Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer |

It would seem common sense when you pick a doctor that is listed in a provider list for an insurance company, his hospital would also be in the plan?

Zoe Friedland and her husband, Bert Kaufman, are expecting their first child. (Courtesy of Bert Kaufman)

Not so according to this from California Healthline.

Insurance giant Cigna and San Francisco-based Dignity Health have failed to ink a 2020 contract, leaving nearly 17,000 patients in California and Nevada scrambling to find new health care providers. Meanwhile, Dignity faces financial and legal challenges while it strives to implement its merger with Catholic Health Initiatives, which created one of the nation’s largest Catholic hospital systems.

“With so many unpredictable things that can happen with a pregnancy, I wanted someone I could trust,” Friedland said. That person also had to be in the health insurance network of Cigna, the insurer that covers Friedland through her husband’s employer.

Friedland found an OB-GYN she liked, who told her that she delivered only at Sequoia Hospital in Redwood City, California, a part of San Francisco-based Dignity Health. Friedland and her husband, Bert Kaufman, live in Menlo Park, about 5 miles from the hospital, so that was not a problem for them — until Dec. 12.

That’s the day Friedland and Kaufman received a letter from Cigna informing them their care at Sequoia might not be covered after Jan. 1. The insurance company had not signed a contract for 2020 with the hospital operator, which meant Sequoia and many other Dignity medical facilities around the state would no longer be in Cigna’s network in the new year.

Suddenly, it looked as if having their first baby at Sequoia could cost Friedland and Kaufman tens of thousands of dollars. “I was honestly shocked that this could even happen because it hadn’t entered my mind as a possibility,” Friedland said.

This is not an uncommon occurrence. Even if patients are aware of a possible conflict there is often a disconnect between printed materials and reality. In fact, most plans have a statement stating patients should call providers and hospitals to be certain they still honor your plan. In an age when patient-centric health care is promoted, the system often fails miserably.  You are paying a premium, however, contracts place the full burden on you, the patient. 

In this particular case at the beginning of a New Year confusion can reign as computer systems can lag.  Normally plans require 3 mos notice from providers and vice-versa to indicate a change in coverage. Not knowing the particulars in this instance, whether the couple had just obtained this coverage or it had already been in effect.  It is difficult to assign blame for this incident. Certainly, the patient's best interests were not served.  Every state has it's own regulatory mechanism that polices insurers.  This couple should report the incident to that department. Usually the Health Insurance Commissioner or the Department of Health and Human Services.

She and her husband are among an estimated 16,600 people caught in a financial dispute between two gigantic health care companies. Cigna is one of the largest health insurance companies in the nation, and Dignity Health has 31 hospitals in California, as well as seven in Arizona and three in Nevada. The contract fight affects Dignity’s California and Nevada hospitals, but not the ones in Arizona.

“The problem is the price,” Cigna said in a statement just before the old contract expired on Dec. 31. “Dignity thinks that Cigna customers should pay substantially more than what is normal in the region, and we think that’s just wrong.”

Tammy Wilcox, a senior vice president at Dignity, said, “At a time when many nonprofit community hospitals are struggling, Cigna is making billions of dollars in profits each year. Yet Cigna is demanding that it pay local hospitals even less.”

In 2018, the most recent full year for which earnings data is available, Cigna generated an operating income of $3.6 billion on revenue of approximately $48 billion. Dignity Health reported an operating income of $529 million on revenue of $14.2 billion in its 2018 fiscal year.

It’s possible Cigna and Dignity can still reach an agreement. Both sides said they will keep trying, though no talks are scheduled.

If you want to read more about how this turned out,  read the reference (spoiler alert: Cigna backed down)

While the push for universal payer will be uppermost in mind for voters, this type of problem may not go away.






Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer | California Healthline:

What’s on your citrus fruit? Trump’s EPA fights to keep controversial in...

. WHAT IS CHLORPYRIFOS AND HOW IS IT USED?

Chlorpyrifos is an inexpensive and effective pesticide that has been on the market since 1965. Farmers across the U.S. use millions of pounds of it each year on a wide range of crops, including many different vegetables, corn, soybeans, cotton and fruit and nut trees.


