but in a multiplicity of other niches.

When a powerful blizzard ripped through North Dakota last winter, hundreds of drivers were stranded as white-out conditions shuttered interstates statewide.Even in large metropolitan areas sudden and large snow storms can paralyze drivers with other cars close by. The recent Chicago Lake Shore drive emphasizes the fact that this does not occur in only North Dakota.

That convinced two local software developers to create the Winter Survival Kit app.

North Dakota State University's Bob Bertsch and Jake Joraanstad came up with the free program for iPhones and Android smartphones to help motorists prepare for winter driving and when things go badly.

One app available through the iTunes app store is a crossover, linking mobile apps for driving and prevention of possible frostbite and even death if isolated by blizzard conditions and being stranded in your car.

The application “Winter Survival Kit” can be downloaded for FREE at the iTunes app store. It will function on the iPhone, iPad  and also on  Android Phones

                             

This app will help you find your current location, call 911, notify your friends and family, calculate how long you can run your engine to keep warm and stay safe from carbon monoxide poisoning.

Version 1.3 update December 2011, and all reviews give it a 4-5 star rating.  

The application provides instructions for preparations for cold weather survival and what to do if stuck in your car.

It also functions as an emergency 911 alert and will supply geolocation information  to emergency dispatchers.

Other information it can calculate is time until your fuel runs out, and to remind you to check your exhaust every 30 minutes to prevent asphyxiation from carbon monoxide.

The application was developed by Myriad Devices  and financial support from a grant from  USDA National Institute of Food and Agriculture   Smith-Lever Special Needs grants.

HealthTrain Express assesses this device as a mandatory  one for anyone who drives in a cold weather climate. It’s usefulness may be restricted in areas that do not yet have cell phone availability. If you are on one of the U.S.National Defense Highways (Interstate Highway System) it’s a fairly safe bet you will have cell coverage.

The only thing it does not seem to do is make hot coffee….perhaps in version 2.0

Remember also that if cell phone strength is week text messaging may still function….use Twitter, SMS or IM.

del.icio.us Tags: winter,survival,mobile apps,iPhone,android,smartphones,911,geolocation,prevention

California Health Budget Slash

 

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

del.icio.us Tags: medi-california,budget,Governor Brown,Health Insurance Exchange

Unprotected Sex and Fellatio

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 !

del.icio.us Tags: fellatio,oral sex,carcinoma,smoking,public health,cdc

The Dangers of Social Media and Self Diagnosis

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.

del.icio.us Tags: self diagnosis,internet health,social media,patients,physicians