Health & Communications

Gary M. Levin M.D.

Many of the barriers to teaching our patients, care-givers and health professionals have dissolved thanks to the digital age, the internet, mobile applications, and an open door between information technology and medicine at all levels, from practitioners to personal health records, to hospitals, government, data integrators, analytics, biomedical applications, and basic research.  New applications developed to bridge the void between previously unintelligible scientific information (scientists, clinicians) and user friendly software for patients and professionals alike.

Much like the Ronald Reagan era our health system  is tearing  down the walls between ‘east and west’. (providers/caregivers—patients)

Health 2.0 Innovators have developed applications that mine data previously buried in huge data files at HHS, Medicare, CDC, and converted them into legible interactive graphic presentations sorted by regions, diseases, public health statistics, and more.

For Instance: These are some apps which extract data from tables of information into a legible user friendly interface. (click on the link)

In 2010, The National Conference on Health Communication, Marketing, and Media presented multiple video sessions addressing Health Communications

This year on August 9-11, 2011 the conference will again be held in Atlanta Georgia

del.icio.us Tags: health communications,barriers,data analytics,government,health 2.0

Physicians Take Back Your Hospital !

 

Physicians, Take back your Hospitals !

I was listening to Piers Morgan interviewing Jack Welch, former head of General Electric. Jack Welch led General Electric from a $30 billion dollar company to one worth over $130 billion dollars. Watching the interview one thinks, how could he not succeed ?

“An organization's ability to learn, and translate that learning into action rapidly, is the ultimate competitive advantage.”

“Change before you have to. Control your own destiny or someone else will. Face reality as it is, not as it was or as you wish it to be.”
“The Internet is the Viagra of big business”
(Jack Welch’s quotes)

In listening to Jack Welch speak one realized he has the remnants of a slight stutter, a challenge he overcame in due time. One thing for sure, he never stuttered in his vision for General Electric.

Jack’s enthusiasm overflows onto his audience. I was moved by it and wondered how this enthusiasm could be transferred to you and me as physicians.

Jack talks about integrity, something which has eroded in our medical ethics and perhaps the foundation of what our patients admire most in physicians. Patients still trust physicians to accomplish what is most important for them when they come to us in hospitals, clinics and the operating rooms of our hospitals…

What has happened is that too many of us, not out of greed, but necessity have allowed bureaucrats, government and foolish regulations to control our patient’s destinies, and thereby us as doctors. Most physicians are now bogged down with financial survival, having business that must be sustainable. This is true whether we are in private solo practice or a large multi specialty practice. Some think that a large practice insulates them from financial ruin or disaster. This is just not true, although it appears this way in the present phase of growth of overwhelming regulation and intrusion of government bureaucrats and insurance companies..

Creativity is maximized by ‘protected time’ a commodity rare in clinical practice.

Bureaucrats are convinced they know more about outcomes, evidence based medicine, cost containment, telling physicians to practice medicine and let them run the business. During my career I have seen this lead to many disasters.

Today many of our brightest innovators and bright minds are choosing technology industries to make a living. I write a column on technology, and it is apparent the energy is there. Young and old entrepreneurs are dynamic, innovative, daring and have a goal in mind. Our young physicians are turned out, and quickly become burned out, too busy and overwhelmed to energize their own creativity.

Some of our brightest minds go into medicine, only to become disillusioned at the prospect of preferred practice patterns, regimented paradigms to ‘improve outcomes’ when there is little scientific evidence that it works. The results thus far are disappointing, and not tested by time.

I agree that systems are critical to hospital efficiency and safety. Within reason some hospital activities would benefit from business techniques such as sigma six.

How many physician executives demonstrate the enthusiasm exhibited by a Jack Welch or a Donald Trump? Most clinicians are senior when they become executives or management leaders. True creativity for most occurs in late teenage years, and early adulthood. There are some rare older leaders in medicine, however they usually demonstrate this skill at a younger age and are promoted to leadership by staff members as a result of their demonstrated exceptional clinical skills. It is a rare physician that excels in clinical acumen and leadership qualities making for a competent departmental leader. Academic medicine has the distinct advantage of structure and close peer review leading to the correct selection of physician leadership. This is not true in private practice where individualism outweighs collaboration and team spirit.