Like other organophosphate insecticides, chlorpyrifos is designed to kill insects by blocking an enzyme called acetylcholinesterase. This enzyme normally breaks down acetylcholine, a chemical that the body uses to transmit nerve impulses. Blocking the enzyme causes insects to have convulsions and die. All organophosphate insecticides are also toxic and potentially lethal to humans.

Until 2000, chlorpyrifos was also used in homes for pest control. It was banned for indoor use after passage of the 1996 Food Quality Protection Act, which required additional protection of children’s health. Residues left after indoor use was quite high, and toddlers who crawled on the floor and put their hands in their mouth were found to be at risk of poisoning.

 Citrus groves have been infiltrated by residential housing.  Large citrus groves such as this one now have large residential developments. In Southern California, most commercial citrus operations have moved elsewhere.

The Central Valley of California is now where most commercial groves operate.



Despite the ban on household use and the fact that chlorpyrifos doesn’t linger in the body, over 75% of people in the U.S. still have traces of chlorpyrifos in their bodies, mostly due to residues on food. Higher exposures have been documented in farm workers and people who live or work near agricultural fields.





 WHAT’S THE EVIDENCE THAT CHLORPYRIFOS IS HARMFUL

Researchers published the first study linking chlorpyrifos to potential developmental harm in children in 2003. They found that higher levels of a chlorpyrifos metabolite – a substance that’s produced when the body breaks down the pesticide – in umbilical cord blood were significantly associated with smaller infant birth weight and length.


Subsequent studies published between 2006 and 2014 showed that those same infants had developmental delays that persisted into childhood, with lower scores on standard tests of development and changes that researchers could see on MRI scans of the children’s brains. Scientists also discovered that a genetic subtype of a common metabolic enzyme in pregnant women increased the likelihood that their children would experience neurodevelopmental delays.

These findings touched off a battle to protect children from chlorpyrifos. Some scientists were skeptical of results from epidemiological studies that followed the children of pregnant women with greater or lesser levels of chlorpyrifos in their urine or cord blood and looked for adverse effects.

Epidemiological studies can provide powerful evidence that something is harmful, but results can also be muddled by gaps in information about the timing and level of exposures. They also can be complicated by exposures to other substances through diet, personal habits, homes, communities, and workplaces.

A katydid which often invades citrus groves.






3. WHY DID IT TAKE SO LONG TO REACH A CONCLUSION?

As evidence accumulated that low levels of chlorpyrifos were probably toxic in humans, regulatory scientists at the U.S. EPA and in California reviewed it – but they took very different paths.

At first, both groups focused on the established toxicity mechanism: acetylcholinesterase inhibition. They reasoned that preventing significant disruption of this key enzyme would protect people from other neurological effects.

Scientists working under contract for Dow Chemical, which manufactured chlorpyrifos, published a complex model in 2014 that could estimate how much of the pesticide a person would have to consume or inhale to trigger acetylcholinesterase inhibition. But some of their equations were based on data from as few as six healthy adults who had swallowed capsules of chlorpyrifos during experiments in the 1970s and early 1980s – a method that now would be considered unethical.

California scientists questioned whether risk assessments based on the Dow-funded model adequately accounted for uncertainty and human variability. They also wondered whether acetylcholinesterase inhibition was really the most sensitive biological effect.

In 2016 the U.S. EPA released a reassessment of chlorpyrifos’s potential health effects that took a different approach. It focused on epidemiological studies published from 2003 through 2014 at Columbia University that found developmental impacts in children exposed to chlorpyrifos. The Columbia researchers analyzed chlorpyrifos levels in the mothers’ cord blood at birth, and the EPA attempted to back-calculate how much chlorpyrifos they might have been exposed to throughout pregnancy.

On the basis of this analysis, the Obama administration concluded that chlorpyrifos could not be safely used and should be banned. However, the Trump administration reversed this decision in 2017, arguing that the science was not resolved and more study was needed.

For their part, California regulators struggled to reconcile these disparate results. As they saw it, the epidemiological studies and the acetylcholinesterase model pointed in different directions, and both had significant challenges.

