Thursday, May 12, 2011

The Walking Gallery (of Patients)

 

I just had to take a break from the endless list of challenges in health care and reform, to let you know about a friend of mine.

I think you will enjoy linking up with some of these interesting events, and also to her blog and website. 

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Regina Holliday caught my eye about a year ago when she appeared at a medical meeting.  She was standing in an obscured dark corner in the back of the meeting hall, painting away.

I found her tweet address @reginaholliday  and began tweeting with her.  Like me, I think you will find her commentary about health care and some of the inexcusable gaffs that some physicians make during patient encounters. The commentary is always accompanied by a “Holliday Painting”, poignant and a visual sensation to the observer. 

Regina, forgive me for bragging about you…..you deserve it for your patient advocacy and talent.

The Scarlet Letter         The Walking Gallery        The Cake is a Lie

"The Menu Set"

Give Us Our Damned Data!

Sunday, May 8, 2011

What’s In A Name ?

 

Pharma  has undergone tremendous changes. From a physician perspective we see cost to our patients as a large issue, as well as the length of time for FDA approval for new drugs. Another issue is sales rep access to physicians and the ever present perception of reps buying our business with luncheons, meetings and other inducements.

Hidden behind the scenes is the number of mergers, acquisitions and consolidations in the pharmacy industry, paralleling consolidations of hospitals an health plans.

 

Many innovative transformative companies have been absorbed by larger entities once it is realized the profitability is marginal and their venture capitalist backers have maximized their investments. It is also reflective of the huge cost of bringing a new compound to market. In many cases the investment is lost on a promising drug that fails in clinical trials.

  Say goodbye to many of our favorite bottle labels.

Among these companies whose logos .have changed are:  Sanofi-Aventis, Genzyme, Synthelabo, Schering-Plough, Warner-Lambert, Pharmacia, and Wyeth…..all now part of Pfizer.  Welcome and Beecham, great drug companies, now lost somewhere in GlaxoSmithKline. Biotech names like Genentech, Immunex and Imclone vanished, too.

Much of this may have been due to “collateral damage” of the 2008 market crash, investment bank fiasco such as Lehman Brothers, Merrill Lynch, Fannie Mae, and AIG.   We should all be happy the taxpayer did not have to bail out Pharma. But wait….that is coming with ObamaCare.

Tuesday, May 3, 2011

Inland Empire Health Information Exchange

 

SBCMS presents the EHR Best Practices Series

For those of you who have been reading the writings here at Health Train back in 2005 when it began (as the Inland Empire RHIO) the formation of a RHIO, specifically the Inland Empire Regional Health Information Exchange.   Riverside Health February 24, 2005 will take you to the initial blog about the RHIO. Health Train (then called the Inland Empire RHIO) published several times a month as a newsletter. You can follow the stream to see how It evolved and functioned as a conduit for information for those working on RHIOs across the country. As interest lagged after several years, the name changed to Health Train  Express to more accurately describe it’s content. (little did I know I was a pioneer in Social Media Networking).  Most people back in 2005 did not know what was blogging.

Despite a small group’s interest in establishing a RHIO, and several meetings the plan lay dormant for several years. The early meetings were more educational than productive about the HIE envisioned.

Years  passed by and about 18 months ago the project arose once again, this time named the Inland Empire Health Information Exchange Collaborative which began serious work on governance, and building a sustainable business model, and a consensus for a project management. Consultants were contracted, Many more scheduled meetings were held, and hospitals and stakeholders invested considerable funding. A financial plan developed and annual subscriptions to the IHIE were offered.    With this foundation the project began in earnest.

The development of the IHIE parallels HIE development across the United States in the manner forecast by the ONC for a NHIN, beginning in 2004 and initially funded by executive order of President George W. Bush. Bush appointed David Brailer MD, who at that time was the head of the Santa Barbara RHIO (extinct).

