The number of board-certified emergency doctors in the United States will likely fall short of hospital emergency department staffing needs in the future, say Massachusetts General Hospital (MGH) researchers.

The scientists suggested that alternative strategies for staffing emergency departments are needed.

"Thousands of emergency departments are not currently staffed by physicians with this type of training," study leader Dr. Carlos Camargo, of the department of emergency medicine, said in an MGH news release. "We questioned whether staffing every department with residency-trained, board-certified emergency physicians -- which some individuals have advocated for decades -- was a realistic goal. So, we set out to estimate emergency physician workforce needs, taking into account the diversity of hospitals across the country and projections about the future physician supply."

TMJ pain treatment, wink, wink, wink—if the "muscles of the face, neck, shoulders and chest are all interconnected," then he should be doing it in male patients as well; where are they?

 interesting, should physician and nursing errors be glitches too? how come software gets off easy?

Robert Wachter, professor of medicine at the University of California-San Francisco and an authority on hospital medicine and patient safety, cautions that the rapid expansion of the no-pay idea looks like a "cost-cutting effort clothed in the garb of patient safety" that is "nowhere near ready for prime time."

While withholding payment for inexcusable medical mistakes is a sensible concept, Medicare's decision to penalize hospitals for more nuanced complications raises the bar too high. You cannot regulate perfection.

For years a booming economy camouflaged the burden of medical debt. Patients borrowed against their homes or whipped out credit cards, including some specially designed to pay medical or dental bills. But falling house prices and tightening credit have eliminated those options for many.

As a result, the problem of medical debt is climbing the income scale, affecting not just the poor or the uninsured. Millions of Americans covered by health insurance are paying more for less -- fewer benefits, higher co-pays and additional deductibles -- and are at risk for large out-of-pocket bills when serious illness or injury strike.

[...]

Experts define the underinsured as those forced to spend at least 10 percent of their income on health care, excluding premiums. But the nonprofit Center for Studying Health System Change found recently that financial pressures on families increase sharply when out-of-pocket spending on medical bills exceeds 2.5 percent of family income. New York's Commonwealth Fund has reported that 72 million adults under age 65 had problems paying medical bills or were paying off medical debt in 2007, up from 58 million in 2005. Many had insurance, and 39 percent said they had exhausted their savings paying for health care.

The shift toward temporary assignments comes as the traditional way of practicing general surgery is fading in many parts of the country. For decades, general surgeons have been the backbone and economic engine of the community hospital. While maintaining their own private practices, they staff trauma and critical-care units and perform most common abdominal procedures. Without them, hospitals couldn't provide many emergency-room services. In rural areas, their backup is necessary for everything from complicated births to inserting chest tubes.

But the increasingly grueling schedules, shrinking payments and the temptation of more profitable surgical niches have made the field less attractive. Over the past 25 years, the number of general surgeons per capita has declined 25%, according to a study published in the Archives of Surgery earlier this year. Other specialties are also seeing shortages as their ranks grow more slowly than the overall population, but the decline in general surgery is steeper than most. And while the number of physicians overall isn't in decline, general surgery is one of the few fields where the absolute number of surgeons is actually shrinking.

ACS Press Release 

The committee said current health IT systems present difficulties in sharing data across platforms and in integrating new features. They also offer little in the way of cognitive support -- programs that help doctors integrate raw data, like lab tests, to get a whole picture of the patient.

Many health care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient.

The United States will face a severe shortage of gastroenterologists as the population ages and the demand for colorectal cancer screening increases, a health care consulting firm has projected.

At current rates of cancer screening, the United States will need an additional 1,050 gastroenterologists by 2020, according to the study by The Lewin Group. If colorectal cancer screening rates were to increase by 10 percent, the nation would need as many as 1,550 additional gastroenterologists by that time, the firm found. Colon cancer is the nation’s second leading cancer killer. There are currently 10,390 practicing gastroenterologists in the United States, according to the report.

Now, though, researchers say they are alarmed by what they are finding as they track patients for months or years after an I.C.U. stay. Patients, even young ones, can be weak for years. Some have difficulty thinking and concentrating or have post-traumatic stress disorder and terrible memories of nightmares they had while heavily sedated.

While patients may be suffering lingering effects from illnesses that landed them in the I.C.U., researchers are increasingly convinced that spending days, weeks or months on life support in the units can elicit unexpected, long-lasting effects.

So now some I.C.U.’s are trying what seems like a radical solution: reducing sedation levels and getting patients up and walking even though they are gravely ill, complete with feeding tubes, intravenous lines and tethers to ventilators.

Time was, rights were defensive. They were to prevent government from doing things to you. Today, rights increasingly are offensive weapons wielded to inflict demands on other people, using state power for private aggrandizement. The multiplication of rights, each lacking limiting principles, multiplies nonnegotiable conflicts conducted with the inherent extremism of rights rhetoric, on the assumption, Howard says, "that society will somehow achieve equilibrium if it placates whomever is complaining."

But in such a society, dazed by what Howard calls "rule stupor" and victimized by litigious "victims," the incentives are for intensified complaining. Read Howard's book, and weep for the death of common sense.

Book: Life Without Lawyers: Liberating Americans From Too Much Law.

All the fuss at the meeting centered on something called Ubuntu and a man named Mark Shuttleworth, the charismatic 35-year-old billionaire from South Africa who functions as the spiritual and financial leader of this coding clan.

Created just over four years ago, Ubuntu (pronounced oo-BOON-too) has emerged as the fastest-growing and most celebrated version of the Linux operating system, which competes with Windows primarily through its low, low price: $0.

More than 10 million people are estimated to run Ubuntu today, and they represent a threat to Microsoft’s hegemony in developed countries and perhaps even more so in those regions catching up to the technology revolution.

{COBRA}

The cost of buying health insurance for unemployed Americans who try to purchase coverage through a former employer consumes 30 percent to 84 percent of standard unemployment benefits, according to a report released yesterday.

The National eHealth Collaborative intends to work cooperatively and aggressively in the months ahead to accelerate progress on a number of initiatives critical to the achievement of a secure, nationwide electronic health information network, including:

• Consistent standards to guide the development, sharing and updating of confidential individualized health information within a secure national network;
• Education, guidance and incentives for widespread adoption of electronic health records by health systems, health professionals and individuals;
• Creation of the secure, interoperable network that enables immediate, consistent, protected access to relevant personal health information at the point of care, anywhere and anytime it is needed;
• Collaboration among a wide variety of institutions and organizations to enable broad, efficient, seamless and confidential exchange of secure, individualized health information—leading to system-wide improvements in health outcomes, access, and quality of care, as well as reduced costs over time; and
• Partnership with members of the Nationwide Health Information Collaborative and others to develop a governance plan for the Nationwide Health Information Network.

A committee of academic and industry experts found the information systems at eight U.S. medical centers noted for leadership in information technology failed to provide timely, efficient, safe and patient-centered care.

"The committee observed a number of success stories in the implementation of health care IT," the report noted. "But although seeing these successes was encouraging, they fall far short, even in the aggregate, of what is needed to support the Institute of Medicine's vision of quality health care."

In a decision with broad implications for health care consumers, the California Supreme Court has ruled that medically insured patients may not be billed for emergency care that their health plans refuse to pay.

In a unanimous decision released Thursday, the high court provided strong support to patient advocates who claimed that emergency room doctors and hospitals were unfairly going after consumers and putting patients in the middle of billing disputes with health maintenance organizations, or HMOs.

Balance billing is controversial because patients are sometimes hit with emergency-room bills because they go to the nearest hospital or other medical facility regardless of whether it accepts their insurance. Health-care providers argue that they need some way to guarantee that they can be paid for their services.

