Daily Healthy: health care

The Legend of Health Care

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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”. 
 
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. 
 
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. 
 
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. 
 
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). 
<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. 
 
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. 
 
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. 
 
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. 
<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. 
 
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… 
<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. 
 
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>

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...

12 Penyebab Terkena Kanker Payudara (Gejala & Pencegahannya)

2:40 PM Khalil Gibran 0 Comment

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Setiap tubuh manusia sebenarnya sudah memiliki bakal sel kanker. Bakal sel kanker ini dapat terpicu oleh beberapa faktor, yang akhirnya bisa menyebabkan tubuh mengalami serangan kanker, termasuk payudara. 
 
Penyebab kanker payudara sebenarnya masih tidak bisa untuk diketahui secara pasti. Sehingga memang agak sedikit rumit, tidak bisa di pastikan penyebab pada setiap penderita adalah sama. 
<a href="https://draft.blogger.com/null" name="more"></a> 
Untuk penyebab yang dapat memengaruhi tingkat risiko kanker payudara, ada beberapa seperti apabila seseorang pernah mengidap kanker payudara, atau juga mengalami perubahan sifat sel kanker non-invasif yang terkandung di dalam saluran payudara menjadi sel kanker invasif... 
 
...maka hal ini bisa berakibat pada orang yang mengalaminya terkena kanker payudara, baik itu pada bagian payudara yang sama (jika sebelumnya sudah terkena kanker) ataupaun pada payudara satunya. 
 
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Penyebab terkena kanker payudara  
 
#1. Benjolan jinak yang dialami 
Terkena masalah benjolan jinak sebenarnya tidak serta merta membuat orang yang mengalaminya terkena kanker payudara, akan tetapi benjolan tertentu memang bisa meningkatkan risiko kanker payudara. 
 
Perubahan kecil pada jaringan payudara, seperti pertumbuhan sel yang tidak lazim dalam saluran (lobulus), bisa meningkatkan risiko terkena kanker payudara. 
 
#2. Faktor genetika 
Memiliki anggota keluarga, seperti ibu, kakak, adik atau anak, apabila ada yang mengidap kanker payudara (ovarium), maka risiko terkena kanker payudara meningkat. 
 
#3. Faktor usia 
Risiko kanker bisa meningkat seiring dengan bertambahnya usaha, dimana kanker payudara umumnya dialami oleh wanita berusia di atas 50 tahun, yaitu sekitar 80 persen. 
 
#4. Paparan Radiasi 
Paparan radiasi juga mengakibatkan meningkatnya risiko kanker payudara, paparan radasi termasuk berasal dari prosedur medis, seperti  melakukan rontgen dan CT scan. 
 
#5. Risiko paparan estrogen 
Risiko kanker payudara juga bisa meningkat akibat tingkat paparan terhadap estrogen di dalam tubuh, kondisiya yaitu: Jika seorang wanita tidak memiliki keturunan hingga usia tua... 
 
...maka berakibat meningkatkan risiko kanker payudara karena paparan terhadap estrogen tidak terhalang oleh proses kehamilan. 
 
Hal lainnya karena mengalami masa menstruasi yang lebih lama 
 
#6. Akibat terapi penggantian hormon 
Terapi penggantian hormon kombinasi memiliki risiko lebih tinggi dibandungkan terapi penggantian hormon estrogen. 
 
Tetapi tetap saja, keduanya tetap meningkatkan risiko terkena kanker payudara. 
 
Risiko kanker payudara meningkat seiring durasi lamanya terapi, tetapi kondisi bisa kembali normal setelah berhenti menjalaninya. 
 
#7. Kelebihan berat badan 
Kelebihan berat badan setelah menopause bisa berakbiat pada meningkatnya produksi estrogen, yang akan membuat meningkatnya risiko kanker payudara. 
 
#8. Konsumsi minuman keras 
Sebuah penelitian yang dilakukan terhadap 200 wanita pengonsumsi minuman keras dan 200 wanita bukan pengonsumsi minuman keras. 
 
Hasilnya, ditemukan bahwa mereka yang mengonsumsi minuman keras bisa terserang kanker sebanyak tiga kali lebih besar. 
 
Risiko kanker payudara meningkat seiring dengan banyaknya jumlah minuman keras yang dikonsumsi. 
 
