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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.
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Friday, March 23, 2012
Learn on The Health Train Express Social Cruise
Relax and get your new tablet or ultra book or maybe even your ancient Dell Desktop, and follow along.
Social Media in Healthcare is a moving target. Like the stock market at times the best indicator is the moving average indicator. Social media sites grow rapidly, wane and flux and at the same time the user base shifts from platform to platform.
If you are a newbie, intermediate or advanced social-izer the best source for all learners or more advanced users is a Prezi course by Bertalan Mesko M.D.
The course is on Webcina and you can read about it here. Dr Mesko is an organizer from the get go. He has produced a great deal of content in social media in an articulate graphic and easily understood format.
For those of you who have never read or produced a Prezi presentation it will prove to be an interesting and captivating tool. The only other presentation tool I have seen or used that approaches Prezi is Pearltrees. Other useful slide deck platforms are Google Presentation and Slideshare.
No matter where you are on the learning curve for social media, web search, rss feeds, Bert Mesko puts together an array of amazing tools. Each venture into his social media space nets me a wealth of new features.
Perhaps that is what makes social media so enticing to users. Each trip into the social sphere gains the user. I would definitely bookmark Webcina for easy reference.
Thursday, March 22, 2012
The California Health Benefit Insurance Exchange
California is a leading state in formation of Health Benefit Exchanges. The Health Reform Law as specified in the Patient Care and Affordability Act two years ago mandates the formation of Insurance Exchanges for each state to create a structure to make available plans for the uninsured or uninsurable.
California frequently goes where no man has gone before, or where others dare not trend. Unlike many states who have chosen to push back on federal mandates with legal means, or refusal to initiate a health benefit exchange, California is travelling down the tracks at great speed.
I took some time to sit in on a Webex presentation (archive available) of the recent California Health Benefit Insurance Exchange today. For those who missed it (probably 99.999% of my readers) The link(s) here will take you to an archive of the meeting. The Agenda is also here..
This is the second anniversary of the passage of the Affordable Patient Care Act. (2010)
Important points of the California Health Benefit Insurance Exchange meeting follow:
Health provider and Public misperception is that the Health Insurance Benefit Exchange program is a government run entity. This is not true. The current involvement is a grant mechanism as a startup for HBIEs. This grant funding will end in December 2014, after which the HBIE must be self sustaining from it's own business model.
Should the state(s) decide not to build their own exchange, then the federal government has the option or mandate to do it for each state.
I thought it important for a physician to attend this meeting. I was unable however to attend the “executive session” which was not broadcast.
The development of the California Health Benefit Insurance Exchange is well underway.
Mission:: For all Californians to have Health Care. The CBHIE goal is to develop a marketplace
California's unique challenges
California is larger than most countries, and most states, with great diversity in income, rural/urban, ethnicity,languages, education,
California Timeline for plan and implementation relatively short.
Consumer centric: rural urban education
Exec Director Peter Lee
Business development..tracks
CBHIE Human Resource Needs for staffing
Qualified Health Plans by Price Waterhouse
CBHIE Enrollment System: Critical Backend IT platform
Assessing Federal Regulations
Setting standards for QHPs
Multi-state plans may be exempt from some requirements
CBHIE Will include dental plans, mental health,
Standard rates
At The Table was Donald Berwick MD former CMS head
Assessments:
Several shifts in Individual markets ,Group, Medi-Cal, Uninsured, Undocumented ? 1 million
Exchange prediction is working from vague statistics and estimates.
Enrollment penetration: 2014 20% 2019 100% Rates will be critical
Market surveys.
Beware of program being construed as a 'government program”
Balanced approach, linked to health services
Spectrum of support services
Much of Health Benefit Insurance Exchange planning involves outreach and research into transitions, loss of employment, moves, divorce, connecting graduation, education, student loan program
Pre-enrollment from other plans from public programs, and for life transitions.
Wednesday, March 21, 2012
Innovative uses of Health 2.0 and Social Media
Imagine a ‘Wiki” to empower patients
Several Health Wiki’s are already online.