In its decision, the California Supreme Court overturned a lower-court ruling and found that billing disputes over emergency medical care must be resolved solely between providers and health plans.

WASHINGTON -- Tom Daschle, President-elect Barack Obama's choice to be health secretary, said he will work with Congress to overhaul the U.S. health-care system and promised to take a science-based approach to food and drug regulation as well as health research and public health.

"I think that the cost of the status quo, the cost of doing nothing, may be the most expensive option of all," the former Senate majority leader told members of the Senate Committee on Health, Education, Labor and Pensions at a hearing Thursday.

Anunta Virapongse, MD, MPH; David W. Bates, MD, MSc; Ping Shi, MA; Chelsea A. Jenter, MPH; Lynn A. Volk, MHS; Ken Kleinman, ScD; Luke Sato, MD; Steven R. Simon, MD, MPH

Arch Intern Med. 2008;168(21):2362-2367.

Background  Electronic health records (EHRs) may improve patient safety and health care quality, but the relationship between EHR adoption and settled malpractice claims is unknown.

Statewide, hospitals report a 73 percent increase in consumers expressing hardship in paying out-of-pocket medical expenses, according to a November survey of chief financial officers at hospitals statewide.

The number of uninsured emergency room patients is up 33 percent, while elective procedures, often a lucrative area for hospitals, are down by 30 percent, the survey shows.

Medicaid provides coverage to poor and disabled Americans, many of whom face the highest burden of chronic disease owing to cultural and socioeconomic challenges. The program beats being uninsured, but it often relegates the poor to inferior care.

Reimbursement rates are so low, and billing the program so complicated, that it is hard for internists like me to get beneficiaries access to specialized care or timely interventions.

According to New York firm Manhattan Research, doctors are adopting mobile technology more quickly than is the general public. The group published a report in September 2008 saying 54% of U.S. physicians own a PDA or smartphone. Separate research by Dallas-based Diffusion Group predicts that by 2011, 70% of physicians will own a smartphone or PDA.

That compares with only about 20% of physicians who have adopted electronic medical record systems, though there's hope that increased smartphone use will raise that number. Already, developers are creating EMRs that operate from a cell phone.

Hm, seems a tremendous jump from "I have a smartphone/PDA," to "I'll use an EMR." What percent of mobile devices in 2008-2011 were not either a smartphone or PDA? Isn't this more a statement about the device market and not about physician preferences.

A self-described student who was present at the birth of a stillborn child cannot use the "Good Samaritan" defense in her attempt to persuade the court to dismiss a medical malpractice claim against her, a New York state judge has ruled.

Citing deposition testimony of the parties involved in the July 2004 birth, Supreme Court Justice William R. LaMarca held in Lacy v. My Midwife, P.C., 1719/06, that there was sufficient evidence to raise a question of fact as to Julia Chachere's "claim of lack of involvement, i.e. that there is no medical malpractice on her part."

[...]

GOOD SAMARITAN DEFENSE

Further, LaMarca held, Chachere could not rely on §690 of the Education Law, commonly known as the "Good Samaritan" provision, as a defense.

That section provides that "any licensed registered professional nurse ... who voluntarily ... renders first aid or emergency treatment ... shall not be liable for damages for injuries" unless it is established that injuries or death were caused "by gross negligence" on the part of the nurse rendering treatment.

Here, the judge wrote, "the issue of whether gross negligence occurred is an issue for the trier of facts to determine." Additionally, he held, an issue of fact remained as to whether Chachere's status at the birth would fall under the Good Samaritan law.

There are several reasons for large crowds and long waits in emergency rooms. In the course of a decade, emergency room visits increased by nearly a third to 120 million per year, according to the most recent government data available, released in 2006.

While the need for emergency care has increased, we haven't increased the infrastructure to meet the demand.

The U.S. Bureau of Labor Statistics predicts about 233,000 additional jobs will open for registered nurses each year through 2016, on top of about 2.5 million existing positions. But only about 200,000 candidates passed the Registered Nurse licensing exam last year, and thousands of nurses leave the profession each year.

Several factors are in play: a lack of qualified instructors to staff training programs, lack of funding for training programs, difficult working conditions and the need for expertise in many key nursing positions.

Businesses, governments and educational institutions reported nearly 50 percent more data breaches last year than in 2007, exposing the personal records of at least 35.7 million Americans, according to a nonprofit group that works to prevent identity fraud.

The 2 biggest problems I see with sharing patient information between doctors are:

1. Doctors who aren’t using an EHR and won’t give up their paper charts
2. Defining the rules for sharing

 Present solutions: Drobo, TimeMachine, SuperDuper, MobileMe, Amazon S3

But according to a growing body of research, there are serious shortcomings with this type of directive.

For one thing, few patients have advance directives. Although the Patient Self-Determination Act of 1990 requires most health care organizations to inform patients of their right to make advance directives, fewer than a third of Americans have a living will. Only half of patients with terminal illnesses have directives.

Moreover, physicians often lack access to advance directives. Three in five patients with living wills do not give them to their doctors, and families often are unaware of whether their loved ones have an advance directive. About 40% of hospitalized patients have some diminished decision-making capacity.

Even when patients have medical directives and doctors can access them, the instructions often are vaguely worded and fail to match the clinical realities. What does it mean, for example, to have "no chance" of survival?

another misunderstanding of the law and misunderstanding of the constituencies involved in the original statute, let alone new statute

For years, he said, government has tried to stem rising health care costs by placing limits on how much Medicare and Medicaid would reimburse doctors.

It didn't work, Fleming said, because doctors and other health providers felt financially squeezed and ended up ordering other procedures to increase their income.

In a recent open letter to the president-elect, a top technology adviser to the American Academy of Family Physicians said that current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices.

"If America's physician practices suddenly rushed to install the systems of their choice, it would only dramatically intensify the [tower of] Babel that already exists," wrote David Kibbe, a senior adviser to the academy and a longtime proponent of health information technology, and Bruce Klepper, a healthcare market analyst.

The large health care IT companies love regulation and they love government mandated standards. You might wonder, no other industry has government setting standards, why health care?

It’s simply because HITSP and ONCHIT, the organizations set up by industry and the government to mandate standards, are controlled by the large archaic systems vendors.  Standards selected and set by these organizations are unnecessarily complicated, expensive to implement, and protective of the big players. They stifle innovation and like the Big Three automakers, keep health care IT completely out of step with the general computer industry.  Health care IT and HITSP standards are at least a decade behind the open data standards and open-source progressivism of the general computer industry.

1,000 primary-care physicians who have given up their doctor’s pens over the past year to collect the smallest details of their patients’ lives in a database as part of a $60 million city health department project.

Experts say it is the most ambitious government effort nationwide to harness electronic data for public-health goals like monitoring disease frequency, cancer screening and substance abuse.

Experts say that most drugs, whatever the disease, work for only about half the people who take them. Not only is much of the nation’s approximately $300 billion annual drug spending wasted, but countless patients are being exposed unnecessarily to side effects.

No wonder so much hope is riding on the promise of “personalized medicine,” in which genetic screening and other tests give doctors more evidence for tailoring treatments to patients, potentially improving care and saving money.

Young doctors trained on technology say they feel less capable if they have to go into an environment that does not have it.

For the next generation of physicians, information technology is as essential a tool as the stethoscope -- so much so that they are uneasy when they are confronted with practicing in a paper-based environment.

A study published in the December 2008 issue of Academic Medicine, the journal of the Assn. of American Medical Colleges, found that new physicians coming out of high-tech learning environments feel less capable of providing safe patient care when placed in environments with less health information technology.

Fear of lawsuits prompts doctors’ to overprescribe diagnostic tests.

Health care costs are out of control, as we heard constantly during the presidential campaign. Yet that doesn't stop sensible physicians from shunning the sickest patients or ordering needless hospitalizations, drugs, tests and invasive procedures.

Against their better judgment, physicians practice "defensive medicine" — actions designed to protect themselves from lawsuits rather than serve patients' best interests.

Why? The threat of being sued is pervasive, and doctors simply don't trust the legal system. One in seven obstetricians/gynecologists has stopped delivering babies, and three-quarters have been sued at least once, according to a 2003 study. Years of staggering malpractice premium increases have forced many to alter their practices or quit treating patients.

And what is the cost of satisfaction medicine? Medicine that is provided, not in defense, because of an expectation that something needs to be done (patient or physician generated). Where are (or better, when are) the studying showing that physician grading impacts cost. We have swapped quantity (as a surrogate) for quality?

Medicare spent $2.5 billion on AIDS treatment in Florida, mostly in Miami, compared with $978 million for the other 49 states combined, according to the federal government.

About 8 percent of the nation's HIV/AIDS patients live here, but Florida is responsible for 72 percent of Medicare spending on the disease - mostly for dubious infusion therapies like Audette got.

"To look at health care fraud and not look at the fact that the beneficiaries are somehow involved is to be blind to the problem," said Peggy Sposato, a former emergency room nurse who recently joined the Justice Department as an investigator after working for the Miami U.S. attorney. "We've got people out there who brag about the fact that they are making large amounts of money abusing Medicare."

In calling for a "new" medicine, Veatch wants to sound progressive, enlightened, and postmodern. Instead, his new world seems postapocalyptic to me. It is a barren, isolating world in which sick patients "will have to take charge and heal themselves." It is a simple, syllogistic world in which anything that is not a proven scientific fact is a subjective value over which physicians have no say and little insight. It is a naively flawless world in which patients almost always know what is best and are rarely scared, confused, or functionally illiterate ("the new patient . . . especially [will be] a whole person"). Veatch contorts autonomy to sketch an autocratic world in which patients may choose not to seek the comfort and care of any physician who has a shred of paternalism.

Veatch does us a real service by mapping such an unappealing world. His articulation of the strongest conceivable version of patient autonomy convinces at least this reviewer of how fundamentally wrong this position is. Therefore, Veatch unintentionally helps to sharpen our appreciation for how medicine necessarily must accommodate more enlightened forms of paternalism than those that prevailed in the past.

Emergency room waits are decreasing at some Massachusetts hospitals as they prepare to comply with a new state rule that, as of New Year's Day, will prohibit swamped ERs from turning away ambulances.

• Related: Hours without ER access for ambulances

Since state public health officials decided last summer to end the closing of ERs, a practice called "diversion," hospitals have aggressively taken steps to speed the flow of patients through their emergency departments, including hiring more nurses and doctors.

Crowded emergency rooms often are caused by backups on inpatient floors, so hospitals are finding ways to discharge patients more quickly.

Medicaid is the primary medical insurance for 55 million Americans. Another 47 million are uninsured and finding ways to cover these people is expected to be a big point of focus for the administration of President-elect Barack Obama.

But what you get varies widely depending on where you are. Unlike Medicare, which takes care of senior citizens, Medicaid is a patchwork of 51 different state programs that get federal funds of between 50 cents and 77 cents for every taxpayer dollar they spend.

State budgets are often strapped, and priorities differ, so the quality of care, what patients need to do to get coverage and what the plans will pay for all vary wildly from state to state.

The Check's in the Mail

How big state Medicaid programs stack up when it comes to paying doctors, according to AthenaHealth. These are states for which there was enough billing volume to make the list.

Source: AthenaHealth

This six-page package of statistics show a snapshot of information within different sections of the healthcare industry. Those sections are:

• Information Systems
• Insurers/Managed Care
• Labor/Staffing
• Medical Technology
• Medicare/Medicaid
• Suppliers/Purchasing

The ECRI Institute, which researches patient safety issues, issued its second annual report on the top 10 technology hazards that every hospital should pay more attention to.

Without further ado, here are the top five problems for 2008:

1. Alarm hazards

2. Needlesticks and injuries from sharps

3. Air embolisms from contrast media injectors

4. Retained devices and fragments left in patients

5. Surgical fires

Some findings from this year's snapshot include:

• Workers at private sector businesses of all sizes are experiencing an increased likelihood of being uninsured, although it is most pronounced in businesses with fewer than ten employees.
• More than a third of the uninsured have family incomes of more than $50,000 per year.
• Twenty-seven percent of families with incomes between $25,000 and $50,000 are uninsured.
• Seventy percent of uninsured children are in families where the head of the household has a year round, full-time job.
• Nearly 60% of the state's uninsured are Latino.

President-elect Barack Obama has promised to expand health insurance coverage for everybody. But fulfilling this promise will require enough doctors on the firing line - internists, family doctors, pediatricians, gerontologists and others - to treat the additional people covered. Primary care is a part of the total healthcare system, and the Obama administration must craft a national health manpower policy to provide resources and reverse primary care's decline.

Studies show that the number of medical students choosing training in internal medicine, family medicine and geriatrics is down, and many physicians now in practice are leaving the field. Reasons cited include long working hours, the complexity of dealing with chronically ill patients, paperwork, insurance issues and reduced reimbursement by insurers and Medicare.

From left to right: Yugoslav President Slobodan Milosevic, who was later charged with war crimes but died before his trial ended; the Rev. Jesse Jackson; and U.S. Rep. Rod Blagojevich, who is now governor of Illinois and facing federal corruption charges for allegedly trying to sell Barack Obama’s vacant Senate seat, among other things.

Congress is considering adding money for health information technology to January's stimulus package. Doing so could spur a critical mass of the nation's doctors to finally enter the information age, but unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good.

Combining forms all inspired by Twitter, what might be called a free nano-blogging service. It helps small groups share what they’re thinking or doing in just 140 characters per message, or tweet, as such a message is called. The service has generated new words and related Web sites. Tweet-up, for example, is either a meeting of people organized through Twitter, or the Web site that helps bring about the meetings.

The prospect of having ISPs as copyright cops, however, isn't music to the ears of a number of technology bloggers.

"Why can't the RIAA and its label cronies stop with the fear of the Web already and just embrace online realities?" writes Don Reisinger on the Digital Home. "A number of independent artists, as well as better-known bands like Radiohead have done extremely well offering their songs for free and asking for donations whenever people feel compelled to do so."

Rising health care costs "pose a serious threat" to the economy, but some of the more popular cost-control policies promoted by lawmakers will do little to help, warn government reports out Thursday.

No simple solutions exist, but unless changes are made, the USA will spend 25% of its total economy on health care by 2025, up from about 16% now, the Congressional Budget Office says in two reports that do not make policy recommendations.

In addition, the number of uninsured could jump 20% in 10 years, up from about 45 million in 2009 to 54 million, the CBO says.

 This is nothing new (common law), the rescuer always assumes the liability of his/her rescue efforts. The story should be that CA has statutory protections for health workers that trump the common law of torts.

A study sponsored by federal regulators found that pharmacies too often failed to provide consumers with needed drug-safety information in the leaflets stapled to their prescriptions.

The quality of leaflets given out with new prescriptions varied widely, the study found. Many failed to specify standard doses or to warn users to stop taking medicines immediately if side effects arise. Meanwhile, some contained other material, such as vitamin promotions or nail-care tips, that the study's authors said distracted patients from key information they needed.

PatientsLikeMe, a social networking Web site, provides an interactive online community for patients with what Ben Haywood, co-founder, calls "life changing illnesses:" Parkinson's disease, multiple sclerosis, ALS (Lou Gehrig's disease), HIV and mood disorders.

But what makes the Web site's business model particularly interesting is its focus on aggregating data that payers, providers and industry can use to create products and services that improve the lives of patients. Heywood also says the site is generating interest from payers because of its potential as a disease-management "lite" tool.

In a nutshell, you are. While the Communications article ends with Berman's top ten recommendations for data preservation, here are three things you can do right now:

1. Make a plan: Determine who is going to be in charge of your digital data once you are no longer capable of looking after it.
2. Make multiple copies: When it comes to valuable data, store it in different formats at different locations
3. Migrate to new technologies: Don't wait for storage media to become obsolete, migrate to new technologies and formats as they become available.

Forbes talks with Dr. Kevin Pho of KevinMD.com about health policy matters as President Obama takes office.

Kevin Pho

Kevin Pho, an internal medicine doctor in Nashua, N.H., has a busy medical practice. But he's also become an influential voice as the country embarks on another round of health reform under President Obama and "health czar" Thomas Daschle. Pho runs KevinMD.com, the most popular doctor blog.

The 13 hospitals are:

The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature

Conclusion  Guidelines published in the peer-reviewed medical literature during the past decade do not adhere well to established methodological standards. While all areas of guideline development need improvement, greatest improvement is needed in the identification, evaluation, and synthesis of the scientific evidence.

 An old article with sage advice.

People who have cochlear implants should avoid newer models of M.R.I. machines, which can damage their hearing devices irreparably, researchers say.

The machines in question are known as 3T scanners and are much more powerful than early versions. The problem is they can demagnetize an important component of the implants.

3 Tesla machines implicated 

Here are the three criteria I have for determining whether something is a cloud service or not:

1. The service is accessible via a web browser (non-proprietary) or web services API.


2. There is zero capital expenditure required to get started.


3. You pay only for what you use as you use it.

But a national expert on patient privacy said it's naive to think that your health record is secure. And with the federal government pushing for more electronic records, security will only get worse.

"Because of the primitive state of health technology, there are a lot of risks with electronic records, frankly far more than paper," said Dr. Deborah Peel, founder of Patient Privacy Rights, a nonprofit organization based in Austin, Texas.

A government and technology industry panel on cyber-security is recommending that the federal government end its reliance on passwords and enforce what the industry describes as “strong authentication.”

Such an approach would probably mean that all government computer users would have to hold a device to gain access to a network computer or online service. The commission is also encouraging all nongovernmental commercial services use such a device.

[Ann Emerg Med. 2008;52:595.]

The American College of Emergency Physicians believes that:

Approved by the ACEP Board of Directors titled, “Health Information Technology” August 2008 “Health Information Technology” replaces the policy, “Internet Access” that was rescinded August 2008 Revised and approved by the ACEP Board of Directors titled, “Internet Access” February 2003 Originally approved by the ACEP Board of Directors titled, “Internet Access” October 1998

[Ann Emerg Med. 2008;52:581.]

The American College of Emergency Physicians (ACEP) believes that all emergency patients should have access to safe, timely, efficient, and courteous medical care.

ACEP supports creativity in the development of effective measures to evaluate and improve patient care. ACEP also supports innovative approaches to medical education, including approaches that foster empathy toward patients by health care providers.

Some institutions reportedly have used fictitious patients to help evaluate the service aspects of emergency care. Some medical schools have had students pose as patients as part of their training.

ACEP opposes the use of fictitious patients in emergency care units. Deception is unethical and may undermine the trust essential to the relationship between patients and emergency caregivers. Such practices may have unintended negative effects, such as the delays in treatment for other patients, unnecessary administration of medications and improper billing practices.

Originally approved by the ACEP Board of Directors June 2008

CMS came up with a secret shopper program and promised the committee chair Herb Kohl of Wisconsin, who has been critical of the privately run plans, data on the investigations.

Enter contractors Booz Allen Hamilton and Advanced Pharmacy Concepts, who joined 30 CMS officials in a series of 240 “secret shopping” missions involving 30 health plans. They found that some insurance companies weren’t giving out full info on deductibles, restrictions and co-pays. CMS froze one firm’s marketing and has sent warning letters to some others, as a result.

 Did BeWell check past popular usages of the phrase "be well?"

Social networks like PatientsLikeMe let people take charge of their own care--changing the nature of drug research and the practice of medicine

International Business Machines Corp. is hoping to convince corporate customers that they no longer need Microsoft Corp.

IBM says it has created a "Microsoft-free" virtual desktop -- a complete suite of applications that run on a backroom server and don't require Microsoft software or costly desktop hardware.

The software package, available immediately, uses the Linux operating system and a set of IBM office applications that can be displayed on so-called thin clients, which don't have processing units or hard drives.

A Sacramento judge has affirmed state regulations aimed at protecting consumers in payment disputes between hospitals and insurers, easing the financial burden on patients who get stuck with the cost of emergency care that they assumed would be paid by their medical policies.

The case, which will likely be appealed by hospital and medical associations, is the latest skirmish over a practice known as "balance billing," which affects people who are members of HMOs.

About 20 million Californians are members of HMOs.

The trade group for health insurers on Wednesday offered its own universal-coverage proposal that calls for Congress to slow the growth of health-care costs by 30% in five years, envisioning a total savings of more than $500 billion.

The money could be used to fund coverage of the uninsured and to cut costs for those with insurance, said officials from America's Health Insurance Plans. The group called on Congress to establish a public-private advisory group to recommend action in three areas: reducing wasteful spending, changing how doctors and hospitals are paid, and reducing administrative costs.

You might expect to pay more if you choose a doctor outside your insurer's network. But what if you don't know a doctor's status -- or are in no position to ask? The result can be a nasty surprise known as balance billing.

Insured patients are sometimes hit with unforeseen charges after emergencies, when they are taken to the closest hospital regardless of whether the facility accepts their insurance. Consumers also may be billed after visiting in-network hospitals if they received treatment from medical providers who work there but don't participate in the same health plans. When that happens, insurers often pay part of the doctors' fees, and the physicians bill patients for the difference. This is the practice known as balance billing, and it can leave consumers battling both the insurer and the medical provider to get the charge reduced.

The partnership includes:

• A new online consumer health information resource on WebMD.com (www.webmd.com/fda): Consumers can access information on the safety of FDA-regulated products, including food, medicine and cosmetics, as well as learn how to report problems involving the safety of these products directly to the FDA.  In addition, WebMD will bring the FDA public health alerts to all WebMD registered users and site visitors that request them. The cross-linked joint resource will also feature FDA's Consumer Updates—timely and easy-to-read articles that are also posted on the FDA's main consumer Web page (www.fda.gov/consumer).
• The FDA contributions to WebMD The Magazine: FDA Consumer Updates will also be featured at least three times a year in WebMD's bimonthly magazine, which reaches nearly nine million consumers. The magazine is distributed to physician office waiting rooms across the country.

The partnership includes:

-- A new online consumer health information resource on WebMD.com (www.webmd.com/fda): Consumers can access information on the safety of FDA-regulated products, including food, medicine and cosmetics, as well as learn how to report problems involving the safety of these products directly to the FDA. In addition, WebMD will bring the FDA public health alerts to all WebMD registered users and site visitors that request them. The cross-linked joint resource will also feature FDA's Consumer Updates -- timely and easy-to-read articles that are also posted on the FDA's main consumer Web page (www.fda.gov/consumer).

-- The FDA contributions to WebMD the Magazine: FDA Consumer Updates will also be featured at least three times a year in WebMD's bimonthly magazine, which reaches nearly nine million consumers. The magazine is distributed to physician office waiting rooms across the country.

The new proposal outlines strategies to achieve four main objectives: controlling costs; helping consumers and purchasers; achieving universal coverage; and adding value. 

Controlling costs: A financially sustainable and affordable health care system can only be achieved by bringing underlying medical costs under control.  If health care costs are allowed to continue rising at rates far exceeding economic growth, they will thwart all efforts to improve coverage and care.

Health plans are urging Congress to set a bold target of reducing the future growth in health care costs by 30 percent over the next five years.  Based on the current projected growth rate of 6.6 percent, this could produce a cumulative savings of more than $500 billion over five years.

To achieve these goals, health plans are proposing that a public-private advisory group be created to provide specific policy recommendations to Congress on reducing health care costs.  This new advisory group would include input from a wide variety of stakeholders to provide objective, independent recommendations. 

Helping consumers and purchasers: Insurance market rules need to be reformed to help individuals and small businesses access affordable coverage while avoiding duplication of administrative and regulatory responsibilities. These reforms must be coupled with initiatives to provide one-stop access to coverage options and clear, consistent information on quality and cost of care. 

Health plans propose that a new portable health plan be available to individuals and small businesses in all states.  This affordable “essential benefits plan” would provide coverage for prevention and wellness as well as acute and chronic care.  To maintain affordability, the essential benefits plan would not be subject to varying and conflicting state benefit mandates. 

The essential benefit plan would also be made available to workers who are going through a job transition or are eligible for COBRA to ensure they are able to maintain health care coverage.

The proposal also calls for protecting low-income individuals and working families from medical bankruptcy by making available tax credits to those who spend a set percentage of their income on out-of-pocket health care expenses, including premiums and cost-sharing. 

Achieving universal coverage: By addressing rising costs, reforming insurance market rules, and enhancing value in care delivery, the nation can provide all Americans – those with and without coverage today – affordable coverage they can keep.

Health plans propose guaranteed coverage for people with pre-existing medical conditions in conjunction with an enforceable individual coverage mandate.  To help working families afford coverage, advanceable and refundable tax credits should be available, phasing out as income approaches 400 percent of the federal poverty line.

The plan also calls for shoring up the health care safety net by making eligible for Medicaid every uninsured American living in poverty and strengthening the Children’s Health Insurance Program.

Adding value: The nation must create a 21st century system where quality and effectiveness are rewarded, administrative efficiency is achieved, and primary care and wellness are encouraged.

1. "I could get into trouble for telling you this, but…"
2. "Delete this email immediately."
3. "I really shouldn't put this in writing."
4. "Don't tell So-and-So." Or, "Don't send this to So-and-So."
5. "She/He/They will never find out."
6. "We're going to do this differently than normal."
7. "I don't think I am supposed to know this, but…"
8. "I don't want to discuss this in e-mail. Please give me a call."
9. "Don't ask. You don't want to know."
10. "Is this actually legal?"

Put briefly, the three principles are:

1. No Legal Barrier to Sharing (law (copyright law) should not block sharing);

2. No Technological Barrier to Sharing (code (limitations on downloads, for example) should not block sharing;

3. Free competition (no alliances should favor one commercial entity over another, or commercial over noncommercial entities).

EMERGENCY specialists have attacked as risky and dangerous plans to allow only patients assessed as being the most seriously ill to see them and to divert other patients to GP-led hospital clinics.

Under the plans -- part of the 1100-page Garling report into NSW public hospitals released on Thursday -- only patients judged as needing to be seen within 30 minutes, equivalent to triage categories 1, 2 and 3, would be treated by an emergency department specialist.

All other patients arriving in emergency departments, those in the less urgent categories 4 and 5, would instead be treated in new "primary care centres" within the hospital, staffed by non-specialist doctors or GPs working part-time and funded by Medicare instead of the hospital.

Two predictions:

I proposed a simple six-step checklist for doctors to follow when meeting a hospitalized patient for the first time:

• Ask permission to enter the room; wait for an answer.

• Introduce yourself; show your ID badge.

• Shake hands.

• Sit down. Smile if appropriate.

• Explain your role on the health care team.

• Ask how the patient feels about being in the hospital.

Do doctors really need to be told to do such obvious things? Unfortunately, anyone who has spent time in the hospital as a patient or a physician knows how haphazardly such actions are performed, and as Samuel Johnson wrote, “Man needs more to be reminded than instructed.”

Federal health officials estimate that the struggling economy will speed up by one to three years the exhaustion of the Medicare trust fund covering hospital and nursing home care.

Trustees for the Social Security and Medicare programs warned last March that the trust fund for Medicare Part A would become insolvent in 2019. But the chief actuary for Medicare said Monday the economy will likely generate less revenue through payroll taxes than the trustees had projected.

A survey of health care workers at 102 nonprofit hospitals from 2004 to 2007 found that 67 percent of respondents said they thought there was a link between disruptive behavior and medical mistakes, and 18 percent said they knew of a mistake that occurred because of an obnoxious doctor. (The author was Dr. Alan Rosenstein, medical director for the West Coast region of VHA Inc., an alliance of nonprofit hospitals.)

Another survey by the Institute for Safe Medication Practices, a nonprofit organization, found that 40 percent of hospital staff members reported having been so intimidated by a doctor that they did not share their concerns about orders for medication that appeared to be incorrect. As a result, 7 percent said they contributed to a medication error.

Almost one in five young American adults has a personality disorder that interferes with everyday life, and even more abuse alcohol or drugs, researchers reported Monday in the most extensive study of its kind.

The disorders include problems such as obsessive or compulsive tendencies and antisocial behavior that can sometimes lead to violence. The study also found that fewer than 25% of college-aged Americans with mental problems get treatment.

A study being presented Tuesday at a medical conference in Chicago suggests that radiologists should start examining something they usually ignore: the human face.

The eyes of modern radiology are so trained on high-tech images of arteries, organs and bones that actual patients can become abstract concepts, rarely encountered in the flesh. But a study out of Israel found that including photographs of patients in their files enhanced radiologists' performance. "We recommend adding patient photographs as a routine protocol to the digital file of all radiographic examinations," the study concludes.

But free medication samples, which at first glance look like a win-win-win situation for manufacturers, doctors and patients, can have hidden costs. Doctors might pick a sub-optimal drug simply because they have a sample. Plus, only makers of expensive brand-name drugs are doling out samples. And leaving pharmacists out of the equation might raise the risk of errors.

"Doctors think they're saving their patients money and helping them by giving out free medication," says David Miller, a general internist at the Wake Forest University School of Medicine in Winston-Salem, N.C. Paradoxically, Miller says, "they are likely costing those patients more money down the road."

TANSTAAFL

Here’s why: a handful of Con Law scholars seem to feel that the Emoluments Clause of Article I, Sec. 6 disqualifies Hillary Clinton from serving as Secretary of State, an appointment that arrived a moment ago. (Click here for part of the discussion, courtesy of the Volokh Conspiracy.) The Emoluments Clause states:

No Senator or Representative shall, during the Time for which he was elected, be appointed to any civil Office under the Authority of the United States, which shall have been created, or the Emoluments whereof shall have been encreased during such time . . . .

 another big boy's stake in the sandbox

Not wishing to be outdone by the likes of Microsoft and Google, UnitedHealth Group today launched its own Web site for people to store their personal health information.

Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.

"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."

 rickrolling

Folks, wake up! We cannot afford to cover 50 million more Americans unless and until we do something meaningful about costs!

Once people get insurance, they tend to use it. And as we've seen with Part D, once the medical/pharma/device/hospital industry figures out there are a lot more people with coverage, they will raise prices, buy more technology, and build more capacity to service those new customers

[...]

Put all this together and existing health care programs--Medicare, Medicaid, and Schip--would be expanded, new health-care regulation for business and individual policies would be established, and America would have a vast new health-care program, run for and largely paid for by the government. Government, with little input from you or your doctors, would run it, regulate it, supervise its performance, mandate how companies must participate in it, and somehow come up with more than several hundred billion dollars each year to pay for it all.

The Baucus plan says in its opening paragraphs that the U.S. "is the only developed country that does not guarantee health coverage for all its citizens," and that there are 46 million uninsured people and some 25 million more underinsured. Giving those people the funding through tax credits or subsidies to purchase their own health insurance is a good idea. Europeanizing American health care so that government rather than individuals make health care decisions is not.

But like it or not, when our new government takes office in January, socialized medicine may well be on its way into America.

The housing market's collapse is forcing a growing number of Americans sitting on large medical bills to choose between paying the mortgage and paying the doctor.

People have long resorted to borrowing against their homes to pay for medical care in times of illness or after an accident. But with home values plummeting and interest rates on adjustable mortgages ratcheting higher, some indebted patients are at risk of losing their homes in order to pay for surgery, cancer treatment, drugs and other big-ticket medical expenses. Other patients are forgoing health care in order to keep from losing their homes.

The Cost of Care

Medical debt is putting more patients at risk of losing their homes.

• Consumer advocates say people generally shouldn't refinance or use home equity to pay medical bills.
  
• Hospitals are often more willing than banks to forgive debts or set low payments.
  
• Patients may be able to persuade a home lender to modify a loan by documenting their medical bills.
  

Parents who take their kids to the emergency room for non-urgent care aren't doing it to abuse the system.

Instead, they're doing so because they have concerns and questions about the care and attention they receive at primary care physicians' offices.

But now there is a growing movement to gather a new kind of evidence, the kind that will fill some of the biggest gaps in medical science: What treatment is best for typical patients with complex symptoms...

A group of advocates, including medical researchers, medical societies and insurers, is lobbying Congress to pay for an Institute for Comparative Effectiveness Research that would assess treatments and identify gaps in evidence. When there are gaps, the institute would initiate what are being called “real world,” or “pragmatic,” clinical research trials to gather the evidence.

With Congress ready to spend $700 billion to prop up the U.S. economy, enacting health-care reform may seem about as likely as the Dow hitting 10,000 again before the end of the year. But it may be more doable than you think, provided we dispel a few myths about how health care works and how much reform Americans are willing to stomach.

1. America has the best health care in the world.
   
2. Somebody else is paying for your health insurance.
   
3. We would save a lot if we could cut the administrative waste of private insurance.
   
4. Health-care reform is going to cost a bundle.
   
5. Americans aren't ready for a major overhaul of the health-care system.

 opinion piece: 5 myths, some w/ large grain sand

A web where each participant is their own central node on a web-wide social network.

It is the only natural conclusion of the vision of Data Portability.

It will be made possible by a series of futurists, technologists, philanthropists and engineers developing core building blocks like OpenID, oAuth, APML, PortableContacts, XMPP, RSS/ATOM, OPML, Microformats and more.

Perhaps the most striking part of Daschle’s plan is his call to create a Federal Health Board, modeled on the Federal Reserve Board that manages monetary policy. The basic idea is to create an institution, run by experts, that answers to the government but is “largely insulated from the politics and passions of the moment,” he writes.

“Like monetary policy, health-care policy shouldn’t be subject to the whims of subcommittee chairmen and special interests,” Daschle continues.

The board wouldn’t regulate the private insurance market, but it would have power over federal health-care programs, including Medicare and Medicaid, whose decisions are often followed by private insurers. It would also set the terms for private insurers who wanted to participate in the federal employees’ insurance pool.

Perhaps most importantly, the Board would assess the effectiveness and costs of various treatments.

American Well aims to reinvent the house call.

Patients who are members of the health plan pay a co-pay, just like at the doctor’s office. Doctors hold 10-minute appointments, which can be extended for an optional fee, and can file prescriptions through the system. Uninsured patients can also use it, for a fee that the health plans choose but which will be less than $50, much less than a visit to the emergency room, which is where the uninsured often end up. Health plans pay American Well a license fee per member to use the software, as well as a transaction fee of about $2 a patient each time a patient sees a doctor.

Doctors, meanwhile, pick up a few extra dollars on the side.

Dr. Schoenberg expects it to be popular among retired physicians or those who have practices but want to see a few more patients when they have a free hour on a Saturday afternoon. “Then, if they decide they want to watch ‘Lost,’ they’re finished,” he said. “That flexibility is why we’re getting such a favorable response from physicians” who have felt shackled by the burdens of scheduling, chasing down payments, filing with insurance companies and paying for office costs and malpractice insurance.

 licensing? malpractice? not really mentioned

from: Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future (PDF )

Economic Viability

• Align performance and payment systems to meet quality and efficiency-related goals
  
• Use process improvement tools to increase efficiency and reduce costs
• Pursue coverage options to ensure patient access to, and affordability of, health care services
• Address how general acute hospitals and specialty hospitals can both fulfill the social mission for health care delivery.

Technology Adoption

• Make the business case and sustainable funding to support the widespread adoption of health information technology
• Redesign business and care processes in tandem with health information technology adoption
• Use digital technology to support patient-centered hospital care and extend that care beyond the hospital walls
• Establish reliable authorities to provide technology assessment and technology investment guidance for hospitals
• Adopt technologies that are labor-saving and integrative across the hospital

Patient-Centered Care

• Make adoption of patient-centered care values a priority for improving patient safety and patient and staff satisfaction  
• Incorporate patient-centered care principles into the activities of hospital oversight bodies and transparency initiatives
• Address barriers to patient and family engagement, such as low health literacy and personal and cultural preferences
• Eliminate disparities in the quality of care for minorities, the poor, the aged and the mentally ill 
• Improve the quality of care for the chronically ill through coordinated, multi-disciplinary care
• Use robust process improvement tools to improve quality and safety

Staffing

• Establish fair migration and compensation policies for countries facing shortages of health care workers
• Expand health professional education and training capacity to accommodate the growing demand for health care workers
• Create workplace cultures that can attract and retain health care workers
• Develop professional knowledge and skills necessary in a more complex health care environment   
• Educate health professionals to deliver team-based care
• Develop the competence of health professionals to care for geriatric patients
   

Hospital Design

• Improve safety with evidence-based design principles such as single rooms, decentralized nursing stations and noise-reducing materials
• Address high-level priorities, such as infection control and emergency preparedness, in hospital design and construction
• Include clinicians and other staff, patients and families in the design process to improve staff work flow and patient safety, and create patient-centered environments
• Design flexibility into the building to accommodate advances in medicine and technology
• Incorporate “green” principles in hospital design and construction

The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.

The proposals, put forward by the insurers’ two main trade associations, have the potential to reshape and advance the debate over universal health insurance just as President-elect Barack Obama prepares to take office.

 increasing the risk insured pool

An interesting point that with social-mediated research the N sufficient to show no benefit might be reached years before it would have been without the social mediation. But how tragic would it be if the N was sufficient to show actual harm and shorting the already shortened lives.

missed this excellent post on magical healthcare thinking

WASHINGTON (Reuters) – Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.

And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.

"The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome," the Physicians' Foundation, which conducted the survey, quoted one of the doctors as saying.

The proposed rule would prohibit recipients of federal money from discriminating against doctors, nurses and other health care workers who refuse to perform or to assist in the performance of abortions or sterilization procedures because of their “religious beliefs or moral convictions.”

[...]

Mr. Obama has said the proposal will raise new hurdles to women seeking reproductive health services, like abortion and some contraceptives. Michael O. Leavitt, the health and human services secretary, said that was not the purpose.

