Jaundiced View

Quote of the day:

Nostalgia isn't what it used to be. - Peter De Vries

 

By now most readers who come to my blog realize they "don't always get what you waahnt" (Mick Jaeger), and " you can't get noosaatisfaaction".  You try and you try....but. You probably get my drift here.

When I think about today's medical practice I often drift off into days long gone by, the Doobie Brothers, Chambers Brothers, amongst others.  Perhaps I like the fantasia of it all....much more pleasant than the daily self importance of dealing with absolute garbage in my daily practice.  The good thing is almost all of it is automatic on my part.  My favorite thing is now listening to my patients ,  not so much about their disease state, but about their lives.  I usually can figure out what is going on just by listening to their history. There are large parts of my practice that are mechanistic and technical.  I am constantly amazed at the people living in this small city of about 60,000 just south of Riverside.

1. I have been given several books from patients who detailed their lives in concentration camps, who escaped Hungary in the 1950s during the "Hungarian Revolution".  In California it is fairly easy to start off after your history with a "so where are you from".

Far more interesting than looking at a computer screen is drawing out the patient and his(her) concern and how his disease affects his life, work, hobbies....and his "family".

Although there may be an upside in the transition of digitizing the medical record in an EMR, it will require someone to input data, and checking off boxes does not quite convey history and/or physical findings precisely.

Butterfly Effect

Quote of the day:

You see, wire telegraph is a kind of a very, very long cat. You pull his tail in New York and his head is meowing in Los Angeles. Do you understand this? And radio operates exactly the same way: you send signals here, they receive them there. The only difference is that there is no cat. - Albert Einstein

 

Those of you who are physicists or students of chaos theory know what the butterfly effect is.  This is a theory that someone turning on a fan in Brazil can cause a domino effect which causes a tornado in Kansas. It can be applied to politics, weather-forcasting, and even health care and health care policy. It is the law of unintended consequences......a coconut falling off a tree in Jamaica causing a series of earthquakes in California.

Few forsaw the effect of Medicare introduction in the 1960s and what would cascade forward with the huge growth of senior citizens, increased longevity, decreased birth rates, inflationary booms and recessions.  The necessity of managed care, evolution of integrated healthcare delivery systems to cope with increasing technologies, demand for health care services.  The economic effects of poor reimbursement to primary (used to be called, family doctors, or general practitioners) care providers that would transform primary care in many localities to "triage" offices.

The uptick in consumer directed medicine and internet social networking allows a transfer of heath information among consumers, (patients) prior to physician office visits.  This too is health information exchange, at the grass roots level.

In Health Information Exchanges in relation to medical care

ie, patient goes to doctor, doctor sees patient, doctor treats patient  Besides, say opponents, a computer in the same room situated between a doctor and a patient changes the human chemistry between the two. Some things are best expressed through the head of a pen rather than the click of mouse. Computers are not magical machines. Computers are human too(ls)

Reading Below the first Blog Entry

Like most things , blog readers have short attention spans. How many of you read beyond the first or second entry.

I thought I would summarize a few items that are posted on the left hand side of the blog, or you can read it here. (have I lost you already?)

This blog is meant to "stimulate" discussion about all things regarding health care changes.  I invite readers to comment.

Anyone who would like to write a guest entry may contact me directly at gmlevinmd123@hotmail.com .

You may notice I have a few blog links down the left hand side of my blog.  I rarely have my coffee in the AM without obsessing over Surgeon's Blog, Medinnovation, Panda Bear, Kevin MD, Edwin Leap and at time Health Care Blog. If I am in the mood to be nauseated I will read "Leavitt's Blog"  This is not a personal attack on Michael.....( it has everything to do with our schizophrenic CMS).Michael Leavitt  has had a long and distinguished career as an administrator and  "policy maker".  I also think  he is on our side. (Depending on who "our' is. (I know that is a a broken fragment since my ABC tells me  so, but it sounds nice.

Anyway to get back from my ramble readers are invited (encouraged) to link to my site (please). I need some more hits otherwise my spouse will make me do  more house chores.

