I Will be out on the Links this weekend..tweet me.

 

Interesting news from the NHS.

NHS Hospital doctors told to rethink weekend working

A shortage of senior doctors is said to be at the heart of the problem.  There is mounting evidence of an association between higher death rates and weekend care. We can't prove that it is a causal link, but we cannot ignore it either.

Dr Mark Porter, the British Medical Association's consultants chairman, said the mounting evidence about the problem meant it was time for doctors to put themselves forward if needed.   At the end of last year, the research company Dr Foster found mortality rates rose by 10% at weekends. Other studies have shown similar correlations, in particular the presence or absence of senior doctors - has been highlighted as a key factor.

NHS medical director Sir Bruce Keogh added: "Having more senior staff and consultants around at weekends is fundamental to the NHS shifting from a five-day-week to a seven-day-week.

The NHS has a radically different management system for it’s hospitals. Each ‘trust’ is responsible for the management of their system. This gives the illusion of ‘freedom of choice’ and more independent thinking rather than a top down mentality.

Those in command of our system (is there anyone?) should assess these finding carefully.

In the American system it is a matter of a department and medical staff assessing availability at the local level and bringing resources in alignment with need. Deaths on weekends should be addressed on specific cases not administratively. Peer to peer pressure would be the most efficient manner to bring a better result.

Can and will social media help?

Technorati Tags: on call,weekends,nhs,deaths,twitter

You Tell me Your Story and I will tell you Mine

 

The Web Is Awash in Reviews, but Not for Doctors. Here’s Why.

The New York Times in its 'Money' section attempts to analyze the failure of Web based physician review sites. They attempt to equate sites such as Zagat, Yelp, Angieslist, and others to physician review sites.

 

Companies have tried to collect reviews of doctors since the early days of the Web, and RateMDs.com has gathered more than most. The founder, John Swapceinski, was inspired to create it after his success with a site called,Other doctors have taken matters into their own hands. Writing in the online magazine Slate n 2008, Dr. Kent Sepkowitz, of the prestigious Memorial Sloan-Kettering Cancer Center in New York, gleefully recounted his creation of fake reviews on a couple of sites.

These physicians are probably outliers, though. The American Medical Association speaks for most doctors. Robert Mills, a spokesman, sent me a statement that he said was from the A.M.A.’s president, Dr. Peter W. Carmel, that read, in part, “Anonymous online opinions of physicians should be taken with grain of salt and should not be a patient’s sole source of information when looking for a new physician.”

Companies have tried to collect reviews of doctors since the early days of the Web, and RateMDs.com has gathered more than most. The founder, John Swapceinski, was inspired to create it after his success with a site called RateMyProfessors.com, which is well known for the “hotness” rating that college students assign (or not) to their teachers.

But getting in the faces of the previously untouchable professional class has inevitably led to legal threats. He says he gets about one each week over negative reviews and receives subpoenas every month or two for information that can help identify reviewers, who believe they are posting anonymously.

None of the litigants at Angie’s List have been doctors so far, but that doesn’t mean they are thrilled with her health reviews. “They told me that ‘patients aren’t smart enough to figure out whether I’m a good doctor,’ ” she said. “But I told them that these conversations have been happening all along.” The only difference with the site, she pointed out, is that the doctors get to listen in.

Other doctors have taken matters into their own hands. Writing in the online magazine Slate in 2008, Dr. Kent Sepkowitz, of the prestigious Memorial Sloan-Kettering Cancer Center in New York, gleefully recounted his creation of fake reviews on a couple of sites.

These physicians are probably outliers, though. The American Medical Association speaks for most doctors. (authors note: The AMA represents only about 160,000 doctors out of 850,000 doctors in the United States ) Robert Mills, a spokesman, sent me a statement that he said was from the A.M.A.’s president, Dr. Peter W. Carmel, that read, in part, “Anonymous online opinions of physicians should be taken with grain of salt and should not be a patient’s sole source of information when looking for a new physician.”

The question of privacy and confidentiality are uppermost in healthcare providers minds and the patient's rights are codified in the HIPAA law protecting their information. Turning the other shoe, what would patients reactions be if physicians rated their patients individually and posted it on the web? Of course physicians are prohibited from doing so. What's good for the goose may also be good for the gander.

