The Legend of Health Care

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6WsJ9hN7tFLOpfmIK9qieASNcfO3mhbwXeP7UNHXGd20M4St-mOAnTNrYM_2uEYM3S0YDUzwixCCstH9WKdJEwvkAq7hyLnwHTlc1MvRMr-ExGSRurRHyy8mQcIopVtdfw9WVD1eZhCo/s1600/Fantasia.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="375" data-original-width="500" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6WsJ9hN7tFLOpfmIK9qieASNcfO3mhbwXeP7UNHXGd20M4St-mOAnTNrYM_2uEYM3S0YDUzwixCCstH9WKdJEwvkAq7hyLnwHTlc1MvRMr-ExGSRurRHyy8mQcIopVtdfw9WVD1eZhCo/s200/Fantasia.png" width="200" /></a></div> Once upon a time, in a kingdom by the sea, broad consensus has been reached, which seems rather weird nowadays. America, you see, was spending too much money on health care for too little in return. We spent almost twenty percent of our GDP on health care, which was much more than any other developed country in the world, but our health outcomes were middling at best. And the costs just kept rising. Something had to be done before health care terminally crowded out every other public need. The Affordable Care Act, Obamacare, was that something. It was supposed to “bend the cost curve” and everybody was supposed to learn that “less is more”.<br /> <br /> And so the nation rolled up its sleeves and got to work. Insurance companies were supposed to limit their administrative waste and tightly mange care. Hospitals were supposed to bundle and warrant episodes of care. Doctors were burning out trying hard to cut the volumes of their expensive services, while exercising stewardship of scarce resources (i.e. dollars). Pharmaceutical companies were to be taken to the shed for regular beatings. Patients were educated to choose wisely and seek value for every insurance penny. And in a bizarre remake of Fantasia, the government was cheerfully orchestrating the entire effort with rules, regulations, computerizations and spontaneously generated armies of consultants. <br /> <br /> It didn’t work. Not even a little bit. Yes, across the board industry profits and stocks were soaring, as were the loudly lamented loses from sky-scrapping premiums paired with ballooning deductibles (don’t ask, health care is complicated). And yes, Obamacare put a big dent in the “free loader” problem (as the uninsured issue was described to the Supreme Court by the Obama administration), but other than that, everything else was in the “showing potential” or “more research is needed” stage. It wasn’t for lack of trying either. The levels of “disruptive innovation” were positively dizzying. Ever increasing heaps of monies were getting shuffled relentlessly from here to there and back again, amidst vigorous debates on the merits of this or that “initiative”, but for some peculiar reason, not one dollar was ever taken off the health care table.<br /> <br /> And then the warm and cozy incubator, where health care expenditures were being raised and nurtured for ages, experienced the mother of all disruptions. Donald Trump got himself elected President. Bluster and bravado notwithstanding, Mr. Trump is a weak President, with no political machine and no support inside the criminal beltway, or the moneyed power-centers that rule this country. The raging crowds that propelled Mr. Trump’s unusual ascent turned back into pumpkins at midnight on November 8th, 2016. He is virtually alone in Washington DC and it seems that slowly but surely the President is realizing that you gotta dance with the one that brung ya.<br /> <br /> The Republican Party is now aiming in earnest to take a good portion of government money off the health care table. After seven years of planning, plotting, squirming and howling, the conservative wing of the GOP finally got its hands on the chips’ rake, and they intend to use it. This should not come as a surprise to anybody, but the Obamacare repeal and replace theater can be very instructive in ways that have little to do with a succession of wacky bills that will never become law. For starters, it’s worth noting how beautifully the current commotion validates that Paul Ryan and his fiscally responsible buddies are, and always have been, less than concerned with the infamous 47% of Americans who would never vote for Mitt Romney (but somehow voted in droves for Donald Trump). <br /> <h2 style="text-align: left;"> Health Care Hopscotch</h2> Most importantly though, the responses to Mr. Ryan’s slash and burn reform proposals, from both sides of the fake ideological aisle, teach us that we will never be able to “bend the curve” of health care costs through a regular parliamentary process. Never.  And here are some vignettes that might explain why.<br /> <br /> When President Obama signed his landmark health care reform legislation, an individual mandate to purchase insurance was included. The mandate was originally proposed by a premier conservative think tank, and copiously derided by the President himself during his 2008 primaries. Once Obamacare became law, the Republican Party took its objection to the individual mandate all the way to the Supreme Court, and when it lost its case there, embarked on a seven years (and counting) quest to repeal and replace Obamacare. Somewhere in the middle of that journey, the GOP fielded presidential candidate Mitt Romney, the first implementer of the individual mandate in Massachusetts (with Paul Ryan, the greatest Obamacare warrior, as his running mate).  How much of the Republican opposition to forcing people to buy insurance had to do with conservative ideology and how much it had to do with political opportunism, and how much it had to do with Mr. Obama himself, is up to you to decide.<br /> <br /> Back during the 1995 budget wars President Clinton <a href="https://www.washingtonpost.com/archive/politics/1995/12/07/clinton-vetoes-gops-7-year-balanced-budget-plan/e7a56467-ea2d-467e-a818-790640a4f5d8/?tid=a_inl&utm_term=.913cad0d502b" target="_blank">proposed</a> a “"per capita cap" on federal spending for Medicaid, in which federal payments would be made for each eligible person but with the amount rising each year only according to adjusted inflation increases”. Although the Medicaid cap never came to be, according to then Senate Minority Leader Thomas A. Daschle (D-S.D.) "Virtually every Democrat indicated today that they could support it. In fact no Democrat indicated that he could not support it”. Fast forward twenty years or so, and the GOP proposal to impose inflation adjusted per capita caps on Medicaid is equivalent to the murder of millions of Americans in the eyes of current Congress Democrats, many of whom were also there in 1995.<br /> <br /> Heath Care is just a political bludgeon. There are two ideological bookends for the theoretical idea of health care: equality vs. free markets. But when it comes to gory details, and heath care is a cornucopia of goriness, there are no principled positions to be taken. Everything can be twisted and fit into all but the most extreme ideologies (i.e. either everybody has a right to all the care they want or you get what you can pay for) and there are few, if any, people firmly entrenched at each end of the spectrum. Once you acknowledge that there is a morally valid spectrum, you can hop, skip and jump all over the place to serve your immediate political needs, which easily explains the vignettes above and many more acts of intellectual and linguistic chicanery commonly employed in health care policy propaganda.<br /> <h3 style="text-align: left;"> The Unbending Curve</h3> When the Democratic Party had its chance to bend the curve, they chose to spend more upfront and hope that harassing doctors and managing patients will bend the curve in mysterious ways. Republicans seem more inclined to use brute force to push the curve down at its weakest point, while hoping that the same doctor and patient harassment tactics will counteract the damage caused by any shortages in health care funding.  Whereas Obamacare brought us a flurry of innovations designed to move the system to value-based payments so we can save a few bucks, GOPcare will be bringing us a flurry of equally impotent innovations designed to move the system to value-based care so we can squeeze more quality from fewer bucks. In other words, the more things change, the more they stay the same.<br /> <br /> If we want to spend less money on health care, then we need to spend less money on health care.  That pesky curve is not going to bend itself. All industry innovations claiming to save money are simply moving coins from one profit center to another, usually where the profit margins are higher and efficacy is lower or practically nonexistent. Curbing patients’ utilization of proper medical services, which is already lower compared to other developed countries, is a virtuous endeavor. Curbing the wanton rise in prices of said services is either evil Communism, or heartless Capitalism, depending on how the winds blow in Washington DC. The simple truth is that bending the curve means paying less than the industry feels entitled to, and the medical industrial complex shall not be denied. But there is new hope now…<br /> <h3 style="text-align: left;"> Dollar Store Care</h3> The progressive half of our ruling class seems to have had an epiphany of sorts. Medicaid, you see, is now an array of no frills, managed care, commercial health plans with atrociously narrow and underpaid networks. Medicaid is the Dollar Store of health care and as such it is the ultimate value-based solution. Wouldn’t it be nice if we could put the entire former middle-class on Medicaid and call it universal health care or even single payer? Besides, Medicaid accessorizes very nicely with that new and so very hip universal basic income pushed by progressive billionaires who are sucking up every bit of wealth from every living thing. The conservative half of the ruling class would much rather see a free market of Dollar Stores for health care. The GOP value-based solution is to reduce public funding for health insurance and let the market for Medicaid style commercial plans do its thing unencumbered by the heavy hand of government and the excessive burden of Federal dollars.<br /> <br /> The existential question now before us is whether the government will be charitable enough to subsidize our Dollar Store purchases or not so much. There is no longer any debate about the race to a Dollar Store standard of care in America. The goal posts have been moved. Expectations have been reset. Mission accomplished. A win for progressives is Medicaid for all. A win for conservatives is Medicaid for some. The final score: Billionaires 1, America 0. What’s next?</div>

health health care minority mental health substance abuse The Legend of Health Care

Once upon a time, in a kingdom by the sea, broad consensus has been reached, which seems rather weird nowadays. America, you see, was spe...

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Who’s Afraid of the Medical Home?

