Thursday, January 8, 2015

100 Ways To Change Your Life In 10 Minutes Or Less

The most effective way to meet any goal, experts say, is through a series of tiny changes. Here are 100 that work.

1. Wipe down your office doorknob.
Using disinfectant wipes on commonly touched objects like doorknobs can reduce the spread of cold- and flu-causing viruses by up to 90%, according to researchers from the University of Arizona.

2. Meditate in the morning.
"I start my day with a simple meditation practice; it sets the tone for my day and clears my head to prepare for what's ahead," says Tiffany Cruikshank, an internationally renowned yoga instructor and the founder of Yoga Medicine.

3. Eat sardines twice a week.
They're packed with protein and omega-3s, and most worthy of a place on your plate. Try these 3 easy recipes with sardines—your heart will thank you.

4. Make your own salad dressing.
Skip the not-so-healthy bottled stuff; all you need are a handful of ingredients to bring out the best in your greens. Try these easy 5-ingredient salad dressings.

5. Cook with blood-pressure-lowering herbs.
Add these super-healthy spices to your recipes, and check out these 25 healing herbs you can use every day.

6. Get Sugar Smart.
Americans eat an insane amount of sugar—and much of that sugar is hidden in foods without you realizing it. Take back control with The Sugar Smart Diet, written by Prevention's own Anne Alexander (published by Rodale, which also published Prevention).

MORE:.........

Dry brush your whole body.

Answer an email in person.
Not only is it friendlier, but it also forces you to walk around, which you should do at least once every hour if you have desk job, says Martha Gulati, MD, director for preventive cardiology at Ohio State University Wexner Medical Center. Studies link sitting to weight gain and poor heart health.

Make a food plan for the week.
Chalkboards are trendy, but they're also good for guiding your mind and your mouth toward a healthy meal at the end of the day. (Fill your menu with these freezer-friendly recipes you can make ahead of time.)

Volunteer your time.You get what you give: Research shows volunteering regularly can lower your risk for death by up to 24%. All that usefulness and altruism might cause your brain to produce more oxytocin and progesterone—good-vibe chemicals that curb stress and reduce harmful inflammation. (Here's how to find the good deed that matches your personality.)

There are many more excellent ideas, such as

Wear sunscreen every single day.
With a reduced risk of skin cancer, and fewer wrinkles and sunspots, there are a million reasons to protect your skin, says Alison Sweeney, author of Scared Scriptless and host of The Biggest Loser. "Each morning, I make a point of taking care of my skin by applying moisturizing sunscreen. It gives me a few minutes of quiet and I'm protecting myself for that day and the years ahead."

Spike your breakfast with cinnamon.
The spice has been shown to reduce insulin resistance and may help lower cholesterol and triglycerides, blood fats that could contribute to diabetes risk. Find it in these 12 energy-boosting breakfasts.

Take your walk to greener pastures.
The University of Essex in the UK found 30 minutes of walking in a green scene reduced depression in 71% of participants.

and....

Thirty More Health Hacks

Wearable Devices add a new flare to your fitness program

Simple nasal irrigation is painless, eliminates many allergens such as pollern, mold, and reduces frequency of colds.

Yogurt and honey.....what more to say.

6 inflammation-causing foods no one talks about..

There's a five-alarm fire sounding these days about inflammation, and with good reason. Heart disease, cancer, Alzheimer's, and acne are just some of the possible consequences of too much inflammation in the body.According to Nicholas Perricone, M.D., the pioneering nutritionist and dermatologist (who wrote the book on anti-inflammation eating), our bodies actually depend on temporary inflammation to help fight off sudden injuries or infection. But when that inflammation becomes chronic, "the immune system mistakenly attacks normal cells, and the process that ordinarily heals becomes destructive.Like so many health issues, the main culprit is too much sugar, and surprise, some Yogurts may not be healthy.