Word of mouth is another matter where an individual patient does not recommend a particular doctor or may remark to another person that they did not like the physician in question. Publishing opinions in a public forum without concrete evidence is merely opinion. disclaimers opens one to libel and slander actions. Ranking 1-5 in different categories is vague and is not “standardized” as to what is a 1, 2,3,4, or 5.

Technorati Tags: zagat,yelp,angieslist,webmd,healthgrades,ratemd,privacy,libel,slander

CMS Morale Low?

 

The Washington Post recognized that there is trouble in Paradise. CMS (the center for Medicare and Medicaid Services) or what used to be known as Medicare has a big problem (other than funding).

  Outgoing Secretary Kathleen Sibelius

President Obama is fighting to save his signature health-care reform law in the Supreme Court and on the campaign trail, where Republican candidates are promising to kill the Affordable Care Act. Yet even if the president prevails, he’s got a big problem: The agency that must implement the law has a revolving door at the top.

Never heard of the CMS? It’s the agency charged with making the Affordable Care Act, known as “Obamacare” to critics, work by drafting regulations and providing oversight. With a budget of $820 billion, the CMS is one of the largest purchasers of health care in the world, paying for services for one in three Americans and interacting daily with thousands of hospitals, doctors and other providers.

But for years, Congress has undermined the agency’s authority and, on the eve of historic change, has left it without a permanent leader. (Office of the Secretary)

The administration’s two-year-old law brings the agency significant new responsibilities: helping oversee insurance exchanges in 50 states, finding ways to deliver care more efficiently, and guiding changes to and expansions of the agency’s core programs.

While everyone complains about the size of ‘big government’ CMS is probably the most efficient administration in the federal system. 

In an interview, Berwick, a physician and expert on health-care quality, said he was “impressed and gratified” by the way his staff rallied around his call to implement Obama’s sprawling initiative. The administration’s two-year-old law brings the agency significant new responsibilities: helping oversee insurance exchanges in 50 states, finding ways to deliver care more efficiently, and guiding changes to and expansions of the agency’s core programs.

In fact, Congress has been putting more on the agency’s plate for years. The CMS has had to oversee a 2003 prescription drug benefit for seniors, ensure patient privacy, help weed out waste and fraud, and develop a system for grading hospitals and nursing homes. Meanwhile, it has been criticized for focusing more on getting checks to hospitals and doctors than on ensuring quality or finding ways to trim health spending.

In 1999, a group of former administrators and health policy experts wrote an open letter to Congress decrying the “mismatch” between the CMS’s resources and its “mammoth assignment.” The number of Medicare and Medicaid beneficiaries has soared since the programs started in 1966, with tens of millions of baby boomers expected to swell the rolls in coming years. Yet the agency has the same number of employees it had during the Carter administration — about 4,900. By comparison, the Social Security Administration, with a smaller budget, has 62,000 workers.

Gail Wilensky, who ran the agency for two years under President George H.W. Bush, said the CMS has become a much more sophisticated operation. “It’s not just a check-writing agency anymore,” she said. But the turnover at the top sends the wrong message to employees, who she said respond by being “more inward and protective.”

“What happens, I think, when you have a lot of turnover is senior staff loses its confidence and is less willing to take risks,” Berwick said, adding that the churn in administrators “demoralizes and confuses” staff members. As for the GOP: “It’s a game to them,” he said.

Technorati Tags: health train,cms,medicare,sebelius,berwick,wilensky,obamacare,affordable care act,morale

What Hath EMR Wrought?

New technology is wonderful and you can be certain that along with new advantages also comes new challenges and unintended consequences.

Attorneys love written information.  The written word carries with it some degree of ambiguity, illegibility, missing information, however the digitized medical record is a far different beast.

Once entered into a data field it is there….forever. There is little doubt if it was or was not recorded. The EMR most of the time requires a certain amount of information to be entered in critical fields or one cannot continue to the next  step. This can present challenges during depositions and/or trial.

In many cases this has radically changed the process of preparing for and going to trial for medical malpractice.

AMED NEWS today emphasizes and outlines these changes. Hopefully some of the comments here and in their article can guide readers.

New Jersey doctor being sued for medical negligence has been accused by a plaintiff’s attorney of modifying a patient’s electronic history. A printing glitch caused the problem, Flynn said, but the accusation has meant extra time and defense costs. Computer screen shots were reviewed, more evidence was gathered and additional arguments were made.