The paradoxical thing is that most physicians are highly social, and must relate to people of all walks of life, financial means, social setting, and have a better understanding of human nature. It is just not applied other than in a one on one setting, physician to patient and vice-versa.

Jack says, “ Act Quickly”. We must, its almost too late. !

It’s Not Easy Being Right

Justice, and the American Way

The Title of the Post today is a take off from Kermit the Frog, “It’s not easy being Green” (unless you are Al Gore)

There is some good news in the fight for ‘freedom” and opposing laws that are counter to the U.S. Constitution.

ATLANTA (AP) - Judges on a federal appeals court panel on Wednesday repeatedly raised questions about President Barack Obama's health care overhaul, expressing unease with the requirement that virtually all Americans carry health insurance or face penalties.

All three judges on the 11th Circuit Court of Appeals panel questioned whether upholding the landmark law could open the door to Congress adopting other sweeping economic mandates. The panel is made up of two Democratic appointees and one Republican appointee.

During almost three hours of oral arguments, the judges asked pointed questions about the so-called individual mandate, which the federal government says is needed to expand coverage to tens of millions of uninsured Americans. With other challenges to the law before other federal appeals courts, lawyers expect that its fate will ultimately be decided by the U.S. Supreme Court.

Hope ?

del.icio.us Tags: justice,constitution,Affordable care act,Federal appeals court,Atlanta,11th circuit court

Prezi A novel way to present

 

I decided to use a  new presentation application for variety.

 

NHIN-National Health Information Network on Prezi

Where to Go Not to Die (Hospitals)

Thomson Reuters today announced the top 10 Health Care Systems. And there are surprises in the list.

1. Advocate Health Care*  ― Oak Brook, IL

2. Cape Cod Healthcare ― Hyannis, MA

3. Care Group Healthcare System ― Boston, MA

4. Kettering Health Network* ― Dayton, OH
5. Maury Regional Healthcare System ― Columbia, TN

6. Mayo Foundation**  ― Rochester, MN

7. North Shore University Health System ― Evanston, IL

8. OhioHealth* ― Columbus, OH

9. Partners Healthcare ― Boston, MA

10. Spectrum Health** ― Grand Rapids, MI

Health Train’s first observation is that there were three systems in the Boston, MA market, one of which is in a relatively small town on Cape Cod.

Secondly many are in what I consider, smaller markets and finally there were only two systems that has been on the list more than once, and three that have been on it twice. This may be an indication of the effects of outcome studies and penalties for ‘never events’.  Hospitals seem to be paying attention to updated guidelines to ensure patient safety.

Overall Jean Chenoweth, senior VP for Performance Improvement at Thomson Reuters said, 

"To produce consistent, strong performance across multiple hospitals, health system leaders must be providing crystal clear goals and communication as well as the means for staff to execute effectively,"  Chenoweth went on to say, “These systems are positioned well  as we move into the era of health reform”.   The Train is on the move !

The performance of 258 health systems were judged on these metrics:

 

• In-hospital mortality

Medical complications


Patient safety

Average length of stay


30-day mortality rate (post-discharge)

30-day readmission rate (post discharge)

Adherence to clinical standards of care (evidence-based core measures published by the Centers for Medicare and Medicaid Services


Hospital Consumer Assessment of Healthcare Providers and Systems patient survey score (part of a national initiative sponsored by the U.S. Department of Health and Human Services to measure the quality of care in hospitals). 



More details can be found here

del.icio.us Tags: top 100 health systems,thomson reuter,health reform,outcomes,jean chenoweth

Graduation Season in Medicine

 

Here’s a great graduation speech by Zdogg MD who also blogs.

Zdogg raps at  ZDoggMD

I cannot add much to this soliloquy except to say  “Right On”  Remember those days when we were fresh as picked carrots or celery. Ready to overcome all obstacles, then chewed up by life, medicine, and finally our wonderful government.

Mature Physicians May Quit

Mature Physicians May Quit Rather than Recertify

Although many statistics elaborate on how much money physicians earn, these figures, and averages are very distorted.. Averages are very misleading. A few extremely high earners will distort the average. Real statistics including medians, standard deviations, probability factors would reveal the truth about physician earnings.  As overhead continues to rise and reimbursements decline, as well as patient volume being forced to expand Health Train   predicts a rapid decline in physician-surgeon numbers.

Many have already abandoned their private practices and have joined group practices, not only to relieve stress, but also as a transition to a non clinical or even non medical career, using their relatively free time to become educated in business or begin a career in technology, sales, or related biomedical career, consulting for pharma or other medically related business.

Orthopedic surgeon Lee Hieb, M.D., current president of the Association of American Physicians and Surgeons (AAPS), writes that she had to spend time studying theory of joint replacements, which she never does, instead of focusing on spine surgery, her specialty. Then she needed to hire a lawyer because bureaucrats were refusing to allow her to sit for the examination—for lack of a signature sheet on her application.

 

Recertification has become a cottage industry of bureaucrats and testing agencies, dragging with them a few university physicians,” she writes, in the summer 2011 issue of the Journal of American Physicians and Surgeons.

Many physicians are choosing not to recertify. According to the American Board of Internal Medicine, 23 percent of general internists and 40 percent of subspecialists are not renewing their internal medicine certification.

The added requirement of re-certification, while well intentioned, is expensive in it’s own right, and creates loss of income while preparing for the exam and absence from the practice. It is unnecessary and redundant. The addition of unsubstantiated ‘evidence based medicine’ is also ridiculous given the intense study and scientific method of peer reviewed journals in the training process.  Obviously whoever writes these ‘protocols’ is far out of the training loop, and exists in the past by at least a decade.   It should not be in the domain of insurance companies, nor Medicare to set standards when hospital credentialing and medical boards set a standard for medical licensure in each state by requiring documented CME every two years to be eligible for re-licensure. The American Boards were duped into providing these examination without taking these factors into account, rolling over fearing another government agency would take it over. Once again our ‘leaders’ who are mostly academics compromise to appear compliant and cooperative as agents of a government that is out of control.

If these entities want assurance that doctors are up to date let them query state medical licensing agencies, or hospitals. They now  represent consumers, rather than doctors. In California the power and authority have now been given to political figures on our licensing board, in the name of ‘enforcement’, alluding to physician inability to police themselves

In the airline industry who pays for pilot testing and recertification? The airlines. So perhaps hospitals and insurers should do the same for physicians.

Okay I am on the far left (or is it right?)  It really does not matter because I am way out on a limb bringing this up, but I  also know that in the elevator or in the doctor’s lounge, these major annoyance are always discussed by colleagues.

Okay so it may be worthwhile to certify or recertify in skills and newer procedures, but this is in the domain of hospital specialty departments, and is actually served better with peer pressure and education.

I am also getting  suspicious that doctor lounges and elevators are monitored. I know elevators have cameras…why not microphones. I am almost fearful my laptop is monitored with my camera, microphone, and maybe even a key logger….laugh if you will at my pseudo-paranoia, but think about the things that have happened in our dis-belief already.

Physicians & Surgeons alike are retiring early, frustrated, overwhelmed and discouraged, in an environment where physicians are in short supply. While there is an imbalance between numbers of PCPs and Specialists there is no over abundance of specialists. Take a look at wait times to see a specialist….there is your true indicator….not a meaningless misleading ratio.

Common sense must prevail, yet I see no indication that our representatives use common sense (or is it ‘evidence based medicine?) or fathom this simple measure.

del.icio.us Tags: enforcement,continuing medical education,medical boards,AAPS,Doctors Tea Party,PCP,Primary care,Specialty care,mad as hell