4. WHAT CONVINCED CALIFORNIA TO IMPOSE A BAN?

Three new papers on prenatal exposures to chlorpyrifos, published in 2017 and 2018, broke the logjam. These were independent studies, conducted in rats, that evaluated subtle effects on learning and development.

The results were consistent and clear: Chlorpyrifos caused decreased learning, hyperactivity and anxiety in rat pups at doses lower than those that affected acetylcholinesterase. And these studies clearly quantified doses to the rats, so there was no uncertainty about their exposure levels during pregnancy. The results were eerily similar to effects seen in human epidemiological studies, vindicating health concerns about chlorpyrifos.

California reassessed chlorpyrifos using these new studies. Regulators concluded that the pesticide posed significant risks that could not be mitigated – especially among people who lived near agricultural fields where it was used. In October 2019, the state announced that under an enforceable agreement with manufacturers, all sales of chlorpyrifos to California growers would end by Feb. 6, 2020, and growers would not be allowed to possess or use it after Dec. 31, 2020.

Hawaii has already banned chlorpyrifos, and New York state is phasing it out. Other states are also considering action.

5. WHAT’S THE U.S. EPA’S VIEW?

In a July 2019 statement, the EPA asserted that “claims regarding neurodevelopmental toxicity must be denied because they are not supported by valid, complete, and reliable evidence.” The agency indicated that it would continue to review the evidence and planned to make a decision by 2021.

EPA did not mention the animal studies published in 2017 and 2018, but it legally must include them in its new assessment. When it does so, I believe EPA leaders will have great difficulty making a case that chlorpyrifos is safe.

In my view, we have consistent scientific evidence that chlorpyrifos threatens children’s neurological development. We know what this pesticide does to people, and it is time to move to safer alternatives.

At a time when the EPA has been politicized and with a concurrent effort to downsize government (promised by President Trump), important. scientific information has been disregarded by the feds. Fortunately for Californians, this is not so.

A Cultural Disconnect

It's not often when my relatively off the grid town of Riverside becomes a focal point for national news.  Riverside, California is known for its former glory for citrus, smog, and other current attractions such as The Mission Inn, Lunar Festival, Festival of Lights (Mission Inn), and a new UCR School of Medicine, now has become a focal interest for Wuhan's Corona Virus.

Flashback ten or more years ago when the former March Air Force Base was in operation.  It was a major Strategic Air Command location. In those days in the 1950s and 60s, there was a ready alert squadron parked their with dark and looming B 52 Stratofortress bombers and their pilots poised at the southern end of the 13000-foot runway ready to be launched at a moment's notice.

Their daily practice sessions could not be missed with the roar of engines and a trail of smoky engine exhausts.

What a difference, this week 195 souls arrived from the consul in Wahun, China.  There was no fanfare, and there was no rumbling noise heard.  Jet engine technology is much quieter and fuel-efficient.  No one would have known about it, but not for the internet.

Riverside may be known now for the repatriation of our diplomats from China, or it may be known as the entry point for Corona Virus.  Hopefully, the quarantine will be successful.  Although I just hear about an attempted escape from the March Air Reserve Gulag.

I missed seeing the arrival of the chartered Boeing 747,  even though I am able to see departing aircraft (FEDEX, C117s, and occasionally Air Force One. MARB, as it is now known, has been proposed for many things, a medical destination, housing for the homeless. For a time it was a haven for developers.

Most people had no awareness of this once in a lifetime event.  I have not witnessed an outbreak of facial masks, other than the ones some people wear to void off bad air.

So it is now time to segway to the Cultural Disconnect.

LOS ANGELES — Several staff members of a small community health clinic in L.A.’s historic Chinatown spoke on the phone with patients Tuesday while wearing face masks that muffled their voices.

The masks are a recent phenomenon at the clinic, located inside the Chinatown Service Center, a nonprofit community assistance organization that serves mainly Chinese immigrants.

Staffers showed up for work wearing the masks Monday, a day after public health officials confirmed the first two California cases of the new coronavirus, in Los Angeles and Orange counties, said Dr. Felix Aguilar, the clinic’s chief medical officer.