Frozen yogurt

Not all frozen yogurts are created equal, says Andrew Weil, M.D., director of the Arizona Center for Integrative Medicine at the College of Medicine, and an anti-inflammatory evangelist. "Some frozen yogurts contain the milk proteincasein, which may increase inflammation," he explains. "Others contain specific probiotics that may actually reduce it." (And some frozen "yogurts" contain no dairy at all and use coconut milk.)

Froyo has two potential inflammatory culprits: sugar and dairy. Milk can boost insulin levels and male hormones, and it's a common allergen, which means it can trigger inflammatory reactions (anything from diarrhea to hives).

Try some of these and make notes about your progress.

Sunday, January 4, 2015

What's happening in Vegas: the CES 2015 keynotes you won't want to miss

What dedicated health technologist can miss CES ?

The biggest day of CES is the day before CES. Come to think of it, the day before that (today, Sunday) is pretty big too. But Monday is press conference day

The day some of the industry’s biggest and most important companies get on stage and launch somewhere between five and five thousand new products. (Some of them will be washing machines.) If you’re excited about the future of technology and the gadget industry, there’s no bigger day than CES Day Zero.

That day is tomorrow. Monday, January 5th, 2015. We’ll be live all over Las Vegas, following every event, every announcement, every time Michael Bay melts down during a Samsung event because he forgot his lines and should probably stick to directing. For the biggest events, we’ll be on the scene liveblogging, bringing you everything in real time as it happens.

To learn more: Digital Health Space

Monday, December 29, 2014

Hey Doc, Please go Away

Aaron Carroll, over at The Incidental Economist,summarizes a study suggesting that patients do better when cardiologists are away at academic meetings.

High risk patients admitted with heart failure during meetings had a 30-day mortality rate of 17.5%, compared to 24.8% when more cardiologists were there. Cardiac arrest 30-day mortality was 59% during meetings and 69.4% at other times.

Why is this?

There are a number of ways to interpret this. Maybe the best cardiologists were the ones who stayed home. Maybe with fewer cardiologists available, fewer invasive procedures get done, and that leads to better outcomes. Maybe they tell more low-risk patients to wait when fewer cardiologists are available, which gets the higher risk patients more attention and better outcomes. Maybe it’s something else.

I favor the second explanation and am reminded of the excellent judgment of my PCP back in 2007 when I was asked by the touring company to take a stress test before a two-week long kayaking trip to Patagonia.

She says, “No. I refuse to order a stress test for you.”

“Huh?” I reply intelligently.

“Here’s the deal,” she says. “If I order the stress test, our especially attentive (knowing who you are) cardiologist will note some odd peculiarity about your heartbeat.

He will then feel the need, because you are president of the hospital, to do a diagnostic catheterization. Then, there will be some kind of complication during the catheterization, and you will end up being harmed by the experience.”

Minor ST segment changes, may be non-specific.

” I will not authorize a stress test.”

Sunday, December 28, 2014

The Ideal Medical Practice

What and where is the 'ideal' medical practice? Is it a solo, group, or hospital based setting? Is it a government position, or a federally qualified medical clinic?

The answer is "It is in the eyes of the beholder". Like a valuable family heirloom it is a treasured asset, not defined by assets, or market value.

For some practiioners it may be independence, creativity, flexibility, self initiative, and freedom for independent decision making. Contolling your own schedule is an important factor for many solo doctors. Others may hold freedom from administrative duties, collegial interactions, the economic power of a group credit worthiness, or belonging to a larger institution with a standing reputation and/or receiving referrals from within the group itself.

Many disruptions have been caused by government interference, HMOs and insurance companies.

Innovative organizations such as accountable care organizations, PQRS, and health reform such as the Affordable Care Act create confusion, and contribute to increasing cost which is counter to the perceived goals of improving quality and the cost of healthcare.

Jean Antonucci M.D. describes her IMP in the video

John Brady M.D. talks about how the IMP model not only benefits his patients but drives his joy in practice and hope for the future of primary care. Dr. Brady questions if he can continue his practice model, a common concertn for IMPs.

Choosing your medical practice model begins in medical school or training. It may be effected by a mentor, or a practice setting in which a trainee works. There may be an economic incentive with rewards such as loan forgiveness, lifestyle, or geographic location.

Preparation for each of these goals begins in training. Independent medical practice requires additional preparation in business and administration as well as organizational abililties.

Ideal Medical Practices

Tuesday, December 23, 2014

Unlocking DNA secrets with a Canadian genome search engine - The Globe and Mail

Health Train Express Search Upgrade

The number of posts increases monthly and I have incorporated a "search" function, located at the top of the right sidebar. Note the 'advanced' drop down tab. This will enable more specific ranges, by date and other. I trust this will enable you to search and find related posts for the days topic. There is also a Google Web Search available. Happy Holidays from Health Train Express.

See more at: http://digitalhealthspace.blogspot.com/#sthash.nypzt3E8.dpuf

Sunday, December 21, 2014

The highest rated doctors may not provide the best care

Doctor ratings generally focus on the patient experience, such as wait times, time spent with the doctor, and physician courtesy. Those are obviously important issues, but they paint an incomplete picture. Doctors with stellar interpersonal skills may not be the best at controlling patients’ blood pressures or managing their diabetes. High ratings may identify surgeons with great bedside manner, but mask high surgical infection rates.

The quest for ratings perfection influences medical decision making, as patient satisfaction increasingly affects doctors’ salaries. According to the management consulting firm Hay Group, more than two-thirds of physician pay incentives are based on patient satisfaction scores. And Medicare withholds as much as $850 million in payments to hospitals who fail to meet various quality metrics, with patient satisfaction being a significant component. But doing what’s best for patients won’t necessarily make them happy. Denying antibiotics for viral infections or saying no to routine MRIs for patients with back pain are both sound medical decisions, but can anger patients; some vent their frustration by poorly rating their doctors. It’s no wonder that many physicians acquiesce to patient requests. In a survey by Emergency Physicians Monthly, 59% of emergency physicians said patient satisfaction surveys increased the amount of tests they ordered. In another survey by the South Carolina Medical Association, almost half of physicians said that pressure to improve patient satisfaction led them to inappropriately prescribe antibiotics or narcotics. In fact, Senators Dianne Feinstein (D-California) and Charles Grassley (R-Iowa) wrote a letter to Marilyn Tavenner, administrator of the Centers for Medicaid & Medicare Services, saying that “there is growing anecdotal evidence that these [patient satisfaction] surveys may be having the unintended effect of encouraging practitioners to prescribe opioid pain relievers (OPRs) unnecessarily and improperly, which can ultimately harm patients and further contribute to the United States’ prescription OPR epidemic.”

Why Hospitals have to change their Mission

These are really difficult times for hospital executives. The system (and I use this term loosely) is rapidly shifting from a volume-based, fee-for-service business model to a population model that puts providers at financial risk. This means that hospitals have to rethink their core business. Instead of filling hospital beds with patients who need complicated treatments and expensive procedures, hospitals must now try to keep patients out of the hospital and do so with low costs.

Some areas of the country are more accustomed to HMOs and managed care models, but they are in the minority. For the rest of the country, this is disruptive stuff, particularly the part about taking on risk

What will the Future of Medicine look like

Excerpts from The Guide to the Future of Medicine.

Enormous technological changes are heading our way. If they hit us unprepared, which we are now, they will wash away the medical system we know and leave it a purely technology–based service without personal interaction. Such a complicated system should not be washed away. Rather, it should be consciously and purposefully redesigned piece by piece. If we are unprepared for the future, then we lose this opportunity.

Here is the list of the real examples and practical stories demonstrating why we should all be ready for these changes.