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSPf6TCcptgRmIj_BocX2-bTql8OnJgYW3dESveOaEd7CSTFw9noFSwf5aTUc666vmGzpTx9pZPNRlVzkns2XVgvCVckouy_QG7_EA7kP85FXbvQ3VBVnn4o7w48k8gavvni_SlJpTbVk/s1600/pcmh_afraid.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSPf6TCcptgRmIj_BocX2-bTql8OnJgYW3dESveOaEd7CSTFw9noFSwf5aTUc666vmGzpTx9pZPNRlVzkns2XVgvCVckouy_QG7_EA7kP85FXbvQ3VBVnn4o7w48k8gavvni_SlJpTbVk/s200/pcmh_afraid.png" width="200" /></a></div> Obamacare is here to stay, and with it a host of initiatives small and large, some intended and some not so much so, targeting massive transformation of the health care delivery system. One of those initiatives involves the adoption of the principles of a <a href="http://www.acponline.org/running_practice/delivery_and_payment_models/pcmh/demonstrations/jointprinc_05_17.pdf" target="_blank">Patient Centered Medical Home</a> (PCMH) for primary care as formulated by the primary care medical associations, and to a large extent, as translated into operational processes by the <a href="http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx" target="_blank">National Committee for Quality Assurance</a> (NCQA). There are other implementations of the PCMH put forward by public and private organizations, but NCQA’s Medical Home recognition program is considered the gold standard for PCMH. The PCMH concept is also here to stay, and as is the case with Obamacare, the Medical Home model has its supporters, its detractors and all sorts of misconceptions and implementation missteps.<br /> <br /> If you randomly ask a primary care physician about his/her opinion on the Patient Centered Medical Home model of primary care, you will most likely get one of the answers listed below in order of increasing prevalence:<br /> <ol> <li>Absolutely fantastic way to practice medicine. We’ve been doing this for a while and are a Level III recognized Medical Home. </li> <li>The idea is good and we are currently making the transition and working on obtaining NCQA recognition. It’s not easy, but we are hopeful.</li> <li>We are part of a PCMH pilot in our state. It’s a lot of work and I am not convinced that it will have any benefits for my practice.</li> <li>I read about it, but I can’t afford to hire dieticians and social workers and spend time on all the paper work. </li> <li>I don’t have time for this.  Just a bunch of government regulations that do nothing for patient care.</li> <li>This is the final nail in the coffin of primary care. It’s going to drive all remaining independent physicians out of practice, which is what the government wants anyway.</li> <li>My mother-in-law is in an assisted living facility, but other than that I don’t have any patients in nursing homes….. I don’t take Medicaid.</li> <li>Say that again….?</li> </ol> Just like Obamacare is not something invented by overzealous socialists, but the brainchild of extremely conservative thinking, the PCMH is not a government invention, but instead it is based on a statement made by physician associations attempting to define good primary care and the need for insurers to pay more for such excellence. The devil of course is in the details. It’s been said that the “official” NCQA PCMH requirements consist of too many details, and that some of those details are bureaucratic in nature, burdensome, expensive and contribute little to patient care. It’s been said that true quality of care and practice transformation, whatever that may be, is largely independent of counting points, formal testing, certifications and recognitions.  Granted, all these contentions seem reasonable, but before deciding to walk away, how about a quick bird’s eye tour of what NCQA PCMH recognition really is?<br /> <br /> The six parts of formal NCQA 2011 PCMH recognition are called Standards. Let’s take a critical look at each one and note the order in which they are arranged. <br /> <br /> <b>Standard #1 - Enhance Access and Continuity</b> – Continuity here refers to people having a personal physician instead of seeing whoever happens to have time that day. I don’t know many practices where this is not the case anyway, but it’s hard to argue against the need to build a long term relationship between patients and their doctors, and it’s even harder to argue against this being the #1 foundational requirement of delivering high quality longitudinal patient care. Note that by definition solo practices are automatically set up to care for patients this way (just saying…). The second part of this Standard is a bit more problematic from a physician’s point of view, because it does require availability after hours and seeing patients the same day as much as possible. It is not an easy task to start tinkering with your schedule, if you are not currently offering same-day appointments, and done haphazardly, it may have serious financial implications to your practice. How about being available after hours, particularly for a solo or very small practice? How about your family and personal life? If you are one of the new concierge docs with a tiny panel of well-behaved patients, this is obviously not an issue. If you have 2500 patients, or so, on your panel, some creative thinking may be required. How would your patients react if, say, every Tuesday you’d start seeing patients from 12 pm to 8 pm? Or if you closed early on Wednesdays and twice a month you saw patients on Saturday mornings? Or if you had an arrangement with a couple of other practices to provide urgent care at odd hours on a rotating basis?<br /> <br /> A recent study in the <a href="http://annfammed.org/content/10/5/388.abstract?ijkey=&keytype2=tf_ipsecsha" target="_blank">Annals of Family Medicine</a> found that total health care expenditures were 10.4% lower for patients who had access to extended hours of care. This is great news for the “system”, but how about benefits to you and your practice? Whether you like it or not, you are now competing against business models with extremely low overhead, such as grocery store clinics and virtual tele-medicine clinics, offering pseudo-primary-care to your rushed and hurried patients for simple needs, leaving you to deal with complex visits that cost you a lot to deliver, but pay as much (or as little) as the simple ones. Unless you start thinking outside the box, your model of business is destined to become obsolete. Offering some electronic visits, providing hours for urgent care needs and collaborating with others on extended coverage may very well be a matter of survival. Interestingly enough, another recent <a href="http://jama.jamanetwork.com/article.aspx?articleid=1197012" target="_blank">JAMA</a> study, although limited to community health centers, finds measurable correlation between access and continuity and lower operational costs per unit of service. There should be very little doubt at this point that Standard #1 is the place to start work on the viability of any practice, or ignored at significant peril.<br /> <br /> <b>Standard #2 - Identify and Manage Patient Populations</b> – This one sounds onerous and a departure from individualized patient care, but is it really so? The “populations” term notwithstanding, all this Standard requires is that you document patient demographics and clinical information in the chart (seriously?), that you take good histories and that you send reminders to your patients to mind their chronic and/or preventive care needs. There is really nothing here that a good primary care physician doesn’t already do, and probably to a much greater extent than the NCQA standards specify. The one thing that may be different is that this Standard talks about proactive reminders to patients that don’t come in to see you on their own. Good for business and definitely good for patient care on an individual level.<br /> <br /> <b>Standard #3 - Plan and Manage Care</b> – Another statement of the obvious, but this standard uses terminology that may raise some eyebrows. For example, it asks that your care is evidence-based. Is your care not evidence-based? Surely you decide how to treat patients based on your education, what you learned along the years, books, articles and latest research, instead of throwing darts at a random treatments list hanging in your office. And this is really all there is to this Standard, other than practicing medicine, i.e. seeing patients, evaluating conditions, planning care, talking to patients, and generally speaking, being their doctor.  <br /> <br /> <b>Standard #4 - Provide Self-Care Support and Community Resources</b> – This may sound like the new age fluff of patients taking care of themselves, and granted, there is some of that here, but the details are again pretty straightforward in their intent to have patients understand their conditions and do something about it. Primary care docs don’t usually fit the much publicized portrait of aloof and paternalistic doctors who won’t give you the time of day. It is the time constraints in fully loaded practices that may prevent some from fully engaging with their patients, and no certification process will change that without proper shift in reimbursement, or a change to a more direct practice model with smaller patient panels. This Standard’s feasibility is also highly dependent on patients themselves, but there are simple things you and your staff can do to better enable patients to take some responsibility for their own health (most of which you are probably doing already), and this is all this Standard is about. <br /> <br /> <b>Standard #5 - Track and Coordinate Care</b> – Do you send patients to specialists and then forget all about them? Do you order lab tests and don’t care if the results come in or not or if they are normal or not? Do you get calls from the hospital notifying you that one of your patients was admitted, and you hang up thinking that this is not your problem? No? Then you are tracking and coordinating care. Can you do more? Probably, but here you are largely at the mercy of specialists and hospitals in particular. You most likely already have tickler lists to help remind your staff about getting specialists notes and test results, but it is extremely difficult to have the hospital contact you if you are not admitting your own patients (and sometimes even if you do). There is effort (and costs) involved in better tracking and better coordination and payers are starting to take notice as evidenced by the latest care coordination CPTs added to the Medicare physician fee schedule.<br /> <br /> <b>Standard #6 - Measure and Improve Performance</b> – Here it is. This is the measuring, reporting and all administrating bag of requirements, complete with patient satisfaction surveys, sending data to payers and using electronic medical records. While most items here are optional, a medical home is required to set some improvement goals for clinical measures (just goal setting, not necessarily outcomes). So after doing everything outlined in previous Standards, this is where the assumption is implicitly made that a medical home should be able to continuously improve the care it provides. Perhaps you believe that you are already providing excellent care, and no doubt most of you do, but is there anything more you can do? This Standard is asking you to consider this question, and if you have an answer, begin acting on it. And yes, this too may take more time and more effort on your part, and thus be dependent on payments to support these efforts.<br /> <br /> Did I leave anything out? If your opinion of the PCMH was something along the lines of #6 above, you are probably wondering about some “strategic” omissions. How about all that “team care” and nurse practitioners? How about those case managers and dieticians? What of the need to buy, implement and use an expensive EMR? Well, for starters these things are optional in nature. Unless you are a team of one, you already have people helping you out with patient care and administration, and you are not required to use or augment your staff more than you are comfortable with. A good EMR should help, but it is not mandatory either. And yes, NCQA will recognize nurse practitioner led practices as medical homes, but this is reflective of legislation at State levels, and it should be appropriately addressed at a policy and legislative level as well. As to the infamous amounts of paperwork involved, yes, there is plenty of that, but there is also plenty of help out there and you just need to find it.<br /> <br /> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF2P_9ZJ_TMZ80ytnGlupQiOzfMfZfLFe-O1vFqngxEF3sL-_Cqdx0bjyrXOoR_eos8-K-T8_xs1pkNtij0Z-b1ThxYHpJ7i0gSBATRmcl-sdPHswNH2w59iXL2XwVfjFo5QRZbc__Rnc/s1600/NCQAroadmap.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="273" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF2P_9ZJ_TMZ80ytnGlupQiOzfMfZfLFe-O1vFqngxEF3sL-_Cqdx0bjyrXOoR_eos8-K-T8_xs1pkNtij0Z-b1ThxYHpJ7i0gSBATRmcl-sdPHswNH2w59iXL2XwVfjFo5QRZbc__Rnc/s400/NCQAroadmap.png" width="400" /></a></div> <br /> On the surface the NCQA PCMH recognition process is an administrative test for primary care, but if you look at it carefully, you can see that it is also a logically ordered roadmap for quality primary care and a tool for you to take a fresh look at your practice and position it to change with the times without having to sacrifice your ethics and your principles. Some things in this roadmap are at the heart of what you do every day, others are things that you may want to do if time and finances allowed, and few are in the realm of “forget it”. Unlike Meaningful Use, the NCQA PCMH “test” is not an all-or-nothing proposition and there is reasonable freedom for you to discard those “forget it” items, or postpone the wishful thinking for a better day. There should be financial benefits accruing from just doing some of the things on this roadmap (such as Standard #1), and there are financial incentives from payers for doing other things or from just “passing the test”. <br /> <br /> The medical home is a timeless model of care, repackaged for these troubled and technology driven times, and as such, it is also a business model for the future of primary care. You could approach the entire exercise as yet another payer and government mandated intrusion, or you could make this roadmap your own, and look at it as a means by which to refine and sustain an already excellent practice. It is ultimately all up to you. <br /> <br /> <span style="font-size: small;"><i>[Disclosure: I am the founder of BizMed, a company whose mission is to support the viability of independent medical practice, and to that end it offers free software tools to reduce administrative complexity in private practice in general, and PCMH recognition in particular]</i></span></div>

doctor-patient health health care Who’s Afraid of the Medical Home?