#9. Merokok 
Termasuk gaya hidup tidak sehat (yang tidak diragukan lagi) adalah merokok. Pada sebatang rokok mengandung banyak sekali zat beracun, dan sebagian besar dapat memicu pertumbuhan sel kanker. 
 
Tidak hanya perokok aktif yang beresiko terkena penyakit kanker, tetapi juga perokok pasif bisa rentan terkena penyakit kanker tersebut. 
 
Untuk itu, hal yang sangat penting diusahakan, agar kita semua berusaha untuk menjauhi yang namanya rokok, yang merupakan cerminan gara hidup tidak sehat. 
 
#10. Terkena racun Pestisida 
Konsumai sayur dan buah-buahan menjadi ciri gaya hidup sehat. Akan tetapi, hal ini juga bisa menjadi bumerang ketika kesalahan dalam memilih sayur dan buah yang hendak dikonsumsi. 
 
Kandungan pestisida yang menempel pada sayur atau buah bisa berakibat timbulnya reaksi pada tubuh berupa pertumbuhan sel kanker. 
 
Sehngga, penting untuk cerdas dalam memilih sayur dan buah yang organik, yang tidak tercemar pestisida. 
 
Sebuah penelitian yang dilakukan para ahli dari University of Liverpool menyebutkan bahwa pestisida bisa meningkatkan risiko kanker payudara. 
 
Apabila memang terpaksa membeli sayur dan buah non organik, maka dalam pengolahannya harus dicuci hingga bersih sebelumnya. 
 
#11. Akibat implan payudara 
Implan sering ditanam dalam tubuh, Tidak terkecuali di payudara. Wanita yang menggunakan implan payudara terkena resiko kanker payudara yang lebih tinggi dibandingkan perempuan yang tidak memakainya. 
 
Hal ini dikemukakan oleh para peneliti dari Kanada, seperti dilaporkan dalam BMJ (British Medical Journal). <a href="http://www.medicalnewstoday.com/articles/37136.php">medicalnewstoday.com</a> 
 
#12. Melakukan pekerjaan memicu kanker payudara 
Beberapa penelitian yang dlakukan para ahli, menemukan adanya hubungan antara pekerjaan wanita dengan resiko kanker payudara. 
 
Penelitian di Prancis menunjukkan bahwa hubungan antara wanita yang bekerja pada malam hari dan belum pernah mengalami kehamilan, bisa menjadi penyebab kanker payudara. 
 
Selain itu, penelitian dari Kanada menemukan bahwa pekerjaan tertentu, bisa memungkinkan tubuh manusia kontak ke dalam karsinogen, seperti pekerjaan di bar, otomotif, perusahaan manufaktur plastik, dan perusahaan makanan kemasan (kaleng, plastik), yang memicu resiko kanker payudara. 
 
Benarkah konsumsi kedelai memicu kanker payudara? 
Dalam beberapa sumber situs kesehatan, ada yang menyebutkan bahwa kadungan di dalam kacang kedelai dapat memicu pertumbuhan sel kanker di dalam tubuh. 
 
Akan tetapi, peryantaan ini dibantah oleh informasi yang terdapat di situs <a href="http://doktersehat.com/penyebab-kanker-payudara-tipe-dan-pengobatannya/">doktersehat.com</a>, bahwasanya tahu, tempe, susu kedelai dan makanan lain dari kedelai adalah makanan sehat yang kaya akan vitamin E. 
 
Banyak penelitian menemukan bahwa kedelai justsu mampu mencegah kanker, termasuk kanker payudara. Mengapa demikian? 
 
Ternyata kedelai mengandung senyawa bernama isoflavon yang berperan sebagai estrogen ketika berada di dalam tubuh. 
 
Sementara orang menilai bahwa kedelai bisa memicu kanker, yang berdasarkan penelitian isoflavon pada kedelai, justru memiliki pengaruh baik untuk tubuh, selama di konsumsi dalam jumlah yang tepat. 
 
Di tahun 2008, the British Journal of Cancer menemukan fakta bahwa wanita Asia yang sering mengkonsumsi kedelai, bisa berupa tahu, tempe atau susu kedelai, memiliki lebih rendah resiko terkena kanker payudara dibandingkan dengan mereka yang tidak mengkonsumsinya. 
 
Di tahun 2009, American Journal of Clinical Nutrition melakukan suatu penelitian dengan melibatkan sekitar 74.000 wanita di Cina yang berusia 40-70th. 
 