Stop Wasting Doctors' Time (and Money)

Health IT Forecast for 2015 – Consumers Pushing for Healthcare Transformation

Doctors and hospitals live and work in a parallel universe than the consumers, patients and caregivers they serve, a prominent Chief Medical Information Officer told me last week. In one world, clinicians and health care providers continue to implement the electronic health records systems they’ve adopted over the past several years, respond to financial incentives for Meaningful Use, and re-engineering workflows to manage the business of healthcare under constrained reimbursement (read: lower payments from payors).

In the other world, illustrated here by the graphic artist Sean Kane for the American Academy of Family Practice, people — patients, healthy consumers, newly insured folks, kids and caregivers — are seeking convenient, pleasant, frictionless retail-style experiences from the health system.

Demands from these people are pushing the health system to transform in ways that serve them the way Uber, Amazon, Nordstrom and Apple do.

Study: 41% of Home Caregivers Use A Digital Health Device

41 percent of caregivers in U.S. broadband households currently use a digital health device as part of their caregiving routine, including 8 percent who use online tools to coordinate their efforts, according to recent research from Parks Associates.

The research firm’s latest report, 360 View: Health Devices and Services for Connected Consumers 2014analyzes multiple consumer surveys, including a 2Q 2014 survey of 10,000 U.S. broadband households, to analyze consumer health and wellness behaviors, calculate market potential for digital health solutions, and evaluate business strategies for consumer engagement and usage of wellness and fitness apps.

“Among U.S. broadband households, 22% have a head of household who currently provides care for a family member or anticipates doing so in the near future. At 2015 International CES, we’ll see many new digital health devices and software on display, including innovations from companies such as Sleep Number, Independa, Bosch Healthcare, and Grandcare, and wearable tech from iHealth Labs, Misfit, Sensogram, and Vancive Medical Technology.These innovative solutions will find strong interest among current caregivers, but they will also have high standards to meet in improving the ways caregivers can monitor their family members,”said Harry Wang, Director, Health & Mobile Product Research, Parks Associates in a statement.

For caregivers, 44 percent expressed having electronic panic button known as personal emergency response systems (PERS) that can signal can emergency if a family member falls or is unable to get help as their top concern. Also, 30% find an electronic tracking watch with a panic button appealing. Currently only 8% of caregivers use an electronic watch to track the family member under their care.

HealthWorks Collective

Hospital Readmissions Are Costing Us $26 Billion Annually Some Healthcare News and Views

Friday, December 19, 2014

Top 25 Healthcare Blogs | Cision

Covered California II

Enrollment for Covered California began one month ago, and will end on January 15, 2014. The online internet enrollment worked more smoothly and was easy to access. It functions fairly well and most of the time it proceeds without a hitch.

One problem I encountered was an inability to progress from {adding members} to where the web page for adding new members. This attempt repeated itself a number of times when 'next' was selected. After several attempts the next page did appear, and the process proceeded without further difficulty.

The people who receive the 'best benefits/premium cost' are clearly in the Medi-Cal category if their income is at or below the poverty level. The web site performed fairly well with numerous pop-ups and drop down menu selection. Because of the relatively large number of selections and fields it was difficult to scan through deductibles, and/or co pays. The site allowed users to select and compare plans by checking the plans one wanted to compare.

The plans all have deductibles and co pays. The lower the premium the higher the copay and and deductible. In many cases the insurance appears to be 'catastrophic coverage' Common sense would make one wonder how many people could afford a deductible of $2500 to $10,000.

The financial algorithm was designed by people who know little about health care or it's real expenses. It seems the design was to fit health care into the budget process.

Jonathan Gruber, the principal economic adviser and designer is an expert in health economics at the macro level, and is no authority on patient care. He has no medical experience or clinical credentials and is ignorant of patient-provider health process. He had received numerous awards in healthcare economics.
Gruber has published more than 140 research articles (the majority of which were for NBER) and has edited six research volumes.^[11] He is a co-editor of the Journal of Public Economics, an associate editor of the Journal of Health Economics, and the author of Public Finance and Public Policy.^[12] In 2011, he wrote Health Care Reform: What It Is, Why It's Necessary, How It Works, a graphic novel delineating the Affordable Care Act, illustrated by Nathan Schreiber.^[2]

An allegation and video content of Gruber testifying in several resulted in an eruption of public outrage and discontent.