Early on there were many failures, not because of lack of interest, but due to lack of a proven sustainable business model and confidence that such a project would come to fruition. Much has been learned from the early failure and observations of the many failure of RHIO across the country, and the  recent successes are in no small manner the results of those frustrations.

During the ensuing years vendor interest developed and technical solutions matured.

This month the IHIE will meet to select a vendor to deliver the technical back end of the IHIE.

This is very  encouraging.  Despite physician reservations about EMRs and  HIEs the effort will progress and hopefully will improve work and health  for physicians and patients alike.

Important Players in the Journey: The Medical Societies have been and continue to be very supportive in administrative matters and a physical setting for meetings and conferences.

Riverside County Medical Association

San Bernardino County Medical Society

Gary Levin MD

Sunday, April 24, 2011

Social Media Backfire

Alright, you caved in and decided to give SM a try. You decreased your schedule by one hour a day to work on it.  What’s the difference? You are already operating at 25% less efficiency since your EMR went live three months ago. You have been tweeting, face booking, and are now following about 1000 tweeters. You look at the number of your followers…..what? 45? Must be some kind of mistake.

Any physician into social media, (or anyone for that matter) needs to get feedback along the way, and there are several routes to accomplishing this without investing huge amounts of time.

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Social Media Examiner is a great place to start your investigations. SME is a good introduction to the subject of analyzing the responses to your social media efforts. It also sets out a plan and specific applications to utilize in your quest for the million followers.

I’m not going to waste your time and mine expounding on it here. Just click on the links and you can read it for yourself.  This is not rocket science, and it is not medical school....no more spoon feeding from Health Train Express. Explore new Universes, go where no HMO has gone before, follow William Shatner to Priceline.

Politicians and Physicians

"The New Health Law: Bad for Doctors, Awful for Patients."

                                               

Writing this particular edition has been gratifying for two reasons.

1. I took the time to research and  read the material I have linked for you  and to watch these videos, expanding my knowledge base for discussing these issues with colleagues, patients, and congressional representatives.  Our representatives are often give limited, few and inadequate choices by advisors who are self-appointed experts.

2. I enjoyed organizing my thoughts about PPCA and health reform. Admittedly it is overwhelming, too grandiose, and most likely unobtainable for many reasons, and is a subject in itself which I hope to expand upon in another blog.

Take some time to read the links, and watch the videos. There is more here than one can absorb in one sitting, and no busy practicing physician has the time to dedicate to this subject, yet to not do so would be akin to a diabetic not taking their insulin…..

The Galen Institute and Docs4PatientCare are  strong proponents for a rational health reform plan based on rational, carefully thought out measures to reduce cost in health care cost,  and to maintain the atmosphere of patient-physician trust. The Galen Institute sponsored a forum in Washington D.C. during which Rep. Tom Price, MD spoke.

 

  Jason Fodeman, MD has written  a series of  papers   regarding PPACA.at Townhall.com . Jason D. Fodeman, M.D. is an Internal Medicine Resident at UCONN and a former graduate health policy fellow at the Heritage Foundation  where he studied the etiology of rising health care costs. His … read more

The Heritage Foundation

Founded in 1973, The Heritage Foundation is a research and educational institution—a think tank—whose mission is to formulate and promote conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense.

The New Health Law: Bad for Doctors, Awful for Patients

 

The More Things Change..

 

Obama Care on the Front Lines

 

Rep. Tom Price, MD,   gives opening remarks at the Galen Institute/Docs4PatientCare event entitled "The New Health Law: Bad for Doctors, Awful for Patients." Other videos are available.

Hal Scherz and Jason Fodeman

Rep. Tom Price, MD  U.S. House of Representatives

Jason Fodeman, MD

Hal Scherz

Richard Armstrong—PPCA cannot be repaired, it must be repealed.

Saturday, April 23, 2011

Aurora

 

I found this video to be enchanting. I hope you will enjoy it as well.

The Aurora from Terje Sorgjerd on Vimeo.

Tuesday, April 19, 2011

Fueling Medical Social Media in the Real World Today

 

Where do patients turn to for health information?

