Power to the Patient: Mount Sinai Puts Medical Records Snapshot on Smart Cards

Power to the Patient: Mount Sinai Puts Medical Records Snapshot on Smart Cards : "Today, Mount Sinai patients participating in the pilot test can choose to carry a 'personal health card.' This encrypted smart card with 64K of memory holds not only the patient's name, photo, and insurance information, but also a medical history snapshot, including notes on allergies, medications, recent treatment data, and even in some cases, a compressed EKG test result. The goal is to distribute 100,000 cards in the initial pilot project, Contino says. Mount Sinai's registration staffers can use the cards to check in patients quickly and accurately; emergency room triage nurses can use the cards for quick access to relevant patient data."

U.S. Needs to Push Harder for E-Health

U.S. Needs to Push Harder for E-Health: "The U.S. government needs to step up its push for electronic health records because they are not being adopted quickly enough, a group of health advocates said Friday. MORE ON CIO.COM Hurdles to an Electronic Medical Records System Big Hospital Puts Medical Records on Smart Cards Microsoft's HealthVault Health-care providers in the United States continue to make errors that hurt tens of thousands of patients each year, and e-health records could prevent many of those problems, said Dr. Alan Lotvin, senior vice president of oncology for Magellan Health Services. The U.S. health-care system is failing patients 'despite the fact we have the knowledge and the technology to really do a much, much better job.'"

Do your healthcare bills confuse you?

Do your healthcare bills confuse you? " Government and state laws require doctors, hospitals, ambulance services, therapists, and other caregivers to use different bill forms and sometimes-different terms for treatment. You may receive a lot of paper after a doctor or hospital visit, and may be confused by these bills and the words on them.
This booklet also includes a sample of a typical bill. Printed on the sample bill are notes explaining what different areas of the bill mean. We have also included some questions that patients often ask their doctors or hospitals about their bills, and answers to those questions. There is also a page that you can use to write notes or questions to ask your doctor or hospital about your bill."

Patient Friendly Billing

Patient Friendly Billing " The Patient Friendly Billing project is committed to helping the healthcare system create patient bills that are:
❍ Clear: All financial communications should be easy to understand and written in clear
language. Patients should be able to quickly determine what they need to do with the
communication.
❍ Correct: The bills or statements should not include estimates of liabilities, incomplete
information, or errors.
❍ Concise: The bills should contain just the right amount of detail necessary to communicate
the message.
❍ Patient Friendly: The needs of patients and family members should be paramount when
designing administrative processes and communications."

Hospitals can be very "creative" in the way they bill their patients - especially when it's a third party which is paying the bills. Here are some useful guidelines to follow.

Patient friendly billing

Patient friendly billing First, healthcare financial services will need to become more patient-centric in focus. This means coming up with new ways to identify and address patient needs, learning how to communicate with patients as partners, and incorporating such patient-friendly concepts as pricing transparency, point-of-service payment, and simplified charge structures. Providers will also need to provide meaningful information about quality of care.

Second, in order to be successful in the future, providers must be willing to make radical changes. Consumerism in health care poses a truly different way of doing business. Incremental change—nibbling around the edges—will not be enough to get us where we need to go.

Third, we cannot go it alone. The only way to make the system truly work for the consumer is to collaborate creatively with other providers, commercial and government insurers, employers, regulators, and— first and foremost—consumers themselves.

Innovative ideas in healthcare - how to generate them !

Innovative ideas in healthcare - how to generate them !

1. Patient Healthcare Advocate – “Health Buddy”.
Phone and on-site credentialed clinical advocacy services to patients and their family
members sold as a voluntary benefit through employers and to individuals. This helps
put patients more confidently in charge of their care because of access to an
educated advocate.

2. Global Research Network Use electronic medical records to identify potential subjects for clinical research. More rapid access to a broader and more diverse patient population by researchers should accelerate clinical trials, reduce costs, increase drug safety and medical practice innovation and population-wide surveillance.

3. Health Key Providers and other stewards of patient healthcare information use a secure “key” to identify an individual patient’s data. Making those “keyed” data available outside of firewalls gives patients web access to their records anywhere in the world when they need it.

HealthShopper : Vimo Newsletter

HealthShopper : Vimo Newsletter: "The 'Healthy Living' Credit Card Aetna and Bank of America have teamed up to develop the Aetna Healthy Living(TM) credit card for Aetna's medical, dental, pharmacy and behavioral health members. The innovative credit card, available later this year to qualifying Aetna members, is a rewards-based credit card that facilitates payment of out-of-pocket medical expenses as well as everyday purchases while promoting healthy living at the same time. The card offers a convenient way for consumers to manage their healthcare dollars. Members who apply for and are issued the Aetna Healthy Living credit card will have access to a base rewards program that offers one point for every qualifying retail dollar charged to the card and access to a wide variety of redemption options. Additionally, Aetna Healthy Living credit card members will be rewarded with the following unique features that provide incentives for healthy living. * Earn points for money spent on certain health-related purchases including hospital treatments, doctor and dentist charges, sporting goods stores, fitness and weight loss centers, vitamin stores and more. * Receive a discount on dozens of health-related items - gym equipment, spa set, bicycles, blood pressure monitors and more from the WorldPoints catalog."

This is a clever idea ! Now that insurance companies and banks are getting into the healthcare space, this is a logical extension of their offerings.

ConsumerReports.org - Medical ripoffs, overspending on overtreatment

ConsumerReports.org - Medical ripoffs, overspending on overtreatment: "Do more, make more . Paul DeLeeuw, M.D., whose whole-body CT scan led to many follow-up tests but no diagnosis of serious disease. Photo by Roark Johnson When it comes to health care, more is not necessarily better. But more is what patients tend to get. While America's health system has achieved important gains against major diseases, it has also encouraged the overuse of costly treatments. The system pays the vast majority of doctors and hospitals on a piecework basis called 'fee for service.' The more services they provide--a blood test, surgery, an MRI or CT scan--the more money they make. Experts estimate that the nation's $2 trillion annual health-care tab is one-third to one-half higher than need be, in part because of overuse of costly treatments and unnecessary care."

ConsumerReports.org - Medical ripoffs, 10 overused tests and treatments

ConsumerReports.org - Medical ripoffs, 10 overused tests and treatments: " 1 BACK SURGERY. Don't rush to surgery for a simple slipped disk. In 90 percent of cases, the pain goes away on its own within six weeks. In stubborn cases, surgery, which can cost $20,000 plus physician's fees, can relieve pain somewhat faster than physical therapy and medication, a recent study showed. But it also found that both groups of patients wound up with similar improvements after two years. 2 HEARTBURN SURGERY. Doctors surgically tighten a sphincter muscle that blocks stomach acid from backing up into the esophagus. But research shows the operation, which costs $14,600 or more, provides no better long-term relief than taking a proton-pump-inhibitor drug such as omeprazole (Prilosec OTC), which costs less than $1 a day. 3 PROSTATE TREATMENTS. Prostate cancer is often overtreated by surgery that costs $17,000, or by radiation therapy for $20,700 or more, plus physician's fees, without adequate discussion of the alternatives or the high risk of distressing side effects such as incontinence or impotence. Because prostate cancer can grow slowly, sometimes the best approach is 'watchful waiting.'

Check out the entire list !

JS Online: Do online reviews of doctors by patients hurt or help?

JS Online: Do online reviews of doctors by patients hurt or help?: "Hundreds of Wisconsin physicians are being rated on Internet sites such as RateMDs.com, Vimo.com and RevolutionHealth.com. From Rhinelander to Kenosha and Eau Claire to Appleton, patients are grading doctors from all specialties on their helpfulness, knowledge base, personal skills and punctuality. Advertisement Buy a link here According to a recent Forbes magazine article, this appears to be becoming a popular online activity, with some sites averaging 1,000 new reviews per day. Proponents of such sites argue that patients are customers who are paying for a service and should be able to openly express their level of satisfaction and that informed health consumers will make better choices about how to spend precious health care dollars. Critics complain the sites are defamatory and capricious. For example, customers are not qualified to judge a doctor's decision to order a particular test or procedure."

MEDgle - search your symptoms

MEDgle - search your symptoms: "Search over 6000 symptoms and more than 2000 diagnoses. General Medicine Personalized medical search by doctors for everyone (for informational purposes only) All data have been entered by physicians. We are still in BETA and continuously updating the database."

This is a great tool - check this out. You'll have a pretty good idea of what your doctor will be considering once you check out this site !

Health Populi: The Future of Retail - Implications for Health

Health Populi: The Future of Retail - Implications for Health: "The new retail environment for consumer products has direct implications for consumers in health care. Control, co-creation, technology, globalization...these forces are, together, shaping some consumers' approach to health in the current market. By 2015, these forces will be part of the health landscape in which providers and marketers will compete, and where patients will behave more like...consumers."

Health Populi: Health 2.0 Conference -- Present at the Birth

Health Populi: Health 2.0 Conference -- Present at the Birth: "Paul Wallace, Medical Director of Kaiser Permanenete, offered that 'we talk about trust as a zero-sum game,' but that we should look at trust 'as an asset that you can grow.' Instead of thinking about the number of patients a doctor can see in a day in the office, Dr. Wallace thought it more relevant to think about 'how many patients you can touch in a day,' virtually, through e-consults, e-mail, and other technology-enabled tools. This could make each in-person visit richer, longer."

I already "talk" to more patients by email today than I do in real life !

Practice Fusion - Practice Fusion Officially Launches

Practice Fusion - Practice Fusion Officially Launches: "Practice Fusion, a leading force in healthcare IT, today announces the availability of its free, on-demand, no-risk Practice Management and EMR suite. With this launch, Practice Fusion is poised to change the dynamic in EMR adoption, significantly increasing independent practitioners’ ability to quickly select and begin using world class practice management and EMR. “Today marks the end of the era of big vendors taking advantage of independent physicians—we are empowering them to take control of their EMR decision,” enthuses Ryan Howard, CEO of Practice Fusion. “Our Practice Management and EMR Suite, which is free and on-demand, eliminates the risk of those traditional systems and expedites the purchase and implementation processes. Our EMR allows practitioners to stay competitive and thrive in a world of constant change and growing responsibilities and still increase their overall quality of care.”"