WikiPublicHealth (WiKiPH) is a U.K. based information source. It remains an open source for articles by anyone. It appears to allow anyone to register/log in/and create articles
HealthWikiNews is an already established site closely moderated by an advisory panel. It is hosted on WordPress.
Imagine that you have asthma, and rather than give you a set of instructions about what to do if you have an attack, your doctor invites you to help write them? Would that make patients feel more engaged and empowered in managing their health care, and would that ultimately make them happier if not healthier?
These questions are being raised by Dr. Samir Gupta, a respirologist at St. Michael's Hospital.
His research has found that a wiki - a website developed collaboratively by a community of users, allowing any user to add and edit content - can be an innovative new tool for developing individual asthma action plans.
West Wireless Institute: aggressively advancing the mHealth ecosystem
Founded by billionaire entrepreneurs Gary and Mary West, and guided by a blue chip laden executive team with all of the elements required to both think big and execute, the Institute has burst onto the scene in 2011.
There is no single organization worthy of mention in the same breath with San Diego-based West Wireless Health Institute when discussing the contribution of non-profit groups to the mHealth movement.
The opportunity presented itself to interview the Institute’s Chief Medical Officer Joe Smith, MD, PhD. During our conversation I was able to ask Dr. Smith about each of the projects and how they have progressed to date. The complete transcript can be found at the mHealth home page.
The organization also offers Fellowships.
More trends in HIT, will they facilitate Health Reform by enabling cost reduction?
IBM has unveiled a clinical-analytics platform to provide doctors with insight into patients' conditions using natural-language processing and machine-learning capabilities similar to Watson.
IBM is moving on from "Jeopardy" to finding treatments using genetic data. The company announced it has developed a data-analytics platform called Clinical Genomics that uses algorithms and analytics similar to that of Big Blue's Watson supercomputer to find treatments for conditions based on a patient's genetic profile.
IBM's Clinical Genomics fits into the growing trend in health care of using big data to develop personalized medicine, which is the ability to use a patient's personal genetic characteristics to prescribe medical treatment for conditions, such as cancer, hypertension and AIDS.
Sunday, March 18, 2012
Who Reads Instructions?
Okay, I have always been an early adopter. And that extends to the recent introduction of Windows 8 (Metro) Metro seems to be designed to be a GUI that is an enlarged smartphone screen. It is meant to be used on a touchscreen tablet.
Perhaps Redmond intended Windows 8 to be sympatico with Windows phone users even though that market is still very immature and follows on a merger (purchase) of Nokia by MSFT. Nokia as you will remember almost tanked with it’s now defunct Symbian OS.
Loading the OS as a self installing .exe file from a USB stick was straightforward, even though it took several reboots and several long pauses with no indication whether it had crashed. Patience paid off and the opening screen appeared. Warning the opening screen is a mono-color with a strange looking fish in the center. For aquarium lovers, you already realize it is a ‘siamese fighting fish’. There must be some hidden meaning in that logo. Perhaps the code spells out Steve Jobs.
I bring this up on Health Train Express because there are probably many of you who are tempted to try Windows 8. I don’t think I would rush to use it for your office systems as yet. Reserve it for playtime.
Have no fear, despite the warnings of non support, I have not needed it thus far and have used it for almost three weeks.
I took out my backup insurance by copying all my important documents, photos, and personalized settings to an external hard drive and also to the cloud. In the past I have had some very bad experiences whereby a backup program in one OS was incompatible with a recovery in another new OS. With that in mind, all went well, and because I use the cloud now for 90% of my computing both online and offline.
Beginning with blogger I have steadily migrated to more and more of Google’s offerings because of it’s synchronicity and it’s overlap of social media, document sharing, email and it’s android relationship. In the near if Google’s chrome becomes more prevalent the need for Windows is less.
Because I blog and work in social media a great deal of the time, Chrome presents the most usable means of switching from Google + to twitter and Facebook. The addition of Google Hangouts is the pudding in the pie. Don’t forget YouTube as well.
Other than not working with my AIO HP all seems fine. It has a generic HP printer driver that shines. Printer drivers are the acid test for compatibilty, since printers are very finicky and exacting.