 Bright-yellow warning signs instruct patients to tell staff immediately if they have just traveled out of the U.S. and are experiencing cough or fever or are having trouble breathing. (Anna Almendrala/California Healthline)

At the Chinatown Service Center medical clinic in downtown Los Angeles, which serves predominantly Chinese immigrant patients, administrative staff wore medical face masks after local health officials confirmed the presence of two cases of the novel coronavirus in Los Angeles and Orange counties. (Anna Almendrala/California Healthline)

As China grapples with the growing coronavirus outbreak, Chinese people in the Los Angeles area — home to the third-largest Chinese immigrant population in the United States — are encountering a cultural disconnect as they brace for a possible spread of the virus in their adopted homeland. 

 The use of face masks is common in China, to protect against both germs and pollution. But when Chinese immigrants wear them in the U.S., it often conflicts with guidance from officials, who warn that they offer minimal protection and could lull wearers into a false sense of security. It can also draw suspicious gazes from passersby.

“In the U.S., if you’ve got a mask, people will sort of look at you like you’re doing something unusual, whereas in Asia it’s fairly common to do this, and people don’t give it a second thought,” said Dr. Bryant Lin, co-director of the Center for Asian Health Research and Education at the Stanford University School of Medicine.

Alhambra Unified School District in Los Angeles County, where a significant proportion of students are from Mandarin-speaking families, is getting a lot of pushback against school rules that ban face masks for students, said Toby Gilbert, a spokesperson for the district.

“There is no evidence that the mask-wearing in a school setting does anything but create fear,” Gilbert said. “It keeps people from remembering that the primary defense is hand-washing.”

The Los Angeles County Office of Education, which encompasses 80 school districts, notes that the U.S. Centers for Disease Control and Prevention and the L.A. County Department of Public Health do not recommend the use of masks for preventive purposes. It reiterates the view of the county health department that there is “no immediate threat to the general public and no special precautions are required.”

Nonetheless, local stores have run out of masks.

As a final welcome to Riverside, I offer you a bag of oranges and grapefruit.

https://tinyurl.com/v8uwn5d

Chronic Disease Management, A better Way

The management of chronic health conditions such as prevention, obesity, diabetes, and hypertension creates a burden upon health care providers. There are now the means to have better monitoring by non-physicians. Access to monitoring and decision-makers are augmented by several offerings.

One example follows:

Integrated Chronic Care Platforms have transformed disease management and prevention, replacing episodic care with combination therapy of smart connected devices, AI learning, and expert coaching. This digital care model helps payors and large employers lower costs and improve member and employee health.

• Health data monitoring from smart, connected health devices.
• Translation of health readings into insights to make healthy habits and behaviors last.
• A digital health company with outcomes in all of diabetes, hypertension, and prediabetes.
• Scalable care with seamless deployment and enrollment that integrates and doesn't silo.

Chronic disease management takes place in the home, and workplace, requiring a mobile platform (smartphone). Employer-based systems enable employees to access their management programs.  The employer may choose to offer this support to employees as a benefit added to the value of health insurance.

An ideal platform would integrate the employee, employer, and health care provider(s) for chronic disease management.

Help Health Plans and Employers

Prevent and Better Manage Chronic Conditions.

The change from FFS (fee for service) to APM (alternative payment model) requires demonstrated improved outcomes and the use of preventive measures for chronic illness to be proactive rather than waiting for bad outcomes. These new AI-driven programs offer that ability without direct healthcare provider involvement, leading to considerable time and cost-savings

These programs for prevention can be integrated with genetic programs, such as 

23andME

Rather, by integrating information from 23andMe into Lark’s proven and peer-reviewed AI coaching programs for diabetes prevention and weight loss, there is simply an added layer of personalization for customers. The integration uses information from a number of reports already available to 23andMe customers. Those include 23andMe’s reports on Genetic Weight, Saturated Fat and Weight, Lactose Intolerance, Caffeine Consumption, Deep Sleep, Sleep Movement, Bitter Taste and Sweet v. Salty Preference.