Tech Medicine

Tech Medicine: "Dr. Jay Parkinson (MD, MPH) runs an unusual type of medical practice in New York City. Like many 'concierge' physicians, he accepts no insurances -- the flat rate is $500 a year. He has no office -- he makes housecalls to your home or work. $500 gets you two visits and 'unlimited e-visits': email, phone calls, video chat, or instant messaging. In order for this system of primarily mobile medical care to work, Dr. Parkinson chooses his patients carefully. They must be accessible in Manhattan or Brooklyn, and they must be young (less than 40) and generally healthy. He runs his practice on a laptop, an electronic medical record system (Life Record), and an iPhone. Many of his patients don't have insurance and must pay 'out of pocket' for their medical care. To make his practice more appealing, Dr. Parkinson has contacted local laboratories, pharmacies, and radiologists to obtain the best prices on their services. Not only does he see patients, but he acts as their personal medical shopper for products. While there are many potential problems with this model of practice, the reality is that many younger people (who are generally healthy) don't have insurance, are very comfortable with instant messaging and electronic communication, and would prefer this type of online relationship with their doctors."

Enhanced Medical Decisions, Inc. - Announcing DoubleCheckMD.com (Beta) -- A Powerful, First-Ever, Online Medical Search Technology That Empowers Users

Enhanced Medical Decisions, Inc. - Announcing DoubleCheckMD.com (Beta) -- A Powerful, First-Ever, Online Medical Search Technology That Empowers Users To Quickly And Easily Find Accurate Information: "Enhanced Medical Decisions, Inc., a health information technology (IT) innovator dedicated to creating solutions for U.S. healthcare issues -- today announces DoubleCheckMD.com ( Beta) -- a powerful, first-ever, online medical search technology that empowers users to quickly and easily find accessible, accurate information on drug interactions and side affects. Consumers and medical professionals will save vast amounts of time and eliminate irrelevant searches while using DoubleCheckMD.com's groundbreaking 'natural language' search technology. This technology can determine whether any of the following may be causing adverse symptoms or reactions individually or together: prescription drugs, over-the-counter medications, vitamin supplements and herbal substances."

iGuard Drug Interactions, Risk Ratings and Safety Alerts

iGuard Drug Interactions, Risk Ratings and Safety Alerts: "iGuard is the fastest and easiest way to learn about the safety of your medicines. And, by keeping your iGuard profile up-to-date, you can help the FDA and other researchers identify problems faster than ever. iGuard is a powerful communication and research tool designed to: 1. Alert you and your doctor (if you choose) about important safety information for the drugs you are taking. 2. Distribute risk ratings that help you understand your risk today, and in the future as new safety information emerges. 3. Facilitate communication between you and your doctor about medication risks and monitoring. 4. Provide an easily accessible summary of your health to use in coordinating care across all your doctors. 5. Help researchers identify safety problems faster. 6. Support family members and caregivers who are responsible for monitoring the safety of others."

Pew Internet: E-patients With a Disability or Chronic Disease

Pew Internet: E-patients With a Disability or Chronic Disease: "About a fifth of American adults say that a disability, handicap, or chronic disease keeps them from participating fully in work, school, housework, or other activities. Half of those living with a disability or chronic disease go online, compared to 74% of those who report no chronic conditions. Fully 86% of internet users living with disability or chronic illness have looked online for information about at least one of 17 health topics, compared with 79% of internet users with no chronic conditions. Those with chronic conditions are more likely than other e-patients to report that their online searches affected treatment decisions, their interactions with their doctors, their ability to cope with their condition, and their dieting and fitness regimen."

Empowering the physician-patient relationship: The role of the librarian

Empowering the physician-patient relationship: The role of the librarian: "While searching the Internet is often personally empowering for patients, this sense of empowerment does not necessarily translate into self-efficacy in interactions with health care providers. Whether health information found on the Internet is empowering for patients in clinical consultations appears to depend on the power relations between patients and practitioners, how patients use the information they retrieve, as well as on physicians’ affective responses to these patients. Librarians have a role to play in educating health care consumers and mediating the exchange of information between practitioner and patient."

The librarian can play an important role as an infomediary in dispensing information therapy prescribed by the doctor !

Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery -- Rosen and Kwoh 120 (4): 701 -- Pediatrics

Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery -- Rosen and Kwoh 120 (4): 701 -- Pediatrics: "Patient-physician e-mail is a service that patients will use given the opportunity. The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service."

The Partnership for Healthcare Excellence

The Partnership for Healthcare Excellence: "There are a lot of things you can do for your health. You can exercise and eat right — but one of the most powerful things you can do for your health is to be an active and engaged patient. That’s where The Partnership for Healthcare Excellence can help. The Partnership for Healthcare Excellence is dedicated to helping you — as a patient and as a consumer — get the high quality care you and your family deserve. Research shows that patients who are informed about their health, ask questions, and get involved in making decisions, actually get better care. That’s why we’re making it easier for you to get the information you need, by offering you tools, tips and resources that you can use to improve the quality of care that you and your family receive."

The second IVF cycle

For many patients, doing a second IVF cycle is much easier than their first one. There is much less apprehension and anxiety, because they have "been there, done that". They know exactly what is involved; and that there is no physical pain during the treatment. Their comfort levels are also much better, because they have developed a personal relationship with the clinic staff. However, for some patients, the second cycle is much harder. The first cycle is often done with the hope that " it has got to work !" The failure of the IVF cycle can be heart-wrenching and forces patients to confront the reality that there are no guarantees with IVF and that life is full of uncertainties. The fear of another failure can become a huge hurdle in some patient's minds - and many can never muster the courage to try another IVF attempt. This is especially true if their experience with the medical staff has been poor; and the clinic is seen to be impersonal and uncaring.

Fortunately, most patients have much more realistic expectations during their second IVF
cycle , which means that managing them is much easier. The index of a good IVF clinic in my mind is how many patients come back for their second attempt !

I especially enjoy treating patients who have failed an IVF cycle at another clinic. Not only are these patients more medically challenging;, it's much more fun to treat them, because we provide so much more personalised attention and care, which means they are more
appreciative . After all, unless patients have experienced poor quality care at another IVF clinic, how can they judge how much better we really are ?

Helping patients to make a decision

One of the most important roles a physician plays is helping patients to make the right decision. This is always very hard to do , because a good doctor should try to empower patients to make their own decision for themselves !

I see myself as being a Sounding Board, and I try to help my patients walk through their options. I do my best to not impose my answers or to tell them what to do , even though this can be hard . I often play the role of a Devil's Advocate, to make sure they have considered all the pros and cons before deciding. I will often give them a "cooling off" period, during which they have time to mull over their choices, so they can follow their heart.

I do have biases, and I share these with them, so they can factor these in when deciding. At the end of the day, they should have peace of mind they did their best !

From retired caregivers, a spoonful of compassion - The Boston Globe

From retired caregivers, a spoonful of compassion - The Boston Globe: "A prominent Boston physician is organizing retired colleagues to provide the personal attention that is often missing in modern medicine. The volunteers with Bedside Advocates will not practice medicine. Instead, they aim to provide comfort and compassion while helping fragile and elderly patients navigate the increasingly complex medical system by accompanying them to the doctor's office, the hospital, and the nursing home. They hope to help patients get better care by empowering them to ask questions, follow their medication regimes, and get prompt attention to problems. And most of all, they plan to be there when no one else is, providing relief for tired caregivers and support for patients without families, according to Dr. Jonathan Fine, who is leading the effort."

This is such a great idea ! Retired doctors can be excellent patient advocates; and their skills are very poorly used at present. They have a lifetime of wisdom to share - why can't we tap this properly ?

Incidentally, retired doctors are a great resource when you want a second opinion; or when you want a referral to a specialist.

Communication now part of the cure - USATODAY.com

Communication now part of the cure - USATODAY.com: "Retired Boston physician Jonathan Fine became a patient advocate in 2004 when he realized communication between doctor and patient is often the first casualty of a major illness. Miscommunication puts patients at greater risk of becoming victims of preventable medical errors, according to a report this year by the Joint Commission, a national hospital accreditation organization. And the Institute of Medicine reports that medical errors cause up to 98,000 deaths a year."

Two numbers every women should know !

Many women are now choosing to postpone childbearing because they want to pursue their career. However, sometimes it's hard to have your cake and eat it too, and some older women regret their decision when they find out that their eggs are too old for them to be able to have a baby .

So it is safe for you to do so ? At what age should you start worrying about your eggs ? 30 ? 35 ? What about all the celebs having kids at the age of 40 ? And can't IVF fix all problems ?

Unfortunately, there is no alarm on your biological clock, and every woman has a limited number of eggs which will run out as she grows older. So how do you know how old your eggs are and how much time you have left ? How can you assess what doctors call your "ovarian reserve" ?

There are 2 simple numbers which will help you to do so - your FSH level; and your antral follicle count. These are two basic numbers every woman who is more than 25 needs to know, so she can make well-informed decisions as to how long she can safely postpone childbearing.

Let's review some basic biology. Women are born with all of the eggs (oocytes) that they will ever have. A female fetus will have the greatest number of eggs around 16-20 weeks of pregnancy (5 million); at birth this number decreases to about 1 million; and by puberty it's down to about 300,000. This constant and dynamic process of decline continues until menopause and is not interrupted by birth control pills, pregnancy, or ovulation. From this reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive life. Once a women runs out of eggs, she reaches her menopause. About 10 years prior to the menopause is a phase called the oopause, when the egg quality is good enough to produce hormones to generate a regular menstrual cycle ( and this sometimes lulls women into a false sense of security); but not enough to make a baby.

There is a continuous process occurring in the ovaries where eggs are constantly being prepared for the maturation process. It takes 3-6 months for eggs to develop and mature. As the eggs are developing, they transition from a primordial ( immature follicle) to a mature follicle, called an antral follicle. Antral follicles are visible by vaginal ultrasound. Antral follicles therefore represent the reserve of eggs in the ovaries ; and these are the follicles which can be stimulated by fertility stimulation medications (gonadotropins).

An antral follicle count ( AFC) is done during the 2nd-4th days of menstrual flow and is performed by doing a vaginal ultrasound scan. Studies show that the AFC is predictive of the expected ovarian response to gonadotropins. An AFC less than 6 total (between both ovaries), predicts a poor stimulation response. This means a low AFC can correlate with diminished ovarian reserve.