“This has taken a life of its own, and we’ve done virtually no discovery on the medical aspects of the case,” she said. “The cost of the e-discovery alone is in excess of $50,000.”

• How to reduce EMR liability
• See related content

System breaches. Modification allegations. E-discovery demands. These issues are becoming common courtroom themes as physicians transition from paper to EMRs, legal experts say. Not only are EMRs becoming part of medical negligence lawsuits, they are creating additional liability.

Medical data breaches are among the most common reasons that electronically stored information lands doctors in court.

Many of the risks have nothing to do with patient care or medical competence. The term medico-legal liability has taken on a new face.

E-discovery is a growing area of concern, said Joshua R. Cohen, a medical liability attorney and president of the New York State Medical Defense Bar Assn. While legal requests once entailed only paper records, attorneys are now seeking every accessible electronic record, including films, lab reports, emails and phone records.

“Plaintiffs are trying to use e-discovery as a weapon of mass discovery,” Cohen said.

The article in AMED NEWS goes on to cover many points, here are the bullets:

How to reduce EMR liability

As the number of electronic medical records increases, so do certain legal risks, medical liability experts say. Common mistakes doctors make with EMRs and how attorneys recommend that physicians reduce their liability risks:

• Mistake: EMRs allow users to move quickly through patient records, but cutting and pasting information makes it easy to paste incorrect information.
  Recommendation: Refrain from copying and pasting EMR data, and be cautious when moving from one patient’s record to the next.
• Mistake: Computer programs can help doctors make a differential diagnosis, but the templates don’t often include every possible symptom and corresponding medical condition.
  Recommendation: Doctors should not become overly dependent on electronic diagnosis aids. Electronic systems are no substitute for hands-on diagnosis.
• Mistake: Because EMRs allow physicians to move through patient charts much more quickly than paper charts, attorneys are noticing that some doctors are not being thorough when writing notes electronically.
  Recommendation: Physicians should keep meticulous electronic notes on each patient and take time to document each chart.
• Mistake: Some practices can fail to safeguard electronic patient data.
  Recommendation: Practices should encrypt all information on computer devices and have policy that discourages employees from taking portable devices out of the office.
• Mistake: A system may not clearly indicate changes to records.
  Recommendation: Physicians should install systems that show transparency when modifications are made and/or have a program lockout period where no more modifications can be made to a record.
• Mistake: Doctors may fail to follow notification requirements in the event of a data breach.
  Recommendation: Be clear on what your state law requires when a data breach occurs, and make sure employees follow the rules immediately.
• Mistake: Doctors may destroy or delete electronic records when a lawsuit is possible.
  Recommendation: If doctors suspect they are being sued, they must preserve all electronic data related to the patient in question, including emails, phone messages and computer records.

Source: Attorneys Catherine J. Flynn and Michael Moroney of Weber Gallagher Simpson Stapleton Fires & Newby LLP in New Jersey

Technorati Tags: emr,data breach,medic-olegal,mass discovery,e-discovery,attorneys,amed

Hospitals Ineligible for Incentive Payments Lag Behind in EHR Adoption

The CMS incentive payment programs have a strange void and lack of funding for certain health care organizations that are a major part of our health system.

It is obvious that incentives are pointedly directed at primary care practices, since  the criteria for meaningful use have little application in many specialty practices, and would actually require redundant data entry for data that should be present in a patient’s file in the PCP practice.

In fact the original meaningful use metrics were manipulated to allow specialty practices to qualify for incentives.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

 

However, the incentive program excludes certain health care providers are such as:

• Home health agencies;
• Inpatient psychiatric hospitals;
• Inpatient rehabilitation hospitals, Long-term acute care hospitals; and
• Nursing homes.

The exclusion of SNFs is bizarre, since the medical record is essential when a patient becomes a resident for either a short or long term period in the SNF.

Hospitals that are not eligible for meaningful use incentive payments are less likely to adopt electronic health record systems, according to a study  published in the journal Health Affairs, AHA News reports (AHA News, 3/5).

Furthermore this absence of EMR in SNFs, Home Health Agencies will weaken linkage of vital information and undermine the importance of linkage to a health information exchange.