Cautionary Note

Here’s the breakdown on the Lark Apps:

• The Wellness Program will tap into data from the 23andMe genetic reports, and the A.I. coach will focus on suggestions around nutrition, sleep, and exercise. The program can also seamlessly merge data from more than 70 other types of monitors or apps to incorporate that information that in turn can improve the personalization of the A.I. recommendations. To integrate Lark’s Wellness Program and use it with your 23andMe results, it will cost $19.99 a month. There is now a special introductory offer of just $14.99 per month.
• The CDC-recognized Diabetes Prevention Program is a yearlong program meant to lower the risk of developing type 2 diabetes. This program includes specialized coaching, a digital scale, and a Fitbit, and some insurance providers cover it. You can find out if you are eligible by downloading  Lark and taking a survey. For those who do not qualify for insurance coverage, they can still self-pay for the Diabetes Prevention Program. The price for this self-pay option includes a digital scale but not a Fitbit.

COMPARING THE 3 TOP CONSUMER GENETIC ANALYSIS PROGRAMS

The above illustration is but one example of what will be developed in the next several years.  Given the relative shortage of   primary care physicians treating both acute illness and chronic management the development of similar digital AI aids will be cost effective, especially in the era of APM

A New Definition for Hypertension

Categories of Blood Pressure

A new analysis shows no harm in diastolic blood pressure higher than 80 mmHg, but 2017 AHA/ACC guidelines could cause millions to be considered hypertensive and possibly treated inappropriately, authors assert.

Isolated diastolic hypertension is now more prevalent, owing to the definition of hypertension used in the most recent US blood pressure guidelines, but the condition does not appear to be associated with increased risk for cardiovascular outcomes, a new study suggests.

The findings and recommendations are controversial. 

Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes

Importance  In the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, the definition of hypertension was lowered from blood pressure (BP) of greater than or equal to 140/90 to greater than or equal to 130/80 mm Hg. The new diastolic BP threshold of 80 mm Hg was recommended based on expert opinion and changes the definition of isolated diastolic hypertension (IDH). 

McEvoy, who is professor of preventive cardiology at the National University of Ireland, Galway, added: "Our data suggest there is no harm of having a diastolic pressure above 80 mmHg if the systolic is below 130 mmHg and that the new 80 mmHg diastolic threshold means that 12 million adults in the US will be labeled as hypertensive but will not benefit from the diagnosis and may be given unnecessary treatment."

The recommendation to lower the diastolic threshold for hypertension from 90 mmHg to 80 mmHg was based on expert opinion, not on trial data. This change has major implications with respect to isolated diastolic hypertension, now defined as a systolic blood pressure <130 mmHg with a diastolic pressure ≥80 mmHg, the authors write.

McEvoy said he is a strong proponent of the new 130 mmHg threshold for systolic pressure. "But the lowering of the diastolic threshold from 90 to 80 was just based on expert opinion. There is no solid evidence behind this recommendation. Our data suggest there is no harm of having a diastolic over 80, and I do not believe it is appropriate to use diastolic pressure for defining hypertension and treatment targets."

Controversy Now Moves to New Diastolic BP Threshold:

HOW DOES YOUR DOCTOR TRAVEL TO EMERGENCIES ?

Does Medical Specialty Determine Speeding Drivers?  Your will be surprised about the worst offenders. 

According to US research, psychiatrists are more likely to speed when driving to a medical emergency than surgeons and obstetricians. Also cardiologists are more likely to drive flashier cars (41% of all cardiologists) while General Practitioners (GPs) are the least likely speciality to be in a luxury car when booked (20%).

Researchers at the Harvard Medical School in Boston, analysed the speeding tickets issued to 5372 doctors and 19,639 non-doctors in Florida from 2004-17 to determine whether fast driving, luxury car ownership and leniency by police officers differed among medical specialities.

They hypothesised that rates of extreme speeding would vary across specialties, owing to underlying personalities and specific professional requirements. “For example, physicians in some specialties may exhibit thrill-seeking behaviour, whereas physicians in certain specialties such as obstetrics and surgery might be called from home to attend medical emergencies”, they said.

However, they found specialists had broadly similar speeding patterns below extreme speeding levels, traveling an average 24km/h over the limit.

The team found psychiatrists had the highest rate (31% of all psychiatrists booked) of extreme speeding, categorised as more than 32km/h over the speed limit. This is a “behaviour that based on prior research cannot be explained by wanting to get to the golf course in a hurry,” they wrote in the BMJ.