Obamacare is here to stay, and with it a host of initiatives small and large, some intended and some not so much so, targeting massive tr...

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Integrated Health Care and Fitness Jobss

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsxaeR43aFSXljkHHcNsoGqCm0D-0r-77bfDEaxhvoORa6I12KrGkRySihHdF9QtZyH6P_qcqRro1TznJGg9_LVghxdsu5RILiEzUBbohezFV8x7DHS9rcEoMB_uwHJ0iVsBNpdUF1Elk/s1600/American-flag.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" jea="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsxaeR43aFSXljkHHcNsoGqCm0D-0r-77bfDEaxhvoORa6I12KrGkRySihHdF9QtZyH6P_qcqRro1TznJGg9_LVghxdsu5RILiEzUBbohezFV8x7DHS9rcEoMB_uwHJ0iVsBNpdUF1Elk/s200/American-flag.jpg" width="200" /></a></div> The biggest craze in employee health care over the past two years especially has been the concept of wellness. Most employers, including small companies and organizations, are typically very concerned about the general overall health of their employees. The cost to maintain a healthy human capital increases year by year, and one major way to help reduce the expense of a sick population at work is to manage them through wellness initiatives. Keeping workers from getting sick is a challenge for any business owner, human resource director, or department manager. You rely on your staff to be there when you need them, which is pretty much most of every day.<br /> <br /> One way to help with keeping your employees well is to start a fitness program at your company. According to Stephanie Christensen writing for <em>Intuit Small Business Blog</em>, regardless of whether or not you offer health insurance to your employees, you can support wellness in the workplace by offering fitness-oriented programs and activities that can also benefit your small business through enhanced employee engagement and team building. Here are five ways to start an employee fitness program at your office.<br /> <br /> 1. <strong>Create a challenge board.</strong> Bob Choat, author of <em>Mind Your Own Fitness</em> suggests starting a challenge board that prompts all employees to complete daily physical activities selected by each member of the team to mesh with their own passions. The challenges can be fairly simple (“Do 50 squats desk-side every hour for one day”) or relatively complex (“Run five laps around the park before our 5 p.m. meeting”). The board, which tracks everyone’s progress, keeps team members accountable and provides a venue for deepening interpersonal relationships. By asking employees to design their own challenges, which can can collaborative or individual, you’ll learn more about their interests and hobbies outside of work.<br /> <br /> 2. <strong>Offer charitable incentives.</strong> Not all employees will be motivated to improve their health for personal gain, but you can develop a sense of shared purpose by choosing a local fitness-oriented charity event to become a part of. For example, you and your staff could raise funds and train for a 5K run, walk, or bike race together. Ask your employees what charities are near and dear to their hearts, and let them vote on which cause they’re most interested in supporting.<br /> <br /> 3. <strong>Be active volunteers.</strong> Amanda Little, founder of <em>HealthyHerLiving</em>, suggests partnering with a local Boys & Girls Club to keep your team healthy, both physically and mentally. It’s also an opportunity for your small business to give back to the community. Youth and after-school programs also often seek adults who are willing to coach soccer, basketball, baseball, and other games to help kids develop their teamwork and sportsmanship skills. In turn, your employees can benefit from being role models. Establish recurring volunteer opportunities, and let employees have flexible hours on those days, so they view the opportunity as a benefit rather than another time commitment.<br /> <br /> 4. <strong>Leverage employee support.</strong> Research shows that people are more likely to reach their fitness goals when they share them with others for support. <em>Symmetry Software</em> CEO Tom Reahard bought the <em>Fitbit Zip</em>, a wireless health tracking device that costs about $60, for each of his 15 employees. The device tracks steps taken, meals eaten, calories burned, and hours slept — and transmits the data to an online portal that allows users to compare their activity with that of other users whom they’ve “friended” (similar to Facebook). The portal also provides a messaging feature that lets users cheer on one another. <br /> <br /> 5. <strong>Hold one event per month.</strong> A key challenge with implementing any employee wellness activity is keeping interest alive once the newness has worn off. Jonathan Ages, CEO of Blood, Sweat & Cheers, has made it a priority to host a unique team-building event each month at his company. Past events include obstacle course-style fun runs, hard-core <em>Tough Mudder</em> challenges, and “sports bar Olympics.” In lieu of the boilerplate holiday party, BSC held a “Major League Dreidel” event that offered cornhole, shuffleboard, and dreidel games — and donated the registration fee proceeds to charity. Read more at this site: <a href="http://blog.intuit.com/employees/5-tips-for-starting-an-employee-fitness-program/#ixzz2KDrTAjnS">http://blog.intuit.com/employees/5-tips-for-starting-an-employee-fitness-program/#ixzz2KDrTAjnS</a> .<br /> <br /> You can, as an employer, be proactive with your employees to help them on the road to fitness. A small percentage of your work force may already be engaged in some type of regimen, but the majority of your staff needs to be motivated. Offering incentives helps to motivate people, and the cost of implementing a plan pays off with a good ROI after you consider that over time your employees can get healthier and stay healthier by observing a few fitness routines on a regular basis. Just be careful that you don’t violate any PPACA rules. That is a whole different discussion, but you’ll need to follow up on those guidelines so you are compliant. According to Towers Watson, voluntary incentive-based wellness programs are unrestricted as long as they are not discriminatory. <br /> <br /> According to <a href="http://www.healthcare.gov/">www.healthcare.gov</a>, evidence shows that workplace health programs have the potential to promote healthy behaviors; improve employees’ health knowledge and skills; help employees get necessary health screenings, immunizations, and follow-up care; and reduce workplace exposure to substances and hazards that can cause diseases and injury. Although fitness programs can be a good way to motivate your employees to be healthy, they are only part of an overall wellness program that organizations should develop for their workers. <br /> <br /> Found at this website, <a href="http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html">http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html</a> , information about the regulations proposed by the PPACA for wellness programs are further detailed. In order to protect consumers from unfair practices, the proposed regulations would require health-contingent wellness programs to follow certain rules, including:<br /> <br /> • Programs must be reasonably designed to promote health or prevent disease. To be considered reasonably designed to promote health or prevent disease, a program would have to offer a different, reasonable means of qualifying for the reward to any individual who does not meet the standard based on the measurement, test or screening. Programs must have a reasonable chance of improving health or preventing disease and not be overly burdensome for individuals.<br /> <br /> • Programs must be reasonably designed to be available to all similarly situated individuals. Reasonable alternative means of qualifying for the reward would have to be offered to individuals whose medical conditions make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard.<br /> <br /> • Individuals must be given notice of the opportunity to qualify for the same reward through other means. These proposed rules provide new sample language intended to be simpler for individuals to understand and to increase the likelihood that those who qualify for a different means of obtaining a reward will contact the plan or issuer to request it.<br /> <br /> Fitness programs can be a great option for companies who want to help their employees with wellness and staying healthy. For more information, talk with your employees about what they would like in a program, and work with various health care and fitness program providers to build and maintain a good plan of action at your office. The money you spend today on this initiative pays big dividends over time, not only for your business, but also for your employees.<br /> <br /> Until next time.<br /> <br /></div>

Aktifitas health health care Lifestyle Integrated Health Care and Fitness Jobss

The biggest craze in employee health care over the past two years especially has been the concept of wellness. Most employers, including ...