The other simple test for checking how young your ovaries are (the ovarian reserve) is by doing a blood test to measure the level of FSH ( follicle stimulating hormone) in the blood on Day 3 of your cycle . This is called the basal ( day 3) FSH level. Young women with lots of follicles produce a hormone called inhibin, which inhibits the production of FSH, which means they have low Day 3 FSH levels. A normal level is about 3-4 mIU/ml. A high level ( more than 8 mIU/ml) suggests poor ovarian reserve; and a very high level ( more than 20 mIU/ml) is diagnostic of ovarian failure.

These 2 basic tests should be a part of the annual checkup for all women. Unfortunately, most family physicians and gynecologists are clueless about the importance of this test. When a 28 year old asks them whether it's safe for her to postpone childbearing, most of them give her a reassuring pat on the head, and tell her not to worry !

While this advise may be fine for some women, it's a major disservice for others. I feel women need to take matters in their own hands, and ask their doctor to measure their FSH levels, so there is a sound scientific basis for their reassurance. If the FSH level is borderline high, which suggests poor ovarian reserve, further testing to check ovarian reserve is called for, including an ultrasound scan for antral follicle counts.

As Robert Ringer explains, remember that there is a price you pay for every decision you take in your life. There is a price you pay for pursuing a career; and there’s a price you pay for having a baby. No matter what you do in life, do it with your eyes wide open to the tradeoffs involved. And then deal with those tradeoffs with a mature confidence ... and don’t complain. If you find that you are not willing to live with the price of a decision you’ve made, cut your losses short and try to reverse the error as quickly as possible.

ConnectYourCare Consumer-Directed Healthcare Administration of HSA, HRA, and FSA plans

ConnectYourCare Consumer-Directed Healthcare Administration of HSA, HRA, and FSA plans: "ConnectYourCare's CDH Solution provides a complete Consumer-Directed Healthcare platform for employers and employees. Our unique CDH platform provides a pathway for employers to realize healthcare cost containment through CDH adoption. For employees, our solution puts the consumer at the center of the healthcare decision making process, with an enhanced user experience and state of the art tools. Products and Services * Healthcare Account Administration - ConnectYourCare administers all types of healthcare accounts, including HSAs, HRAs, and FSAs. We can administer any combination of accounts, giving employers ultimate flexibility. * Healthcare Payment (Debit) Card - Healthcare accounts can be easily accessed through the card to pay for healthcare expenses at the pharmacy and doctors’ office. * Online Account Access – Participants have online access to account balances, claims and reimbursement requests in real time. HSA participants can also access investment options online. * RapidRequest Claims Processing - State of the art claims process enables automated, paperless claims handling that reduces processing time for speedy turnaround of reimbursements. * Health Education Tools - ConnectYourCare provides a suite of online tools "

Medical Banking - Dr Stephen Parente

Medical Banking - Dr Stephen Parente " I’m very excited about the prospects of medical banking. What intrigues me most is the integration of medical banking and person health records (PHR). There are three elements of vision of medical banking:
- Personal health records (PHR) are a portable resource that patients and their families can use for the long term.
- Patients will use PHR technology as a critical resource for health improvement, prevention, and long term medical care affordability.
- PHR will give patients emergency access to critical information and allow the record to be customized to clearly define their preferences for treatment. For example, pregnant mothers can clearly identify their delivery preference. A delivering OB/GYN still can counter the patient’s preference for the safety of the mother, but there would be no ambiguity about the mother’s wishes. Likewise, patients who want their organs donated in the case of mortal injury could make their preferences known.

The technology platform that appears to be emerging for medical banking is the integrated health card solutions. Several insurers have been experimenting with this technology. Of the early adopters Exante Bank of United Health Groups appears to have made significant progress in developing a product as well as a client base for a early for of this platform know as an integrate health care (IHC) technology."

MedEncentive P4P EBM Ix P4Q

MedEncentive P4P EBM Ix P4Q: "The MedEncentive Program is designed to 'bolt-on' to existing health plans (such as Blue Cross, Medicare, commercial insurers, self-insured employers, etc.) to control healthcare costs by improving the standard of care and encouraging healthy behavior. MedEncentive accomplishes these objectives by financial rewarding both physicians and patients on a per-occurrence-of-care basis for incorporating evidence-based medicine (EBM) and information therapy (I x) through proprietary Internet Website applications, simple but profound checks and balances, and other innovative features. This method of financially rewarding accountability and empowerment falls into a national movement referred to as pay-for-performance or P4P."

McKinsey & Company - A Framework to Guide Health Care System Reform - January 2007

McKinsey & Company - A Framework to Guide Health Care System Reform - January 2007: "The main functions of health care systems – wherever they are in the world – is to promote health among the country's citizens. In designing and operating any system, health care leaders aim to satisfy three leading requirements: ensuring that all people have adequate access to the benefits of health care; making certain that the system delivers care of consistently high quality; and achieving all this at a sustainable level of cost. These three objectives raise a host of complex questions. What constitutes adequate access and quality care? What is sustainable cost? To what extent should market forces be allowed to play a role in managing health care costs, quality and service? Going back a step, shouldn't health care systems shift their current focus on caring for the sick to a more holistic effort to maintain citizen's health? The answers to all those questions vary widely, depending on the historical, political and social context of each national system. But sufficient commonality may exist to construct a universal analytical framework that can help leaders identify reform priorities then design and implement them effectively. By focusing on seven key principles that healthcare intermediaries can use to affect demand and supply of health care goods and services, MGI provides such"

Insurers refuse cover for infertility treatment-The Times of India

Insurers refuse cover for infertility treatment-The Times of India: " Early this year, Tata Consultancy Services, which has more than 90,000 employees, approached New India Assurance Company with a proposal. It wanted New India to devise an insurance package for its employees based out of India which would cover procedures like in vitro fertilisation and artificial insemination. The proposal was prompted by an internal survey's finding that about 15% of TCS employees, both men and women, had fertility problems. Sources say TCS wanted New India to cover each of its employees for Rs 1 lakh. This was meant to be over and above the regular health insurance benefits the company offered. On its part, the insurer examined the proposal and declined to prepare the package TCS wanted. New India argued that these procedures were expensive and did not require hospitalisation. More significantly, the argument went, infertility was not a disease as in such cases it could be a result of, among other things, stress. TCS is not the only company in India to approach insurers for customised packages to cover infertility treatment. Sources in the insurance business say companies such as outsourcing firm Evalueserve, Computer Sciences Corporation and GE have all approached insurers at some point in recent times to seek similar cover for their employees. And all of them have been turned away."

This is actually a big opportunity for a clever and innovative health insurance company in India ! Insurance has now become privatised in India, which means it is no longer just a seller's market. Huge IT companies such as TCS and Infosys employ a large number of young employees who are in the reproductive age group. Many of them get so caught up in the rat race that they tend to put off child-bearing in order to pursue a lucrative career - which means that by the time they are settled and want to start a family, many of them find that their biological clock has ticked on, leaving them infertile. Now these are smart young driven employees, who are used to being successful and getting their own way. They have become senior in the company and can exercise quite a bit of clout ! If they need IVF treatment ( which they feel is partly a result of the overtime and long hours they had to pay in order to advance in the company), they want the company to pay them back by covering for their fertility treatment. Companies are going to start feeling the heat - and they are going to pressurise insurance companies to provide this coverage !

The good news is that many studies done in the US have proven that providing this additional coverage does not increase the cost of insurance cover by a significant amount , so that this is a very cost-effective option insurance companies should be happy to provide. Not only will this be a valuable differentiator for them and a great USP, they can also project themselves as being pro-family and employee-friendly. It's my prediction that infertility coverage is an option insurance companies in India will soon provide to corporates, if they don't want to lose their business. Health insurance is a "hot area" in India right now - and infertile couples will benefit from this.

Of course, if the carrot approach does not work, I think infertile couples need to use the stick option. Many of them are smart and successful executives and entrepreneurs, and they can get together to lobby and advocate for making infertility coverage compulsory for all insurance companies. This is exactly what Resolve did in the US many years ago, as a result of which infertility coverage is compulsory in 13 states in the USA.

Hopefully a group of infertile couples or an infertility support group in India will file a PIL ( public interest litigation) in the High Court, based on the grounds that it's unfair for insurance companies to discriminate against infertile couples by refusing to cover their medical treatment. Infertility is a disease caused by medical problems ( such as blocked tubes); and modern treatment is very successful and cost-effective in providing a solution !

The right to have a baby is something most of us take for granted, and we often lose sight of the fact that 1 in 10 married couples will not be able to have the child they want. Infertility is a very common problem, and if you stop to think about it, you will realise that you know at least one person who is infertile amongst your own group of friends or relatives. However, it remains one of those taboo topics which no one wants to talk about, even though it interferes with one of the most fundamental and highly valued human activities – building a family.

Millions of infertile couples in Indian cities today face many obstacles in their attempts to build a much-wanted family, and one of the most frustrating is the lack of insurance coverage for medical treatment. What this means is that while infertility specialists in India can provide even the most advanced reproductive techniques to solve extremely complex infertility problems, at a level of sophistication which is comparable with that in the West (and at a fraction of the price), most couples cannot avail of these techniques because these are not covered by their insurance policy. So near – and yet so far, would sum up the situation for most couples!

The financial burden that some of the treatments may place on couples can be large, and adding this on to the emotional and physical consequences of experiencing infertility can literally be the last straw which breaks the camel’s back. The strong desire to build a family gives many the strength to face these obstacles, but infertile couples also need additional support from their employers and insurance companies.

While most diseases and medical conditions are covered by insurance, the disease of infertility is often singled out for exclusion, and such discrimination is unfair! Thus, to add further insult to injury, infertile couples not only face the emotional pain associated with not being able to have a child, but also face obstacles put in front of them by their health insurance and employers for reimbursement of the medical expenses they incur on their treatment.

Unfortunately, insurance companies in India still do not provide health insurance coverage for infertility. This is a very archaic attitude, but because the insurance industry in India is still a monopoly, this situation is unlikely to change, until the field gets privatised, or Indian companies fall in line with their Western counterparts.

Insurance companies have traditionally denied claims for infertility on one of the following flimsy pretexts.

• Infertility is not an illness;
  
• Treatment of infertility is not medically necessary;
  
• Treatment of infertility is experimental.
  