Overall, more than one-quarter of doctors given a speeding ticket were clocked extreme speeding.

“The need-for-speed record belonged to a general internist, who drove at nearly 113km/h above the limit”, they reported.

Further, they found doctors can expect little special treatment from police with rates of ‘speed discounting’, a practice that lessens the offence, similar between specialties and between doctors and the public.

But female doctors did score fewer tickets (18%) despite making up one-third of the workforce.

Also recently it was found that certain car manufacturers appeal to physicians across the age spectrum. Toyota topped the preference list at 20%, followed by Honda (15%) [2].

Are you a speedster, road demon or hoon?

Ref:  SERMO

How Digital Health Technology Can Help Manage The Coronavirus Outbreak

Modern Epidemiology has had the benefit of computer modeling of epidemics, which forecast the development of epidemics and pandemics.

Chinese health authorities say an outbreak of a pneumonia-like illness has sickened 305 people and killed five”...   There are many similarities between the current outbreak to the SARS one from its geolocation to its spread to the viruses themselves. 

However, much has changed within the 17-year gap between those two pandemics. For one, technology in the healthcare sector has known an exponential boom. New technologies that were nonexistent or poorly developed in 2003 are now more affordable and widespread and can help manage and even prevent such cases. Let’s see how this can be the case.

Electron Microscopy of Intracellular Corona Virus

A.I. to detect the spread of an epidemic

At the beginning of the SARS outbreak, China covered up the existence of the virus from both its citizens and the world. Even if China seems to have become more transparent in those matters, some might still not be convinced. To circumvent those trust issues, artificial intelligence can be a solution.

Toronto-based health monitoring A.I. platform Bluedot beat both the WHO and the CDC to the punch when issuing warnings about the Wuhan virus’s spread. It even correctly predicted the virus’s likely path from Wuhan to Tokyo after its initial appearance. Bluedot calls itself “a digital health company that uses big data analytics to track and anticipate the spread of the world's most dangerous infectious diseases”. By going through piles of information about news reports, airline data, and reports of animal disease outbreaks, Bluedot’s algorithm can identify a trend which is then analyzed by epidemiologists. The company then shares the information with its clients.

Source: Products :

Interactive maps for monitoring

The Center for Systems Science and Engineering at Johns Hopkins University developed an online dashboard to visualize and track the reported cases on a daily timescale. They also made the complete set of data downloadable as a google sheet. The map shows new cases, confirmed deaths, and recoveries.  The data they use to visualize this is collected from various sources including WHO, CDC, China CDC, NHC and DXY, a Chinese website that aggregates NHC and local CCDC situation reports in near real-time, providing more current regional case estimates than the national level reporting organizations are capable of and is thus used for all the mainland China cases reported in the dashboard.  U.S. cases are taken from the U.S. CDC, and all other country case data is taken from the corresponding regional health departments. The dashboard is intended to provide the public with an understanding of the outbreak situation as it unfolds, with transparent data sources. 

Other new technology can be integrated with machine learning and epidemiology. 

New tech for faster detection

As we’ve mentioned in the introduction, technology has dramatically evolved since the days of the SARS virus. For the current coronavirus outbreak, the culprit was identified within a week of the public announcement and the first diagnostic test was developed shortly after that. “Back then, it took days to sequence,” Georgetown University infectious diseases physician Daniel Lucey who worked on SARS in 2003 said. “Now, it can take hours.” Thanks to technological progress, scientists don’t need to cultivate a sufficient amount of viruses before examining them anymore. Minute amounts of viral DNA can be detected directly from a patient’s spit or blood sample.

Another company based in Singapore, Veredus Laboratories, is working on a portable Lab-on-Chip detection kit that is expected to be commercially available as soon as this February 1st. With faster and portable detection solutions, identifying infected individuals for proper medical care will also be quicker by medical teams on the ground, especially when hospitals are overcrowded.