The only thing Google needs to do is develop a HIPAA compliant secure video conference and you have a low cost ready made teleconferencing solution that could alter the cost equation for healthcare. What used to cost about 50,000 for a telemedicine set up now costs not much more than a laptop or tablet pc. P.S. it also works on a smartphone reasonably well.
Two projects in which I am directing are the use of it for a “Virtual Photo Walk” and “ Blind Veterans Help Desk”. The later seems like an oxymoron, however I have a dedicated Veteran’s Advocate who convinced me it was worth a trial. It seems useful for partially blinded patients to socialize.
Finally, I am glad I did not read the instructions, especially since there are no really official instructions, or accompanying help file.
It took about a week of experimenting with all the icons, buttons and learning to swipe using the mouse on a laptop. Microsoft promises a new $ 75.00 dollar swipable mouse pad in the near.
Online Health Care Discussions 98% Patient Driven
A bold statistic reveals how little medical providers are participating in the use of Social Media regarding health issues.
Recent statistics show that close to 90% of providers are familiar with or use social media such as twitter, facebook or google in their daily activities.
Dike Drummond MD writes on “HealthWorksCollective” and reveals that providers provide less than 2% of information except in the case of lung cancer where it jumps to a “whopping 9%” in online chat. In a number of cases the majority of the discussion is driven by the patient’s caregiver. Alzheimer’s disease tops that statistic as you might expect.
The authors of this infographic focused on disease specific discussions and found the most discussed topics to be
- Depression
- Fibromyalgia
- Breast Cancer
- ADD
- Asthma
- Cardiovascular Disease
Infographic and article source: NMCITE
Despite predictions about the adoption of social media for physicians in reality social media is more often used by caregivers.
There are opportunities for education and training of care-givers in health to enhance their efforts to support either their clients or their family using social media such as facebook, twitter, and Google +
Google + further enables social media with Google Hangouts affording a direct video conferencing ability amongst ten participants.
Further information is available at Digital Health Space on Google Plus.
Physicians should lead their staff in developing this modality.
Saturday, March 17, 2012
ACOs Gaining Ground in Illinois
ACO is the hottest three-letter word in health care
Accountable care organizations take up only seven pages of the massive new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.
New Insurer-Hospital ACO Touts Early Success.
With only six months of data, the largest hospital system in Illinois, Advocate Health Care, and major health insurer Blue Cross Blue Shield of Illinois (BCBSIL) are declaring some early successes with its provider-payer accountable care organization, which is the largest commercial ACO, Scott Sarran, BCBSIL's chief medical officer, said in a Kaiser Health News article.
Advocate Health Care based in Chicago and BLBSIL's ACO called AdvocateCare has 250,000 PPO members and 125,000 HMO members, according to Sarran. In its first six months of 2011, the ACO resulted in hospital admissions per member dropping 10.6 percent, compared to 2010, and emergency department visits decreasing 5.4 percent, Kaiser Health News reported.
Even though the federal government offers under the 2010 health reform law a platform for Medicare ACOs, providers and payers have joined forces to create their own ACOs outside of the Medicare Shared Savings Program. For example, Hoag Memorial Hospital Presbyterian, Blue Shield of California and Greater Newport Physicians IPA just weeks ago announced its intent to create an accountable care initiative, and Pioneer ACO Atrius Health recently hinted in a FierceHealthcare interview that it is considering partnerships with commercial insurers, having already begun talks in reducing costs.
"If we're doing this in the Medicare arena, why can't we do this in the commercial environment, as well, and then be rewarded for the benefit we bring to the reduction in total expenses in Medicare PPO patients?" Atrius Health President and CEO Gene Lindsey said.
"Before, we were limited to the fee-for-service revenue that would be associated with caring for those patients. So this opens up a whole new vista in healthcare finance when we are looking for new ways to fully fund the programs of care that we want to offer," he said.
The administration forming ACOs will take considerable effort and startup costs amounting to several millions of dollars according to:
What are ACO start up costs ?
That's the"$64,000 question"
We have three separate estimates, with disparate figures.