In January 2010, after news emerged that Gruber was under a $297,000 contract with the Department of Health and Human Services, while at the same time promoting the Obama administration's health care reform policies, some conservative commentators suggested a conflict of interest.^[18]^[19]^[20] Paul Krugman in The New York Times^[21] argued that, although Gruber didn't always disclose his HHS connections, the times when he didn't were no big deal.

In November 2014, a series of videos emerged of Gruber speaking about the ACA at different events, from 2010 to 2013, in ways that proved to be controversial. Many of the videos show him talking about ways in which he felt the ACA was misleadingly crafted and/or marketed in order to get the bill passed, while in some of the videos he specifically refers to American voters as ill-informed or "stupid." In the first, most widely-publicized video taken at a panel discussion about the ACA at the University of Pennsylvania in October 2013, Gruber said the bill was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money." He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage.

Writings:

Gruber's published works include:

On February 15, 2006, the Center on Budget and Policy Priorities published an article by Gruber entitled "The Cost and Coverage Impact of the President's Health Insurance Budget Proposals"^[13]
In a December 4, 2008, New York Times op-ed, "Medicine for the Job Market", he claimed that expanding health insurance, even in difficult financial times would stimulate the economy.^[14]
On February 9, 2011, the Center for American Progress published an article by Gruber titled "Health Care Reform Without the Individual Mandate," analyzing the health insurance coverage impacts of alternative policy options for encouraging purchase of health insurance under the Patient Protection and Affordable Care Act, including the mandate, a late penalty, and auto-enrollment.^[15]

Covered California web site illuminates the copay/deductible inverse relationship and premium subsidy. The working of Obamacare obfuscates the ACA bill which was passed by the Democratic party. Very troubling is it did not include Republcan legislators in the design process.

Contrary to Obama's proclamations many patients did not keep their physician,or hospital. Nancy Pelosi's uncannily accurate comment 'we won't know what is in it until we pass it'. Jonathan Gruber's "stupid" must also mean 'congress' was too stupid as well.

Portions of this article are attributable to

New York Times, Covered California (online enrollment)

Wednesday, December 17, 2014

Women in Healthcare IT

Monday, December 15, 2014

Mobile Health, Telemedicine and Walgreens

Walgreens app makes virtual doctor visits a reality

The service is immediately available to residents of California and Michigan and will be rolled out in other states in the next few years. Illinois residents should be able to use the app by the end of 2015. Appointments cost $49, most of which goes to physicians. That fee is also not much more than a copay for an in-person doctor's visit through some insurance plans. “Some insurance companies cover telemedicine”, Leider said.

Walgreens is launching a virtual doctor visit feature on its mobile app, the company announced Monday. The nation's largest drugstore chain is teaming up with MDLive, a provider of virtual health services, to connect Walgreens customers with certified doctors via video chat on a smartphone, tablet or computer.

"Consumers are demanding to do everything through mobile," Parker said. "Everything else they can do through mobile, and now they can do this too."

MDLive stands to gain 2 million people a day through Walgreens' mobile app and website. CEO Randy Parker said the company has 2,000 doctors available.

Last year Walgreens launched a Pharmacy Chat feature on its app to allow users to instant message with pharmacy staff. The company said it averages 9,000 chats a week.

"I think this will become a normal part of health care in three to five years," Leider said. "We have got some real forces that are going to make this very compelling."

He said a shortage of primary care physicians coupled with more people becoming insured through the Affordable Care Act means the market is growing for people who might find telemedicine useful.