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from: Pew Research Center’s Internet & American Life Project

Hospitals and University Social Media Sites:

Johns Hopkins Medicine

Mayo Clinic

Cleveland Clinic

Henry Ford Health Systems

The University of Maryland Medical Center Index

The Online Social Media Governance Guide

The Online Social Media Governance Guide- Hospitals and Health Care

The Social Media Management Handbook

Dual Citizenship for Social Media

 

Words of Caution:

 

An article in the Annals of Internal Medicine, for April 19 Ideas and Opinions section, physicians Arash Mostaghimi, MD, MPA and Bradley H. Crotty, MD call attention to the challenges created by the expanded use of Internet tools by physicians to reach patients at work, while simultaneously using the same tools to keep in touch with friends and family in their personal lives.

Any and all physicians who use social media for private and professional work need to realize the ‘blur’ that these internet creates in segregating personal from public information. Search engines usually ignore this and cannot compartmentalize private vs. public issues.

“This online presence presents a host of challenges for physicians including the demand to “proactively review and maintain their digital lives,” and also the need to create boundaries that both protect the doctor-patient relationship and help prevent awkward moments such as fielding a friend request from a patient.

“Unlike previous advances in communication, such as the telephone and e-mail, the inherent openness of social media and self publication, combined with improved online searching capabilities, can complicate the separation of professional and private digital personae,” they write.

Physicians should assume that all posted materials are public and therefore take care to protect themselves and patient privacy. A 2010 study by the Mostaghimi and Crotty published in the Journal of General Internal Medicine showed that over 30 percent of physicians have some type of personal information on the Internet. The authors also cite research showing that 17 percent of physician blogs contain information that could reveal the identity of the patient or the doctor. They suggest that, “social networks may be considered the new millennium’s elevator: a public forum where you have little to no control over who hears what you say, even if the material is not intended for the public.”

“We’re not suggesting that physicians should be prohibited from using social media sites. Doctors just need to be savvy regarding the content and tone of what they post online. People share information openly using social media, but posts intended for one audience may be embarrassing or inappropriate if seen by another,” said Mostaghimi.

The authors go on to discourage the use of sites like Facebook and Twitter for direct communication with patients since the information is controlled by the social media companies. These types of sites, they say, should be

They advise physicians to regularly perform “electronic self-audits” of their online identity and create “dual citizenship” with a distinct professional profile intended to come up early on a search engine query.reserved for general announcements like flu vaccination.

The article was supported by an Institutional National Research Service Award and the Division of General Medicine and Primary Care. There are no reported conflicts.

Social Media in Medicine III

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Most physicians are now aware of Social Media. The game is still out if it will be incorporated into medical practice or hospitals. It has it's serious flaws in regard to privacy and HIPAA regulations. Apart from that restriction Social Media offers many choices and possible applications for a medical practice (clinic) or hospital setting,

Social media is a highly fluid niche. What began as a recreational hobby has evolved into a digital medium which has caught the eye of venture capital and others in the internet space.

Billions of dollars are being poured into startup ventures and some established media sites that have piddling cash flow at the moment. Their forecasted value is based upon world wide exposure and the attendant potential for advertising revenues. Most of the social media sites remain private equity companies while some are looking at IPOs. (Facebook).

Several social media sites have become lightening rods attracting companies building on APIs (application programming interface). (that is another story)

How are most practices dealing with this new phenomenon? It is a far cry from AOL's “You've Got Mail !!”

Many are dabbling with building their own Facebook pages, Twitter identities, and Blogs. Few physicians are either expert enough or have disposable time to dedicate to the medium personally.

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There are several 'big time' medical bloggers such as KevinMD who are a presence enough to be inteviewed by TV media, or published in the Wall Street Journal and other classical newsprint media. His blog has attracted enough industry attention and is monetized to deliver cash flow. His posts are repeated across other blogging venues and ranks very high in Google's search algorithm, and without SEO. (search engine optimization)

Physicians are a curious lot, especially when it comes to technology. Others are more intent on patient care and have little time to devote to this area. Personally I have enjoyed exploring and using social media, but then I am retired from clinical practice.