Genome sequencing to find potential vaccines

The Wuhan virus’ genome was completely sequenced by Chinese scientists in less than a month since the first case was detected. Since the first sequencing was done, almost two dozen more have been completed. In comparison, the SARS virus outbreak started around the end of 2002 and its complete genome was only available in April 2003. This is again thanks to advances in technology and a drive for international collaboration. Richard Ebright, a biologist at Rutgers University, told Stat News that those genome sequences “will be crucially important for the development of diagnostics [and] vaccines”.

Indeed, the Coalition for Epidemic Preparedness Innovations (CEPI) has supported pharma companies with millions in funding so as to have a vaccine against the virus ready for human testing in just 16 weeks, a process that normally takes years. With such an ambitious aim, the genome sequences will prove to be very valuable. As we will be able to sequence pathogens’ genome quicker with evolving technology, the rate of finding adequate therapies will also speed up and help save more lives in the process.

Robots to the rescue

As it has been determined that the 2019-nCoV virus can spread from human to human, medical staff are at high risk of being infected. However, impervious to cross-infection are medical robots. These can be real game-changers in cases of viral outbreaks.

We’ve seen one such case already in the U.S. where man, diagnosed with the Wuhan coronavirus, is being treated by a robot. The latter allows physicians to communicate with the patient via a screen and it is also equipped with a stethoscope, helping doctors take the man’s vitals while minimizing exposure to the staff. True, it won’t be possible in a jam-packed hospital in China with hundreds of such patients but with time quarantined patients could be better monitored with the help of robots.

No alt text provided for this image

Source: https://edition.cnn.com/

Going further, drones for medical deliveries could also be deployed in similar settings so as to reach quarantined zones like Wuhan currently is with medicines and/or supplies. 

One of the first things to decrease the spread of epidemic illnesses such as SARS or Corona Virus is containment, isolation or quarantine. The movement of personnel and supplies can be replaced by drones or other automated delivery systems.

In any case, the management and prevention of such situations will largely rely on professionals and international collaboration. With the help of technology, containment and eventual treatment of outbreaks can be run more smoothly.  

 #themedicalfuturist #digitalhealth #future #healthcare #medicine #technology #fromchancetochoice #wuhanvirus #coronavirus #epidemics #wuhan

 How Digital Health Technology Can Help Manage The Coronavirus Outbreak 

ARE YOU A STEM CELL TOURIST ?

Stem cell tourism is a term recently coined to describe a growing practice among patients to pay large sums of money to private clinics for often unproven stem cell therapies. Patients can be desperate because conventional medicine has failed to provide a solution for their particular condition. For diseases affecting children, emotions may run particularly high: the children themselves cannot make properly informed decisions, so parents face the additional conflict of wanting the best for them while, at the same time, having to protect them from undue risk. Advertisements for these clinics, often outside the patient’s own country, claim that stem cell treatment can benefit or cure complaints ranging from diabetes, stroke, paralysis caused by spinal cord injury, cerebral palsy, and Lou Gehrig’s disease (ALS), to wrinkles in the skin and age-related hair loss in men.

Potential Risks of Stem Cell Therapies
Uta Kunter, Jürgen Floege, in Regenerative Nephrology, 2011

Stem cell therapies are very likely to have a major impact on regenerative medicine, but for them to succeed we need to be aware of their specific challenges to avoid setbacks as experienced in the first gene therapy trials. In stem cell therapies, just as in gene therapy, malignancies are a major concern. Other concerns relate to contamination of cell preparations and unwanted formation of ectopic tissue (maldifferentiation), but also to the validity of experimental results, e.g. stem cell markers and heterogeneity of stem cell preparations. Consequently, this chapter will address both the medical safety aspects of stem cell therapies and the scientific safety of stem cell-related data. In reflection of the current literature on stem cell therapies in nephrology, the main focus here is on mesenchymal stem cells (MSCs) and other adult bone marrow preparations. However, with rapid developments in the field, safety aspects concerning stem cells other than MSCs may gain importance in the near future and therefore will be mentioned throughout this chapter.

Although there is some progress using stem cells (MSC) in animals, human clinical research has many ethical issues. Questions have arisen about the safety of stem cell transplantation.  There are those who are against 'letting the genie out of the bottle". Concerns regarding maldifferentiation, cancer, and ectopic tumor development have been raised. The Federal government banned the use of Federal money to fund research with HESCs (Human embryonic stem cells)
Ethical concerns included the definition of human life and the pluripotent nature of embryonic stem cells.