Para wanita yang mengkonsumsi kedelai setiap hari cenderung terkena kanker payudara lebih kecil, dibandingkan dengan mereka yang tidak mengkonsumsi kedelai sama sekali. 
 
Laporan yang dimuat dalam Journal of the American Medical Association tahun 2009, para ilmuwan meneliti 5.042 peserta yang mengikuti “Shanghai Breast Cancer Survival Study”. 
 
Hasilnya diemukan bahwa konsumsi kedelai justru dapat menurunkan risiko kekambuhan dan kematian akibat kanker payudara. 
 
Dengan begitu, tidak perlu khawatir dalam mengonsumsi kedelai. Apalagi kedelai memiliki kandungan protein tinggi. Protein kedelai adalah satu-satunya dari jenis kacang yang mengandung susunan asam amino esensial paling lengkap. 
 
Gejala kanker payudara 
 
#Terdapat benjolan 
Munculnya benjolan pada payudara merupakan gejala umum kanker payudara. Akan tetapi, tidak selalu benjolan pada payudara merupakan indikator pasti seseorang baru terkena kanker payudara... 
 
...karena tanpa adanya gejala benjolan pada payudara pun, seseorang bisa saja terkena kanker payudara. Meskipun begitu, benjolan pada payudara harus diwaspadai. 
 
Tanda benjolan yang kemungkinan kanker: 
<ol style="text-align: left;">
<li>Benjolan terasa keras</li>
<li>Benjolan tidak mudah dibedakan</li>
<li>Benjolan tetap di payudara; tidak bergerak</li>
<li>Hanya ada satu benjolan</li>
<li>Tidak ada benjolan yang sama di payudara sebelahnya</li>
<li>Kulit payudara berlesung pipit</li>
<li>Benjolan disertai dengan keluarnya cairan</li>
</ol>
 
Benjolan yang KEMUNGKINAN KECIL menjadi kanker: 
<ol style="text-align: left;">
<li>Benjolan lunak</li>
<li>Benjolan diskrit; mudah dibedakan</li>
<li>Benjolan bergerak di payudara</li>
<li>Ada beberapa benjolan payudara</li>
<li>Ada benjolan di payudara sebelahnya.</li>
<li>Benjolan menghilang setelah siklus menstruasi</li>
</ol>
 
#Tektur berubah 
Berubahnya tekstur payudara  bisa menjadi gejala kanker payudara, sehingga penting melakukan pemeriksaan terhadap payudara sendiri, apakah terjadi perubahan bentuk atau tidak. 
 
#. Keluar cairan kuning 
Pada penderita kanker payudara, apabila putingnya ditekan maka keluar cairan berwarna kuning seperti nanah. Gejala ini cukup jelas, sehingga untuk mengeceknya hanya perlu menekan puting secara lembut dan periksa, apakah keluar cairan seperti itu atau tidak. 
 
#Benjolan di ketiak 
Benjolan dibawah ketiak juga merupakan gejala dari kanker payudara yang umum terjadi. Segera melakukan pemeriksaan kesehatan jika mengalaminya. Bahkan, jika memungkinkan melakukan pemeriksaan USG (apabila mengalami banyak gejala kanker payudara). 
 
#Warna berubah 
Selain benjolan dan perubahan bentuk pada payudara, gejala kanker payudara lainnya adalah terjadi perubahan warna payudara. Anda bisa memeriksa payudara di depan cermin, perhatkan apakah warnanya berubah atau tidak. 
 
#Bentuk puting berubah 
Patut diwaspadai apabla puting payudara terasa gatal, bahkan juga seakan terbakar, ataupun puting seperti tertarik ke dalam. 
 
#Keluar darah 
Tidaklah normal jika puting mengeluarkan cairan seperti darah apabila tidak dalam kondisi hamil atau menyusui. Sehingga perlu diwaspadai sebagai gejala kanker payudara. 
 
#Timbulnya kerutan 
Timbulnya kerutan kecil seperti kulit jeruk pada area payudara. Kerutan tanda kanker payudara bisa dirasakan dengan tangan perbedaannya, permukan kasar dan spesifik di daerah tertentu pada kulit payudara. Biasanya kerutan ini berwarna sedikit hitam dan tidak terlalu besar lingkupnya. 
 
Kulit payudara normal tidak memiliki kerutan, cenderung halus dan permukaan yang rata (kecuali di daerah puting). 
 