Dr. Leider made the bold statement, “"I think this will become a normal part of health care in three to five years," Leider said. "We have got some real forces that are going to make this very compelling."

In October, Deerfield-based Walgreen announced a similar telehealth initiative partnership with health information website WebMD to encourage customers to increase exercise to earn discounts at Walgreens stores. The company said it now awards points on its Balance Rewards loyalty card for logging activities on the WebMD Healthy Target app.

The service is immediately available to residents of California and Michigan and will be rolled out in other states in the next few years. Illinois residents should be able to use the app by the end of 2015, said Dr. Harry Leider, chief medical officer for Walgreens. Appointments cost $49, most of which goes to physicians. That fee is also not much more than a copay for an in-person doctor's visit through some insurance plans. “Some insurance companies cover telemedicine”, Leider said.

"Consumers are demanding to do everything through mobile," Parker said. "Everything else they can do through mobile, and now they can do this too."

Chicago Tribune

ehirst@tribpub.com

Saturday, December 13, 2014

CellScope’s iPhone-enabled otoscope, remote consultation service launches for CA parents

Parents in California who have children who get chronic ear infections will soon have a more convenient way to get their kids care.

San Francisco-based CellScope, a Khosla Ventures-backed Rock Health alum, has begun taking preorders for its FDA registered smartphone-enabled otoscope,called Oto Home. The director-to-consumer device is priced at $79 and will ship in four to six weeks. A feature-rich, $299 version of the system, called Oto Pro, is also available for preorder now to physicians located anywhere in the US.

There are caveats in using this device and parents should be trained how to insert the scope. The Otohome will come with an FDA approved label for users, the same as any FDA approved device or medication.

Friday, December 12, 2014

Buffaloed ?

Thanks to Martin Samuel M.D. I now know why the Canadian Health System works as well as it does.

According to him:

"Some years ago, I was acting as a visiting professor in Canada. I was discussing a patient with a disorder that I thought required a rapid, though not urgent, intervention. I was discussing the optimal timing of the intervention, when a chuckle arose in the audience. I inquired about why people seemed so amused and they told me that considerations of that type did not apply to this particular patient because he was going to be “Buffaloed.”

What could that mean, I inquired?

It means that this patient had private insurance and would go to Buffalo for the procedure rather than wait in the queue in the regular Canadian health care system. The reason the Canadian health care system works as well as it does (and that is not by any means optimal) is because 90% of the population is within driving distance of the United States where the privately insured can be Seattled, Minneapolised, Mayoed, Detroited, Chicagoed, Clevelanded and Buffaloed, thus relieving the pressure by the rich and influential to change a system which works well enough for the other people but not for them, especially when they are worried or in pain."

In the United States, there is no analogous safety valve so the influential simply demand a different level of care and receive it. This includes all the authors of the major books, articles and policies that have been written to repair our allegedly hopelessly expensive and error prone system. The array of suggestions is practically incomprehensible partly because there is a secret hypocrisy. Will the pundit actually use their proposed system themselves?

Whenever anyone writes about the rehabilitation of our health care system, they should be required to publish their own health care history, so the public can see where these experts obtain their own medical care. To protect their privacy, specific diseases need not be declared; just the method by which the pundit handled his or her own medical problems. This would be analogous to requiring that politicians reveal their income tax records or that academic doctors report any real or perceived conflict of interest when publishing a paper. Articles, proposals and laws written by anyone who is unwilling to publish his or her own health care history would simply not be considered or published. If just the leading newspapers and opinion magazines would agree to this system the degree of credibility of proposals for changes in our health care system would be dramatically improved.

Where will you Buffalo ?

My thoughts exactly, and Dr. Samuel expresses it so well

reprinted from The Health Care Blog

Martin Samuels is a practicing neurologist and founder of two Harvard-affiliated neurology departments. He holds a membership in the American Neurological Association, a fellowship in the American Academy of Neurology and a mastership in the American College of Physicians.