Dying in the 21st Century

 

Most of us will die in the Twenty-First Century

I happened to  run across this TEDxNewy 2011 (Newcastle, AU). Not only are we on a health train express we are all on the way to the end of the line.

Paul Saul

Peter Saul is Senior Intensivist in the adult and pediatric ICU at John Hunter Hospital, and Director of Intensive Care at Newcastle Private Hospital. Having trained in Cambridge, London, Sydney and Harvard, he came to Newcastle to help start up the new ICU at John Hunter, and never left. He has been accused of being an "ethicist", which he tries to deny, but does admit to having been Head of Discipline for Medical Ethics at Newcastle University in the past, and now provides ethical advice to the State and Federal health departments. Having been deeply involved in the dying process of over 4000 patients in the past 35 years, Peter has taken an interest in how we die, and how this has changed beyond all recognition in a single generation.

Paul Saul relates in a study of over 4000 patients medical records, only 1% had any documentation about how the patient wanted to die or the end of life treatment they desired. This leaves health professionals and sometimes family or guardians in a quandary as to when and if to stop life support.  Think about this, if 99 people out of a hundred don’t leave instructions their care can be extended significantly. The economics may be staggering since ‘end of life’ care is the most expensive, spent in intensive care units.

How we die lives on in the minds of all who survive us. Stress increases seven fold by dying in intensive care units. In the U.S. one in five will die in intensive care, in Miami three out of five, and in Australia one in ten.”

Comment: from Tonya Roberts:

“The key point is that we're not having conversations around our impending deaths, for reasons of fear predominantly. As a rule, we can assume that most of us don't want to die and not before we have to. It's a fine line b/w delaying death and prolonging life. Don't throw out the whole talk b/c of the euthanasia element. I felt the missed opportunity for the funded 'conversations' keenly - like with many cultural shifts, this one may need to happen at a political level first.

Least frequent, sudden death is rare now, increasing frailty and disability are now the most frequent means of dying.

Intensive care units may be misconstrued as ‘life-saving’  when they are ‘life extending’.

Saul goes on further to say that a continuous dialogue is needed to elevate awareness of choice on dying. If the dialogue ceases the awareness decreases rapidly.

People may need to use the political process to make the entire process patient and family centered rather than ‘medicalized’  This is also fraught with fear and resistance as demonstrated in the Patient Affordability and Care Bill, when fierce emotional reactions resulted yielding the term “Death Board”. This ‘split type’ of analysis does not serve patients or families well. Death cannot be codified by society.

Dame Cicely Saunders, the founder of the hospice movement made these remarks,

“You matter because you are you

And you matter to

The last moment of

Your life”

 

Technorati Tags: TedxNewy 2011,Paul Saul,Euthenasia

The Many Platforms of Social Media in Healthcare

 

Social media in health care began with the formation of a number of interactive web sites, including SERMO, and iMedXchange some time ago.  SERMO and iMedXchange are more formal, and almost a peer reviewed forum requiring authorization and proof of a medical license. They cover subjects organized by specialty category and have business management and policy reform categories.

One could also include the many ‘listserv’ forums as social media, although not immediately interactive it functioned as a ready solution for communications. Chat rooms came into existence in the form of mIRC, AOL messenger, MSN messenger, and other chats in Facebook, and Skype

If today’ s most popular social media is considered, Facebook, Twitter, MySpace, Tumbler, and Foursquare come to mind.

Google + is relatively new, beginning in July 2011, and not yet one year old. Despite the fact that Facebook is the most popular platform and twitter is heavily used, Google launched Google + and a videoconferencing capability for ten users simultaneously. For the uninitiated Google + is somewhat more cumbersome and technically  challenging for new users.

Each social media platform has its own set of strengths and weaknesses differing in  linking friends and messaging. One major factor is the extent of privacy settings, and who can see your posts.

Initialling designed for short texting (as in Twitter) and ‘friending’ as in Facebook iSocial media has grown into a marketing tool for business purposes in  and enhancing visibility and search engine ranking.

A recent study has revealed an increase in physician use of social media for both for personal and professional use.  Personal use far exceeds the professional ;use of social media, however the trend is changing as professionals become more familiar and standards for it’s use are  promulgated by medical societies.