#Nyeri tidak kunjung hilang di bagian tertentu payudara 
Payudara mungkin saja terasa nyeri saat masa menstruasi ataupun ketika sedang hamil. Namun, rasa nyeri tersebut dapat hilang seiring dengan selesainya siklus yang dilalui. 
 
Lalu bagaimana jika rasa nyeri tersebut tidak kunjung hilang? Jika memang rasa nyeri tidak kunjung hilang, perhatian apakah bagian yang nyeri tersebut terletak pada posisi yang sama atau tidak ? 
 
jika iya, yaitu pada bagian yang sama, maka hal ini bisa menjadi ciri-ciri kanker payudara. 
 
Apa yang harus dilakukan pada nyeri tersebut? 
<ol style="text-align: left;">
<li>Jangan di pencet</li>
<li>Jangan ditempelkan dengan’minyak’ pereda nyeri</li>
<li>Segera konsultasikan ke dokter</li>
<li>Jangan dibiarkan terlalu lama, karena bisa sangat berbahaya</li>
</ol>
 
#Puting masuk ke dalam 
Puting susu biasanya timbul, kalaupun sedang mengecil setidaknya akan sejajar dengan kulit. Namun sebuah keanehan jika puting susu menukik ke dalam. 
 
Semua bagian di payudara yang menukik di dalam harus diwaspadai sebagai tanda-tanda kanker payudara. 
 
Puting susu yang Masuk ke dalam bisa terjadi di salah satu bagian saja, ataupun di kedua-duanya. 
 
#Gejala kanker payudara lainnya: 
<ol style="text-align: left;">
<li>Terdapat cekungan seperti lesung pipi pada payudara></li>
<li>Pembengkakan di area ketiak</li>
<li>Sebagian area payudara membengkak dan berwarna merah</li>
<li>Jika puting ditarik, putik tidak segera kembali ke bentuk normal, melainkan mengendur</li>
<li>Timbul rasa sakit setelah puting ditarik</li>
<li>Benjolan atau kulit yang menebal di payudara</li>
</ol>
 
#Ketika kanker telah menyebar, maka akan mempengaruhi bagian lain di tubuh, sehingga timbul gejala lainnya (selain di organ payudara) yaitu: 
<ol style="text-align: left;">
<li>Nyeri tulang</li>
<li>Mual</li>
<li>Penyakit kuning</li>
<li>Kehilangan nafsu makan</li>
<li>Penurunan berat badan</li>
<li>Penumpukan cairan di sekitar paru-paru (efusi pleura)</li>
<li>Sesak napas</li>
<li>Sakit kepala parah dan tidak lekas sembuh</li>
<li>Batuk</li>
<li>Penglihatan ganda</li>
<li>Kelemahan otot tubuh</li>
</ol>
 
Pencegahan kanker payudara 
 
#Hindari minuman alkohol 
Hampir semua penelitian mengungkapkan bahwa minum minuman alkohol meningkatkan risiko terkena kanker payudara. Wanita yang minum 2-5 gelas alkohol dalam sehari terekna risiko 1.5 x lipat dibandingkan wanita yang tidak mengkonsumsi alkohol. 
 
Mengapa alkohol berpengaruh pada perkembangan kanker payudara ? menurut peneliti seperti yang dikutip dari dailymail, alkohol dapat meningkatkan kadar hormon estrogen, salah satu hormon yang mempercepat pertumbuhan sel kanker payudara. <a href="http://www.dailymail.co.uk/health/article-76602/10-ways-prevent-breast-cancer.html">Dailymail.co.uk</a> 
 
#Menjagar berat badan 
Menjaga berat badan (agar tidak mengalami kegemukan) menjadi cara ampuh dalam mencegah dan menghindari kanker payudara... 
 
...bahkan beberapa jenis kanker lainnya juga bisa diturunkan resikonya dengan mengatur berat badan yang ideal. 
 
#Olahraga secara teratur 
Olahraga menjadi salah satu cara untuk mencegah penyakit kanker terutama payudara. Olahraga dapat menurunkan tingkat sirkulasi estrogen di dalam tubuh. 
 
Seseorang yang tidak pernah olahraga maka tingkat estrogen di dalam tubuh bisa tinggi, yang memicu munculnya penyakit kanker payudara. 
 
Olahraga yang baik untuk mencegah kanker payudara, yaitu jenis olahraga yang mampu mengeluarkan toxin (racun) dari dalam tubuh, dalam jumlah yang signifikan. 
 