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Health Care and Glaucoma

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUUhH9XrsZyuSfYyNxu_vry0a0rSX9Xz-R4N-6X8azW16emW0FxJRibK_SDyJoXUTUF8AYRsOaIoHewMf0TsQDpDovVq1x1d9ksX990h-Cc00NYyZwp02VjAODTDvnvcfLR3wzx_unLYk/s1600/American-flag.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="Health Care and Glaucoma" border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUUhH9XrsZyuSfYyNxu_vry0a0rSX9Xz-R4N-6X8azW16emW0FxJRibK_SDyJoXUTUF8AYRsOaIoHewMf0TsQDpDovVq1x1d9ksX990h-Cc00NYyZwp02VjAODTDvnvcfLR3wzx_unLYk/s200/American-flag.jpg" title="Health Care and Glaucoma" width="200" yya="true" /></a></div> Your vision is one of the most valuable assets you have. Being able to see clearly and without impediment is a huge advantage. Just ask someone who is blind or extremely vision impaired. Plus, there are several diseases of the eye that can be identified with a simple exam done by your optometrist or ophthalmologist. According to the National Institutes of Health (NIH), glaucoma is a group of diseases that can damage the eye's optic nerve. It is a leading cause of blindness in the United States. <br /> <br /> According to the American Academy of Ophthalmology (AAO), the most common type of glaucoma — called primary open-angle glaucoma — affects an estimated 2.2 million people in the United States, and that number is expected to increase to 3.3 million by 2020 as the U.S. population ages.<br /> <br /> Glaucoma usually happens when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Often there are no symptoms at first, according to the NIH. Without treatment, people with glaucoma will slowly lose their peripheral, or side vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains. A comprehensive eye exam can tell if you have glaucoma. People at risk should get eye exams at least every two years. They include people in these demographics: <br /> <br /> • African Americans over age 40<br /> • People over age 60, especially Mexican Americans<br /> • People with a family history of glaucoma<br /> <br /> There are several types of glaucoma. The two main types are open-angle and angle-closure, according to <a href="http://www.glaucoma.org/">www.glaucoma.org</a> . <strong>Open-angle Glaucoma</strong>, the most common form of glaucoma, accounting for at least 90% of all glaucoma cases:<br /> <br /> • Is caused by the slow clogging of the drainage canals, resulting in increased eye pressure<br /> • Has a wide and open angle between the iris and cornea<br /> • Develops slowly and is a lifelong condition<br /> • Has symptoms and damage that are not noticed.<br /> <br /> “Open-angle” means that the angle where the iris meets the cornea is as wide and open as it should be. Open-angle glaucoma is also called primary or chronic glaucoma. It is the most common type of glaucoma, affecting about three million Americans. <br /> <br /> <h2 style="text-align: left;"> <strong>Angle-closure Glaucoma</strong>, is a less common form of glaucoma:</h2> <br /> • Is caused by blocked drainage canals, resulting in a sudden rise in intraocular pressure<br /> • Has a closed or narrow angle between the iris and cornea<br /> • Develops very quickly<br /> • Has symptoms and damage that are usually very noticeable<br /> • Demands immediate medical attention.<br /> <br /> It is also called acute glaucoma or narrow-angle glaucoma. Unlike open-angle glaucoma, angle-closure glaucoma is a result of the angle between the iris and cornea closing, according to Glaucoma.org. Additionally, other types of this eye disease have also been diagnosed:<br /> <br /> <strong>Normal-Tension Glaucoma (NTG):</strong> Also called low-tension or normal-pressure glaucoma. In normal-tension glaucoma the optic nerve is damaged even though the eye pressure is not very high. We still don't know why some people’s optic nerves are damaged even though they have almost normal pressure levels.<br /> <br /> <strong>Congenital Glaucoma:</strong> This type of glaucoma occurs in babies when there is incorrect or incomplete development of the eye's drainage canals during the prenatal period. This is a rare condition that may be inherited. When uncomplicated, microsurgery can often correct the structural defects. Other cases are treated with medication and surgery.<br /> <br /> <strong>Other Types of Glaucoma:</strong> Variants of open-angle and angle-closure glaucoma include:<br /> <br /> • Secondary Glaucoma<br /> • Pigmentary Glaucoma<br /> • Pseudoexfoliative Glaucoma<br /> • Traumatic Glaucoma<br /> • Neovascular Glaucoma<br /> • Irido Corneal Endothelial Syndrome (ICE)<br /> <br /> During routine eye exams, a tonometer is used to measure your intraocular pressure, or IOP, according to <a href="http://www.allaboutvision.com/">www.allaboutvision.com</a> . Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers send a puff of air onto your eye's surface. An abnormally high IOP reading indicates a problem with the amount of fluid (aqueous humor) in the eye. Either the eye is producing too much fluid, or it's not draining properly.<br /> <br /> Normally, IOP should be below 21 mmHg (millimeters of mercury) — a unit of measurement based on how much force is exerted within a certain defined area. If your IOP is higher than 30 mmHg, your risk of vision loss from glaucoma is 40 times greater than someone with intraocular pressure of 15 mmHg or lower. This is why glaucoma treatments such as eye drops are designed to keep IOP low.<br /> <br /> Other methods of monitoring glaucoma involve the use of sophisticated imaging technology — such as scanning laser polarimetry (SLP), optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy — to create baseline images and measurements of the eye's optic nerve and internal structures. Then, at specified intervals, additional images and measurements are taken to make sure no changes have occurred over time that might indicate progressive glaucoma damage.<br /> <br /> Visual field testing is a way for your eye doctor to determine if you are experiencing vision loss from glaucoma. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals to make sure you are not developing blind spots from damage to the optic nerve or to determine the extent or progression of vision loss from glaucoma.<br /> <br /> Gonioscopy also may be performed to make sure the aqueous humor (or "aqueous") can drain freely from the eye. In gonioscopy, special lenses are used with a biomicroscope to enable your eye doctor to see the structure inside the eye (called the drainage angle) that controls the outflow of aqueous and thereby affects intraocular pressure. Ultrasound biomicroscopy is another technique that may be used to evaluate the drainage angle. More info can be found at this website: <a href="http://www.allaboutvision.com/conditions/glaucoma.htm">http://www.allaboutvision.com/conditions/glaucoma.htm</a> .<br /> <br /> Glaucoma cannot currently be prevented, but if diagnosed and treated early it can usually be controlled. Medication or surgery can slow or prevent further vision loss. However, vision already lost to glaucoma cannot be restored. That is why the American Optometric Association recommends an annual dilated eye examination for people at risk for glaucoma as a preventive eye care measure. Depending on your specific condition, your doctor may recommend more frequent examinations.<br /> <br /> Patients with glaucoma need to continue treatment for the rest of their lives. Because the disease can progress or change silently, compliance with eye medications and eye examinations are essential, as treatment may need to be adjusted periodically. By keeping eye pressure under control, continued damage to the optic nerve and continued loss of your visual field may slow or stop. The optometrist may focus on lowering the intraocular pressure to a level that is least likely to cause further optic nerve damage. This level is often referred to as the target pressure and will probably be a range rather than a single number. <br /> <br /> Target pressure differs for each person, depending on the extent of the damage and other factors. Target pressure may change over the course of a lifetime. Newer medications are always being developed to help in the fight against glaucoma. Early detection, prompt treatment and regular monitoring can help to control glaucoma and therefore reduce the chances of progression vision loss. Much more information can be found at this website: <a href="http://www.aoa.org/Glaucoma.xml">http://www.aoa.org/Glaucoma.xml</a> .<br /> <br /> Regular eye exams are critical for your vision health, especially if you fall into the high risk categories of those individuals more susceptible to this disease. Don’t put off getting your vision checked. Just pretending it won’t happen to you doesn’t mean you may not develop glaucoma. Prevention, regular check ups, and proper care of your vision can help. If you suspect you may be experiencing any problems with your eyes, get an exam with your doctor. <br /> <br /> Until next time.<br /> <br /></div>

health health care Penyakit Health Care and Glaucoma

Your vision is one of the most valuable assets you have. Being able to see clearly and without impediment is a huge advantage. Just ask s...

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The Bionic Medicine of Programmable People