The projected start-up costs of an accountable care organization (ACO) can vary widely, depending on who you talk to. The Centers for Medicare & Medicaid Services (CMS) estimates that it will take $1.7 million per ACO, based on a 2008 study of the Physician Group Practice Demonstration project, according to an Institute for Health Technology Transformation white paper released last week. The American Hospital Association (AHA), however, estimates ACO start-up costs are between $5.3 to $12 million, depending on hospital size. The Institute for Health Technology Transformation reports that it could take $7.5 to $11.3 million for a 200-bed hospital or $1 to $11.7 million for a 200-physician practice.
FierceHealth IT offers further details
Wednesday, March 14, 2012
We Won’t Know What’s In There Until We Pass It
When the Affordable Patient Protection Bill (APPA) bill was in congress many congressman could not or did not read the entire bill. The bill was 1200 pages of the “Secretary of HHS” shall implement the following”…………..The bill was global, including many issues with health IT, public health, ACOs, and set deadlines for implemenation without regard to the impact of each phase.
Some said that we would not now what was in it until it was passed. That statement is probably the most true statement of the entire furor over health reform.
The initial phase included forbidding exclusions for previous illness and doing away with uninsurabilty as well as allowing dependent minors to remain on parent’s policies until the age of 25. Those two items surely drove up the cost of health insurance. Someone had to pay for insuring uninsurable people. Surely it sounds wonderful and it immediately reduced political pressure about health reform.
It may have been a bit backward to set up the financing after increasing the expense. I don’t understand the math but then again I don’t print money.
Jeff Young, at the Huffington Post describes it this way.
“The good news is that health care reform could lead your employer to put a little more money in your paycheck. The bad news is that if they do, it's probably because they aren't providing you with health insurance anymore.
The Congressional Budget Office estimates that 4 million fewer people will get health benefits from their employers in 2016 compared to what the agency projected a year ago. More people will end up on Medicaid, the government health program for the poor, and more companies will decide to stop offering health benefits and let their workers buy their own coverage through insurance "exchanges" the government will establish in 2014. The Congressional Budget Office doesn't estimate how much wages might increase for those who lose company health benefits.
How could this translate into bigger paychecks for workers? Economists consider health insurance to be part of how much companies "pay" workers because fringe benefits cost them money, said Paul Fronstin, director of the Health Research & Education Program at the Employee Benefit Research Institute. If a company decides to stop providing health insurance, they are likely to pay a little more. Companies may choose to offer workers extra money that could be used to help pay for health insurance instead of providing benefits themselves.
The Congressional Budget Office also says this will allow the government to raise more money to pay for health reform because wages get taxed but money spent on workplace health benefits doesn't. Employers that drop workers from their insurance rolls also will pay penalties to the government.
Jobs would remain the most common way for Americans to get health insurance. The new projections about health care reform don't say fewer people overall will get insurance at work, just a smaller number than the budget agency previously thought. This year, 154 million people are covered by their employers and 161 million will be in 2016, the Congressional Budget Office says.
There's no guarantee things will play out that way. Economic and budget projections are constantly changing and the parts of the health care law that are supposed to expand coverage don't exist yet. Moreover, Fronstin said, economists' assumptions about companies treating benefits like pay aren't always accurate in the real world.
Reading further it becomes obvious there are many ‘what if's’ an unspoken hope that the present economic doldrum will come to an end, and the planners have given themselves more than ‘wiggle room’ to call it a success.
Whatever it is we should not blame “Obama Care” Much of the ideas were formulated long before he came into office.
The Patient Affordability and Protection Act is the correct term. That term seemed the most innocuous and benevolent term for major disruption and uncertainty in the health system.
Part II (later this week)
Health Insurance Exchanges, to be….or not to be. Who will do it?
Tuesday, March 13, 2012
At Long Last ! Inland Empire HIE to go Live April 1 2012
Gary M. Levin M.D.
I feel like the great grandfather who set something in motion that might have occurred anyway. I do have the satisfaction of knowing I was right all along back in 2002 when I am sure I was hailed as the “Don Quixote’ of the Inland Empire. There were few then that could appreciate the vision of what we see unfolding.