Olahraga juga mengaktifkan fungsi syaraf dan otot tubuh, untuk mencegah kanker payudara. 
 
#Jangan Merokok 
Terlepas dari semua studi yang menemukan hubungan antara resiko kanker payudara dengan merokok, sangat penting diketahui bahwa bahaya merokok bukanlah omong kosong, tetapi benar-benar nyata bahayanya. 
 
Segala jenis penyakit berbahaya dan kanker menjadi tinggi resikonya akibat merokok. 
 
Beberapa penelitian telah menemukan bahwa kandungan zat berbahaya di dalam rokok sangat berkaitan dengan berbagai jenis kanker. 
 
Penelitian lainnya menemukan bahwa ASI pada perokok wanita juga dapat terkontaminasi. 
 
#Menyusui 
Menyusui tidak hanya bermanfaat bagi si bayi, tetapi Ibu atau orang yang menyusui mendapatkan manfaat besar. Penelitian telah menemukan keterkaitan langsung antara menyusui terhadap menurunnya resiko kanker payudara. 
 
Menurunnya resiko kanker payudara, (diklaim oleh para peneliti) karena adanya keterkaitan antara aktivitas menyusui dengan kestabilan tingkat estrogen, sehingga memperkecil risiko kanker. 
 
#Hindari Radiasi 
Ada berbagai jenis radiasi yang bisa mengenai tubuh, seperti saat pemeriksaan medis, seperti CT Scan, pemeriksaan MRI, dan rontgen. Selain itu, risiko kanker payudara juga meningkat jika radiasi sinar X dilakukan di dada wanita berusia 20 tahun ke bawah. 
 
#Usahakan menghindari terapi hormon pasca menopause 
Penggunaan terapi hormon sering dilakukan untuk mengatasi sulit tidur, cepat marah, dan faktor lain yang disebabkan menopause. 
 
Kombinasi terapi hormon estrogen dan progestin dapat meningkatkan risiko terkena kanker payudara, disarankan tidak mengambil terapi hormon lebih dari 5 tahun. Saran dokter selama melakukan terapi secara mendetil sangat diperlukan. 
 
#Hindari konsumsi Pil KB 
Beberapa pil KB memiliki kandungan estrogen yang memicu resiko kanker payudara. Studi telah menunjukkan hasil, bahwa perempuan yang mengkonsumsi pil KB memiliki risiko lebih tinggi di bandingkan dengan wanita yang tidak mengkonsumsi. 
 
Risiko ini akan hilang seiring dengan dihentikan penggunaan pil KB. 
 
#Usahakan melahirkan anak (saat di bawah 30 Tahun) 
Wanita yang melahirkan anak di bawah usia 30 tahun memiliki kecenderungan risiko lebih rendah terkena kanker payudara dibandingkan wanita yang melahirkan di atas 30 tahun. 
 
Namun faktor melahirkan bisa berbeda, sesuai dengan jenis kanker yang ada. 
 
Cara mencegah kanker payudara yang beredar di masyarakat 
Selain berbagai cara di atas, terdapa beberapa informasi yang beredar di masyarakat guna mencegah kanker payudara, walaupun belum teruji secara detil akan kebenarannya. Tetapi ada baiknya unuk mempertimbangkannya (selama tidak memberikan dampak negatif), berikut di bawah ini: 
<ul style="text-align: left;">
<li>Mengkonsumsi makanan yang bergizi, serat dan buah buahan yang kaya vitamin.</li>
<li>Melakukan diet rendah lemak.</li>
<li>Hndari penggunaan deodoran</li>
<li>Hindari lingkungan yang terpapar bahan kimia</li>
<li>Hindari aborsi</li>
<li>Hindari bekerja pada malam hari.</li>
<li>Hindari penggunaan BH yang ketat</li>
</ul>
 
Untuk Informasi mengenai pengobatan kanker payudara, kunjungi halaman situs terpecaya <a href="http://www.alodokter.com/kanker-payudara/pengobatan">Alodokter.com</a> 
 