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJy3SfWp8nuDM2xm1fVSDsLjpsDmSZ4kt8i5EQXskcAV27zqeHmfjiLUA6ixTeFjKrM7bQcnZRhTvoLC2SEh03zncoHn6lcs64n4nxsAVAGEoY9PqmH3xkhpNu3aW1hAGqxLvcO8zNBBY/s1600/Silicon_valley.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="The Bionic Medicine of Programmable People-Silicon Valley" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJy3SfWp8nuDM2xm1fVSDsLjpsDmSZ4kt8i5EQXskcAV27zqeHmfjiLUA6ixTeFjKrM7bQcnZRhTvoLC2SEh03zncoHn6lcs64n4nxsAVAGEoY9PqmH3xkhpNu3aW1hAGqxLvcO8zNBBY/s1600/Silicon_valley.jpg" title="Silicon Valley" /></a></div> A couple of weeks ago I wrote <a href="http://onhealthtech.blogspot.com/2012/08/curb-your-enthusiasm.html" target="_blank">a post</a> about the clueless, but endearing, enthusiasm of technology people as applied to solving the health care problem. A few days ago Dr. Davis Liu published a post on <a href="http://thehealthcareblog.com/blog/2012/08/31/vinod-khosla-technology-will-replace-80-percent-of-docs/" target="_blank">The Health Care Blog</a> describing the vision of <a href="http://techcrunch.com/2012/01/10/doctors-or-algorithms/" target="_blank">Vinod Khosla</a>, the famed venture capital maven, of replacing doctors with machines. It turns out that Mr. Khosla wrote a series of <a href="http://techcrunch.com/2012/01/09/khosla-artificial-intelligence/" target="_blank">three</a> articles at the beginning of the year in a technology publication describing how his pioneering vision will replace people in industries where either he or his <a href="http://techcrunch.com/2012/01/15/teachers-or-algorithms/" target="_blank">wife</a> are investing capital. Venture capitalists (VCs), although I’m sure they wouldn’t agree with this assessment, are a combination of professional gamblers and loan sharks. The secret to success is pure luck and ruthlessness, and when the combination works and the ball lands on the exact number on the spinning roulette, venture capitalists make lots of money. This is very different than running a business ala Warren Buffet or even Mitt Romney, let alone inventing a business like Apple or Microsoft. In return for risking funds, venture capital gets its juiciest pound of flesh when the funded business sells itself to the public, hopefully for more than it is really worth, and hopefully for a lot more than the venture capitalist risked. For that to happen, you have to create demand for whatever your fund is investing in at the moment. This is why you find VCs shedding tears at the mere thought of global warming, or telling us that the future is all about “I Robot”, or miraculous genetic “I am Legend” drugs , or “gamification” or whatever happens to make up their current investment portfolio. The problem with letting venture capital dictate humanity’s agenda is that the globe is getting warmer; people are getting poorer, sicker and dumber while a few VCs are getting richer.<br /> <br /> So what is Mr. Khosla selling us now? It seems that his machines, outfitted with “bionic” software are set to replace the 80% of “middling” doctors and also 80% of equally “middling” teachers. Only physicians like Dr. House will remain standing (for a short time) so they can be “leveraged” to create even more “bionic” software, and may I suggest that Albus Dumbledore could be used to illustrate the surviving human teachers of the bionic era. If you are a little bit familiar with the startup world, then you probably know that a business based on services provided by people is not an appealing investment gamble, because it doesn’t scale well, i.e. revenues and EBIDTA cannot go simultaneously through the roof at the same incendiary rate, because people need to be paid for labor. The trick is to find a business model where no labor is required or to find laborers who don’t require payment. A couple of centuries ago we “imported” such laborers from Africa. Today we are “exporting” labor to where those laborers naturally reside. For tomorrow, we are proposing to make machines that work for free. And this in a nutshell is Mr. Khosla’s vision.<br /> <br /> Let’s pause for a moment and address the technorati among us. This is not about medical technology for Dr. Leonard McCoy and Dr. Beverly Crusher or about the holographic doctor in Star Trek Voyager, all very awesome and super cool. This is not about stardate 43632.8 or a galaxy far far away. This is about a time frame of “five or ten years” for “bionic” software and “a decade or two” for an army of “Dr. Algorithm” practicing independently. It should be obvious even to the most ardent believers that, in such a short period of time, neither the science of medicine nor technology will be anywhere near the creation of the medical droid that administered to Padme in childbirth. However, these time frames are short enough to appear on corporate financial projections and startup pro-forma budgets. This is about real money and about some flimsy machinery deployed to play doctor to the poor (China and India are mentioned by Mr. Khosla, but the Mississippi Delta can’t be far behind), and if folks are harmed in the process, oh well…. (See below). <br /> <br /> Now, how about this “bionic” software that Mr. Khosla envisions to be a temporary bridge between human cognitive endeavor and full machine control in “a decade or two”? Turns out that the term was introduced by a <a href="http://bryce.vc/post/12600078312/bionic-software-and-programable-people" target="_blank">serial entrepreneur</a> in the social media/marketing, hotter than molten lava, sector.  Later adopted by the <a href="http://oatv.com/are.html" target="_blank">O'Reilly AlphaTech Ventures</a> folks who invest in clicks and links and data as well, “bionic” software has something to do with “programmable people” and “it has the potential to unlock a massive amount of unrealized human potential”, presumably as programmed and networked by VC funded programmers. According to <a href="http://topics.wsj.com/person/B/dennis-k-berman/1589" target="_blank">Dennis K. Berman</a>, a WSJ journalist writing about technology and “corporate scandals”, also <a href="http://online.wsj.com/article/SB10001424052970203462304577138961342097348.html#ixzz1ioOP4QRs" target="_blank">cited</a> by Mr. Khosla, we should accept the “rise of the machines” just like we accept earthquakes and hurricanes because it is simply inevitable. And if we still have any doubts regarding the superior intelligence of Jeopardy winning machines, we are reminded that “systems are now of such scale that they can analyze the value of tens of thousands of mortgage-backed securities by picking apart the ongoing, dynamic creditworthiness of tens of millions of individual homeowners. Just such a system has already been built for Wall Street traders”. I am so totally convinced now, but if you need more real life examples, you should read about the $108 million in venture funds going to “bionic” software helping pharmaceutical companies track social media activity to identify doctors more likely to influence their peers, or the $84 million venture investment in “bionic” software to spy on customers and make them buy more fatty food stuff. <br /> <br /> According to Mr. Khosla, soon we will advance beyond simplistic “bionic assistance” to “lazy” doctors, and we will no longer be “free to be stupid or political” and “reject” the “cost optimization” served by “Doctor Algorithm” in its medical practice and none of us will need those multitudes of “average” doctors stuck in the “18th century tradition of “first do no harm””. Since VCs are only interested in engineering, as opposed to social engineering, their off the cuff suggestions for the “middling” 80% in any profession or occupation, where wages are proposed to be eliminated from the expenses column, is usually something vapid like “empathy, advice and caring”. Of course “empathy, advice and caring” doesn’t pay anything like actual doctoring, and it is precisely those large wages that need to be eliminated. Highly educated professional workers are also much harder to transform into “programmable people”, like say, the young girls working in one of those infernal laptop assembly lines in China. So once the new troves of captive cheaper-than-machine labor pools have been secured, all that is left in the quest for zero COGS, within the short cash horizons of venture capital, is to eliminate those expensive and volatile knowledge workers from the balance sheet. And since Mr. Khosla’s educated estimate is that “medical diagnosis or 90% of it is an easier task than Jeopardy”, and since he urges us “not to extrapolate the past and what has or has not worked”, it should be easy as pie to imagine a future almost completely free of professional physicians, classroom teachers and non-programmable people in general.<br /> <br /> Thus, in Mr. Khosla’s hospital of the future, medicine will be practiced by thinking machines, while floor scrubbing, sheets changing and bed-pan emptying will be left to humans. Eventually, the medical machines, or the few human lords remaining, will probably take on the last yard of efficiency and create menial machines for janitorial purposes, at which point the only human beings in a hospital will be the patients in the beds, and venture capital’s ROI will be inching towards infinity. Unfortunately for Mr. Khosla, or future generations thereof, the transactional volume will be trending to absolute zero, since the “middling” 80%, after advancing to the mindless 80%, are now mostly extinct or have reverted to gathering wild berries where vegetation still remains. I hope being the Supreme Ruler of nothing at all proves to be a very satisfying experience for Khosla Ventures.</div>

health informed consent medication The Bionic Medicine of Programmable People

A couple of weeks ago I wrote a post about the clueless, but endearing, enthusiasm of technology people as applied to solving the health...

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Alternative Health Information Technology

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZpFSWLPkx-wdg0RWj5deESqFZj7mkEV4de1-KirKKdefkdZNIcsw80WF-egJAaYz-DhkMH6aQyAW2Hhdu7Cxb154g74dovyS089ZvJtcIes-sXf82W2Iayg62K44l1mr_sA_nNWrgzDw/s1600/goldilocks.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Alternative Health Information Technology" border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZpFSWLPkx-wdg0RWj5deESqFZj7mkEV4de1-KirKKdefkdZNIcsw80WF-egJAaYz-DhkMH6aQyAW2Hhdu7Cxb154g74dovyS089ZvJtcIes-sXf82W2Iayg62K44l1mr_sA_nNWrgzDw/s200/goldilocks.jpg" title="Alternative Health Information Technology" width="175" /></a></div> Say you are a pediatrician in an average middle class lily white suburb and most of your little patients are either sitting stiffly in the pews next to you or are elevating your spirits with angelic voices clad in white robes on a blessed Sunday morning. Say little Johnny trips on his way down the altar and ends up taking a ride to the ER to have his forehead stitched. Does the ER doc need to know that the 13 year old altar boy is not a smoker? Does he need to know that Grandpa Joe died from prostate cancer, but other than that the family history is unremarkable? Does the nurse washing Johnny’s forehead need to be informed that the boy has a history of ear infections and had tubes put in when he was 3 years old? Not a fair example, right? Let’s cross the 8 Mile road and look at another Johnny who shows up at the other ER at 2 am with two gunshot wounds to the chest. Does anybody on his care team gives a damn about Mom suffering from depression and diabetes, or the fact that Johnny is a current smoker of tobacco products and has been counseled on cessation? Yes, I know, sometimes these things are pertinent, and sometimes even more details are needed, but not always, and not always the same details. Unfortunately, we are busy building a one-size-fits-all-circumstances infrastructure, which is destined to be too big for most, too small for some and ill-fitting for all but a random handful. <br /> <br /> Leaving aside the troubled business side of medicine, electronic medical records are supposed to ease and simplify the capture, analysis and sharing of clinical information, by utilizing computer software tools. Computers have eased and simplified the capture, analysis and sharing of financial information, supply chain information, manufacturing information, transportation information, and every other type of industrial information you can think of, so why not medical information? Before you go pointing out that clinical information is highly variable and so very unique to the individual, please consider that computers have simplified and eased capture, analysis and sharing of personal information of all sorts from chatting and accessorizing outfits, to making friends and asking a pretty girl out on a date. Surely, nothing is more unique and personal than finding your soul mate. Not even health care. <br /> <br /> If a physician practicing medicine in the U.S. today desires to ease and simplify the capture, analysis and sharing of clinical information, he or she can choose from a large assortment of computer software tools, better known as EHRs, all carefully examined and certified by government sanctioned entities to be capable of easing and simplifying these tasks, and as Pete Seeger might have said, “<i>there's a green one and a pink one and a blue one and a yellow one, and they're all made out of ticky tacky and they all look just the same</i>”. To the dismay of regulatory and certifying authorities, most physicians who are willy nilly adopting these tools, under threat of financial fines and penalties, continue to grumble that the capture, analysis and sharing of clinical information is neither eased nor simplified by EHRs, and quite the opposite is true. <br /> <br /> This strange situation can be, and often is, dismissed as due to physicians being technophobes or just unwilling to do their share in promoting beneficial health reforms. To support these specious arguments, the regulators are constantly parading a handful of doctors who found happiness and efficiency in their EHRs. Unexplainable? Not really. There are always a few lucky folks for whom one-size tee shirts fit as perfectly as if the rag was tailored just for them, while the rest of us have to tuck it in, tie it in the back, cut it off, or pull at the sides to make it stretch, and in all cases it ends up looking like someone else’s garment. A quick look at what is driving health care costs up reveals that physicians as a group are cheerfully adopting things like magnetic resonance, computed tomography, image guided radiation, proton beam therapy, laser surgery, robotic this or that, and a host of other high tech tools that would terrify the average technophobe into crawling under the first available rock. So why is health information technology so different? Or is it?<br /> <ul> <li><a href="http://www.epocrates.com/who" target="_blank">epocrates</a>, the drug reference software boasts 50% of physicians in the U.S. as its users. epocrates has been steadily growing since 1998 and is practically a household name when it comes to medications advice. It is available on iPhones, iPads and mobile Android devices and it has expanded far beyond just lists of indications and contraindications for prescription drugs.</li> <li><a href="http://www.uptodate.com/home/about-us" target="_blank">UpToDate</a> needs no introduction either. The widely used electronic clinical decision support system has been in existence for over 20 years and you would be hard pressed to find an academic institution that is not subscribing to its content and tools, both in the U.S. and the rest of the world. Like epocrates, UpToDate is available on the web and on all fashionable mobile devices.</li> <li><a href="https://www.doximity.com/press" target="_blank">Doximity</a> is a relatively new kid on the block, and a very interesting one to boot. Only 3 years old and already claiming to have “crossed the 200,000 member milestone”. Doximity is a communications platform for physicians allowing members to securely exchange messages, including clinical information, and make referrals or obtain ad-hoc consultations from colleagues. Sort of like a social network on steroids, and of course it is available on mobile phones and tablets too.</li> </ul> epocrates never bothered to obtain Meaningful Use certification for its main product, because what it does and what clinicians find useful is not a certifiable activity. It did however certify its feeble attempt at creating yet another ticky tacky EMR, and then proceeded to quickly dump the resulting stillborn. UpToDate obtained certification only for its peripheral patient education module, and Doximity is nowhere around the target zone of what the government decrees as meaningful use of technology. While both epocrates and UpToDate had ample time to solidify their user base before the advent of Meaningful Use, Doximity experienced its meteoric rise in spite of Meaningful Use and that should give us some hope that any day now, a couple of MIT grads in some basement may launch Patximity and make information sharing between doctors and patients as simple and as easy as apple pie. We can imagine that somewhere far from the limelight a doctor laboring in solitude will come up with the simple and easy to use Charximity to effortlessly capture thought processes at the point of care. And then someone will come up with something better or different or faster or smarter or cheaper… <br /> <br /> Sadly, this crescendo of innovation is very unlikely though, because unless the new software is a clone of some primordial EMR, or parts thereof, and unless it conforms to government devised ways of doing things, most prospective customers will be forced to choose between a new and unknown product and the piles of cash thrown at them by regulators. If say, our imaginary Charximity developers come up with a quick and elegant way to record a dynamically defined set of information, and package it in a small, nimble and universal format that lends itself to being securely moved around the private networks of the fabled Patximity and real Doximity, in a most expedient way, chances are great that this cool innovation will fail to thrive because it can’t inform regulators on Johnny’s smoking status or Grandpa Joe’s prostate trouble, in an exhaustive XML format passed around through interminable chains of certified intermediaries on the federally secured national health information network. The good news is that one day checkboxes and dropdown lists will only exist at the Smithsonian, and good technology will prevail in the end. The bad news is that the end is being pushed further and further away with each additional Meaningful Use stage.</div>