The researchers concluded, "To advance the creation of nationwide health information technology infrastructure, federal and state policymakers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals."

They also recommended that policymakers consider "low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers" (AHA News, 3/5).

And finally,  The Words I will try not to use in 2012

 

Technorati Tags: cms,incentive payments,snf,primary care,ehr,hie,hit

Social Media Office Visits and Mobile Apps

N.H.S. adopts mobile phone apps in lieu of office visit, or prior to office visit for instructions:

An app a day keeps the doctor away: Patients told to use mobile phones for a check-up instead of visiting their GP  Cancer sufferers, pregnant women and those with diabetes, lung problems and heart disease will be urged to take daily measurements and text them into a central computer system.

The scheme is being rolled out by the Department of Health in the hope it will save the NHS millions of pounds through unnecessary visits to the surgery or hospital
Read more:

Ministers also believe that if patients are constantly keeping an eye on their condition they will be less likely to suddenly deteriorate and need to be urgently taken to A&E.
Read more:

But senior doctors and campaigners say it would be a ‘big mistake’ to force patients to use this technology.

They point out that certain groups such as the elderly would be far better off making an appointment than downloading an app.

You can guarantee that elderly people will not be able to use it or anyone else who isn’t very good with technology. If used wrongly it’s a big mistake.’

Would this work in the American Health System? Would it reduce cost? Would it overload staff with text volume. Are there any physician practices willing to pilot this as a test program?

I have expanded our vista on health issues on Google plus at “Digital Health Space” Contributors and participants are  invited, contact me at gmlevinmd@gmail.com or send a post to me at Gary Levin on Google plus.

Watch for the “Photo Walk Tour” which we have co-sponsored for patients who are immobilized and unable to travel about.  More on this later.

Technorati Tags: photo walk tour,mobile apps

Four Sacramento area counties prepare for early test of Obama's health care overhaul

 

In one of the nation’s first tests of how Obama care will work for the uninsured, the Sacramento region of California will implement a slice of President Barack Obama's health care overhaul.

All four Sacramento-area counties are joining a program that will insure tens of thousands of residents who have been without coverage, more than a year before federal health care changes kicks in.

For county governments and health care providers, the Low-Income Health Program is a chance to get a head start and work out some of the kinks in a new and complicated system – one that must emerge by Jan. 1, 2014, but remains largely unformed.

For new patients, the plan could mean the difference between getting sporadic care in unfamiliar clinics (or simply staying sick), and having something that resembles full-fledged health insurance, paid for in county and federal dollars.

This program fills a void until the Federal Low Income subsidy program kicks in in 2014.

Short-lived as it may be, the program will help counties ramp up their systems of care.

By New Year's Day 2014, the federal law says, most adults with very low incomes must be eligible for Medi-Cal. But they can't get started overnight.

Counties first need to vastly expand their corps of doctors' offices that accept Medi-Cal, establish standards and payment systems, enroll patients, and educate them on how to use the new system.

There are many factors remaining to be seen. What will the reimbursement rates look like?  Will physicians accept the new plans? Where will the primary care doctors come from when there is already a shortage of PCPs?

T.E.D. a Potpourri of Potential for Health Applications

 

Health 2.0 encompasses a wide variety of software applications that go far beyond mobile apps on  smartphones.

An entire new industry is developing around several ‘hotspots’ for technology development. This includes health care applications. One fertile ground is the MIT labs.  Progress and practical applications are only limited by venture capital.  Startup Incubators are a financial boost to new ventures whereby value-added resources are loaned (such as free space, equipment, furniture and promotional material) and/or also experience from a senior venture capitalist given to a hopeful entrepreneur.

A no-brainer for visually challenged individuals

Endless Possibilities for people with:

Impaired Vision

Limited mobility

Others:

Presentation software control from a podium.

Technorati Tags: mit lab,ted,technology

Health and the Virtual Photo Walk

 

Virtual Photo Walk

A  photo walk by Jared in the Mountains of Utah for M. Monica on Google Plus using a Hangout with an iPhone.

Watch as John Butterill moderates a Virtual Photo Walk for two challenged patients.

Social interaction is a critical factor in health and wellness. Many of our patients have reached a state where they are no longer well, however suitable means are available to improve quality of life.