<div style="background-color: white; border: 1px #000000 dashed; padding: 10px;">
Baca juga: 
<ul style="text-align: left;">
<li><a href="http://kesehatantubuh-tips.blogspot.com/2015/12/7-gaya-hidup-sehat-yang-perlu-kamu.html">7 Gaya Hidup Sehat yang Perlu Kamu Lakukan</a></li>
<li><a href="http://kesehatantubuh-tips.blogspot.com/2014/11/14-kebiasaan-yang-membuat-cepat-tua.html">35 Kebiasaan & Makanan Penyebab Cepat Tua</a></li>
<li><a href="http://kesehatantubuh-tips.blogspot.com/2014/02/bahaya-membentak-anak-memusnahkan-sel-otak.html">7 Bahaya Membentak Anak (Memusnahkan Sel Otak dll)</a></li>
</ul>
</div>
</div>

health care Penyakit Wanita 12 Penyebab Terkena Kanker Payudara (Gejala & Pencegahannya)

Setiap tubuh manusia sebenarnya sudah memiliki bakal sel kanker. Bakal sel kanker ini dapat terpicu oleh beberapa faktor, yang akhirnya bis...

Quick Medicine quickly explain to your customer

10:38 PM Meme Art Studio 0 Comment

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By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacities, but there will be no one charting on paper. The term “charting” itself may become obsolete, like yonder or popinjay. The term EHR, which is what replaces the paper chart, won’t last either because it doesn’t roll easily off the tongue like say, email instead of letter or missive. EHRs don’t do anything else easily, so chances are EHRs themselves won’t last much longer, relatively speaking. Sooner or later, the national spotlight will shift to something other than health care, and other electronic critters will emerge from the shadows.  What will they be? What should they be? Those could be two very different answers. 
<h4>
What Should Be</h4>
Have you noticed how people advocating for EHRs use the word quickly in practically every sentence? Mega EHR allows you to quickly document XYZ, and Super EHR can quickly gather all historical data and display it in a summary dashboard which allows you to quickly assess the status of the patient. You can quickly send prescriptions to pharmacies, quickly order a bunch of tests, and quickly print out (the horror!) education materials. Your staff can quickly schedule patients, quickly answer questions, quickly verify eligibility and quickly drop claims. Your patients can quickly get answers, quickly schedule visits and quickly have their concerns resolved. 
 
Of course, most of these things are aspirational at this point, but the language is indicative of the thought process behind EHR design: hurry up and get it over with. Time is money and quickly disposing of each patient is absolutely imperative in a high functioning health system. You could argue that there is nothing wrong with speeding up, or even eliminating, administrative tasks, and you would be right. But is reviewing historical information on a patient and documenting today’s encounter an administrative task? When reviewing histories is compressed into briefly glancing at a bunch of <a href="http://en.wikipedia.org/wiki/Sparkline" target="_blank">sparklines</a> like they have for the stock market, it may seem like you are engaging in an administrative task. Buried somewhere deep in the dark chart though, there may be a note you made about Mary’s difficulties to navigate the front porch stairs last year. 
 
Why did you make that old note? It’s not required for billing. It’s not demanded by insurers. What made you type that in? Do you usually make notes about irrelevant things that you fully expect to never see again? When you used paper charts, you had to flip through many pages to gather the information you can now quickly glean from your infographic patient dashboard. And while you were paging back and forth through that chart, chances are you would have stumbled upon that little note that seemed important enough for you to scribble down last year. And maybe you would discover other little notes too. 
 
Is reading a book the same as reading the <a href="http://nfs.sparknotes.com/macbeth/characters.html" target="_blank">SparkNotes</a>? Oh, you will pass the test either way, and may even get better scores with the SparkNotes version, but is it the same? Is reading this: “Ultimately, he is unable to bear the psychic consequences of his atrocities”, the same as reading this: “Tomorrow, and tomorrow, and tomorrow, /Creeps in this petty pace from day to day, /To the last syllable of recorded time; /And all our yesterdays have lighted fools /The way to dusty death. Out, out, brief candle! /Life's but a walking shadow, a poor player, /That struts and frets his hour upon the stage, /And then is heard no more. It is a tale /Told by an idiot, full of sound and fury, /Signifying nothing.”? Which version leaves you better equipped to address the story at hand, and the story-teller himself as a whole person? And which version makes you, the reader, feel more like a whole person? 
 
Whatever else the EHR of the future might do, it should quit trying to quantify, summarize, highlight and decontextualize the soul out of the medical record. Disposing of patients quickly should not be our goal. Other than being demeaning and dehumanizing for all involved, seeing patients quickly is the root of all our health care woes. In an environment increasingly hostile to human interaction, EHRs should ferociously fight to create more time for patients to spend with their doctors. EHRs should automate the business of medicine and eventually the science of medicine, while protecting the art of medicine. And by art, I don’t mean compassion and advocacy. I mean the application of professional judgment, without which the science is incomplete and will always be incomplete, regardless of how many genes we can map or how many bots we can implant in ourselves. 
 