health health care Alternative Health Information Technology

Say you are a pediatrician in an average middle class lily white suburb and most of your little patients are either sitting stiffly in th...

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The Big Birds of Health Care

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRaerG5L9gqg4A-q4e9YxMp9todZPkfHjvQoD5kBAUVkd4kOHPqmSRTzlNAlQ7VyBYNhVQaxYG-tKpqyGAf8qUSIojoQU-3V1XD2j2KWTzzEVXGW_Z2MDWh4-gSjIZKjRf_RK3bwHyE2M/s1600/bigbird.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRaerG5L9gqg4A-q4e9YxMp9todZPkfHjvQoD5kBAUVkd4kOHPqmSRTzlNAlQ7VyBYNhVQaxYG-tKpqyGAf8qUSIojoQU-3V1XD2j2KWTzzEVXGW_Z2MDWh4-gSjIZKjRf_RK3bwHyE2M/s1600/bigbird.jpg" /></a></div> For the first time in this election campaign Mitt Romney came up with a useful “zinger”. During the first <a href="http://www.npr.org/2012/10/03/162258551/transcript-first-obama-romney-presidential-debate" target="_blank">Presidential debate</a> Romney suggested that we should examine our various expenditures and ascertain if the item we spend taxpayers money on is “important enough to borrow money from China”. Unsurprisingly, the first thing that came to Romney’s mind was a public service providing small children with education on racial diversity and basic literacy skills. And although, we are not directly borrowing money from China to pay for things, it wouldn’t hurt to go through our expenses, including the many small and apparently insignificant ones, and see if there’s anything we can do without. It actually may be less painful to make a thousand additive little cuts than to locate one large silver bullet that is certain to cause commensurately large pain. Of course, such exercise would be fraught with controversy, since what may look frivolous to one party, could look worthwhile to another. But if we approach this with an honest intent to generate some savings, would there be some Big Birds that we could all agree to do without for now?<br /> <br /> A day after the Presidential debate the Republican Chairs of the Ways and Means and Energy and Commerce Committees published <a href="http://waysandmeans.house.gov/uploadedfiles/hhs_ehr_mu2_final.pdf" target="_blank">a letter</a> addressed to the Secretary of Health and Human Services asking that Meaningful Use payments and penalties be suspended, and the program be reevaluated because it failed to reach its stated goals of having EHRs “talk to each other”. As political and misguided as this letter is, perhaps there is an opportunity here nevertheless to go looking for Birds. The Meaningful Use program is costing taxpayers around $35 billion, and it has been said that this is just a drop in the bottomless bucket of public health care expenditures, but Meaningful Use has other costs associated with it. Technology vendors subject to these new regulations are spending money to make their products compliant, or certifiable, which is increasing the price provider organizations pay for technology, which is then increasing the prices health care purchasers are charged. These new regulatory activities, consisting mainly of data collection, aggregation and reporting, are imposing additional operational costs on providers, which are then also passed down to purchasers, and since nobody is running a charity in health care these days, all these costs are trickling down to taxpayers in various ways.<br /> <br /> The original idea behind Meaningful Use was that EHRs will eventually pay for themselves in the form of enterprise efficiency that will reduce costs and improve quality of care simultaneously. So far it looks like enterprise efficiency is translating mostly into higher revenues for providers and higher costs for health care purchasers, and as far as quality is concerned, the jury is still out. So should we ditch Meaningful Use because it does not pass the Romney litmus test for keeping Big Birds alive? Not necessarily. Meaningful Use is not a monolithic program than can, or should, be evaluated in one swoop. Some parts of Meaningful Use look reasonably fit for purpose while others look more like clusters of big yellow feathers randomly slammed onto the main regulatory body, and perhaps those should be removed.<br /> <br /> Let’s start with the basic assumption that complete medical records, when made available to clinicians and patients at the point of care, can indeed improve the quality of care for individual patients, and when used for outreach and research, can improve population health and reduce costs. This same assumption, made by <a href="http://onhealthtech.blogspot.com/2010/03/century-of-medical-records.html" target="_blank">Dr. Henry Stanley Plummer</a> in 1907, prompted the revolutionary transition from physician ledgers to today’s patient chart, so this should be a pretty reasonable assumption to make. If that’s the case, does <a href="http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf" target="_blank">Meaningful Use</a> have any unessential feathers that we can safely remove and thus lower the costs of this program without hurting its main intent?<br /> <br /> <b>Yellow Feathers Cluster #1:</b> Both the architects of Meaningful Use and the authors of the letter asking for the program to be suspended, assume that figuring a path through the deep weeds of futuristic technology is a prerequisite to providing physicians with useful information at the point of care. So the regulators deemed it appropriate to require that 50% of discharge summaries, for example, should be produced in a specific format while 10% should be sent out using the latest standards and technologies. What about the remaining 90% of patients? And how do you decide who the lucky 10% should be? If we put aside the technology centric approach to solving problems, we could require that 100% of discharge summaries are sent out to primary care doctors, nursing homes, patients and other care givers, by any means and in any form or shape available. So maybe EHRs can’t really “talk to each other”, but they can make it possible for doctors and patients to “talk to each other” more efficiently. Would any hospital stand up and argue that generating and sending discharge summaries by secure email, electronic fax, plain fax, FedEx, carrier pigeon or whatever, is a hardship? I don’t think so, and if they did, they would probably pressure their technology vendors to automate the process. <br /> <br /> <b>Yellow Feathers Cluster #2:</b> Meaningful Use was supposed to have 3 stages: data collection, information exchange, quality improvement. Since Stage 4 is already in discussions, I would assume that Meaningful Use is envisioned to have transformed from a temporary tool to spur technology adoption to a perpetual mechanism for enforcing policy through technology. Either way, the starting point was presumptuous, ineffective and wasteful. Clinicians in all settings were already documenting what they thought was necessary to document in the patient chart. Before endeavoring to let information be exchanged, the Meaningful Use architects decided to enforce their vision of what should be documented and subsequently exchanged. Thus we now have smoking status on every piece of paper, along with race and ethnicity, and in Stages 3 & 4 we will have disability status, sexual orientation and gender identity in the header of every clinical summary, and armies of disenchanted doctors and nurses clicking away at boxes. What would happen, if instead of defining the fields required in “clinical summaries”, we would ask that 100% of referrals (and consults) be accompanied by at least the last visit note, a referral letter and the last test results, if any? Again, by any means available and in any format the referring (consulting) physician can produce.<br /> <br /> <b>Yellow Feathers Cluster #3:</b> Other than complex attempts at new venues for information exchange, Meaningful Use is chock full of a veritable smorgasbord of little features and functionalities, which may be nice to have if money was no object, and doctors’ time was unlimited, and others that are ridiculously self-evident, such as creating visit notes and recording family history (seriously?). Should we “borrow money from China” to ensure that every doctor stares at the insurance company formulary for a few seconds before he prescribes Amoxicillin? How many dollars should we take out of the ailing Medicare trust fund in order to pay hospitals and doctors for sending a “failed message” to an immunization registry?  How many kids should we kick out of Medicaid so that the militant app developers can dupe patients into “transmitting” their medical records to their marketing machines on the physician’s dime and infrastructure? It’s easy to come up with ever increasing complexity when there are no real constraints. It’s called scope creep and it’s been the death blow of many good projects, even for those who don’t need to “borrow money from China”.  How about picking two or three realistic things that will give us the biggest bang for the (limited) buck and just concentrate on doing those really well, so we can build from there? <br /> <br /> <b>Yellow Feathers Cluster #4: </b>This last cluster is impossible to completely remove. The Meaningful Use incentives structure is just plain unfair and exceedingly wasteful, although more than likely intended to be so as a means to a policy end. There are no published numbers from CMS or ONC indicating the number of incentives recipients that bought and implemented an EHR long before Meaningful Use was created. Most of those “early adopters” were big systems like Kaiser and financially comfortable medical groups. Even if we accept the assumption that Meaningful Use of an EHR can improve quality of care, why would we borrow money from China to pay businesses for investing in their own bottom lines of their own accord? Whenever I ask why it is that Kaiser’s premiums are not much lower than its less “effective” competition, I am reminded that Kaiser must recoup its billions in technology investments. By my back of the napkin calculations, they should have recouped that already, so why should taxpayers deplete their old age medical funds to throw a few hundred millions more in Kaiser’s way? If we really want to improve quality of care, shouldn’t we concentrate on bringing up the rear, and shower Critical Access Hospitals, Rural Health Clinics and small practices everywhere with technology funds? Every study out there shows that these small providers are struggling financially and technically. Meaningful Use incentives should have gone exclusively to these small and needy establishments, most of which are serving equally impoverished patients, instead of padding the pockets of large systems so they can more easily buy these small providers and create the currently preferred “too big to fail” model of health care delivery. <br /> <br /> I’m sure you can think of more feathers and clusters, and Meaningful Use is just one health care program that lends itself to productive plucking. Shall we begin applying the Romney China Test to all other sacred Big Birds in health care and start adding up the billion dollar drops in the bucket? Or will that make us look dumber than we would like to look?</div>

health health care Native Americans natural disasters The Big Birds of Health Care

For the first time in this election campaign Mitt Romney came up with a useful “zinger”. During the first Presidential debate Romney sug...