Google Plus has several ways of collecting individuals with like interests and/or goals.  The circles of  G+ offer a collective approach for individuals with common interests, ie photography, disability, disease categories, etc.

Virtual Photo Walks provides a platform for invalids to participate in observation of scenic walks, visits to theme parks, cruise ships, casinos and perhaps even city council or other political activities.

Digital Health Space has partnered with Google, Veterans Today, and Virtual Photo Walk in this endeavour for patient advocacy for a group largely lost to social affairs due to limited mobility or very limited access to public spaces. While the Americans with Disabilites Act empowered the mobility impaired in the physical space, Virtual Photo Walks extends this Act into the virtual space with a flick of a mouse pointer.

Technorati Tags: digital health space,veterans today,ken smith,virtual photo walks,john butterill,google hanout

EMR vs. Paper Records:

 

  

[INFOGRAPHIC]

Remarkable changes in attitudes by healthcare providers has occurred in the past three years, in regard to electronic medical records.  Physicians were the leading naysayers with many reservations about cost, true effectiveness and return on investment.  Now a significant number have become adopters of EMR and those providers who use EMR doubt if they could be as efficient without EMR.

Patient Opinions

About 18% of patients in paper-based practices said they would not find it very valuable if their physician adopted an EHR system, and about 10% said they would not find it valuable at all.

About 21% of patients whose physician primarily uses a paper-based health record system said they would find it very valuable if their physician adopted an electronic health record system, and about 52% said
Read more: 

When asked about the possible effects of their physician transitioning to an EHR system, about 48% of patients in paper-based practices said the transition would have a very positive or somewhat positive effect on their quality of care.

About 41% of patients in paper-based practices said the shift to EHRs would have no effect on their quality of care, while 10% said it would have a somewhat negative or very negative effect on patient care.

Read more:

The report is based on an August 2011 online survey of 1,961 U.S. adults, including 808 U.S. adults whose physician primarily uses a paper-based health record system.
Read more: Physician Opinions

Eighty-four percent of health care providers say they consider health IT "invaluable" or "valuable," according to a survey by CDW Healthcare, FierceHealthIT
Read more:

Among the 202 surveyed caregivers, CDW Healthcare found that:

• 50% said they considered health IT "invaluable" because it "delivers capabilities that could not be replaced by non-IT tools;" and
• 34% said they considered health IT "valuable" because it "significantly aids in the delivery of care."

In addition, 71% of health care providers said they would not be able to complete more than 50% of their workload without health IT

Read more: Health IT Professionals

Among the 200 surveyed health IT professionals, CDW Healthcare found that:

• 56% said they have deployed an electronic health record system in their hospital in the past 18 months (FierceHealthIT, 2/27); and
• 48% said they have deployed a computerized provider order entry system in the past 18 months (CDW Healthcare report, 2/27).

In addition, the survey found that:

• Nearly 80% of health IT professionals said the infrastructure to support health IT sometimes is implemented as an afterthought; and
• 58% said they had implemented data storage, a server or a network program after adopting a new health IT system at least once (FierceHealthIT, 2/27).

Read more:

Social Media

   

Health Train Express believes that social media platforms and their use is at about 2008 in comparison.  EMRs rapidly evolved and purchased  during the period from 2008 to 2012 with the promise of $ 18 billion funding by the U.S.Government.

At first glance the medical market place for social media would seem to be much smaller than EMR, however given it’s popularity healthcare in  will fuel growth for the  space. Many medical equipment companies both in manufacturing and sales use social media daily. 

Social media has evolved from Twitter to Facebook to Google plus.  With each iteration the capabilities of the platforms continues to expand.

We will continue to follow healthcare and social media closely.

Technorati Tags: social media,hcsm,healthit,twitter,facebook,google plus,emr,stimulus funding,tarp

Using Social Media, Digital Resources and Health 2.0

 How to Health 2.0 Your Patient Portal

Using Social Media, Digital Resources and Health 2.0 to your advantage

Time for all of us is precious and is one of those resources like finances that is limited.

Fortunately many changes have occurred which increase efficiency in dealing with healthcare. Many of these improvements are on the patient side as well and the physician side of the equation.

Let's categorize these

Insurance:

1. Search engines can be use to identify appropriate insurance policies for you and your family. Many insurance companies now operate a central source for different companies as well as programs that compare rates and coverage limits.