Assuming that the business of health care will be marching along the glorious path currently laid out by our betters, the EHR of the future should endeavor to become a silent background processing machine. Natural language processing should be the first and foremost feature to be implemented to perfection. The EHR should parse and extract useful information from doctor-patient interactions to maximize physician reimbursement by maximizing claim values (yep, I just said that), and by scouring all opportunities to obtain incentives and bonuses from the overlords, and automatically applying for all, without user intervention. Not an easy task, but IBM Watson could drop out of medical school and take this on. 
 
The flip side of maximizing revenue is to cut overhead. No practice needs a scheduler. Let patients schedule themselves online or on the phone. Let them check in and let them room themselves (think about those little restaurant gizmos that beep when your table is ready). Let them take their own vitals and answer all those preliminary questions on their own. For the outliers, the frail and the elderly, one medical assistant can cover these tasks for bigger practices. It doesn’t sound much like an EHR because it isn’t. 
 
What else costs money, but has practically nothing to do with medicine? All the school notes, the back to work notes, the disability forms, trade forms and all other forms, authorizations, pre-authorizations, eligibility checks, statements and everything in between, can be delegated to computerized self-service. Get the medical records online and let patients have at it. Make it user friendly like all other trivial consumer facing apps that have absolutely no bearing on enterprise technologies. Make them colorful and fun. Show pictures, animations and ads. Put them on the iPhone. Monetize the heck out of everything, and remove this purely administrative burden from the practice. 
 
And then comes a moment when restraint needs to be religiously exercised. Stay the heck away from the exam room. Let people say whatever they want to say. Let doctors ask whatever they want to ask. Forget about boxes, no matter how useful they look. Forget about structure too, because Watson will be taking care of that. Don’t make documentation easy, because taking notes is not just about documentation. It is mostly about the background thought process that makes one decide what to note and what to discard. Remember, the way you would use different styles of handwriting and text of different sizes or boldness, and how you added critical notes in the margins, or big pointy arrows? Actively taking notes helps you synthesize information, internalize, memorize and understand the narrative (programmers, think back to your college days). 
 
If EHRs want to be helpful, let them be secretaries. Arrange the notes in a way conducive to better information retrieval. Don’t summarize and don’t impose your (or your machine’s) notions of what is or is not important. Collate and bind everything into a patient book. Remember that this is a reference book and the user can read at a 30th grade level. It is not a cookbook and it is certainly not a picture book. Add a table of contents. Use the computer to make it dynamic. Make it easy to flip pages in an electronic context. Make the fonts nice and large, and do learn from beautifully maintained old paper charts. Go out and look at some before they are extinct. You can’t improve that which you don’t know. 
<h4>
What Will Be</h4>
Of course none of the above is going to materialize in a meaningful way, except maybe the infantilized consumer facing EHR. Health care is going retail and health care will care about its customers precisely as much as Walmart and Amazon do. And health care will care for its employees as much as Walmart and Amazon do. When providers are all transitioned to having their employer paid for value, EHRs will become very easy to use. A few big buttons, at the bottom of pages prefilled with stereotypes and sprinkled with colored sparklines, should quickly do the job (i.e. Order, Refer, or Deny). There will be nothing for you to document and nothing for the patient to convey because the system already knows everything there is to know. Eventually, it will dispense with the buttons altogether, and your job will be to quickly explain to your customer why the system did what it did. And you will never have to use a computer ever again. Mission quickly accomplished.</div>

health care Medical medication Quick Medicine quickly explain to your customer

By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacit...

Who’s Afraid of the Medical Home?

11:15 PM Meme Art Studio 0 Comment

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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. 
 
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: 
<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? 
 
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. 
 
Standard #1 - Enhance Access and Continuity – 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? 
 
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. 
 
Standard #2 - Identify and Manage Patient Populations – 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. 
 
Standard #3 - Plan and Manage Care – 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.  
 
Standard #4 - Provide Self-Care Support and Community Resources – 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. 
 
Standard #5 - Track and Coordinate Care – 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. 
 
Standard #6 - Measure and Improve Performance – 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. 
 
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. 
 
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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”. 
 
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. 
 
[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]</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...

Integrated Health Care and Fitness Jobss

9:52 PM Meme Art Studio 0 Comment

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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. 
 
One way to help with keeping your employees well is to start a fitness program at your company. According to Stephanie Christensen writing for Intuit Small Business Blog, 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. 
 
1. Create a challenge board. Bob Choat, author of Mind Your Own Fitness 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. 
 
2. Offer charitable incentives. 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. 
 
3. Be active volunteers. Amanda Little, founder of HealthyHerLiving, 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. 
 
4. Leverage employee support. Research shows that people are more likely to reach their fitness goals when they share them with others for support. Symmetry Software CEO Tom Reahard bought the Fitbit Zip, 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. 
 
5. Hold one event per month. 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 Tough Mudder 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> . 
 
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. 
 
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. 
 
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: 
 
• 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. 
 
• 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. 
 
• 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. 
 
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. 
 
Until next time. 
 </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 ...

Health Care and Glaucoma

8:48 PM Meme Art Studio 0 Comment

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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. 
 
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. 
 
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: 
 
• African Americans over age 40 
• People over age 60, especially Mexican Americans 
• People with a family history of glaucoma 
 
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> . Open-angle Glaucoma, the most common form of glaucoma, accounting for at least 90% of all glaucoma cases: 
 
• Is caused by the slow clogging of the drainage canals, resulting in increased eye pressure 
• Has a wide and open angle between the iris and cornea 
• Develops slowly and is a lifelong condition 
• Has symptoms and damage that are not noticed. 
 
“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. 
 
<h2 style="text-align: left;">
Angle-closure Glaucoma, is a less common form of glaucoma:</h2>
 
• Is caused by blocked drainage canals, resulting in a sudden rise in intraocular pressure 
• Has a closed or narrow angle between the iris and cornea 
• Develops very quickly 
• Has symptoms and damage that are usually very noticeable 
• Demands immediate medical attention. 
 
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: 
 
Normal-Tension Glaucoma (NTG): 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. 
 
Congenital Glaucoma: 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. 
 
Other Types of Glaucoma: Variants of open-angle and angle-closure glaucoma include: 
 
• Secondary Glaucoma 
• Pigmentary Glaucoma 
• Pseudoexfoliative Glaucoma 
• Traumatic Glaucoma 
• Neovascular Glaucoma 
• Irido Corneal Endothelial Syndrome (ICE) 
 
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. 
 
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. 
 
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. 
 
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. 
 
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> . 
 
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. 
 
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. 
 
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> . 
 
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. 
 
Until next time. 
 </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...

Alternative Health Information Technology

9:00 PM Meme Art Studio 1 Comment

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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. 
 
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. 
 
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, “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”. 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. 
 
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? 
<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… 
 
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...

The Big Birds of Health Care

10:05 PM Meme Art Studio 0 Comment

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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? 
 
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. 
 
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. 
 
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? 
 
Yellow Feathers Cluster #1: 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. 
 
Yellow Feathers Cluster #2: 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. 
 
Yellow Feathers Cluster #3: 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? 
 
Yellow Feathers Cluster #4: 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. 
 
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>

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

Health Care and Data Breaches

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This blog post is my 500th article!!!  
 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></div>
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According to Modern Healthcare magazine, 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></div>
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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></div>
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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></div>
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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></div>
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According to Health IT Security, 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></div>
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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></div>
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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></div>
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·         According to OCR, there were 253 healthcare breaches that affected 500 individuals or more with a combined loss of over 112 million records.<o:p></o:p></div>
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·         The top 10 data breaches alone accounted for just over 111 million records that were lost, stolen or inappropriately disclosed.<o:p></o:p></div>
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·         The top six breaches affected at least 1 million individuals–and four of the six were Blue Cross Blue Shield organizations.<o:p></o:p></div>
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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></div>
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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></div>
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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></div>
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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></div>
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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></div>
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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></div>
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Here are four lessons, according to BHR, healthcare providers can consider when thinking about data breach prevention and preparedness:<o:p></o:p></div>
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1.    Don't fall prey to known vulnerabilities.<o:p></o:p></div>
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2.    Utilize experience-based training.<o:p></o:p></div>
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3.    Consider a third party for security audits.<o:p></o:p></div>
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4.    Create a contingency plan.<o:p></o:p></div>
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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></div>
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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. 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></div>
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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></div>
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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></div>
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Until next time. </div>

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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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