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Health Care and Short Term Memory Loss

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTKA3XIAJj1fYIktaRjqJ3FUpStZS4O01gf3tWXURA8IT8S-MEHUXyWYVKi6zaD4P92jE6lToYLFh9nTz2dIJkymWuFcL6cJj7mbd2U8EOjNZJ3WW6GKWQj69v7lzjwc_CVTKt9_wARDU/s1600/American-flag.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTKA3XIAJj1fYIktaRjqJ3FUpStZS4O01gf3tWXURA8IT8S-MEHUXyWYVKi6zaD4P92jE6lToYLFh9nTz2dIJkymWuFcL6cJj7mbd2U8EOjNZJ3WW6GKWQj69v7lzjwc_CVTKt9_wARDU/s1600/American-flag.jpg" width="200" /></a></div> <span style="font-family: "arial" , "sans-serif";">There’s a long standing joke about people who can’t remember where they put their keys, or what they were supposed to buy at the grocery store, or where they parked their car at the shopping mall, or what instructions to follow:<o:p></o:p></span><br /> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">Two men met on the city street in the evening, and had a number of drinks together. The one who lived in the suburbs became confidential, and exhibited a string tied around a finger.<br /><br />"I don't dare to go home," he explained. "There's something my wife told me to do, without fail, and to make sure I wouldn't forget, she tied that string around my finger. But for the life of me I can't remember what the thing was I am to do. And I don't dare to go home!"<br /><br />A few days later the two men met again, this time in the afternoon. "Well," the one asked, "did you finally remember what that string was to remind you of?" The other showed great gloom in his expression, as he replied:<br /><br />"I didn't go home until the next night, just because I was scared, and then my wife told me what the string was for all right--she certainly did!" There was a note of pain in his voice. "The string was to remind me to be sure to come home early."</span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">You might laugh at such a silly story, but the actual truth is that short term memory loss, beyond just being an inconvenience or temporarily embarrassing, can be a problem for many people—especially if it persists or gets worse. It can be dangerous, and may be a precursor of more problematic health issues such as alzheimer’s or dementia.</span><span style="color: #545454; font-size: 14.5pt;"><span style="font-family: "calibri";"> </span></span><span style="font-family: "arial" , "sans-serif";">Short-term memory loss can be a natural side effect of aging, or can be caused by disease, injury, stress, or as a side effect of drug use.</span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">You have difficulty concentrating or it feels like your short-term memory isn’t as good as it used to be. You may also notice that normal tasks seem hard to focus on, you are more forgetful, you forget things that you normally wouldn’t, or you have difficulty forming thoughts or carrying on conversations. </span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">You may also start something and uncharacteristically forget what you were doing soon after. You may also have difficulty remembering where you placed things, who you just called, what you just talked about, or what you were looking for or thinking about. You uncharacteristically may have difficulty remembering what you just ate, phone numbers, names, or things you recently did. Things that you would normally not forget, you now do.<o:p></o:p></span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">According to a report issued by Rutgers University, short-term memory refers to memories which last for a few minutes. Unlike sensory memory, which is stored in the exact form it was experienced, short-term memory has received some processing; thus, "A" is stored not as a visual stimulus, but as an abstract concept of the letter "A". Short-term memory is of limited capacity, usually 5-9 items ("7-plus-or-minus-two"). Beyond this capacity, new information can "bump" out other items from short-term memory. This is one form of forgetting.</span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">Objects in short-term memory can be of indefinite complexity: thus short-term memory can hold several numbers, or several words, or several complex concepts simultaneously. Thus, while an individual may only be able to remember seven random digits, it may be possible to remember more digits if they are "chunked" into meaningful objects: thus, "1776-2001-1941" represents twelve separate digits -- well beyond most people's capacity -- but only three easily-remembered chunks. </span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">Items can be maintained indefinitely in short-term memory by rehearsal: e.g. by repeating the information over and over again. An example would be a seven-digit phone number, which is maintained in short-term memory by repetition until the number is dialed, and then fades from short-term memory once the conversation starts. Repetition may also increase the probability that items in short-term memory will enter permanent storage in long-term memory. More details about how your memory works can be found at this website: </span><a href="http://www.memorylossonline.com/glossary/memory.html"><span style="font-family: "arial" , "sans-serif"; mso-ansi-font-weight: normal;"><span style="color: #015692;">http://www.memorylossonline.com/glossary/memory.html</span></span></a><span style="font-family: "arial" , "sans-serif";"> .</span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN;">When testing for any type of memory loss, a doctor will take a medical history and perhaps ask a few questions to test a patient's memory. Other exams may include cognitive testing to check the patient's mental status and ability to think. The doctor may also order blood tests to check for various conditions including vitamin B-12 deficiency and thyroid disease, according to LiveScience.com.</span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN;">Depending on the results, other tests may include an MRI or CT scan of the head and an EEG to measure electrical activity in the brain. A cerebral angiography may also be ordered to examine blood flow to the brain. If the cause of the short-term memory is related to a psychological trauma, a therapist or psychologist may be consulted. </span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN;">One of the most common suggestions for a better short-term memory is to use mnemonics. Mnemonics is the technique of attaching a word, phrase or image to an object. One example of a mnemonic is the trick many people learned in school to remember how many days are in a month. “Thirty days hath September, April, June and November …” You can also use the trick to remember things such as a name, such as "Rob wore a red shirt."</span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN;">Another trick is to have someone put a number of objects out on a table. Give yourself 30 seconds to memorize them. Then take the objects away and try to write down as many as you can in 30 seconds. Doing activities that engage your brain, such as Sudoku and crossword puzzles, and reading in general can also help improve your memory. More material on this subject can be found at this site: <b style="mso-bidi-font-weight: normal;"><a href="http://www.livescience.com/42891-short-term-memory-loss.html"><span style="font-weight: normal; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="color: #015692;">http://www.livescience.com/42891-short-term-memory-loss.html</span></span></a>. <o:p></o:p></b></span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN;">And did you know chewing gum<b style="mso-bidi-font-weight: normal;"> </b>impairs short term memory? According to Prevention Magazine, a study out of Cardiff University in the UK found that not only does chewing gum <em><span style="font-family: "arial" , "sans-serif";">not</span></em> help your short term memory: It impairs it. <span style="mso-spacerun: yes;"> </span>In a series of three experiments, 97 university students were asked to recall either a short sequence of letters or identify the missing item in a list. </span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN;">They performed significantly worse when chewing gum, no matter how vigorously or how lazily they chomped. Researchers speculate that the tongue, mouth, and jaw movements of gum chewing disrupt short-term memory. More info on this topic can be found at this site: <b style="mso-bidi-font-weight: normal;"><a href="http://www.prevention.com/health/brain-games/chewing-gum-hurts-short-term-memory-study"><span style="font-weight: normal; mso-ansi-font-size: 11.0pt; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold;"><span style="color: #015692;">http://www.prevention.com/health/brain-games/chewing-gum-hurts-short-term-memory-study</span></span></a></b>.<o:p></o:p></span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span lang="EN" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN;">Much more detail on memory loss in general can be found at the National Institutes for Health (NIH) website: <b style="mso-bidi-font-weight: normal;"><a href="http://www.nlm.nih.gov/medlineplus/ency/article/003257.htm"><span style="font-weight: normal; mso-bidi-font-weight: bold;"><span style="color: #015692;">http://www.nlm.nih.gov/medlineplus/ency/article/003257.htm</span></span></a>.</b></span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">Short term memory loss may be just a sign of being distracted or some other issues that are not really problematic. However, it could be a signal that more serious mental health problems are developing. If you are seeing this condition develop more and more in yourself or someone you know, see your doctor for testing. Don’t excuse it away, or you might forget why.<o:p></o:p></span></div> <br /> <div class="MsoNoSpacing" style="margin: 0in 0in 0pt;"> <span style="font-family: "arial" , "sans-serif";">Until next time.<o:p></o:p></span></div> </div>

Alzheimer's Disease health mental health Health Care and Short Term Memory Loss

There’s a long standing joke about people who can’t remember where they put their keys, or what they were supposed to buy at the grocery ...