The Golden Rule

"He who has the gold, rules"

Consumer Directed Health Care (CDHR) is beginning to make major intrusions and fund IT.  CALPERS is acting on behalf of it's employees by directing it's pension fund to  invest in Health IT. Beyond that they are directing their insurers to do the same, following their lead.  No doubt CALPERS has enormous purchasing power in the market place.!

California Retirement Fund Backs Statewide Health Data Exchange

The California Public Employees' Retirement System -- which serves 1.2 million state and local employees, retirees and dependents -- has endorsed and will support the California Regional Health Information Organization's statewide health information exchange, called CalRHIO, Health Data Management reports.
CalPERS has directed its health insurers -- Anthem Blue Cross, formerly known as Blue Cross of California, Blue Shield of California and Kaiser Permanente -- to negotiate contracts with CalRHIO. CalPERS also plans to work with CalRHIO to ensure the privacy and security of member information as it is transferred over the health data exchange (Health Data Management, 4/24).
"The electronic exchange of health data will lead to increased safety, higher quality and better coordination of care," Rob Feckner, CalPERS Board of Administration president, said (CalPERS press release, 4/23).
CalRHIO is supporting the development of local health exchanges intended to be interoperable and help form a statewide network. CalRHIO's initial project will create a resource in which physicians in high-volume emergency departments will be able to access patient data (Health Data Management, 4/24).

April 24, 2008

HHS Secretary Pushes Transparency, Health Care IT Adoption

At the fifth annual World Health Care Congress in Washington, D.C., on Wednesday, HHS Secretary Mike Leavitt said his agency will continue to drive efforts to increase health information transparency and health IT adoption during the final months of the Bush administration, Healthcare IT News reports.
The Bush administration's value-driven health care plan relies on health IT adoption to record quality measures, as well as to collect and provide cost and quality information to consumers. However, only about 10% of small physician practices have adopted IT applications, Leavitt said.
Leavitt dismissed the idea of waiting for the government to pay for health IT. He noted that Internet adoption is being driven by the market and is not funded by the governme

California Retirement Fund Backs Statewide Health Data Exchange

The California Public Employees' Retirement System -- which serves 1.2 million state and local employees, retirees and dependents -- has endorsed and will support the California Regional Health Information Organization's statewide health information exchange, called CalRHIO, Health Data Management reports.
CalPERS has directed its health insurers -- Anthem Blue Cross, formerly known as Blue Cross of California, Blue Shield of California and Kaiser Permanente -- to negotiate contracts with CalRHIO. CalPERS also plans to work with CalRHIO to ensure the privacy and security of member information as it is transferred over the health data exchange (Health Data Management, 4/24).

"The electronic exchange of health data will lead to increased safety, higher quality and better coordination of care," Rob Feckner, CalPERS Board of Administration president, said (CalPERS press release, 4/23).
CalRHIO is supporting the development of local health exchanges intended to be interoperable and help form a statewide network. CalRHIO's initial project will create a resource in which physicians in high-volume emergency departments will be able to access patient data (Health Data Management, 4/24).

THE SPIN STOPS HERE: Michael Leavittt has the real inside scoop. Another unfunded mandate….

Health Train Express version upgrade

Health Train and it's affiliated VARs, Independent software vendors, all levels of the federal government, state governments, DEA,FDA,CMS,PMS,DOD,IHS, INS,FBI, CIA VA,CINCPAC, CINCUS, BBC, VFW, announce the introduction of  Web 2.1a and Health 2.1a .  We will no longer support ver 2.0 despite the petition signed by one health care provider and 100,000 HIT geeks.  Health 2.1a is not backward compatible with Health 2.0 and users may find that certain drivers of health care (illness, chest pain,rashes, sniffles, and other unknown issues) may not be compatible with Health 2.1a. (see KB article 45983-5098-5092-234953098a)  Please be patient, at times our server is under very heavy load due to sharing space with HALO and Microsoft Live.

We are looking for charitable donations to upgrade our dial up 56K to modern 128 K DSL.  Knowledge base articles include the relevant fine points of the user interface which will make your browsing user friendly and intuitive.