 

source:  PowerDMSuite

In setting standards the medical organizations give implicit approval for the use of social media with emphasis on protecting patient confidentiality and privacy.  And many health organizations recognize the strength of social media as it relates to direct patient relationships and as a means of increasing their visibility in cyberspace advertising their hospital and meetings and centers of excellence.

Google abandoned it’s Google Health Record due to lack of interest on the part of patients, lack of a support base with EMRs and a nervousness on the part of health providers as to the security and privacy of patient’s EHRs

Google + with their new social media platform has expressed a direct interest in supporting advocacy and support applications for disabled people, and for professional use. They have already developed special screen readers for use in chat rooms and on Google hangouts for visually impaired patients.

We have had some success in early development of “Blind Veterans Help Desk” as part of the Veterans Workshop.  This non-profit organization will facilitate the use of Google technology so that deaf veterans and blind veterans can assist each other and also facilitate caregivers improving communications and assistance to patients requiring support and/or in home health service. Google hangouts may reduce the frequency of at home visits by visiting nurses, or post hospitalization.  In my opinion the potential is endless.

We will be announcing a mechanism for interested parties to contribute to veterans wellness through the Veterans Workshop

We expect an announcement and demonstration around Memorial Day of this year.

Technorati Tags: veterans today,veterans workshop,non profit,google plus,google,deaf,blind veterans,deaf veterans,sermo,imedxchange,facebook,twitter,myspace

If Health Care Reform Falls, Look in the Mirror

 

 

Karen Dolan is a fellow at the independent Institute for Policy Studies and Director of the Cities for Peace and Cities for Progress projects there. She specializes in domestic economic inequality issues.

At times those sitting dispassionately at the sidelines see much more than we do, those who are immersed in a chaotic system, and are attempting to salvage what we use on a daily basis.

Hypothetically we all want the same, an improved health system with benefits for all,  but are fearful of the unknown even if the present system is untenable.

In her Huffington Post Blog,

“Supporters of Obama's health care reform are "keeping a stiff upper lip" reports The Hill as reaction to three tough days of oral argument and questioning on aspects of President Obama's Affordable Care Act (ACA)."

“The entire health reform effort seems to hang in balance, dangerously. It looks like a very real possibility that Americans who do and will need health care, and who do or will have health conditions -- i.e., pretty much everyone -- will again be excluded from coverage for pre-existing conditions and others priced out of coverage at alarming rates if the unusually conservative and ideological Supreme Court backs the GOP”

It didn't have to be this way. We had the power to make things different. In fact, we still have the power to make things different.

“As poorly as the administration calculated, strategized, composed and communicated their reforms, they did what Administrations do. They brought industry to the table, they excluded single payer advocates, they vastly overestimated their ability to bring the other side on board, they vastly underestimated the extreme ideology that opposed reform and they botched the messaging of all of it.”

“Candidate Barack Obama campaigned on universal coverage. He told would-be supporters that, if he were "starting from scratch," single-payer would be ideal. Indeed, he even understood that the only true reform, that would sufficiently control costs and actually achieve universal coverage, was a single payer, government-sponsored health care system. The evidence is overwhelming that only such a system can achieve those goals.”

Of course this smacks of downright socialism, yet we already have a large segment of the population using socialized funding for healthcare (seniors, disabled, children in poverty.

President Barack Obama however, not only quickly abandoned any thought of a fight for a true universal system, he set his left flank where he wanted to end up: the public option.(VIDEO Robert Reich).   In addition to current private plans, geographical regions would have another choice, a "public option" which would have the power of the federal government behind it to negotiate down premiums.

But progressives did fight for the public option. With some notable exceptions, almost exclusively. Instead of being the rallying grassroots campaign and reasonable solution desired by all progressives, universal, single-payer health care became the pariah of the organized progressives, scoffed at and scorned as unachievable.

The administration should have allowed it, encouraged it, engaged it, used it. Progressives should have fought like hell for it.

“So, while progressives, Democrats, Americans who want affordable health care for all of us go forward wringing our hands and "keeping a stiff upper lip," blaming the misinformed conservative ideologues in Congress, in the Supreme Court, in Tea Party get-ups, perhaps we should take a long look in the mirror.”

If we had ended up with a single-payer system, then of course the "individual mandate problem" is non-existent. Even if we had ended up with a "public option," we would not have had this the question before the Supreme Court this spring. Justice Kennedy himself suggested so in his comments that the Individual Mandate problem could be avoided by a tax funded single payer national health service.

“This is a fight for the most basic value a society can have. Will we care for our people or let them become sick, bankrupt, disabled and die unnecessarily because we failed to fight for an affordable quality health care system that covers everyone. Will we slash every other government program virtually out of existence to fund an ever-escalating for-profit insurance system? Isn't it time to fight for Medicare for all?”

(GML)  It’s time to cut our losses, and not travel down a doomed path guaranteed to fail miserably at building a system that will keep us healthy. Perhaps we should not call it ‘health insurance’.  That system has not functioned effectively for many years.”

 

Technorati Tags: justice kennedy,universal payer,karen dolan,affordable care act

Twitter Melts down covering Three Rounder at SCOTUS may be a Technical Knockout

 

News reports seem to be biased towards a favorable decision for the plaintiff (28 states, and AAPS.

The participants are licking their wounds and the states appear optimistic about a decision.

The defendants’ counsel came out of his corner of the court ring stumbling and staggering as he was unable to make the first jab. A quick glass of water from his corner energized him a bit.

SCOTUS will have more than two months to decide a ‘winner’  Health Train Express proclaims that it will be a split decision with one vote carrying the prevailing party. I am making no predictions. Either side will lose no matter the decision. The costs will be measurable for administrative cost, insurance company losses, and the delay in  planning and implementing a good plan should Obamacare, or parts of it be negated.

The larger issue, as to the legal severability of Obamacare may be the deciding punch in the contest.

In Supreme court matters this is the most frequent outcome…all the way to the end.

The Three Round Contest went something like this:

Medicaid expansion issue

Severability Issue

Individual Mandate Issue

Anti-Injunction Act Issue

The details are forthcoming here:

The Decision Expected by June 2012

 

Technorati Tags: supreme court,scotus,obamacare,severability,mandate,medicaid

Inland Empire Health Information Exchange

Inland Empire Health Information Exchange will “Go Live” April 1, 2012.

The Inland Empire Health Information Exchange (IEHIE) is a collaborative of Riverside and San Bernardino County hospitals, medical centers, medical groups, clinics, IPAs, physician practices, health plans, public health and other healthcare providers. IEHIE brings needed technology to access and securely share electronic patient health records for more than 4.1 million people living in the Inland Empire. The IEHIE gives healthcare providers immediate access to a state-of-the-art electronic health records network. IEHIE technology allows doctors, clinics, hospitals and other healthcare providers to electronically review and access medical records, resulting in timely, safer and improved quality of healthcare for the patients in our community.

With that announcement the real purpose and mission begins.

Physicians, provider groups and hospitals are all at different stages of implementing eHR.

Many providers also are using practice management software and focused software solutions already implemented for practice workflow.

The health information exchange means nothing without proper use by providers.  It is perhaps the last link in the workflow equation, but may present it’s usefulness at the first patient encounter with the provider who requires historical information about a patient, or a laboratory result.

Not all health information exchanges are created equal nor do they provide identical information. HIE is not something that is delivered in a 'black box' and is just plugged in.

Similar to planning for an electronic medical record, it will be important to assess a workflow of a practice to determine where the HIE fits. It may have several applications at different segments of your workflow....pre-visit, admissions, laboratory portal and others.

Anticipate that your HIE may not deliver all that you expect initially. Each component of the EMR and medical record requires interoperability to exchange information, and each type of data set uses different standards.

The standards have been designed by the NHIN so that any NIST certified electronic medical record should work with the IHIE. Meaningful use requires that your EMR communicate with the IHIE.

The Inland Empire Health Information Exchange can also be utilized by providers who do not yet use an EMR by using the WEBportal for laboratory, imaging, and patient identifiers. Patient identifiers can be assigned, such as diagnosis, immunization and others

Inland Empire EHR Related Links & Resources: (RESOURCE CENTER)

Electronic Health Records Desk Reference 

Eligibility Crosswalk

IEEHRC's Meaningful Use (Stage 1) Reporting Guide

Health IT Tutorials for Physician Practices

 

The key to choosing an EMR or eRX platform is studying workflow to determine how and which EMR will serve  you best.

Technorati Tags: emr,hie,workflow planning,nhin,interoperatility,meaningful use,health it tutorials,rec

Geriatrics Health App is Already Here

Longevity Studies have shown people who are married and/or have significant others live a healthier and longer life. 

Social media and Google plus Hangouts offer a special tool to empower social media participants, healthcare providers and staff to establish a significant other partnership with seniors who are alone, widowed, divorced, and/or childless.

 

Even when well, socialization, having a meal together virtually, can enhance and improve quality of life for the elderly.

Visit a senior center, nursing home, assisted living facility and train personel for this activity. The benefits will be amazing….both for patients, families who are distant from their loved ones, and you.  Put a face on your social media activity with Google plus hangouts, Facebook video and/or Skype.

Top Geriatric Social Media Sites

Geriatric Social Media  Hashtags  #

Social media opens social world to elderly, disabled

Technorati Tags: geriatric,elderly,social media paradigm,disabled,socially isolated

Excerpts from Monday's Supreme Court arguments

 

over whether legal challenges to President Barack Obama's health care law are premature under the Anti-Injunction Act, which bars lawsuits against a tax until after the tax is paid:

Solicitor General Donald Verrilli: This case presents issues of great moment and the Anti-Injunction Act does not bar the Court's consideration of those issues.

Donald Verrilli

 

Robert A. Long:  (amicus curae, friend of the court)

Somewhat to my surprise, "tax" is not defined anywhere in the Internal Revenue Code.

Justice Sonia Sotomayor:

Assuming we find that this is not jurisdictional, what is the parade of horribles that you see occurring if we call this a mandatory claim processing rule? What kinds of cases do you imagine that courts will reach?

Justice Antonin Scalia:

If it's not jurisdictional, what's going to happen is you are going to have an intelligent federal court deciding whether you are going to make an exception. And there will be no parade of horribles because all federal courts are intelligent.

Justice Stephen Breyer: What we want to do is get money from these people. Most of them get the money by buying the insurance and that will help pay. But if they don't, they are going to pay this penalty, and that will help, too.

Justice Samuel Alito: Today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax. Has the Court ever held that something that is a tax for purposes of the taxing power under the Constitution is not a tax under the Anti-Injunction Act?

Verrilli: No, Justice Alito, but the Court has held in the license tax cases that something can be a constitutional exercise of the taxing power whether or not it is called a tax. And that's because the nature of the inquiry that we will conduct tomorrow is different from the nature of the inquiry that we will conduct today. Tomorrow the question is whether Congress has the authority under the taxing power to enact it and the form of words doesn't have a dispositive effect on that analysis. Today we are construing statutory text where the precise choice of words does have a dispositive effect on the analysis.

All food for thought for every physician, and American

 

Technorati Tags: verrilli,scotus,obamacare,alito,breyer,robert long,scalia

Health Reform Updates

 

Monday  The Day At the Supreme Court

Will your line at the doctor’s office exceed the line at the Supreme Court on Monday?

Legal challenges to the Affordable Care Act finally come to the Supreme Court on Monday, when the public will learn for the first time what the justices ask about President Barack Obama's signature legislative achievement.

1200 pages and endless discord and argument now Does it all come down to two attorneys? 

As US solicitor general, Donald Verrilli is representing the Obama administration and will argue that the court should affirm the constitutionality of the ACA.

Washington lawyer Paul Clement is no stranger to the podium at the nation's highest court. To date he has argued 55 cases before the justices. He is representing Florida and 25 other states in their challenge to the constitutionality of the ACA's individual mandate.

As the high court begins three days of oral arguments over the constitutionality of the Affordable Care Act — the sweeping health care overhaul some call Obamacare — many legal and political experts agree the decision in HHS v. Florida will be among the most important in American history

*********************************************************

Premium Support in Medicare

Two Success Stories For Public Reporting Of Provider Performance Information

Why doctors aren’t prescribing health apps to patients

Study: Small medical offices lead in EHR adoption growth

U.S. leads many nations in health IT 

 

Patients recognize quality and security benefits of EMRs

The need for health IT workers is growing

We’ll expand further on these topics later this week.

Technorati Tags: affordable care act,supreme court,health reform,constitution,Paul Clement,Don Verrilli,ehr,health it,medicare

The New Social Media Paradigm in Medicine

Our patients are our allies in the pursuit of health and wellness.  This is no longer a euphemism. We have seen the onset of the new age….patient-centric medicine, the medical home, open access to information, even patient participation in medical meetings.

The twitter health care social media hashtag, use it to be heard.

Many others can be found here

Today, courtesy of Medpage Today, The American College of Cardiology broadcast a live webinar on heart disease.  The premise of the course was that, Patients who "see” their diseased arteries are more likely to lose weight and follow other ’heart-healthy’ advice. Graphic visualizations and angiography demonstrate changes from atherosclerosis and hyperlipidemia.   The topics included Late Breaking News from Clinical Trials of Stem Cells. (Texas Heart Institute), and analysis of Coronary Artery Calcium focused on patient compliance for achieving weight loss. Other topics included

The most successful physicians are the ones that accommodate those patients who are interested in bringing information to their visits.  Most of our patients are curious about their health and how we practice our art. Even if we are rushed for time it pays to receive their information openly and consider it for a patient by telling them you will need time to review the information and then respond with an answer. This does not have to occur during the visit.  This positive reaffirmation to a patient that their material will be reviewed is a powerful tool for patient awareness and compliance with anticipated treatments. Furthermore it builds confidence and expands the informed consent process for treatment protocols and/or surgical procedures.  The additional resources of references from the internet, library reference sources, and prepared brochures on commonly seen diseases should be made available for your patients.

Email attachments or twitter links sent to a patient can deliver the message when they arrive home or on the next day, saving office time, your time and staff time.

Technorati Tags: #hcsm,health social media,telemedicine,medpage today,cardiology,social media paradigm,twitter,hashtags

A Moronic Social Media Post on Health Train

(not meant to be a serious blog post)

The following discussions are ongoing in The Club Car. No jacket, tie or fee required for admission

Will Social Media help repeal Obama Care? 

Can Social Media reduce deficits, or save the Medicare trust fund?

Will your next health insurer be Facebook? Google? or Twitter?  It may be so.

Even now some companies have targeted their web presence linked to a Facebook.com/name url address as they position themselves for page rank in Google’s new algorithm.  The shear volume of traffic on Facebook makes it a ‘gateway’ landing page.  The sheer industrial size of Facebook’s servers would benefit anyone wanting to host their company’s web pages (gratis)  Just slip a link to re-direct a one line landing page over to your Facebook name page.

 

Check our formula for the answer:

Everyone wants your

 

One of the most well-known and effective copywriting formulas is the AIDA methodology. AIDA stands for Attention, Interest, Desire and Action. To write compelling copy, you should attract Attention, arouse Interest, stimulate Desire and present a call to Action. As marketing changes in the online world, I’ve found it more effective to change one component of the formula — Interest. Of course, you absolutely want your reader interested in your copy. But in online marketing, if you’ve done your job on the first step — Attention — by writing a killer headline that has gotten your reader to click on your article or scroll down to read more, you’ve already piqued their interest. Now what you should do to really sell or convince is show an Advantage.

The Ultimate D.I.Y. Repair toolkit :  Available Online from Amazon.com

What has any of the above have to do with Health Train Express? Just testing headlines and content for AIDA, which  stands for Attention, Interest, Desire and Action

Technorati Tags: aida,attention,interest,desire,action,health train express,robotic hands,do it yourself,facebook,google,twitter

<img src="http://cdn.shopify.com/s/files/1/0053/8772/files/The_Holstee_Manifesto.jpeg?105904" width="960" class="alwaysThinglink"/><script src="http://www.thinglink.com/jse/embed.js#190477988448436224"></script>

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.

Dr. Mesko has sixteen icons on the landing page, each a rich source for social media, bloggers, wikis, and stories about Google.

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.

 

Technorati Tags: bertalan mesko,health wiki,blogger,webcina,prezi,pearltrees,slideshare,google presentation,healthcare,learning

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.

Technorati Tags: insurance exchange,california,uninsured,patient care and affordability act