2. Enrollment applications can and are processed online. Much of your medical history can be entered because the online sites are encrypted and private in accordance with HIPAA regulations.

3. Insurance notifications and contact confirmation can be sent via email to confirm your application(s)

4. In addition to receiving ID cards via regular mail, some companies will also send you a copy via email.

 

Office or Clinic

1. Online web portals are becoming omni-present. These may include patient education, search engines by doctor location or specialty.

2. Not infrequently the web portal will contain significant information about physician's resumes, credentials, hospital staff memberships, office hours, and specialty interest.

3. Appointment scheduling.

4. Laboratory, Imaging result reporting online.

5. It's not necessary to sit and wait in a reception area with patients who may have infectious illnesses. If you have a cell phone or a smartphone ask your doctor's office to send you a text message or a 'tweet' when they are ready for you. (even a phone call works).

6. Bill payment online.

Pharmacy:

1.       Physicians now frequently use eRx a form of electronic transmission of your prescription to pharmacies. This eliminates errors due to illegible prescriptions. However, it is not foolproof and recent studies have shown significant errors still occur. Double check your prescription when you pick them up.. It is important to update your doctor as to where you want your prescription sent to for each visit.Many pharmacies offer automatic refill at no additional charge. Ask your local pharmacy for their requirements. It will save time, your prescription will be ready, you will not forget, and it will reduce effort.

 

Technorati Tags: health 2.0,web portal,electronic prescription,online appointment,digital health,social media

Comic book explains, Advocates Health Care Reform

 

The health care overhaul is complex. It’s confusing. There are multiple misconceptions about it.

So Jonathan Gruber decided to set the record straight in simple fashion: a comic book.

It’s classified as a “graphic novel,” illustrated by award-winning artist Nathan Schreiber. But it’s not fiction.

In fewer than 150 pages, the two combined their expertise in “Health Care Reform: What it is. Why it’s necessary. How it works.”

The paperback volume is a primer to help people understand — and buy into — the ideas contained in the Affordable Care Act.

There’s no question that Gruber, a professor of economics at Massachusetts Institute of Technology, is an advocate of the changes.

He is director of the health care program at the National Bureau of Economic Research. He was the main designer of Massachusetts’ health care law. The Obama administration consulted him to help construct the national act. He is a member of the Institute of Medicine.

Gruber walks the reader through the situations fostered for each in today’s health insurance climate and explains the financial consequences. Then he presents a case for the changes envisioned by the Affordable Care Act.

Read more here:

Perhaps Congress should have read this before they voted:

Now even doctors can understand the  new law.

Technorati Tags: obamacare,participatory medicine,institute of medicine

Is There an “Oscar” for Healthcare ?

 

 

Much like entertainment, health care information will become available on all media. The convergence of many technologies such as Television, cable, internet, smartphones, tablets, desktops and more devices stimulates openness and transparency. The convergence of all these formats is occurring rapidly each year.

We all know as according to Phil Bauman that “Health is Social” Yet why do physicians either recoil or are dismissive about social media?

Tonight I am watching the Academy Awards on an internet live stream with a choice of six different cameras with upfront face-to-face encounters. It’s all in HD. Television still does not yet have the events on live. (5PM PST).

I have four active windows to select from: Arrivals, Grand Entrance, Red Carpet and  Interviews. All windows are in real-time and simulcast.

Who are the  nominees for the Health Care Oscars in 2012 ?

Categories:

Best use of Health 2.0

Best Electronic Medical Record

Best Social Media Platform

Best mobile application

Best Health Information Exchange

Best Health Insurance Reform Plan

Best Translational Science application

Best genomic discovery an application in healthcare's

Best Health Blog

Best General Medicine Journal

Best Specialty Medicine Journal

Perhaps the Nobel Prize, Woman in Science Award, The National Academy of Sciences Awards,

LASKER AWARD

The Lasker Award, 

The Elliott Cressen Gold Medal Award, (now a part of The Franklin Institute)

The Alpha Omega Alpha Honorary Society (AOA),

Wolf Prize in Medicine,

Further suggestions are invited @glevin1 or email  gmlevinmd@gmail.com

Technorati Tags: oscar,academy award,lasker award,cressen award,wolf award,alpha omega alpha