Based upon the "wild enthusiasm" and acceptance of ver 1.0 we are releasing ver 2.1a  as a pre-lease beta without charge. It will be valid for 15 minutes after download. Your authorization and download will allow us to send to you your login ID and Password, which must be ulltrasecure with at least five numbers, 10 letters (in any language) five of which must be in upper case, five in lower case, no more than three vowels and three consonants. Numbers and letters may not be sequential, ie a,b,c

1,2,3  etc.  Exceptions will be allowed for Hebrew, Aramic, Farsi,and your choice of  1.German 2. French 3. Hip-hop.

At this time only Windows ver3.1 is supported  You must file a NEMB and a waiver of exclusion from Medi-cal and assign all your router addresses  to us.

After reading the EULA  please check off if you agree or disagree with the licensing restrictions.  Your identity will be stripped off the data, so that you will not be held responsible.  Notice the "other"  check space if you do not agree with  yes or no. Move the sliding bar with your mouse pointer from 1-10 to rate the strength of your "other".

Future releases and their dates are listed below.

Web 2.1.1.1.1  May 1, 2008

Web 2.1.1.1.2  May 2, 2008

Web 2.1.1.1.3  May 3, 2008

Additional releases will be announced with 2 hours notice.

All  versions will be released as pre-beta

Health care providers will receive priority customer support via telephone (remember we are on Singapore  time) between the hours of 1 AM and 2AM  Monday and Sunday.

Please be certain that you back up all important files and data prior to each upgrade   Health 2.0 and later versions will not be responsible for any data corruptions or transmission of infectious diseases.

Health Train Express disavows any support, repudiation, or poliltical innuendos, lobbying activity, and/or earmarks.

HIMSS VIRTUAL CONFERENCE

 HIMSS VIRTUAL SYMPOSIUM

 

Today I am attending the HIMSS Conference from my easy chair at home.  Otherwise the lack of travel challenges, expense and loss of time away from your primary office (which sometimes are enjoyable as a distraction from the hum-ho drone of daily practice life.

This "Second Life" approach to dissemination of knowledge gives the user a very real appearance of a "symposium" duplicated in a virtual world over the internet, one of the best applications of Web 2.0

Jonathan Bush, CEO  AthenaHealth, gave a very articulate and understandable view of the conundrum that doctors and healthcare face in adopting HIT.  Mr Bush correctly states it is like hitting a moving target that not only changes direction, and  speed, but enters new dimensions.  His  presentation reveals the confusion and stress the health information technology industry faces......he offers the reader the opinion that the government is asking for impossible things now and probably well into the future, the complexity of codes, numerators,denomitators. He points out the fact that the provider cannot even get reliable eligibility information or co-pay amounts at the point of service that are accurate.  There is paper everywhere and he does not feel there will be much less paper very soon. He bemoans the fact that EOBs still arrive in paper form. 

John Hamlaka, CIO,CareGroup, Harvard Medical School

Interoperability  Labs, CCHIT, Roadmap, SNOMED,

Historical development, privacy, HIPAA is not uniform, regional differences for privacy concerns from hospital to hospital.

Security standards must address these differences.

Guidelines 10 rules

AHIC USE CASES ROUNDS

STREET DOC

Jay Parkinson MD practices family medicine and pediatrics in Williamsburg,Brookly, N.Y.  His approach to health information exchange has been to use it to revolutionize medical practice using commonly available software and special proprietary software to increase information to patients that most physicians leave to their staff, at considerable expense. Judging from the comments on his web site, this has produced commentary ranging from "ridiculous" to "way to go Jay"

Young physicians are not thoroughly indoctrinated in the "business of medicine"  They are idealistic and want to transform medical practice.  Some of us "older folks"  (myself excluded) have systems set up that we have become comfortable using, even if they don't work as well as we might think.  It's hard to invest a lifetime of education and practice and at the end realize it no longer works well.  The "younger generation" who I anoint with the term "generation T" (which stands for technology) should be encouraged to innovate. The system will pick and chose what thrives and what fails.  It will be along hard road to overcome entrenched systems.  Universal payor may simplify and further entrench outmoded system.

Dr Parkinson offers the following video excerpt. In the tradition of ER, Nip and Tuck, I like to call this "Street Doc"