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Health Care and Data Breaches

<div dir="ltr" style="text-align: left;" trbidi="on"> <div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqbchCk-WQMi9yg5vgkzJtYfvNx4j7xMkm4PL4yWPlNpeYk5FoWokfSXgwtDzTKvylqvjCnKF4S1nt6AJ3oDnMkz5Y4QhAKhywhKg5oOnk5L0qrbd95FuQtcf8Wi21r1zzPIsTMi5qe4s/s1600/American-flag.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqbchCk-WQMi9yg5vgkzJtYfvNx4j7xMkm4PL4yWPlNpeYk5FoWokfSXgwtDzTKvylqvjCnKF4S1nt6AJ3oDnMkz5Y4QhAKhywhKg5oOnk5L0qrbd95FuQtcf8Wi21r1zzPIsTMi5qe4s/s200/American-flag.jpg" width="200" /></a></div> <div class="MsoNoSpacing"> <span style="color: red; font-family: "arial" , "sans-serif";"><b>This blog post is my 500th article!!! </b></span><br /> <span style="font-family: "arial" , "sans-serif";"><br /></span><span style="font-family: "arial" , "sans-serif";">One of the most critical issues in the healthcare field today, for medical providers and facilities and for consumers, is the breach of personal health care information. The theft of personal medical records is big money on the black market, and ID theft due to that crime is rampant. <o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">According to Modern Healthcare magazine, </span><span style="font-family: "helvetica" , sans-serif;">2016 is being deemed the “year of data security” in healthcare—if only because 2015 was a substantial wake-up call for the industry. Nearly 90 percent of healthcare providers have been hit by data breaches in the last two years, according to security research firm Ponemon Institute, with many large-scale and criminally driven attacks publicized in 2015. More details are located at this website: <a href="http://www.modernhealthcare.com/article/20160227/SPONSORED/160229900/2016-the-year-of-data-security">http://www.modernhealthcare.com/article/20160227/SPONSORED/160229900/2016-the-year-of-data-security</a><o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">HIT Consultant reports that one in three Americans were victims of healthcare data breaches in 2015, attributed to a series of large-scale attacks that each affected more than 10 million individuals. These and other statistics are contained in Bitglass’ 2016 Healthcare Breach Report.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">Among the most significant findings of the report was that in 2015, 98 percent of record leaks were due to large-scale breaches targeting the healthcare industry. These high-profile attacks were the largest source of healthcare data loss and indicate that cyber attackers are increasingly targeting medical data. <o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">Such breaches include the widely publicized Premera Blue Cross hack involving 11 million customers, and the Anthem hack which resulted in 78.8 million leaked customer records. More info is located at this website: <a href="http://hitconsultant.net/2016/01/28/hackers-caused-98-of-healthcare-data-breaches/">http://hitconsultant.net/2016/01/28/hackers-caused-98-of-healthcare-data-breaches/</a>. <o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "helvetica" , sans-serif;">According to Health IT Security, </span><span style="font-family: "arial" , "sans-serif";">80 percent of organizations handling sensitive information report concern for large-scale data breaches, based on a survey conducted by Advisen. This survey included organizations from several different industries, but the most highly represented industry was healthcare, comprising 22 percent of the respondent sample.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">Despite the growing concern for large-scale data breaches, the study’s authors report that organizations may not be doing enough. While three quarters of respondents report having some sort of data breach response plan, these plans may not go through rigorous enough testing. You can find more material on this subject at this site: <a href="http://healthitsecurity.com/news/large-data-breaches-top-worry-for-health-pros-survey-shows">http://healthitsecurity.com/news/large-data-breaches-top-worry-for-health-pros-survey-shows</a>.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">Forbes Magazine reported that 2015 was the worst year yet for data breaches. The online mechanism for the Office of Civil Rights (OCR) under Health and Human Services publishes data breaches as reported to them and required by HIPAA. The numbers last year are just staggering:<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;">         </span></span><!--[endif]--><span class="tweetquote3"><span style="font-family: "arial" , "sans-serif";">According to OCR, there were 253 healthcare breaches that affected 500 individuals or more with a combined loss of over 112 million records.</span></span><span style="font-family: "arial" , "sans-serif";"><o:p></o:p></span></div> <div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;">         </span></span><!--[endif]--><span class="tweetquote3"><span style="font-family: "arial" , "sans-serif";">The top 10 data breaches alone accounted for just over 111 million records that were lost, stolen or inappropriately disclosed.</span></span><span style="font-family: "arial" , "sans-serif";"><o:p></o:p></span></div> <div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l1 level1 lfo1; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;">         </span></span><!--[endif]--><span class="tweetquote3"><span style="font-family: "arial" , "sans-serif";">The top six breaches affected at least 1 million individuals–and four of the six were Blue Cross Blue Shield organizations.</span></span><span style="font-family: "arial" , "sans-serif";"><o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">While HIPAA is the legislation (passed in 1996) designed to protect patients against loss, theft or disclosure of their sensitive medical information, the fines and penalties don’t appear to be having a discernible effect on either patient privacy or data security.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">A recent data breach study estimates that breaches cost the healthcare industry about $5.6 billion annually. As healthcare moves toward connected care, the amount of data exchanged between organizations is only going to grow. So what does this mean? It means that in 2016, the healthcare industry is going to see a huge movement towards encryption in hospitals and other healthcare facilities in order to protect EHRs (electronic health records) and other vulnerable PHI (Personal Health Information). More detailed material is located at this website: <a href="http://www.forbes.com/sites/danmunro/2015/12/31/data-breaches-in-healthcare-total-over-112-million-records-in-2015/#3f9cb33b7fd5">http://www.forbes.com/sites/danmunro/2015/12/31/data-breaches-in-healthcare-total-over-112-million-records-in-2015/#3f9cb33b7fd5</a>.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">Oddly enough, however, according to Health IT Security, the first few months into 2016 are showing a slightly different trend, with results from the Department of Health and Human Services (HHS) indicating that stolen devices and improper disposal are the top threats currently facing the industry. Patient names, addresses, phone numbers, Social Security numbers, dates of birth, health insurance numbers, other medical status and assessment information as well as some financial information have been exposed with these incidents.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">The top five healthcare data breaches of this year so far do not involve hacking or an IT incident, according to the HHS Office for Civil Rights (OCR) data breach reporting tool. Instead, theft, loss, improper disposal, and unauthorized email access or disclosure have caused the largest incidents in 2016. More info is located at this website: <a href="http://healthitsecurity.com/news/top-5-healthcare-data-breaches-in-2016-not-from-hacking">http://healthitsecurity.com/news/top-5-healthcare-data-breaches-in-2016-not-from-hacking</a>.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">According to IT Business Edge, a big part of the problem is that security organizations are still focused on preventative security — looking for a silver bullet that will keep an attacker out of their networks in the first place. Despite a Gartner recommendation that organizations shift security efforts toward the detection of network intruders and the emergence of promising new behavioral analytic tools and security strategies, well under 1 percent of enterprises have the ability to find a post-intrusion network attacker. Cyber criminals continue to have the potential for unimpeded, long-term success. More info is located at this site: <a href="http://www.itbusinessedge.com/slideshows/2016-security-trends-whats-next-for-data-breaches-06.html">http://www.itbusinessedge.com/slideshows/2016-security-trends-whats-next-for-data-breaches-06.html</a>.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">Hospitals, health systems, payers and any organization with stewardship of healthcare data are prime targets for cyberattacks, according to Becker’s Hospital Review (BHR). And there are plenty of cautionary tales showing just how much damage hackers can do. While no healthcare organization will ever be completely invulnerable to such attacks, they can learn from others' mistakes. <o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">Here are four lessons, according to BHR, healthcare providers can consider when thinking about data breach prevention and preparedness:<o:p></o:p></span></div> <div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;"> <!--[if !supportLists]--><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB; mso-fareast-font-family: Arial;">1.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;">    </span></span><!--[endif]--><strong><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; font-weight: normal;">Don't fall prey to known vulnerabilities</span></strong><b><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">.<o:p></o:p></span></b></div> <div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;">2.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;">    </span></span><!--[endif]--><strong><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; font-weight: normal;">Utilize experience-based training</span></strong><b><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">.</span></b><b><span style="font-family: "arial" , "sans-serif";"><o:p></o:p></span></b></div> <div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;">3.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;">    </span></span><!--[endif]--><strong><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; font-weight: normal;">Consider a third party for security audits</span></strong><b><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">.</span></b><b><span style="font-family: "arial" , "sans-serif";"><o:p></o:p></span></b></div> <div class="MsoNoSpacing" style="margin-left: .5in; mso-list: l0 level1 lfo2; text-indent: -.25in;"> <!--[if !supportLists]--><span style="font-family: "arial" , "sans-serif"; mso-fareast-font-family: Arial;">4.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal;">    </span></span><!--[endif]--><strong><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; font-weight: normal;">Create a contingency plan</span></strong><b><span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">.</span></b><b><span style="font-family: "arial" , "sans-serif";"><o:p></o:p></span></b></div> <div class="MsoNoSpacing"> <span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;"><br /></span></div> <div class="MsoNoSpacing"> <span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">More information about this topic is available at this website: <a href="http://www.beckershospitalreview.com/healthcare-information-technology/4-healthcare-data-breach-lessons-to-take-to-heart.html">http://www.beckershospitalreview.com/healthcare-information-technology/4-healthcare-data-breach-lessons-to-take-to-heart.html</a>.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span lang="EN-GB" style="font-family: "arial" , "sans-serif"; mso-ansi-language: EN-GB;">Businesses, especially in the healthcare field, must always make every effort to protect patient information. That is their responsibility, and they can be held civilly responsible, and criminally responsible if there is a proven negligent act. </span><span style="font-family: "arial" , "sans-serif";">As a consumer, you may receive a letter or an email informing you that your personal information may have gotten into the wrong hands as a result of a data breach.  Perhaps a media report alerted you to a security breach at a company where you do business. <o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">Regardless of the type of data breach, medical information is more difficult to recover, manage, and restore, especially for consumers. According to Privacy Rights Clearinghouse, there are helpful tips on what to do if a breach has occurred. Much more detail is located at this website: <a href="https://www.privacyrights.org/how-to-deal-security-breach">https://www.privacyrights.org/how-to-deal-security-breach</a>. <o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <div class="MsoNoSpacing"> <span style="font-family: "arial" , "sans-serif";">Always be diligent to monitor your healthcare information. Take steps to protect your personal data, and never provide your information to businesses that have no protection or privacy capabilities in place. Always ask who will see your information, and request a copy of their privacy policies. If you discover that a breach has occurred, take quick action to reduce the exposure and limit the damage that can be done. It’s your life. Keep it secret. Keep it safe.<o:p></o:p></span></div> <div class="MsoNoSpacing"> <br /></div> <span style="font-family: "arial" , sans-serif;">Until next time. </span></div>

health health care Health Care and Data Breaches

This blog post is my 500th article!!!  One of the most critical issues in the healthcare field today, for medical providers and facilit...

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