Some familiarity is in order to plan if and when your practice should enter social media, and how you will use it.

Social media challenges medicine in it's use of arcane acronyms (abbreviations) as a 'secret' insider code. There are glossaries for Twitter acronyms and other social media sites. 1 2 3 .

Sage advice would be to have an 'expert' build your site. One of your children probably is expert at this, if not there are many teenagers or young adults who are willing to do this for very little money or for just the 'resume builder”. Elance.com is a freelancer writer web job board where many aspiring social media designers and writers congregate.

Dailly posting should be relegated to a knowledgable ghost writer. Most are willing to work for about $5.00/ day (one post) It is as easy as dictating into your PC or laptop and sending the post as an mp3 file via and attachment email or an Instant messaging file. If you don't know how to do that, ask one of your kids, or younger employees.

Motivation for Medical Social Media Sites in a survey found that 94 percent of respondents have used Facebook to gather information on their healthcare, 32 percent used YouTube, 18 percent used Twitter and MySpace 2 percent used FourSquare, a location-based website. Key findings of the NRC survey: (National Research Corporation)

  • When asked about social media's influence, one in four respondents said it was "very likely" or "likely" to impact their future healthcare decisions.

  • When asked for their level of trust in social media, 32 percent said "very high" or "high," and only 7.5 percent said "very low."

  • Respondents still backed hospital websites are the premiere source of online healthcare information with one in two preferring heath provider websites to any source. Fourteen percent preferred an integrated approach of hospital websites and social media combined. Three percent preferred only social media.

Another survey of Type II diabetic patients and weight loss surgery found that social media was used as a tool to spread information about patients' experiences with bariatric surgery and its benefits. Business intelligence company Wool.labs used its technology WebDig to track every conversation accessible on the Internet and determined the trends among diabetes patients and healthcare providers as related to options to help manage diabetes including bariatric surgery.

The study found diabetes patients who had tried bariatric surgery used social media outlets to advocate for the procedure and show how it had positively impacted their Type II diabetes. "We believe that the patient wave of support in social media has helped push diabetes surgery into mainstream acceptance faster," said Michele Bennett, chief operating officer of Wool.labs. "In this instance, we believe patients are leading the way and it will be interesting to see how far physicians and the industry will take it from here.

A report, which was conducted by the Pew Internet & American Life Project and the California HealthCare Foundation, found that only 62 percent of adults living with chronic disease go online, compared with 81 percent of adults who report no chronic diseases. Lack of Internet access, not lack of interest in the topic, is the primary reason for the gap, according to the report. In fact, when demographic factors are controlled, Internet users living with chronic disease are slightly more likely than other Internet users to access health information online and

"We can now add chronic disease to the list of attributes which have an independent, negative effect on someone's likelihood to have Internet access, along with age, education, and income level," says Kristen Purcell, an associate director of the Pew Internet Project and a co-author of the report.

According to the report, more than any other group, people living with chronic disease remain strongly connected to offline sources of medical assistance and advice such as health professionals, friends, family and books. However, once they have Internet access, people living with chronic disease report significant benefits from the health resources found online.

"The deck is stacked against people living with chronic disease. They are disproportionately offline. They often have complicated health issues, not easily solved by the addition of even the best, most reliable, medical advice," says Susannah Fox, an associate director of the Pew Internet Project and a co-author of the report. "But those who are online have a trump card. They have each other. Those who have access use the Internet like a secret weapon, unearthing and sharing nuggets of information found online."

Looking at the population as a whole, 51 percent of American adults living with chronic disease have looked online for any of the health topics included in the survey, such as information about a specific disease, a certain medical procedure, or health insurance. By comparison, 66 percent of adults who report no chronic conditions use the Internet to gather health information.

The report found that information about prescription or over-the-counter drugs is the topic that draws the most significant interest among Internet users living with chronic disease, compared with other Internet users.