Officials at the Health and Human Services Department said they intended to issue a final version of the rule within days. Aides and advisers to Mr. Obama said he would try to rescind it, a process that could take three to six months.

 ah the grey zone 1-3 months!

In Bias Test, Shades of Gray

 @bobambrogi

 how to handle it properly!

Kevin Kelly

I gave a talk yesterday at the Web 2.0 Summit. It's a short talk, only 10 minutes long, so I decided to skip Web 3 - Web 9 and just speak about the upcoming Web 10.0 and what I think will happen in the next 6,500 days.

Enforcement of HIPAA privacy and security regulations is largely dependent on complaints about entities suspected of breaking the rules.

Here's what the system produced in 2007:

Source: Dept. of Health & Human Services

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.

Prominent among these other factors are:

1. higher prices for the same health care goods and services than are paid in other countries for the same goods and services;
2. significantly higher administrative overhead costs than are incurred in other countries with simpler health-insurance systems;
3. more widespread use of high-cost, high-tech equipment and procedures than are used in other countries;
4. higher treatment costs triggered by our uniquely American tort laws, which in the context of medicine can lead to “defensive medicine” — that is, the application of tests and procedures mainly as a defense against possible malpractice litigation, rather than as a clinical imperative.

There are three other explanations that are widely — but erroneously — thought among non-experts to be cost drivers in the American health spending. To wit:

1. that the aging of our population drives health spending
2. that we get better quality from our health system than do other nations, and
3. that we get better health outcomes from our system

“The Personal Health Record (PHR) is an Internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it.”

A new study (CITL's The Value of Personal Health Records, PDF) makes the bold claim that widely adopted personal health records could save the U.S. health care system more than $19 billion annually after expenses.

The study concludes that providing interoperable PHRs to 80% of the population would cost $3.7 billion in startup costs and $1.9 billion in annual maintenance costs. And it finds that these PHRs would save more than $21 billion annually, with most of the savings going to payers.

The predicted savings break down as follows:

• Sharing of complete test results: $7.9 billion
  
• Congestive heart failure monitoring: $6.3 billion
  
• E-visits supported by PHRs: $4.8 billion
  
• Electronic medication renewals: $1.1 billion
  
• Smoking cessation management: $1.04 billion
  
• Electronic appointment scheduling: $170 million
  
• Pre-encounter questionnaires: $72 million
  
• Sharing of complete medication lists: $9.2 million
  

The Value of Personal Health Records (PDF) report examines the value proposition for implementing personal health records (PHRs) thoughout the US.

This analysis quantifies the cost-benefit of a variety of infrastructure, administrative, and clinical PHR functions including:

• Sharing of complete medication lists
• Sharing of complete test results
• Appointment scheduling
• Medication renewals
• Pre-encounter questionnaires
• E-visits
• Congestive heart failure (CHF) remote monitoring
• Smoking cessation management

CITL modeled these eight functions for provider-tethered, payer-tethered, third-party, and interoperable PHRs, examining differing deployment strategies to achieving 80 percent adoption by the US population. The report includes a detailed cost model for each type of PHR system.

Interoperable PHR systems that collect and share information such as patient test results and medication lists improve efficiency in healthcare delivery by reducing waste and errors, and decreasing administrative and clinical costs, according to the center's report. {CITL report: The Value of Personal Health Records}

Defining exactly what Health 2.0 is doing is not an easy task. It's related to Web 2.0 and Medicine 2.0, both of which come with similarly nebulous definitions. 

On the Health 2.0 Web site, this is the "traditional" definition:

"The use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health."

One is characterized by caution.   Don't try to do too much too fast, its proponents argue.   Start with what's achievable, given the poor state of the economy, and build from there, working systematically to lower costs and expand coverage over time, they argue.

The other is characterized by sweeping ambition.  Incremental reform won't make any difference except at the margins:  something much bigger, something really transformative is needed, its supporters insist.

In the first camp are those who want to expand the State Children's Health Insurance Program when Congress reconvenes next year and include extra Medicaid funding for the states in an economic stimulus package.

In the second camp...Divided We Fail includes AARP, Services Employees International Union, the Business Business Roundtable and the National Federal of Independent Businesses, organizations that a decade ago didn't agree on much when it came to this topic.

* Mandating EMRs based on penalties would create more unwarranted problems on the physician community that already has difficulties identifying and realizing the return on investment in time and financial terms regarding EMRs.

* Top-down strategies that are not carefully coordinated with the medical community will fail in the same way as such projects have in other countries, notably the United Kingdom.

Instead, the new Administration has a great opportunity to orchestrate a consensus on some of the most important issues that are directly linked to EMR implementation, by:

* Working with all stakeholders to create continuity of care: This was the original goal of EMR visionaries some 30 years ago. Technologies are ready today for ensuring that all clinicians have all relevant patient information when they provide care to patients. The leadership of your Administration can make this a reality and thus save substantial monies by reducing duplicative tests and efforts, improving the quality of care, and reducing medical errors.

* Using the Federal Government's leadership to involve all stakeholders in reforming the financial healthcare processes into 21st century approaches that include charge capture from EMR documentation, real-time transactions, and automated claim adjudication.

* Creating the necessary infrastructure for electronically supported care by reducing or eliminating barriers for inter-State care and Internet-based e-care. For example, clinicians should be reimbursed for email communications with patients as well as for other electronically delivered healthcare services.

* Coordinating efforts with payers and providers to shift our healthcare system to one that pays for keeping people healthier rather than only for treating the sick. This is a major paradigm shift your Administration could orchestrate.

another use for "HIE," here HIE = Health Insurance Exchange 

 death by thousands of codes

About 7 million people nationwide would qualify for treatment under the JUPITER protocol, at a cost of about $116 a month — or $9.7 billion a year, Stein says. For that price, the drug would prevent, taken together, about 28,000 heart attacks, strokes and cardiovascular deaths each year.

The cost of saving one life, he says, would total about $557,000. Using a generic statin would be much more cost-effective. Stein calculates that, at $5 a month, generics would cost $420 million, or $24,000 to save a life.

so true

• Amazement that the debacle in financial services actually makes the health sector look healthy by comparison.
  
• Relief that the financial wizards who invented financial market derivatives, collateralized mortgage obligations, and credit-default swaps did not also invent health care derivatives, "collateralized health obligations," or health savings account default swaps.
  
• Trepidation that the daisy chain of sub-prime mortgage lending that laid the groundwork for the financial meltdown bears certain similarities to what’s happening in health care.
  
• And fear that even if current health system trends don’t trigger a financial meltdown, an equally traumatic adjustment may still lie ahead.

The NTSB recommends all medevac operators:

• Use increased weather-minimum and pilot-rest duty requirements on all medically staffed flights.
• Use formalized dispatch and flight-following procedures that include up-to-date weather information and assistance in flight-risk assessment decisions.
• Install helicopter terrain awareness and warning systems and train flight crews to use them.
• Develop and implement flight-risk evaluation programs and training procedures, and consult with others trained in EMS flight operations when weather risks reach a predefined level.

The top ten most irritating phrases:

1 - At the end of the day

2 - Fairly unique

3 - I personally

4 - At this moment in time

5 - With all due respect

6 - Absolutely

7 - It's a nightmare

8 - Shouldn't of

9 - 24/7

10 - It's not rocket science

define Health 3.0 analogy here; junk data, junk apps, etc

* U.S. Census figures project that the number of Americans 65 or over will double by 2030, and that two-thirds of today’s 65-year-olds will require some period of long-term care later in their lives.

* At the same time, according to one recent study, the number of geriatricians has actually declined in recent years, to about 7,750; that translates to one for every 4,254 older Americans. In addition, the country will face a shortage of more than 800,000 nurses by 2020.

* According to U.S. government surveys there were 2.5 million Americans living in either nursing homes or assisted living facilities in 2004. The average cost of a private room in a nursing home, according to a recent MetLife study: $75,000 per year.

* The AARP notes that two-thirds of older Americans who needed long-term care now rely completely on unpaid help — in most cases, family.

If no pulse is restored after 20 minutes, the city's fire-department–based EMS personnel can remotely contact a physician for authorization to terminate the resuscitation effort, said Eckstein, who is medical director of the Los Angeles Fire Department and was previously a New York City paramedic.

For the most part, he said, "the only patients who will have a neurologically intact survival are going to be those who get a pulse back in the field." By definition, prepping the patient for transport interrupts chest compressions, which diminishes chances for survival. "If the patient is delivered [to the hospital] with CPR in progress, that patient probably isn't going to survive."

 definitely my experience

The prospect of universal health care -- or in the shorter term, an expansion of children's health care and changes in Medicare and Medicaid purchasing -- will create new winners and losers.

Democratic lawmakers have made it clear that payments to private insurers for Medicare plans are a big bull's eye in any health-care overhaul. Currently, private insurers receive more per beneficiary than the government would spend if it covered people directly.

But insurers could benefit from a health-system overhaul. Aetna Inc.'s chief executive, Ron Williams, supports requiring people to buy health insurance. Some of Aetna's rivals oppose that position, but Mr. Williams says that without such a requirement, healthy people would opt out of the collective insurance risk pool and costs would spiral.

"We're saying to policy makers, 'Tell us what you're trying to achieve, and we'll tell you from our experience what companion solutions work together,' " he says.

Reducing the number of uninsured people could help millions of additional Americans afford drugs, benefiting the pharmaceutical industry. But drug makers also face potential pressure from a Democratic Congress, which could push a plan to give the government power to negotiate the prices for drugs sold to Medicare recipients.

Billy Tauzin, president and CEO of the Pharmaceutical Research and Manufacturers of America, likes to remind politicians that the industry employs more than 500,000 people and spends nearly $60 billion a year on research and development. "There are things Congress could do to drive it out of the country," he says

• An overwhelming proportion of opinion leaders (85%) reported they support or strongly support revising the Medicare fee schedule (i.e., the resource-based-relative value schedule) to increase payments for primary care.
  
• Respondents voiced strong support for realigning the system to pay for transitional care services (77%), paying physician practices a monthly per patient fee for serving as a medical home (74%), and eliminating payments resulting for "never events," like avoidable infections or complications in hospitals (67%).
  
• Nearly three of four opinion leaders are in favor of Medicare negotiating pharmaceutical prices and engaging in competitive bidding for durable medical equipment as strategies to reduce the growth of health care costs.
  
• Nearly three of five (57%) health care opinion leaders said shared accountability for resource use—holding health care organizations, including hospitals and physicians, accountable for the resources used in caring for patients over time and sharing a portion of costs saved—is an effective strategy.
  
• Slightly more than a third (37%) believe paying for performance—providing bonus payments to providers for high performance—would be effective or very effective in improving health care efficiency.

 another HIE project; if statewide, at 2M, = 1/5 the size of LA county; scalability big issue!

More than six out of 10 physicians surveyed rated the program difficult, and only 22 percent were able to download the PQRI feedback report for their practice. To maximize physicians' experience with the program and to encourage more to participate, the Centers for Medicare and Medicaid Services (CMS) should place a greater emphasis on early education and feedback. In addition, Congress should allow CMS to develop a process that allows physicians to appeal CMS judgments on inaccurate reporting.

Survey: PDF 

Medicity, RHIO

 PHRs trump RHIOs in long haul

 disparation

 in my community—go to the ER

Basically, the docs calculated the mean time it took to get through the ER for a given test or procedure — then added 20% when they told patients what to expect. In a standard patient satisfaction survey, all nine variables related to wait times improved after the ER adopted this policy (the improvement was statistically significant for five of the variables).

now multiple by the number of US hospitals; how unknown are privacy breaches

 our national health policy: just go to an emergency room

Did you feel healed the last time you went to the doctor?

My bet is no. If you were lucky, maybe you got 10 minutes with the doctor. In not much more time than you might have spent in a fast food drive-thru, the doctor wrote a prescription, ordered a battery of lab tests and sent you off for a thousand dollars worth of imaging studies.

Somewhere along the line too many doctors stopped being healers and became prescribers and technicians.

We became business people and started thinking in terms of relative value units -- the coin of the medical finance realm -- as much as how to make patients better. We took seminars in medical coding, so we could talk the same lingo as the government and the insurance companies.

Tysabri contracted a deadly brain infection, marking the sixth such case and darkening the commercial prospects for the medicine, already withdrawn from the market once over safety concerns...the patient, a woman, had contracted the infection known as progressive multifocal leukoencephalopathy, or PML.

 "Usually there will be 15-20 people hanging out in the chatroom while they listen, making fun of me as the show is going on," quipped Dr. Anonymous—also known as Dr. A, or in real life...

In California, illegal immigrants account for about 1,350 of the 61,000 people on dialysis. Their treatment cost taxpayers $51 million last year. 

 excellent piece on our present financial crisis, healthcare and education

 w00t apps come to LinkedIn

 @denniskennedy

 gross understatement!

 man has the stones to flush lover...

1. Ask everyone if they’ve washed their hands.
   
2. Ask nurses to read drug orders out loud and confirm that they match the patient’s ID bracelet. If it’s a new medication, ask what it’s for and what to expect.
   
3. During long stays, be alert for bedsores. Make sure the patient is moved often, and lifted rather than slid.
   
4. Don’t try and help the patient into or out of bed by yourself.
   
5. Don’t give the patient medications on your own.
   

rescue MRI in the ER, sure, but make sure the cardiology and radiology but in too

not "overcrowding," but crowding — the use of the former implies the latter is acceptable; wrong!

 ER: order in chaos, it's like a dance

iffy upgrade?

nice: In a nod to Amazon's progress in selling cloud computing services, Mr. Ozzie said Microsoft was "standing on their shoulders."

 Twitterist. The potential for use of Twitter and other Web tools and mobile technologies by terrorists is dependent on the availability of mobile service, the report added. "For example, terrorists could theoretically use Twitter social networking in the US as an operation tool," the report said. "However, it is unclear whether the same theoretical use would be available to terrorists in other countries and to what extent."

 KP is king on EHR

good coverage; if mainstream, perhaps a professional paid version will be coming?

 who says safety in numbers; large lemmings

 D'oh!

 1 accident = 100 calls

NEHI's research, which describes waste as "the triumvirate of overuse, underuse and misuse of care," identifies five sources of wasteful practices that, if eliminated, would offer dramatic cost savings:

 is there a Second Life?

A quick review of the 95 theses proposed in The Cluetrain.

 The study involved 679 internists and rheumatologists...most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives.

 just what is needed, another abbreviation, iEHR — just pick one term and move on!

 Jungle Disk goes to Rackspace

 silo builders: "Because regional health information organizations will take several years to become fully functional, hospitals should take other steps now to improve the exchange of data with area physicians, one chief medical information officer advises."

 Despite the fact that we can complete our taxes and perform complex financial transactions digitally over the Internet, medical records have faced an impasse preventing a transition to the digital age. Patient charts are still paper-based in most doctors' offices across the country.

 Paramedic students in London are being trained in how to deal with emergency situations using the virtual world of Second Life.

 Conclusion  Some common assumptions regarding uninsured patients and their use of the ED are not well supported by current data.