All I can add is a profound “Thank you to those who took up the baton when I laid it down, as I weathered several serious illnesses. There are now many community physicians, paid consultants, and champions of the movement. My dream and ambition would not have occurred except for them.
Ten years passed. And today I read some good news.
“ One of those exchanges is Inland Empire Health Information Exchange (IEHIE), which is made up of 48 providers in Riverside and San Bernardino counties, and is scheduled to become operational April 1.
At a time when the value and sustainability of public health information exchanges (HIEs) are being questioned, Inland Empire Health Information Exchange (IEHIE), which plans to go live on April 1, is making a case for both.
IEHIE, comprising 48 healthcare organizations in Riverside and San Bernardino counties including hospitals, physicians and payers, boasts an operational self-funded business model and a collaborative spirit. These two critical components make IEHIE unique, according to Executive Director Richard Swafford.
There is no public funding or state grants for IHIE. Any public funding comes from county stakeholders, a large managed care medi-cal organization (IEHP) which serves 600,000 participants and multiple hospital and physician group stakeholders. From day one IHIE was drawn up and implemented by the stakeholders without public involvement and it will be sustainable.
The collaborative spirit carried over to the business model. All stakeholders agreed to pay for value-added services via a fee structure determined by participant type – payers by number of lives, medical groups per physician and hospitals by bed size. IEHIE was formed as a 501(c)3 organization, with the goal of breaking even, not making a profit, Swafford explained. Although the HIE infrastructure contract with Orion Health, whose Orion Health HIE platform is powering the exchange, was completed some six months ago, it wasn’t signed until the current 14 pilot participants paid their fees in advance. “We aren’t relying on grants as a mechanism for sustainability,” he emphasized.
Sustainability has always been the glass barrier for RHIOs and now HIEs. Some of the most successful HIEs failed shortly after the startup grant money was gone. (Santa Barbara Exchange, started by David Brailer MD, the first head of ONCHIT.)
IEHIE’s strategy is also to be the utility for entities that want to leverage other programs and capabilities. The accountable care organization (ACO) model, for example, requires the ability to share patient information in order to effectively participate in an ACO environment. “We rely on our participants to tell us what their requirements are so we can integrate them into our overall strategy,” Swafford said.
When the community-based HIE goes live April 1st, Gagnon predicted, “We’re going to knock everybody’s socks off.”
Monday, March 12, 2012
Online Web Rating Sites: FAIL WHALE
Columnist Ron Lieber writes that consumers are not posting online reviews of their health care experiences as often as they are posting online reviews of restaurants and other services.
Lieber writes that websites such as HealthGrades, RateMDs, Yelp and Angie's List have offered a platform for health care reviews, but "listings are often sparse, with few contributors and little substance." He adds that there is a "demand and supply problem: many people want this information and more consumers would trust it if the sites had more robust offerings."
According to Lieber, some physicians have "silenced patients away" by asking patients not to review them online or by suing patients who do so.
In addition, some patients might choose not to review their doctors "for a far more ordinary reason: if they live in a small town or are only one or two degrees of social separation from physicians or their family members, they may not want to create any awkwardness," Lieber writes.
He also notes that some patients might "idolize their doctors," adding that it is "exactly this sort of unquestioning mind-set that may cause such low participation (or disproportionately positive reviews) at many review sites."
Lieber writes, "The only solution, then, is to keep populating these sites en masse if you dare and your doctor doesn't seem to be the suing sort, taking care all the while to tell the truth and be fair" (Lieber, New York Times, 3/9).
Sunday, March 11, 2012
Black Holes in Health Care…What Comes out The Other Side
Eric Topol MD calls for the “Creative Destruction of Medicine”
My readers will verify that I am always ‘guessing’ that technology increases the cost of medical care. But not always. Eric Topol readily gives an alternative, and probably viable explanation in most cases.
Certainly many diagnostic advances and procedural advances in surgery which shorten hospital stays, shorten surgical procedures, convert in patient events to outpatient events, and more accurate billing. Hopes for using computers to assess outcomes and new treatments may decrease costs of re-hospitalization, prevent ‘never happen” incidents and reduce errors in prescribing.