• Infertility treatment is too costly for a country like India to offer

However, it has now been well established that infertility is an illness, which is caused by various medical causes which result in the abnormal functioning of the reproductive systems (such as blocked fallopian tubes or a low sperm count); and that these can be successfully treated in most cases.

Medically necessary is usually defined by insurance policies as medically appropriate for treatment of an illness under professionally recognized standards of health care – and treatments such as IVF are now universally acknowledged to be standard medical treatments, which are no longer experimental.

While certain infertility treatments can be costly, most are quite inexpensive, and only about 5% of all infertile couples will need expensive treatments like IVF. Moreover, if expensive medical procedures like bypass surgery can be covered, then why should treatment for an abnormally functioning reproductive system be excluded?

Why this discrimination against infertile couples in India? Ironically, this is because of the high premium Indians have always placed on the family unit! The major role of the woman in Indian society was seen to be to have children to propagate the family name. Therefore, if a woman could not have children, she was singled out, ridiculed, ostracised and stigmatised.

In fact, given the value Indians have placed on having children, infertile couples should actually receive even more tender loving care from others – and be helped in their quest to complete their family!

However, because of centuries of misconceptions and myths regarding infertility (for example, "a barren woman has been cursed by God, and being punished for the sins of a prior life"), it will take a long time for social attitudes in India to change. Infertile couples are an easy and soft target for everyone –

Ranging from:

• friends ("life is incomplete without a baby!");
  
• in-laws ("when will I become a grandmother?");
  
• relatives ("what do they want to earn money for – they do not have any children to leave it to!"),
  
• neighbours ("they may have a lot of money, but what’s the use, they don’t have any children");
  
• acquaintances (" no good news yet? Go see this doctor my sister-in-law’s cousin went to – he’s the best!") ;
  
• co-workers ("you don’t have any kids, so can you stay on a little longer to finish this job – I need to go back to take care of my children!");
  
• right to servants (" the reason she shouts so much is because she doesn’t have any children – serves her right!)

(Gentle reader, if you recognise yourself here, please suffer a pang of guilt, and promise to improve your behaviour the next time round!)

Many otherwise enlightened people take the attitude that infertility treatment is elective – and even compare it to cosmetic surgery. However, infertility is a serious medical condition – it is both a disease and a life crisis.

Others pontificate that these couples should just adopt a baby, rather than take treatment. While adoption is an excellent method of building a family for some couples, it is not acceptable to everyone– and forcing couples to do so when they don’t want to is very unfair.

A major problem is that infertile couples in India are too ashamed to stand up for their own rights – with the result that they often suffer in silence. However, infertility exacts a high toll! Not only do many marriages break up, many women are abused for being infertile as well. Also, infertile employees, because of the emotional stress they are under, are often not as productive in the workplace as they could have been if their problem was successfully resolved.

Fortunately, this discriminatory attitude is now being challenged by advocates for infertile couples – at least in the US. The pathbreaking Americans with Disabilities Act (ADA), provides protection against discrimination for Americans with a disability – a disability being defined as" a physical or mental impairment that substantially limits one or more major life activities."

The US Supreme Court has clearly ruled that reproduction is a major life activity. Since infertility is a physical impairment that substantially limits the ability to reproduce, this means that if an individual experiences discrimination because of his or her infertility, a claim can be made that this is illegal under the ADA. Thus, a police woman employed by the city of Chicago sued the city recently because it did not provide infertility insurance coverage. The Court ruled that infertility is a disability under the ADA, and today the city of Chicago covers the cost of infertility treatment incurred by all its employees.

Many employers in India are not still aware of the issues and concerns facing those with infertility. Employers need to be more understanding of the special needs of those of their employees who are infertile, and be willing to make workplace accommodations for those undergoing infertility treatments – for example, allowing the employee to change her work schedule or to take some time off. Employers, insurance companies, and legislators in India also need to take steps to recognize that reproduction is a major life activity – and that infertile couples need all the help we can give them.

Unfortunately, most infertile couples in India do not feel comfortable speaking publicly about this very private struggle, even though they represent all racial, religious, socio-economic and ethnic groups, as well as both sexes.

We all need to remember that infertile couples are our neighbors, co-workers, friends and relatives - and they just want to experience the joy of raising a family - an experience that so many of us take for granted!

A Tale of Two Doctors « Customers Rock!

A Tale of Two Doctors « Customers Rock!: "-WOM (Word of Mouth) referrals mean nothing if the customer experience is poor. The first doctor was a referral from my friend. I trusted that this would be a good doctor. However, the customer service we had (long wait for phone, surly phone agent, no appointment) discouraged us greatly. I found out that the person who answered the phone was a call center rep that answered calls for all the clinics in this particular physican’s network. A nurse from the office called me later in the day to chastise me for not taking the “new patient intake” appointment as they are apparently very difficult to come by. When I told her I wasn’t sure I wanted to have a doctor that was this busy, she told me all their doctors were very busy. I told her that was fine, and we would find another doctor! - You can hear a smile over the phone. Just by listening to the lady from the second doctor, I could actually hear her smile; she sounded glad to be talking to a potential new patient. I felt welcome! This is important for anyone representing your company by phone, including not just customer service but also sales and marketing.

McKinsey & Company - Synthesis - Accounting for the Cost of Health Care in the United States - January 2007

McKinsey & Company - Synthesis - Accounting for the Cost of Health Care in the United States - January 2007: "The United States spends more of its income on health care than other developed countries and that share is rising. It is an arresting statistic that the U.S. now spends more on health care than it does on food. In this new report MGI finds that the United States spends approximately $480 billion ($1,600 per capita) more on health care than other OECD countries and that additional spending is not explained by a higher disease burden; the research shows that the U.S. population is not significantly sicker than the other countries studied. Instead, MGI found that the overriding cause of high U.S. health care costs is the failure of the intermediation system — payors, employers, and government — to provide sufficient incentives to patients and consumers to be value–conscious in their demand decisions, and to regulate the necessary incentives to promote rational use by providers and suppliers. Given the less than optimal access for all U.S. citizens (relative to peer countries), MGI concludes that major opportunities for cost improvement —even if not the full $480 billion—are as possible as they are necessary although no single reform is likely to succeed in achieving the needed rebalancing. "

Consumer-focused healthcare

Consumer-focused healthcare: "# Consumers don't want to actually take control of healthcare, much as they didn't want control over their retirement funds-- but employer survival is forcing the transition # True consumerism likely to happen in ambulatory care setting: e.g., retail clinics, as that is where 80% of the people are. Current focus tends to be on 80% of the costs occurring with acutely ill people # Consumerism may look like 5% adoption in CDHP plans, but increasing consumer responsibility and cost-sharing is penetrating nearly all plans today # The coming revolution will be about lower cost combined with higher convenience. Likely, people will decide they don't need to go to see the physician (e.g., retail clinic is good enough)"

Scott Shreeve, MD: Athena Health: The History of the First Health 2.0 IPO

Scott Shreeve, MD: Athena Health: The History of the First Health 2.0 IPO: "I have previously written on several occasions about one of my all-time favorite companies - Athena Health. It is appropriate to once again put finger to key to congratulate Jonathon Bush, Todd Park, Nancy Brown, Ed Park, Jon Hallock, and the rest of the Athenista's for their recent IPO (September 20, 2007). It was the largest IPO of 2007 and bodes well for the ongoing wave of investment in healthcare information technology. I find the history, growth, and now the prosperity of Athena to be fascinating. Athena was founded by my fellow IT co-conspirators, Jonathon Bush and Todd Park, Athena has steadily advanced over the last decade birthing the 'software as a service' (SaaS) model within healthcare industry. I say 'birthing' because I have watched the labor pains of Athena fairly closely over the last 5 years since first meeting Todd Park in Waterbury, CT on my first ever presentation with Medsphere. We discussed then, and watched again and again, as Athena began to take a bigger and bigger swipe at the 'healthcare hairball'. The hairball (or at least the part I am referring to) is the traditional general practice outpatient clinic. As you may be aware, ~80% of all medical care is delivered in an ambulatory office setting. The office setting is completely disparate - ranging from huge conglomerate multi-specialty practices (50-250+ MD's), to medium-sized groups (10-49 MD's), to the single shingle proprietors in Nowhere, ND. After somehow convincing Todd to leave a schlickety consulting gig at BAH to run a "single shingle" woman's health clinic near San Diego (Dude, I am so interested to know what the pitch was), Jonathon and crew tried to figure out how to make money in modern medicine.

Gumption after gumption, piece by piece, they were able to develop a software system that could actually manage the insurers and all their crazy denial rules. Those late night Mountain Dew runs started to pay off as they began to AGGREGATE data from various insurers to increase their percentage of first time claims approval. Soon, an emergent rules engine was developing based on the power of their ANALYTIC engine. This then allowed them to automatically ADVISE practices of insurance rule variations before they were submitted for adjudication. They began to share this software engine with the other clinics they purchased and soon were selling their services to affiliate organizations. (These three elements - AGGREGATE, ANALYZE, and ADVISE - are three core ingredients to Health 2.0 companies)."

Scott Shreeve, MD: The Canonical Health 2.0 Representation

Scott Shreeve, MD: The Canonical Health 2.0 Representation: "# Begin by defining Health 2.0
# Realize that Health 2.0 is all about Patient Empowered (not the misnomer 'Consumer Directed') Healthcare whereby patients have the information they need to be able to make rational healthcare decisions (transparency of information) based on value (outcomes over price). In the Health 2.0 paradigm, everyone in the healthcare process is focused on increasing value for the patient.
# Realize that Health 2.0 is absolutely reliant on interoperability of health information. Everything from the Personal Health Record (PHR), to the Clinic Health Record (CHR), to the Enterprise Health Record (EHR), to the National Health Record (NHR) must be based on standards, be seamlessly transitioned between environments per standardized security and privacy protocols, and be accessible anytime from anywhere.
# Undergirding this foundation of information, the Four Cornerstones (Connectivity, Price, Quality, and Incentives) of the Value Driven Healthcare movement begin to create a virtuous cycle of innovation and reform. Transparency serves as a key catalyst in this process by creating positive sum competition that can deliver better outcomes at a lower cost.
# As more information becomes available as a result of increased transparency, there will be a wave of innovation at all points along the full cycle of care to appropriately determine value.
# An increased amount of personal health and outcomes information will create an ongoing role for infomediaries and related services providers to add value at each stage of the full cycle of care. These value added Health Advisory Services (more later) will offered by hundreds of companies, in thousands of forms, to millions of people who are can benefit from the remixing of medically related information. It is easy to see how the new Web 2.0 framework, with its inherent social networking and collaboration tools, will make this "long tail" of medicine a "value"able venture.

PeerClip

PeerClip: "What is PeerClip? PeerClip combines the two preferred ways physicians gain knowledge—reading medical literature and interacting with peers—into a powerful online tool. Who can use PeerClip? PeerClip is exclusively for physicians, physician assistants and nurse practitioners. PeerClip is free to qualified users. Why should I use PeerClip? PeerClip is the first-of-its-kind service that offers physicians an efficient way to store important medical information coming from a variety of online resources. With PeerClip, physicians are able to quickly capture key information in a central location while gaining insight from the collective intelligence of their peers."

SEC Info - Athenahealth Inc - S-1/A - On 8/31/07

SEC Info - Athenahealth Inc - S-1/A - On 8/31/07: "The dynamic and increasingly complex healthcare market requires an integrated solution to effectively manage the reimbursement and clinical landscape. We believe we are the first company to integrate internet-based software, a continually updated database of payer reimbursement process rules and back-office service operations into a single internet-based business service for physician practices.

We deliver these services at each critical step in the revenue and clinical cycle workflow through a combination of software, knowledge and work:

• Software. athenaNet, our proprietary internet-based practice management and EMR application, is a workflow management tool used in every work step that is required to properly handle billing, collections and medical record management-related functions. All users across our client-base simultaneously use the same version of our software application, which connects them to our continually updated database of payer rules and to our services team.

• Knowledge. athenaRules, our proprietary database of payer rules, enforces physician office workflow requirements, and is continually updated with payer-specific coding and documentation information. This knowledge continues to grow as a result of our years of experience managing back office service operations for hundreds of physician practices, including processing medical claims with tens of thousands of health benefit plans.

• Work. The athenahealth service operations, consisting of nearly 400 people in the United States, and more than 700 people at our off-shore service provider, interact with clients at all key steps of the revenue and clinical cycle workflow. These operations include setting up medical providers for billing, checking the eligibility of scheduled patients electronically, submitting electronic and paper-based claims to payers directly or through intermediaries, processing clinical orders, receiving and processing checks and remittance information from payers, documenting the result of payers’ responses and evaluating and resubmitting claims denials. "

CureHunter

CureHunter: "The CureHunter Discovery Engine is the world's only fully unified and integrated numeric index of all known drugs, biologically active agents, diseases and empirical statements of all effective clinical outcomes published in the United States National Library of Medicine. The engine you are accessing online right now computes: 121,000 drug and biological agent data points X 11,600 diseases X 15,000,000 peer-reviewed research articles X several hundred thousand additional variables of Gene, Protein, Enzyme, Hormone, Growth Factor, Ligand, Kinase, Receptor, Inhibitor and other important small biologically active molecules. The CureHunter Engine essentially defines the Clinical Outcome in cross-comparable numerical weights for all successful agents and allows discovery clustering and pattern finding that illuminate both pathogeneses and cures."

I like their philosophy of empowering patients with access to this information.

As they put it ---

" I am not technically trained, should I be using CureHunter at all? And can I understand it?

Don't underrate yourself. As a general rule we believe it is fundamentally good for patients to become knowledgeable about the diseases life may throw at them and the medicines they are advised to take. Often by reading extensively, participating in their patient associations, and talking to others with their condition, patients can support the efforts of their doctors to help them get well. You may, for example, become aware of signs and symptoms that help your physician refine your diagnosis. You may note particular side effects--sometimes very subtle--of medications you are taking that would cause your physician to change your prescription. And with serious study, you may even develop insights to new cures. Only you really know the patterns of your daily life, the stresses put on you by work or school or family or play; the daily
choices of food and medicines you consume. You are your own best instrument and always monitoring your good health as well as your illnesses and the aches, pains, and dysfunction they bring with them. The more aware you are of your own body and behaviors, the more likely it is you can bring good information to your physician and team up with him or her. The fact that you have ordered a CureHunter Patient Summary Report means that you are already a "patient activist" for your own best health. To use this report well, however, you must have a general understanding of the science and methods that produced the data contained here. That said, CureHunter is very different from most "consumer health information" resources you might find on the Internet or at your public library. Because CureHunter does not rewrite (or water down) the technical medical articles for "consumer consumption," in many cases the actual "key statements of outcome" shown in your Summary Report will be very difficult to understand because they are
directly extracted from the peer-reviewed scientific literature and are quoted without modification. This "control on original sources" is critical so that similar findings can be counted, and most importantly repeated patterns in many thousands of clinical observations can be analyzed for how those patterns shed light on both the causes and cures for human diseases. In the final analysis, even if you are technically trained in one area of science, this is pretty complicated work. And that is why we recommend you take printed versions of your CureHunter Patient Summary Report to your physician. Talk about the data
together and see what your doctor thinks. You may wish to discuss your report with your pharmacist, too. Or if you have friends or associates in the biological sciences or in your patient association, ask them for their opinions. Getting well is a team effort. No one, "knows it all" with over 200,000 new research articles published each year."

Medicine on demand -

Medicine on demand : "'Video has always been an incredible educational tool, but the Web in the past didn't support it,' says Nan Forte, executive vice president for consumer services at WebMD, a popular medical site. Now, health-information consumers are demanding online video and getting it.

•General medical sites from WebMD to MayoClinic.com are expanding their video libraries. At the Mayo site, you can see how to do a biceps curl, inject insulin and check your blood pressure. At WebMD, a mix of expert interviews, patient stories and news pieces grows by the day.
•Sites devoted to specific disorders are adding video, too. The American Cancer Society (www.cancer.org) features videos on its campaign to increase access to cancer care. Autism Speaks (www.autismspeaks.com) offers a set of videos that show the early signs of autism. Videos on seizures and their treatment can be found at epilepsy.com.
•A revamped eMedTV site, coming soon, will be built around 1,200 short videos that explain procedures, disorders and medications. Many of the videos have been used in major hospitals to inform patients before they consent to treatment, says the site's developer, physician Art Schoenstadt.
•Video bloggers ('vloggers') are sharing their own health stories "

And you can see our library of healthcare videos at www.drmalpani.com/health-videos !

Majority Use Online Health Sites Before and After Visit to the Doctor

Majority Use Online Health Sites Before and After Visit to the Doctor : "We knew the number of people going online for health research is constantly growing, but these recent stats are pretty astounding: more than three-quarters of Internet users in the United States go online for health information, according to Burst Media. It looks like people in the droves are turning to online resources to learn more about conditions, procedures and medications. Is it a flawed healthcare system that drives people online? Speaking from personal experience and that of friends around me, we’ve often found hospital doctors too busy to explain illnesses and conditions that unwell family and friends are being treated for in hospital. Niche health sites, such as Healthline, Quality Health and WebMD have helped me decipher the “mumbo jumbo” of medical terms thrown at me, so I’ve been able to go back to the doctors with meaningful questions. And it seems my experience is one that many have. Of the BurstMedia respondents that go online for health research, more than one-third researched health topics online before visiting a medical professional. After a medical appointment, 43.5% of respondents went online to learn more."

About HealthPricer.com - Comparison Shopping for Health Products

About HealthPricer.com - Comparison Shopping for Health Products: "HealthPricer Interactive Limited is leading the way in comparison shopping for consumer healthcare products. HealthPricer.com is a top destination site for finding and buying healthcare products from a comprehensive list of trusted merchants across the web. Focusing solely on consumer healthcare products, HealthPricer offers shoppers great benefits such as simplified product search, accurate merchant ratings and reviews, detailed product information and discount prices - an unparalleled time & money saving experience for online shoppers. HealthPricer.com is a one-stop comparison engine where consumers can find, compare and buy the best health products such as prescription drugs, contact lenses, non-prescription medicine and supplies, vitamin and nutritional supplements, and beauty and personal care products online at the best discount prices available. We take responsibility for the products we refer consumers to and ensure that all of the online retailers we provide access to are legitimate, quality companies."

What Consumer Guided Health Insurance Means

What Consumer Guided Health Insurance Means: "Consumer Guided Health Insurance is designed to help fix the traditional health insurance system, in which costs have been spiraling out of control for decades. The idea is to let consumers apply their own common sense about cost and value to health care, then make smart buying decisions — just like they would for any other purchase. Simply put: when customers can see real value, they can choose real value and minimize out-of-pocket costs. To make Consumer Guided plans work, HealthMarkets is using new insurance ideas and technologies that make it much easier for our customers to be smart consumers of their own health care. For instance, our plans are the first to show relative cost information for different doctors and hospitals nationwide — with information for over 400,000 doctors and 45,000 facilities for more than 20,000 procedures readily available to customers, to help them choose the best value. Consumer Guided Health Insurance rewards consumers who become involved in the process of knowing their plan and making decisions related to their health care. These rewards are many — including the ability to attain lower costs for competitive benefits, giving our customers greater freedom to choose a doctor or provider based on their own priorities. That puts the ability to control costs and benefits back in consumers' hands, where it needs to be ."

Interactive Health Communication

Interactive Health Communication: "The rapid proliferation of information and communication technologies that have emerged during the last several years has both hopeful and alarming implications for the future. These technologies have already produced profound changes in the US economy and continue to exert increasing influence on many aspects of daily life, including personal health decisions and behaviors, health care delivery and financing, and public health systems. Evidence of this phenomenon is the growth of interactive health communication (IHC): the interaction of an individual—consumer, patient, caregiver, or professional—with or through an electronic device or communication technology to access or transmit health information, or to receive or provide guidance and support on a health-related issue. IHC applications include health information and support Web sites and other technology-mediated applications that relay information, enable informed decisionmaking, promote healthy behaviors, promote information exchange and support, promote self-care, or manage demand for health services."

Health Information Translations

Health Information Translations : "Health Information Translations is a collaborative initiative to improve health education for limited English proficiency patients. This site is intended to be a valuable resource for helping health care professionals teach health education to those patients with limited English skills. By leveraging the combined skills and experience of 3 of Central Ohio's largest health care organizations, this project will produce some of the most valuable resources for health care education in diverse communities."

Even though India is a leading IT power and exports medical skills and people to the West, it's a tragedy that there is such little good quality information for patient education written in Indian languages on the Web. Ironically, it's easier to find Hindi materials for patient education on a US website than on an Indian
website !

Healthy Roads Media

Healthy Roads Media: "Health information access is a basic healthcare need. Literacy, health-literacy, illness, aging, disability and language are all issues that can pose barriers to obtaining basic health information. This site contains free health education materials in a number of languages and a variety of formats. They are being developed to study the value of these formats in providing health information for diverse populations in a variety of settings. We need your feedback! Our Materials There are many contributors to Healthy Roads Media. Our text is always from reliable sources and the information is reviewed regularly. Sometimes our partners provide both English and non-English text. We only accept translated materials that have been created through a quality controlled process. If Healthy Roads Media does the translation, then the work is carried out by certified translators, again through a quality controlled process. We work to make sure that the translations are done in a way to make them easy-to-read and as accessible as possible to people with literacy challenges. High quality translation is a complex and difficult process, especially when trying to accurately communicate health information. We welcome any suggestions."

This is an extremely valuable resource - we need to grow this !

The pregnancy ultrasound overtesting scam

As an infertility specialist, I refer our patients to obstetricians for their antenatal care once they get pregnant. What's very alarming is the large proportion of our patients who are being subjected to unnecessary caesarean sections for their childbirth. Many of these women are healthy young women who are perfectly capable of giving birth normally. However, many doctors these days seem to prefer doing elective caesarean sections for them - a practise which is remunerative for the doctor, but harmful for the patient.

So how do they convince the patient to sign the dotted line and give "informed consent" for the surgery ? Doctors are cleverly misusing ultrasound testing to do so. While there is no doubt that ultrasound scanning is extremely helpful during pregnancy to confirm the well-being of the baby, the commonest racket is to get the ultrasonographer to over-report minor variations as abnormalities, and then scare the patient that the baby's welfare is at stake.

The number of "abnormalities" which are reported are mind-boggling for their creativity ! I have seen patients being subjected to caesarean sections for a huge range of normal findings , including:
1. nuchal cord . This is a condition in which the umbilical cord is near the neck. This is perfectly normal and safe, but they scare the patient by saying that this cord can tighten during delivery and strangle the baby, which is why a caesarean is much safer !
2. reduced amniotic fluid. It's common for the amniotic fluid volume to decline as the pregnancy progresses. Here, the scans are repeated frequently, and the sonographer "documents" a declining trend in the amount of fluid. This is "creatively interpreted" as suggesting "fetal distress" which requires a caesarean section !
3. oblique lie. Often the baby's head does not settle down into the pelvis until quite late during pregnancy. If it does not do so by 36 weeks, patients are told that this suggests that head is "too big" or the "pelvis is too small" and that a caesarean section is needed to prevent birth trauma !

The beauty of these "reported abnormalities" is that they are "soft findings" which are dynamic and therefore cannot be conclusively documented. Since a baby is a "high-investment" product, no patient wants to take chances, and they are happy to do what their doctor suggests.

What's even worse is that if they get a second opinion from another obstetrician, the new doctor will also most probably agree with the first one, since it's much more profitable for a doctor to do surgery, than to allow for a normal vaginal birth !

Interestingly, ultrasound over-reporting seems to be widely prevalent in gynecology as well. Patients who are infertile are "documented" to have small subserous fibroids ( of no clinical importance) and then advised to undergo laparoscopic surgery ( which is projected as being "minor surgery") to remove these. The other common "finding" is a small ovarian cyst ( which is extremely common) for which they are advised to undergo laparoscopy to "rule out and treat" endometriosis.

Similarly, older women with heavy menstrual bleeding are diagnosed as having fibroids or endometrial hyperplasia ( a fancy term for a "thick endometrium " ) and told that they need a hysterectomy !

It's becoming increasingly difficult for patients to protect themselves from this sort of overtesting and overdiagnosing which lead to unnecessary overtreatment ! The best bet is to find an ethical doctor who will guide you properly !

Patient Education to help Health Insurance Company's Marketing and Sales efforts

Patient Education to help Health Insurance Company's Marketing and Sales efforts : " Consumer-centered health plans will lead employer and consumer markets. Just as stock brokerages, banks, and travel agencies made an innovative shift to empower their customers with information, so too will traditional insurance plans. Health plans that differentiate based on consumer decision support will have a huge advantage with both their employer and consumer customers.

* Demonstrate significant value with employers
* Improve employee health care decisions
* Add value to member services
* Attract the young and wired market
* Increase Web services success
* Build marketable benefit designs"

Consumer Medical Information for Physicians & Clinics

Consumer Medical Information for Physicians & Clinics: "Ask physicians to name the most important thing they do for their patients, and they'll probably say 'provide information.' If you ask patients what they most value from their physicians, they'll likely say 'information.'"

This is exactly why patient education libraries are so important. They are a very cost effective way of providing reliable information to patients; and can save the doctor and hospital valuable time and energy !

Why health insurance plans should educate their customers

Why health insurance plans should educate their customers : "Consumer-directed health insurance policies will succeed only if they integrate a way to help members make good decisions. Without evidence-based information to guide their decisions, your members may under use effective prevention and treatments. They may overuse commercially promoted treatments that may in fact be of little value to them.

Healthwise Supports Consumer-Directed Health Plan Goals
* Help members make health-improving choices
* Help members make cost-effective choices
* Add differentiating value for employers
* Build satisfaction"

Massachusetts Patients First

Massachusetts Patients First: "A bill now pending before the Massachusetts legislature would codify many of the elements contained in the voluntary Patients First initiative and, therefore, hospitals are strongly supporting its passage. The Patient Safety Act is truly a groundbreaking initiative that both addresses the nursing shortage and injects transparency and accountability into the health care system.

Specifically, Senator Moore's bill:

* dedicates needed resources for nursing scholarships, loan repayments, mentoring programs and faculty development to increase the number of nurses.
* requires all hospitals to file their staffing plans for each unit with the Department of Public Health, and to publicly post the plans.
* requires hospitals to use and publicly report on “nurse-sensitive” measures to track how patient care is affected by the nursing care hospitals provide."

A Healthwise “Gray” Paper:How the Baby Boomers Can Save Healthcare

A Healthwise “Gray” Paper:How the Baby Boomers Can Save Healthcare " In the context of a complex system, it sometimes takes a
few simple rules and tools to break out of the old patterns. The Ix Solution rules and tools can create the disruptive innovation needed to reinvent health care in a more positive and cost effective way.

3 Rules
#1 The Self-Care Rule. Help Boomers do as much for themselves as they can.
#2 The Guidelines Rule. Help Boomers ask for the health care that they need.
#3 The Veto Rule. Help Boomers say “No” to care they don't need.

3 Tools for Health Care Transformation

Self-Service Tools: 24-7 access to health information, symptom checkers, and decision aids in self-care guides and on Web sites.
Information Prescription Tools: Short information prescriptions “prescribed” to patients by their doctors or health plans at every “moment in care.”
Long-Term Engagement Tools: Ongoing, interactive programs that are personalized and targeted to meet each individual’s self-management needs over time."

A great way to convert problems into opportunities !

FIVE QUESTIONS FOR .... Maureen Regan and Julie Vargo / Two authors bring infertility out of the closet

FIVE QUESTIONS FOR .... Maureen Regan and Julie Vargo / Two authors bring infertility out of the closet: "In metropolitan areas, there's a delay in having children because women go to these areas to have careers. The older you get, the more precious time you lose to have a child. Women here are beautiful -- 50 is the new 30. It's a very healthy city to live in, San Francisco. You're looking at yourself in the mirror and you look great. But it's not connecting -- the idea that just because you look good on the outside, that your eggs look good on the inside. Vargo: Women only have 12 times a year to get pregnant, and that's only if the egg is released, if the cilia, or hairs, in the Fallopian tubes, push the egg from the ovary and if you have sex at the right time, along with a lot of other factors. Q: How can women balance their quest for fertility -- and all the anxiety it produces -- with the rest of their lives? Regan: Our culture is about 'I want this, I want this now.' You have to keep your mind open rather than say, 'I can only have children this way.' That puts limits on how you will find your family. Vargo: You get baby lust, baby stress. "

WellPoint doctors to get Zagat ratings

WellPoint doctors to get Zagat ratings: " One of the nation's largest health insurers, WellPoint, has teamed with Zagat Survey to let patients rate their doctors, just as diners rate restaurants in Zagat's burgundy-colored guides. Instead of Zagat's four categories for restaurants — food, décor, service and cost — the ratings guide will consider trust, communication, availability and office environment. In addition to giving doctors a numerical score based on a 30-point scale, the site will include comments from patients. The WellPoint program will be available online to more than a million members by the end of March. It plans to roll it out to all of its 35 million members but would not give a schedule. The move by the insurer comes as consumers increasingly turn to the Internet to learn about products and services — and see customer reviews."

Great idea. Of course, initially they will measure only what they can - and not the most important stuff ( clinical competence). But at least it's a start. Getting doctors ( and nurses !) to rate doctors would also be a useful metric which is worth tracking !

"Just relax !"

This is the commonest advise doctors give patients - for example, when doing an embryo transfer. But how does one relax when lying on a cold examination table, with a mind which is full of worries and fears ?

Interestingly, it's not possible for you to relax your body - after all, you can only contract your muscles - you cannot relax them ! So what's the secret ? Here's a simple tip. What you need to do is to actively contract the opposing muscles. So if you want to relax your biceps, you need to contract your triceps !

What this means is that during the embryo transfer, you need to actively push your buttocks down to the bed; and keep your knees wide apart. This will force the inner thigh muscles ( the adductors) to relax, allowing your vaginal muscles to relax, thus making the doctor's life ( and yours !) much easier.

Learning how to do pranayama ( a type of breathing which yoga teaches) and meditation also help !

10 Patient Safety Tips for Hospitals

10 Patient Safety Tips for Hospitals: "10 Patient Safety Tips for Hospitals Medical errors (or adverse events) can occur at many points in the health care system, particularly in hospitals. These tips for hospitals are from studies by the Agency for Healthcare Research and Quality (AHRQ), which has funded more than 100 patient safety projects since 2001. Many findings from AHRQ research can be put into practice in hospitals by following 10 practical tips."

Choosing your words carefully: how physicians would disclose harmful medical errors to patients.