There are no FDA guidelines regarding stem cell usage. Neither have there been any documented regulations as to the preparation, indications, side effects, dosing, adverse reactions.  The typical label which accompanies all FDA approved medications provide that type of information for medications you purchase at your pharmacy.

Currently, the only stem cell therapies approved by the FDA use cells from bone marrow or cord blood to treat cancers of the blood and bone marrow. But doctors in the Cell Surgical Network have moved ahead with using cells for autoimmune, neurologic, and other serious conditions.

If you are interested in the current network of private and commercial stem cell doctors or clinics refer to the Cell Surgical Network. Health Train Express advises extreme caution in choosing this option.  Many of these stem cell doctors are no longer offering this treatment as a result of a court action with a permanent injunction regarding these sources of stem cell treatments. There is also a monograph by Dr. Elliottt Lander and Dr. Mark Berman on the history of Stem Cell treatments along with several anecdotal stories.

FDA Regulation of Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P's) Product List

If readers wish to learn more and read peer-reviewed scientific articles can be found at PubMed or Google Scholar

Important HIPAA Update: New Penalties - Clinics get $85,000 Fines for NOT Releasing Data to Patients

Important HIPAA updates can have a far-reaching impact. Learn how to stay compliant. 

Yes Virginia HIPAA defines what is secret and confidential and also what must be transparent to the patient.  It is their data!

Everyone thinks of HIPAA as a security lock-down law, and indeed it is: a major part of HIPAA regulations is about the data holder’s responsibility to be careful with it. There have been huge penalties for allowing data leaks.  

Fewer people realize that HIPAA regulations have also always included a “right of access” - here’s that page on the HHS website. It means that patients are allowed to request copies of their records, and providers must comply. This has always been true, but there’s an important change: in 2019, the government settled its first two major cases (with big fines) where a patient asked for their data and the provider dragged its feet.

The right of access has never been enforced. But that has changed.

How would you like an $85,000 fine? Plus a year-long corrective plan?  That’s what Korunda Medical (in Florida) agreed to in December. It’s also what Bayfront Medical settled for in September. For deeper information about both settlements, see this blog post by Deven McGraw, who many believe is the world’s leading HIPAA authority. Her company Ciitizen’s scorecard project showed that half of the providers were in violation.

Each $85,000 fine was for a single violation - a single (but persistent) failure to honor one patient’s legal request.

If they ask for it by email, you must deliver it by email

Another commonly misunderstood issue is whether a patient can request that their information be delivered by email. Commonly, providers (even their HIPAA compliance people) refuse to do this, because ordinary email is unsecured and hackable. But if the patient requests it by email, the provider must comply.

This is so widely misunderstood that it’s now on a Frequently Asked Questions page. Here’s a screen capture Dec 17 from HIPAA FAQ #570, on the Office for Civil Rights website: 

You’re not allowed to say “Regardless of the law, we don’t do that.”

Unfortunately, if the law says you have to do it, you’re not allowed to have a “policy” that says “not me.” That’s like saying “My policy is that I do get to steal your car.”

The community created a Google Doc containing those screen captures and a slew of additional information: bit.ly/HIPAAemail with links to the above and numerous other details. 

Be informed. Stay out of trouble. Save money.

You can imagine that in both of those cases that ended with $85,000 fines, the provider incurred far greater costs in the months of dealing with investigators, not to mention the impact on their reputation in the local community of all the resulting news coverage. 

Avoiding this is straightforward - not necessarily trivial, but not complicated: know the law. Study HIPAA’s “right of access,” look at the links in that google doc, and do the right thing. It’s a lot easier than coping with the consequences of getting caught. And it’s the right thing to do for the patients.

Want to know more about HIPAA and other regulations in relation to patient communication? Read our free guide, "Become a Text and Email Compliance Guru."

Learn how to become a text and email compliance Guru

HIPAA Update: New Penalties - Clinics get $85,000 Fines for NOT Releasing Data to Patients: