Fasten your seatbelt, it’s going to be a bumpy ride, if you can get there at all. If you wish to read Jonathon Rauch’s popular article in National Journal Review, read on…..comparing Airline Travel and Health Care. otherwise watch the video.
Friday, July 8, 2011
A Marxist Turned Libertarian on The Health Train
In preparing for today’s journey on the Health Train my travels took me to a video by Thomas Sowell. Dr. Sowell was born a poor African-American black man (as opposed to a poor white African American (which is a real possibility, although statistically unlikely), whose innate intelligence, drive, and smart choices enabled his gifts. He chose to follow the ideas and the man who mentored him rather than the institutions that brought them together.
Thomas Sowell indicates that his mentor was Milton Friedman, a name well known to those interested in economic theory. Here is the video….it should spark some controversy and lead you to learn more about Mr. Sowell and more important, the simplicity and detail about how Government Medicine works and why it does not work well.
Dr. Sowell’s opinions are at times controversial. (Wikipedia)
Dr Sowell has been a senior fellow at the Hoover Institute of Stanford University (1980-present)
Sowell has been criticized for various remarks such as a comparison he
made between President Barack Obama and Adolf Hitler in an editorial for Investor's Business Daily[26] after the creation of a relief fund for the BP oil spill. This has been criticized by liberal groups such as Media Matters[27] and the Democratic National Committee.[28] However, Republicans such as Sarah Palin[28] and Representative Louie Gohmert[29] have endorsed Sowell's comparison. Sowell was also criticized for an editorial in which he stated that the Democratic Party played the Race card, instigating ethnic divisions and separatism, and argued that a similar situation occurred between the Tutsis and the Hutus in Rwanda.[30][31]Which List Do You Want to be On?
Tweeting has added a new dimension for connecting to others with similar interests. The short 140 character only slightly exceeds my short attention span. I can quickly absorb and scan through tens of ideas between patients, while waiting in the doctor’s lounge to start a surgery, and G-d forbid waiting for an attorney to give a deposition.
A tweet attracted my attention from @MtnMd, ,Founder&Chief Medical Officer of eMedicalMall, technology company serving medical community & patients to improve health care. @ MtnMD also posts a blog,
Sprocket, a compendium of lists divided into categories of credibilty. Sprocket is now added to my followed blogs, I find it useful as a starting point to expand my meager knowledge base of social media stars in medicine.
Medical State of Mind
Medicine has gradually been drawn into a state of mind where legalese and bureaucracy have replaced medical and scientific results. “Evidence based medicine” has surpassed scientific results, or empirical outcomes as the arbiter for treatment choice. Anecdotal clinical opinion has been replaced by ‘hearsay’, and humans are enhanced or even replaced at times by machines.
Evidence Based Medicine can best be graphically modeled by the ‘evidence pyramid’ a term borrowed from the food pyramid:
The pyramid best outlines the progress in medicine, and the addition of 4 new levels of critical analysis of treatments.
Clinical medicine is never stationary,nor should it be, without which there would be no progress.
Has blogging enhanced medical practice? I say yes, and the evidence is the exponential use of the social media, which allow practitioners to share knowledge on a daily basis, not only in science, and clinical practice, but in the management of medical business. It can be accomplished from the office, home, even on the street. The same resources are present almost no matter where you are working.
3D imaging is becoming available which will enhance mobile CT, MRI, and Optical Coherence Tomography and remote telemedical applications.
Nanotechnology is now better understood and wishful ideas about it’s applications are becoming a reality in drug delivery systems, manufacturing of better, stronger and more durable products. These will slowly infiltrate our biomedical devices in the operating room, endoscopic equipment and electronic equipment, including computers.
Physicians and patients alike will have another ‘gee-whiz’ device.
L-R Physician, Patient
Drug Delivery System
Hopefully this new ‘paradigm’ will bear fruit, and not deceive us.
a field manual to fallacies in thinking
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Friday, July 1, 2011
Welcome new Interns and Residents
Another July 1st arrives at the Medical Centers of America. Educated observers remark at the fresh neatly pressed white coats entering the hospital. At the same time these fresh young eager newbies enter there are others exiting, looking a bit scraggly, with facial hair and coats that are a bit yellowish in places.
Most of these new entrants have already accomplished registration, parking lot ID cards for their cards, and obtained personal ID badges, computer access codes, locker keys, and been directed to where their incoming mail is deposited.
Some are already familiar with electronic medical records, while some may not be, however all will have to learn a new EMR system (unless they went to Medical School at this Medical Center)
Some people know better than to be admitted to a teaching facility during July, and certainly not in the first week, certain that new interns and residents will make errors, and forbid, ‘A Never Event’.
Now there will be additional stress and inefficiency as the new house officers struggle taking three times as long to enter data into an EMR as it does to see and care for you, the patient. However I am told, “This is progress”
Many changes have taken place over the 4 decades I have been in clinical medicine. Work hour limitation rules,, Specific competency certification and documentation of procedures and the numbers performed by each trainee, also a bevy of new numbers, NPINs, DEAs,UPINs, Medicare, Medicaid, MD license, and many more.
Most are carrying their own preference for a smart phone..pagers are almost gone, iPads and lightweight notebooks are in. Many are comparing their iPhone apps or Android apps seizing opportunity where it may be.
eMail and Chat are out, Social Media is in. So much in fact that major health centers have developed strict guidelines for the use of Twitter, Facebook and lesser known social networks.
Health Blog Q&A: Mayo Clinic’s New Center for Social Media announced the creation of a Center for Social Media.
Washington University, St. Louis has promulgated Social Media Guidelines
The Wall Street Journal weighs in with advice for tweeting for new medical residents.
The Mayo Clinic’s social media statistics read; Twitter 60,000 followers (paltry compared to Lady Gaga), although their YouTube channel is said to be the most popular medical provider channel. Their Facebook page enumerates over 20,000 connections (or friends)
Mayo Clinic
The Use of Social Media in the Patient Care Environment:
3 commentaries on Social Media Admonitions
del.icio.us Tags: twitter,facebook,tweeps,social media,mayo clinic,cleveland clinic,geisinger,interns,resident physicians,emr,white coat
ACO's and CMS
The Accountable Care Organization is really an accounting mechanism and may have little to do with quality of care, or improving outcomes. Commonly called, “ACO” in health care circles it holds a high place in current opinion and controversy revolving around health reform.
Added to the mix are claims that HIT is an essential component of ACO. Health IT is essential not only to accountable care organizations (ACO) but also healthcare in general, said HIT advocate Kathleen Sebelius, MPA, Secretary of the U.S. Department of Health & Human Services (pictured), at today's Second National Accountable Care Organization Summit in Washington, D.C.
Reactions from organizations and providers have ranged from lukewarm ambivalence to visceral outrage from some of the leading health systems and professional physician associations. CMS is currently reviewing 1,200 comments after it issued the draft rules in March and is expected to take the comments into consideration before issuing a final rule.
Some health systems reacted with letters to HHS with suggestions based upon their own plans and projections for developing integrated health systems. In reviewing many of these projects it becomes apparent that the ACO moniker applies to many forms of integrated health systems. Some have been in development for five or more years.
12 ACO Developments Between Hospitals, Payors and Health Systems
At the same time, some health systems have implemented ACOs of their own design without HHS mandates or guidelines. Some are in different stages of planning and implementation.
The process is gradual and some have utilized their early iteration of integration as a base for further progress for their organizations. That is as it should be. For HHS, CMS or any governmental organization to mandate how this will be done is foolish and probably very wasteful.
One of the barriers to ACOs, organizations and providers have criticized, are the associated start-up costs of implementing such an overhaul of the system for Medicare payments away from fee-for-volume In addition, ACOs present legal challenges in which antitrust laws may prevent market dominance that could be an indirect result of organizational and provider collaboration. In addition, there are challenges in patient notification of ACO participation.
Several large prominent Health Systems, such as the Mayo Clinic, Cleveland Clinic, Geisinger Health System, and Intermountain Health Care have either indicated they will not participate in ACOs or have blasted CMS. Numerous physician groups, the AMA, AMGA, AAFP, and ACP call into question the ability to form ACOs without massive disruption of health care.
The Center for Medicare and Medicaid Services (CMS) has released it's draft rule, 42 CFR Part 425, a proposed ruling in the Fedral Register, Vol 76, No 67/April 7, 2011), not quite as long as the Patient Affordable Care Act (1200 pages) however 127 pages
The current iteration of ACO by HHS is by no means final. Secretary Sibelius acknowledged that the proposed draft was just that, a proposal. CMS is currently reviewing 1,200 comments after it issued the draft rules in March and is expected to take the comments into consideration before issuing a final rule.
Wednesday, June 29, 2011
ePatient Dave is In The Room
Some of us talk about the “elephant in the room’ which everyone knows about but ignores. We also may make the same mistake about the person across from you in the examination room.
Watch this video….Dave deBronkart is not only articulate and entertaining at this TED talk, he has some original ideas about communicating ideas to patients.
Let’s see if Google or some other software can develop this one. If Facebook and twitter are worth so much money, how much would these advances make for our patients.
follow ideas on twitter glevin1 facebook/gmlevin
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