 

Monday, April 18, 2011

Freedom?

Outrage on the Health Train Express

Let us all pause for a moment on this Passover Seder Night and ask “why is this night different from all other nights"?”

Listen up. We are in the midst of a budgetary crisis. Standard & Poor's is about to downgrade the U.S. Government as a reliable debtor, health care reform threatens to bankrupt  the  Government, and we are told if we do not make the changes we will go bankrupt anyway.

In  the midst of EMR arguments pro and con, transparency issues, outcome studies, and plans for ACOs from  out of Michigan comes this late breaking story from the American College of Surgeons.  I somehow or other know now why I never went after that  FACS title, FAAO was enough.

The New York Times ran this story by Tara Parker-Pope who must have laughed all the way to wherever she goes at the end of a day.

I know I and several other well known bloggers thought this was hilarious, although admittedly none (at least me) would admit to being an academic

(evil looking, discredited surgeon, tongue-in-cheek)

image(picture at least 20 years old, maybe 30)

Dr. Greenfield, 78, was the editor in chief of Surgery News when the editorial was published but resigned that position in the wake of the controversy; and not only was the article retracted, but all existence and reference to that issue were expunged from the scientific literature.  The entire issue of the newspaper was withdrawn.

Lazar Greenfield is one of the truly pre-eminent, almost legendary figures in modern general surgery.

Dr Greenfield is a Professor-Emeritus of General Surgery at the University of Michigan. In ordinary lay language that means ‘retired’.

The Valentine’s Day Massacre

 Forget chocolate on Valentine’s Day, try semen, says Surgery News editor. Retraction, resignation  follow.

IMHO, the only ones discredited is the ACS for electing him and for the General Surgery Journal for printing the article in the first place.The position is obviously one of honor given in reward for a long and dignified and respected career.  Perhaps the position should go to a younger surgeon still actively engaged in practice. The position is also obviously a ‘political appointment’, and much like political appointments, the appointee goes down in disgrace.

I hope that Dr. Lazar Greenfield (retired) is enjoying retirement, away from controversy and high risk adventure, as well as sperm counts.

I pray he is laughing out  loud  each month when he draws his pension from the bank.

And now he is truly a LEGEND, among great and famous surgeons.  All who trained with him will have an unforgettable story to tell their residents !

Saturday, April 16, 2011

EYE MD A New Blogspot

 

Just what is needed in bloggerville, another medical blog. This one is on a topic very near to my heart, after 30 years of eye surgery, treatment of glaucoma, diabetic retinopathy, plastic surgery of the eyes, and my favorite area….pediatric ophthalmology…here’s a sample…Buzz on Over to Eye MD. You will find it at http://eyeinfo4you.blogspot.com 

Here’s a “Trailer”

Eye MD

Friday, April 15, 2011

A New Blog Spot

Get ready, this blog is going to have some really cool, interesting and accurate information about the science of the visual system, clinical practice, sources for eye care, innovative treatments, and what can we  expect in the next ten years. How will Health Reform impact your Eye Health?

Warning !  Some of the  images may be disturbing. Not intended for the faint of heart.

Here is the first one !

Leave a comment:  What are these??

GML

Posted by Eye MD at 7:21 AM 1 comments

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Wednesday, April 13, 2011

So, What’s the Problem, Duh !

 

INDIANAPOLIS -- Health insurer UnitedHealth Group's earnings rose 21 percent last year and so did the compensation it gave CEO Stephen Hemsley .

The 58-year-old executive received a pay package totaling $10.8 million from the Minnetonka, Minn., managed care company. That includes a salary and performance-related bonus amounting to $4.7 million and stock and options valued at $6 million.

UnitedHealth is the largest health insurer based on revenue. Its net income climbed 21 percent last year to $4.6 billion, and its share price rose 18 percent. That's higher than the increase recorded by the Standard & Poor's 500 index in 2010.

ENUFF SAID !!!