"Choosing your words carefully: how physicians would disclose harmful medical errors to patients." This study surveyed 2637 medical specialists and surgeons regarding how they would disclose harmful medical errors to patients. Prior research revealed that patients wanted the physicians to apologize for the error, explain how it occurred, and discuss how such errors could be prevented in the future. Whereas most respondents in this study supported error disclosure in general, only a minority of medical specialists and surgeons would explicitly inform the patient, especially for less clinically significant errors. Approximately half of respondents declined to explain how the error occurred or discuss specific plans to prevent such errors in the future. Most respondents would explicitly apologize to patients, although surgeons were significantly less likely to do so than medical specialists. A companion study explored factors influencing physician's support for full disclosure of medical errors."

Electronic Health Records: Just around the Corner? Or over the Cliff?

Electronic Health Records: Just around the Corner? Or over the Cliff?
" We recently implemented a full-featured electronic health record
in our independent, 4-internist, community-based practice of general
internal medicine. We encountered various challenges, some
unexpected, in moving from paper to computer. This article describes
the effects that use of electronic health records has had on
our finances, work flow, and office environment. Its financial
impact is not clearly positive; work flows were substantially disrupted;
and the quality of the office environment initially deteriorated
greatly for staff, physicians, and patients. That said, none
of us would go back to paper health records, and all of us find
that the technology helps us to better meet patient expectations,
expedites many tedious work processes (such as prescription writing
and creation of chart notes), and creates new ways in which
we can improve the health of our patients. Five broad issues must
be addressed to promote successful implementation of electronic
health records in a small office: financing; interoperability, standardization,
and connectivity of clinical information systems; help
with redesign of work flow; technical support and training; and
help with change management. We hope that sharing our experience
can better prepare others who plan to implement electronic
health records and inform policymakers on the strategies needed
for success in the small practice environment.
Ann Intern Med. 2005;143:222–226. www.annals.org"

Long Term Conditions Management | Solutions | Clinical Solutions, Bringing Decisions to Life

Long Term Conditions Management | Solutions | Clinical Solutions, Bringing Decisions to Life: "“A patient outreach solution based on our world class medical technology.” The long term conditions management (LTCM) solution combines clinical expertise with telephone communications and tailored software. It gives patients autonomy over their care by educating and supporting them through a tailored programme designed to help them manage their specific condition. With the expert input of the clinician, patients help to structure their own care plan, increasing their chances of success. Clinicians provide reassurance and reinforcement through regular telephone contact. By linking with telehealth or telecare monitors, the clinician can receive accurate feedback and monitor progress alongside the patient."

Do you think it's acceptable for doctors to lie under special circumstances ?

Medicine is a complex art and there are lots of grey zone areas.

When is it allright for a doctor to lie ? Is it safe to allow the doctor to decide ? Even if it's much easier to just insist that the doctor tell the truth all the time, regardless of the circumstances, is such an "all-or-none" approach the right one for all patients at all time ? Isn't this taking a legalistic approach and oversimplifying a complex problem ? Shouldn't doctors be allowed to be flexible and can't they be trusted to use their own judgment when making these decisions ? Or has society become so distrustful of the medical profession that this would be considered anathema, and that we should insist that doctors should tell the truth every time, even if it harms their patient ?

I'd like to hear from you !

Fill in the survey at
http://malpani.questionform.com/edit/Should-doctors-ever-lie

Should doctors lie ?

The simple answer would be No, but few things in life are as simple as they appear to be, and I think a more thoughtful reply would be - Yes, sometimes.

In fact, the distinguishing mark of a senior doctor is that he knows how to lie - and when to do so. This is not something which can be taught or written down, which is why it is a sixth sense which is acquired by experience. I am sure all senior doctors will agree that they have lied for their patients' good during their career - and anyone who does not agree with this is telling a much bigger lie.

Is it ethical to lie ? This is a hard call. It's much easier to just tell the truth all the time - but there are times when hiding the truth and lying is in the patient's best interests. Good doctors know this - and will use a lie as a valuable therapeutic tool, when they feel that the truth would harm their patients.

Am I suggesting that we return to the "good old days" when the "doctor knew best" and cancer was a word which was never discussed openly. Of course not ! I am a big believer in patient autonomy and the patient's right to know . However, in clinical practise, there are situations when the patient does not want to know the truth ; and times when the truth can actually be harmful. Some patients what their doctor to shield them from the truth, and good doctors can sense this . They know when to hide the truth; and from whom.

This is not an easy skill to acquire, and requires reflective contemplation and practise. It's a privilege which can easily be abused by a bad doctor, but a good doctor can use a lie ethically , if he does so in order to help his patients .

CNN - Study says doctors will lie to get best patient care

CNN - Study says doctors will lie to get best patient care : "Would doctors, frustrated by managed health-care programs with strict coverage limits, lie to deliver the best-quality care for patients? A new study indicates many would. 'When it comes down to something like a nose job or a rhinoplasty, only 3 percent said they would do it. But for very significant things like whether or not they thought a bypass was indicated, and it was being withheld, over 50 percent were willing to endorse fudging the data,' said Dr. Daniel Sulmasy, one of the study's researchers. According to the report, published in this week's Archives of Internal Medicine, many also would lie to obtain what they consider important diagnostic tests -- like mammographies for patients who need them. "We asked whether the physician would be willing to write on the sheet 'suspicious breast lump,' and more than a third of physicians were willing to do that," said Sulmasy, who works in the Department of Ethics at St. Vincents Hospital and Medical Center in New York.

Why don't hospitals invest in patient education libraries ?

" Although apparently it may seem antagonistic to profit making for hospitals, the model of putting health education units in hospitals actually makes great business sense where hospitals can make real good money by properly distributing materials, tailored patient care settings, and educating patients. A prominent example of the success of your type of business model is Nicotrol CQ the nicotine substitution with controlled quitting for smokers. It took the pharmaceutical companies years to realize the worth of patient education, but once they got the hang of it, it changed the way medicines were brought to people. Think of insulin and Novartis campaigns to educate patients.

Unfortunately, you cannot change the "perceptions" of hospital administrators, but you can hope to change practices. Medicine is information science, and those in the medical profession who take it as business than a profession, play the following game, that's characteristic of any business transaction --

a) you should have an information advantage over your client (or patient), and

b) you should scare your client/patient/patient-party and then you let them decide what's best for them.

QED, system-wise, in areas and times when the practice is slow, the number and frequency of surgeries/cesarian sections/expensive intervention goes up. Hospital administrators too take advantage of this asymmetry of information and therefore create imposing structures in the names of hospitals, as if hospitals are factories where the "sick" are made better.

Your concept is aimed at tipping the scale at the other end, empowering the patient. If I were you, I'd not bother messing with the hospital administrators, they are not our audience. I'd focus on the patient (or people at risk) and then go for tailoring messages to the segment of population that matter. Information presentation is the crucial key here. In presenting the information, revert the two points we alluded to above:

c) the patient should now have an information advantage (one, he or she already has, his or her personal physical problem, that he or she knows better than the doctor to start with. The physician, on the other hand, is an expert with the technical knowledge as to what works). Educate the patient so well that she knows what's the problem and the physician then will be able to fine tune the diagnosis and the treatment process. That means creating evidence based literature and translating that in the language of a class Eight pass idiot. Can we the doctors, do it? With similes, stories, comparisons, parables, comics, graphic novels, games, etc?

d) Information, if properly tailored, should minimize irrational fear in the mind of the patient.

Some of the best doctors with whom I got trained, without exception, I found all these "best"/great doctors were extremely polite and teacherlike with their patients, even in their most busy schedules. It's purely my personal opinion and therefore it's of little worth, but I must share this with you -- I found that the technically most incompetent doctors also tend to be very rough and ruthless with their patients. Sorry for this long post, and I will sign off with these two aphorisms by Don Berwick

e) from the perspective of patients, the aphorism is -- "Nothing about me without me": in other words, patients should be clearly explained why some diagnostic procedures or treatments were offered
f) from the perspective of the doctors -- "Every patient is the only patient" -- self explanatory. "

Dr. Arin Basu MD MPH
Allan Smith's Research Group
1950 Addison Street
Berkeley, CA 94704
United States

Why patient education libraries are important

" Traditionally future health professionals were very often simply expected
to learn and memorize the structure of their chosen field of medicine and
then apply it for patient care.

However a complete top down approach delivered on the basis of human
memory in present day health care is increasingly unable to support health
care practice as the volume of information keeps growing by leaps and
bounds.

"Half of what you are taught as medical students will in ten years have
been shown to be wrong. And the trouble is, none of your teachers know
which half"
Sydney Burwell, Dean, Harvard Medical School 1956

One response of the present health care structure to this problem has been
an ant like division of labor where health care workers specialize in
certain areas so that they can focus on a smaller volume/area of
accumulated information and thus offer their expertise in their chosen
areas.

There is an old adage often used to qualify this approach as, "Knowing
more and more about less and less until one has known everything about
nothing".

Interestingly there isn't much historical evidence to suggest that this
approach is doing wonders to present day health care. (Loefler 2000) On
the contrary present day patient satisfaction with health care seems to be
at an all time low. (Kenagy 2002)

One of the important present day problems with this approach is that from
the patient perspective finding the health professional with the
appropriate expertise to tackle their particular individual problem
becomes like looking for a needle in a haystack.

This is where the library model and the medical information scientist
adding informational services to patients comes in with a ray of hope."

Loefler IJ, (2000) Are generalists still needed in a specialized world?
The renaissance of general surgery. BMJ. 2000 Feb 12; 320(7232): 436-40.
Review

Kenagy J W, Christensen C M, (2002) Disruptive Innovation - New Diagnosis
and Treatment for the Systemic Maladies of Healthcare, Business briefing:
global health care

Dr Rakesh Biswas. Malaysia

Teaching patients using pictures

Why don't more doctors use pictures to teach patients ?

" There are several reasons why these strategies are not used more often.
The most commonly cited reason is the time it takes to help someone truly
understand something; time is money in the modern world and reimbursement
for healthcare education is not reimbursed well if at all in most
healthcare scenarios. Perhaps an even more common but unacknowledged
reason is that most clinicians have little if any training in teaching and
LEARNING. If the clinician knows nothing about learning, s/he cannot
possibly appreciate the value of pictures in medical/health education.
Both of these root causes are remediable---but only with the development
of the political will to make it happen."