He speaks to not only IT advances and emphasizes advances in cancer therapy
“The title simply captures the extraordinary opportunity we have to vastly improve the way we think about and practice medicine. The term “creative destruction” denotes a transformation that accompanies radical innovation. But this transformation is not likely to emanate from the medical community, the traditional way innovation jumps forward. In the current era of social networking, the transformation will likely come from a convergence of technology and consumerism, especially in the cancer space, which offers the most near-term opportunity for positive change.”
This is an extraordinary statement by Eric Topol MD . We all sense the tsunami of changes occuring in health care…reform, financial, information technology, genomics, proteomics,
I have already seen this occuring in social media, with group advocacy circles on Google plus and interpersonal interaction for patients in Google Hangouts, a video conferencing application whereby 10 participants can interact in real time visually, and share documents, videos and background window’s screens.
You will say what about HIPAA and privacy? The folks using this space seem to say,
“Frankly Scarlet, I don’t Give a Damn” People want change and will use the means to accomplish it, and meet their needs. Government, move out of the way or get run over or kicked out. They don’t want more bureaucracy.
By self-organization—there are groups out there already taking the lead with online patient empowerment communities. The people in these communities trust their peers more than their doctors, for one reason, because their peers have like conditions that are discussed freely. <We have already seen the profound impact of social networking in the health space, and it’s just the tip of the iceberg. When people have their personal physiologic metrics and genomics on handheld devices, they’ll band together, and you’ll see a movement that will change medicine.>
With creative destruction, you destroy very expensive methods with marginal benefit. In the United States, we spend $350 billion per year for prescription dugs, and we know at least one-third of that is total waste, offering no benefit or, even worse, inducing serious side effects.
Pharmacogenomics is a perfect way to destroy the old wasteful model of prescribing drugs. It’s very inexpensive to run genotypes, once we have basically cracked the code—knowing the specific variant allele(s)—for each drug.
We have inexpensive ways to drill down to the things that produce good outcomes. For instance, I’m a cardiologist and I don’t have to send a significant proportion of patients to a facility to have a formal echocardiogram, because I have a handheld high-resolution device that’s just as good as the hospital laboratory. Why do we send people to facilities for sleep studies that reimburse at $3,000 per night when the same study could be done in the person’s home for less than $100 and get the same data? (Yes, there are home devices to do it yourself sleep studies.) And insurance will pay for it.
Most physicians are busy already keeping up with journals and advances in medicine, surgery, CME, hospital responsibilities, night and weekend call and the like I call for a new resource….”Digital Health Space”. Digital Health Space will attempt to take over your searches for solutions in software, hardware and technology to solve your problems in managing your office, patients and hospitals.
Saturday, March 10, 2012
THE ROCK & THE HEALTH TRAIN
Several days ago THE ROCK began it’s journey from a dusty rural quarry near Riverside California on it’s way to the LACMA. The trip has been in planning for many years.
It’s journey unexpectedly created a ‘pop culture’ movement as it travelled along surface streets because it is too big to ride on the freeways. Top speed was 8 MPH on the straight-always. Thousands gathered at several points creating spontaneous block parties and cheers.
MAKES YOU WONDER, HOW DID THEY BUILD THE PYRAMIDS ? THIS WAS ONLY ONE ROCK !
Riverside CA can be proud that a piece of ‘The Rock’ will be levitated at the LACMA.
THE ROCK ARRIVES AFTER A WEEK LONG JOURNEY:
Details on how the rock came to be can be found
Levitated Mass by artist Michael Heizer is composed of a 456-foot-long slot constructed on LACMA's campus, over which is placed a 340-ton granite megalith. As with other works by the artist, such as Double Negative (1969), the monumental negative form is key to the experience of the artwork. Heizer conceived of the artwork in 1968, but discovered an appropriate boulder only decades later, in Riverside County, California. At 340 tons, the boulder is one of the largest megaliths moved since ancient times. Taken whole, Levitated Mass speaks to the expanse of art history, from ancient traditions of creating artworks from megalithic stone, to modern forms of abstract geometries and cutting-edge feats of engineering. Frequently asked questions.(PDF | 234kb)