Health Train Express

Thursday, May 5, 2016

YaleNews | New technology will allow patients to become partners in research

“In the future we want to conduct research in partnership with people — not as subjects, but as our partners,” said Joanne Waldstreicher, MD, Chief Medical Officer of Johnson & Johnson. “Hugo holds the promise to empower people with their data and will create innumerable opportunities for them to participate in programs and projects that are customized to their interests and needs — and provides opportunities to be part of communities that contribute to knowledge that will help us all.”

The benefits of enabling data to flow more easily extend beyond research. Patients face the same hurdles as researchers in accessing their health information from different health systems. Hugo is designed to enable patients to acquire their data in a single platform for their own use, for example when seeking a second opinion, and increase transparency in health care. It will also allow them to be the carriers of their longitudinal health records.

Researchers at the Yale School of Medicine are launching a novel approach to research that engages people as true partners in science. Using an innovative health information technology platform called Hugo, which was developed in partnership with Yale New Haven Health System, people will be able to acquire their health-related data and use it to participate in studies.

Hugo is a highly secure cloud-based personal health platform that enables people to access their electronic health records (EHRs) from multiple health care systems and synchronize them with a research database. Designed to be user-friendly, it also allows people to contribute information from wearable devices and questionnaires.

“This could be a game changer. Hugo harnesses the very latest in digital health technology and puts patients in the center, making them true research partners,” said Dr. Harlan Krumholz, the Harold H. Hines Jr. Professor of Medicine, director of the Center for Outcomes Research and Evaluation (CORE) at Yale-New Haven Hospital, and a developer of Hugo.

source: Yale News

YaleNews | New technology will allow patients to become partners in research

Wednesday, May 4, 2016

Sandeep Kishore at TEDMED 2012

Tuesday, May 3, 2016

Medical Costs Vary Wildly Around The Country : Shots - Health News

Medical Costs Vary Wildly Around The Country : Shots - Health News : NPR

Monday, May 2, 2016

The Dangerous Patient Safety Delusions of Evidence-Based Medicine

Is common sense being overruled by Evidence Based Medicine ? That is the core argument in this article in The Health Care Blog written by clinicians, they can lead to clinical errors. MICHAEL L. MILLENSON summons Nortin M, Handler M.D. as his muse, stating the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious rors.

No slouch at his own erudite ambivalence about edicts from the National Academy of Medicine, Millenson comes out as highly suspicious and pessimistic about the evidence based medicine cult which appears to have the upper hand, becoming embedded in institutional cement. Some of his reticence results from the seemingly lack of effect of evidence based medicine in parts of North Carolina Perhaps this is a local cultural resistance to centralized federal government edicts and perhaps the exception that proves the rule. The United States is such a large country and has a heterogeneous diverse population both genetically, in socioeconomic strata as well as culturally that one should not be surprised by regional variations.

“The current medical culture is obsessed with perfect replication and avoidance of error. This stemmed from the 1999 alarmist report of the National Academy of Medicine [formerly the Institute of Medicine], entitled “To Err is Human,” in which the absurd conclusion was propagated that more patients died from medical errors than from breast cancer, heart disease and stroke combined; now updated by The National Academy of Medicine’s (formerly the IOM) new white paper on the epidemic of diagnostic error.

Not long after the National Academies published “To Err is Human. Building a safer health system”, a study from the US Veteran’s Administration demonstrated that the preventable hospital deaths due to medical errors was very much “in the eye of the reviewer.”[1]

In a recent post, the renowned neurologist, Martin Samuels, paid homage to the degree to which uncertainties create more than just anxious clinicians, they can lead to clinical errors. That post was followed by another by Paul Levy, a former CEO of a Boston hospital,arguing that the errors can be diminished and the anxieties assuaged if institutions adhered to an efficient, salutary systems approach. Both Dr. Samuels and Mr. Levy anchor their perspective in the 1999 report of Institute of Medicine Report,

Dr. Samuel's post on THCB is similarly worthy for championing the role of the physician in confronting the challenge of doing well by one patient at a time. Mr. Levy and his fellow travelers are convinced they can create settings and algorithms that compensate for the idiosyncrasies of clinical care. I will argue that there is nobility in Dr. Samuels’ quest for clinical excellence. I will further argue that Mr Levy is misled by systems theories that are more appropriate for rendering manufacturing industries profitable than for rendering patient care effective.

Physicians must not be coerced by government guidelines. These metrics are ruled by the least common denominator, and filtered by ta hierarchy of committees.

America has made a tremendous investment in intensive care units. We have many times the ICU beds per capita as any other resource advantaged country, 25 per 100,000 people as compared to 5 per 100,000 in the United Kingdom. Not surprisingly, when we build them we also build the demand, so-called demand elasticity.[2] The indications for admission in America result in a very different case-mix than anywhere else. We need ICU beds for patients with acute or potentially reversible conditions, but do we need them for the frail elderly or the terminally ill? Maybe the error is not so much in their medical treatments as in the lack of appreciation of their humanity.

Credits:

Nortin M. Handler, Michael Millenson,

The Dangerous Patient Safety Delusions of Eminence-Based Medicine | THCB

Tuesday, April 26, 2016

Health Reform Troubles and the Affordable Care Act

We are now several years into the Affordable Care Act. There are now facts and figures which reveal troubling tremors in the financial underpinning of health insurance for all patients. No one will be exempt from these market forces.

Some politicians and President Obama (for whom the ACA was renamed "Obamacare") insist on how many millions of Americans are now insured. Yes, they carry a card, either a blue one with a stripe (Medi-caid) or a private plan. What many of these newly insured do not know is the card they carry from the ACA is not the same that fully paying patients have in their wallets. The term "What' in your wallet" may be applied to health insurance cards as it has been to certain credit cards. The similarities are frightening.

These subsidized plans required providers to sign new contracts with less reimbursement eliminating any incentive to be credentialed for the affordable care act. It required providers to re-program their practises management software to bill different amounts for the ACA and to accept a lower reimbursement for each procedure code.

In some Western states the impact of undocumented workers remains largely unknown. However there are those who want to include the segment of our population. I think these immigrants do need to be protected, and not be excluded from the American health system. We have always been a country that welcomes immigrants and usually assimilate them fairly quickly.

Here is what is building.

ACA News

Will Covered California Sell Health Coverage To The Undocumented?
ObamaCare premiums expected to rise sharply amid insurer losses
United’s Departure From Marketplaces Could Impact Consumers’ Costs, Access

United HealthCare has absorbed multiple other companies during the past two years, to insulate itself from competition and have full reign over the market for insurance plans. These mergers include or will include the following competitors.

United HealthCare and Humana to Merge - PR Newswire

Wikinvest lists these UHG mergers and acquisitions and divestitures in the past ten years

This includes former independent health insurers, Oxford, Pacificare,Mid Atlantic Medical Services Inc.,Definity Health Corporation (Definity).Uniprise USS, Exante

United Health Group has several other companies in their sights Humana and Aetna. Anthem also
has eyes on Humana and Aetna is bidding on Cigna. As the old baseball adage goes (So who's on first?)

Readers can see more..........

The changes will impact consumers in different states, according to market share and other factor such as the amount of care to patients with long standing expensive chronic disease, more advanced because of neglect in the group of the uninsurables. The impact of lifestyle becomes a significant issue for some states where poor nutritional habits affect health and the development of chronic illness, diabetes, obesity, hypertension, the effects of depression, unemployment, environmental hazards. Social change and erosion of the middle class will impact health as well.

The longstanding organization of employee based health care is disappearing, and group policies are re-organizing.

Wall Street is ablaze with speculation and the huge increase in share value for many of these companies.

Fortune's headline proclaims,

UnitedHealth-Aetna colossus would overtake Apple on the Fortune 500.
As things develop eventually there may only be several players in the health insurance
market....."too big to fail". Uncle Sam steps in when all is lost.......and there you have it "UNIVERSAL PAYER" Who wudda thot ?
So where do patients and providers fit in?
Parts of this article are from Fortune, and reporting from the California Medical Association.

Planning for the Next Generation of Health Care Delivery: Designing for Telemedicine Spaces – Telehealth and Medicine Today ™

Sunday, April 24, 2016

F.A.S.T. Are you at Risk for a Stroke

I have had many illnesses, including heart disease and a mild stroke. I went through open heart surgery and several angioplasties for heart disease.

On a scale of dread, heart disease was about a 2 on a scale of 1 to 5. The idea of a stroke was a 6 in my mind, and when it happened quite suddenly, while I was asleep i had an acute anxiety attack.

When I awoke I realized there was something amiss in my non-dominant right hand, it was numb. In the past I would at times awaken and have one of my hands tingling or numb which I attributed to a cervical disk problem.(one of my cervical disks bulges,and I have had a surgery on my lower back for a ruptured intervertebral disk) However this did not go away even with stretching my neck. Try as I might my right arm and hand refused to obey my commands.

I am fortunate. The symptoms and signs diminished quickly over a period of two weeks. I was left with some residual balance and gait disorder, for which I have learned to compensate.

The best way to treat a stroke is to not have one. I ignored a serious and common factor for stroke risk. Snoring and sleep apnea, both of which are successfully treated. It is listed as a risk factor, but is overshadowed by cholesterol issues, hypertension, and diabetes. I ignored my spouses warnings about my snoring and periods of sleep apnea. Sleep apnea occurs when there is total airway obstruction from snoring. Patients are unaware of these episodes but whoever sleeps with or near them will hear a gasp and see the victim roll over or moan.

Sleep apnea or severe snoring should be characterized as an urgent medical problem. There are tests to easily diagnose the problems, and even an at home testing device, which screens for sleep apnea. A formal sleep apnea test in a sleep lab is still necessary. It's a small price to pay, sleeping away from home for a night, however it is a small price as compared to paralysis

I share this as an admonition for this month' preventive measure as well as weight reduction, a healthy diet, and exercise.

AUT researchers have developed an app to calculate stroke risk factors. Available on both iOS & Android platforms, the Stroke Riskometer App was selected by leading doctors as a top health app for 2014 from 100,000+ apps available. It is available on iTunes and Google Play Store.It is endorsed by the WSO (World Stroke Organization

Remember !

	Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven?
	Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
	Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." I s the sentence repeated correctly?
	Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you'll know when the first symptoms appeared. This is critical for medical personnel to know if blood thinners will be effective in treating the stroke.