Dr Howard J Zeitz, MD
Co-Chair, Rockford Regional Partnership for Health Literacy (RRPHL)

Google says working to solve health record dilemma - washingtonpost.com

Google says working to solve health record dilemma: "Google started out two years ago on a service called Google Co-op. This taps various expert organizations to categorize high-quality health and other information, to make it easier to search and find on the Web, Mayer said. She said the scale of health-related information is huge, with an estimated 2 billion X-rays alone created every year. The Silicon Valley company also is looking at creating a special layer of doctor and medical-related locations on its online Google Maps service. This could help people find local doctors, understand their specialties or related practitioners. Mayer said personal health records might be stored on a keychain-sized digital storage dongle and protected by passwords. This would allow a consumer to travel around the world and supply their medical records to local doctors in a secure fashion."

Video for patient education

Video for patient education: "'The importance of supporting patient-physician communication cannot be overstated,' said Ron Davis, MD, President of the American Medical Association. 'Providing doctors with technology like the video-enabled iHealth Web services can help improve patient care and encourage patients to take a more active role in their health care.' Offering strong support for a video-enabled physician Web sites, a recent Harris Interactive poll found that 80% of US adults are now online and nearly three-quarters (71%) of adults have used the Internet to research health information, while another Harris poll found that YouTube videos are utilized by 42% of Americans. 'By incorporating video into practice Web sites, we have created a dynamic new way for physicians to connect with their patients, strengthen the physician-patient relationship and grow their practices,' said Edward Fotsch, M.D., CEO of Medem Inc., which provides the iHealth service. 'Given the power of this technology to engage consumers we anticipate seeing video used for a wide range of patient education, disease management and wellness programs delivered to patients by physicians, health plans and other organizations to better connect with patients.'"

The teach-back technique

The teach-back technique Do not ask a patient, “Do you understand?”
• Instead, ask patients to explain or demonstrate how they will undertake a recommended
treatment or intervention.
• If the patient does not explain correctly, assume that you have not provided adequate teaching. Reteach the information using alternate approaches.

In using the teach-back technique, clinicians take responsibility for adequate teaching. If patients cannot explain or demonstrate what they should do, clinicians must assume that they did not provide patients with an adequate explanation or understandable instructions. The result should be new efforts to ensure that patients learn what they need to know. And, of course, it is important not to appear rushed, annoyed, or bored during these efforts—your affect must agree with your words.

Pictures for patient education - why they work

Pictures for patient education - why they work Show or draw pictures to enhance patients’ understanding and recall The saying that “a picture is worth a thousand words” is particularly true when communicating with patients who may have trouble understanding medical concepts delivered in words. It has long been known that visual images are remembered better than letters and words. That is why we often recall a person’s face but not their name, or the picture on a book’s cover, but not the name or author of the book. Research shows that pictures enhance patients’
understanding of what they need to do. Pictures are not substitutes, however, for written or verbal communication, as understanding is best when pictures are combined with written or verbal
explanations. Furthermore, the most effective pictures are simple.

Health Literacy Innovations - Products

Health Literacy Innovations - Products: "To help simplify health information before it gets to the consumer, Health Literacy Innovations introduces the Health Literacy Advisor, the nation's first software tool to help make health information health literate. As a 'health literacy checker,' the Health Literacy Advisor streamlines the health literacy review process using electronic readability indices, including the Fry-based formula, and taps into a glossary of more than 9,000 interchangeable terms. The program, which is add-on to Microsoft Word, operates like a spell-checker and scans a document for its readability and its health literacy. If it finds words or terms that reduce health literacy, it will highlight those words and offer an alternative."

Clever Networks Transforms Chronic Disease Management

Clever Networks Transforms Chronic Disease Management: "Precedence Health Care's Chronic Disease Management Network, CDM-Net: ABroadband Health Network for Transforming Chronic Disease Management, will use broadband to transform the management of chronic disease thanks to $2 million in funding by the Australian Government. CDM-Net will create a network of health services for monitoring and supporting care management. 'Chronic illness requires close monitoring and ongoing management across an entire team of care professionals,' Senator Coonan said. 'People suffering from chronic disease need to be provided with a care plan, detailing medications, treatments, tests, and referrals tailored to their specific circumstances, and CDM-Net will facilitate that. CDM-Net will use secure broadband services to connect healthcare providers to one another and to their patients. It will assist healthcare providers create and track care plans for their chronically ill patients and support patients in their adherence to care plans through electronic reminders and alerts. 'The network will improve care coordination by sharing information on patient care across the entire care team,' Senator Coonan said."

IBM urges healthcare institutions to embrace 'Patient-Centric Healthcare' |

IBM urges healthcare institutions to embrace 'Patient-Centric Healthcare' : "'Putting the patient at the center of the healthcare ecosystem is really the key to continuing improvement in levels of care,' said Matej Adam, Healthcare Industry Leader, IBM Central and Eastern Europe. 'Healthcare institutions are coming under increasing pressure worldwide to drive both levels of care upwards and costs downwards: a challenge that requires fundamental changes across many parts of the healthcare system. The patient-centric healthcare model puts the patient in charge of his or her well-being by defining treatment and operational policies that center around the individual. IBM technology now makes this approach practical and allows institutions to realize business efficiencies as well as improving levels of patient care.'"

Why is consumer-driven healthcare important to employers?

"By teaching our employees how to navigate the medical system, use preventive measures, and comply with treatment regimens, employers will see an immediate increase in productivity and competitiveness. Years of quality living and money beyond imagination will be added to the balance sheets." Fred Williams, Director of Benefits and Strategic Alliances, Quest Diagnostics, Inc.

And yet, inspite of knowing this, most corporates do so little to promote their employee's health and wellness ! Sadly, the only contribution most Indian companies ( even the most enlightened ones !) provide towards their employee's health is to pay their employee's health insurance premium under a group health insurance plan !

Affordable Health Care for All Americans: A Matter of Literacy?

Affordable Health Care for All Americans: A Matter of Literacy? : "Some medical experts are now asserting that the failure to provide or support a public policy educating Americans into a more than Basic health literacy level is bringing about needlessly high costs in terms of individual health, healthcare spending, and the economic well-being of the nation as a whole. 'Our findings suggest that low health literacy exacts enormous costs on both the health system and society, and that current expenditures could be far better directed through a commitment to improving health literacy,' said John A. Vernon, PhD, Department of Finance, University of Connecticut, and lead author of the new report."

This would be even more relevant to India !

Entrepreneurial Programming and Research On Mobiles

Entrepreneurial Programming and Research On Mobiles: "EPROM, part of the Program for Developmental Entrepreneurship within the MIT Design Laboratory, aims to foster mobile phone-related research and entrepreneurship. Key activities include: * the development of new applications for mobile phone users worldwide * academic research using mobile phones * the creation of a widely applicable mobile phone programming curriculum Today’s mobile phones are designed to meet Western needs. Subscribers in developing countries, however, now represent the majority of mobile phone users worldwide. We believe the adoption of new technologies and services within this vast, emerging market will drive innovation and help shape the future of the mobile phone."

We hope to be able to use the mobile to deliver memorable patient educational graphics to help patients better manage their illness !

BestMed Journeys

BestMed Journeys: "Medical travel is different for everyone. Some people seek the lowest cost for everything, while others desire a 'sky is the limit' approach. Most medical travelers are somewhere in the middle. Fortunately, as a medical traveler, you have many options which means much of your budget will depend on your personal preferences (i.e. Must you stay in a 5-star hotel, a 4-star hotel, or do you prefer more economical lodging? Will you hire a private nurse for a few hours a day, 24-7, or will having one on call suffice? Do you want privately catered meals, or do you plan to eat whatever the hotel/local restaurants serve, even if it's not quite the bland food your doctors will recommend following surgery?) When planning your budget, don't forget to include the costs of your companion. Many of your expenses can be shared (lodging before and after treatment, taxis), but others will be separate (airfare, laundry, meals). In either case, once you've selected your companion, the two of you should agree what companion related expenses you're paying for, if not all."

Very useful check list for medical travellers !

BestMed Journeys

BestMed Journeys: "What particularly impressed me in India, however, was the superior level of care and hospitality which existed in many hospitals and clinics throughout the country. The reason medical travelers would come to India became clear. In India, medical travelers: 1) spend significantly less money for their medical care 2) have greater access to doctors (no waiting for hours on end in doctors’ waiting rooms) and a greater ability to speak directly with doctors (Indian doctors willingly spend time with their patients) 3) could have certain procedures not readily available in the U.S. and/or 4) have the option to convalesce in a remote, relaxing and comfortable environment – all of this while expanding one’s horizons and experiencing India’s intriguing culture. But the hospitals needed a company to give western patients the comforts they’re used to and lead them through the challenges that going abroad entails."

Here's a great idea which provides US citizens with the best of both worlds !

Using google calendar for IVF treatment cycles

Google calendar can be a very useful tool for IVF patients. You can have a look at the google calendar I setup for normal IVF patient in our clinic. It's very easy to modify and adapt this for your own use !

The Wellness Community: Patient Active Concept

The Wellness Community: Patient Active Concept: "The following statement reflects a core part of the Patient Active Concept and a firm belief by those associated with The Wellness Community: 'Combining the will of the patient with the skill of the physician - a powerful combination in the fight against the common enemy - cancer!' --Harold Benjamin, PhD, Founder of The Wellness Community"

Linking thinking - Self-directed learning in the digital age

Linking thinking - Self-directed learning in the digital age: The 6 prerequisites for online learning.
" - Connectivity: An essential precondition for online engagement;
– Competence: Developing a range of vital skills;
– Content: Ensuring affordable access to quality digital resources;
- Credibility and confidentiality: The basis of trust in the unseen;
– Capturing information: Locating needed information in the boundless domain of Cyberspace;
and
– Collaboration: Realising the transformative potential of technologies."

We need to apply these for patient education !

eHR Blueprint- Building Consensus For Common Action.

eHR Blueprint- Building Consensus For Common Action.“ This is a guide to “enhancing health and healthcare improvement strategies through the use of health IT and health information exchange.” Key focus areas of the Blueprint are as follows:
Engaging consumers•
Transforming care delivery•
Improving population health•
Aligning financial and other incentives•
Managing privacy, security, and confidentiality•

Make your own cartoons online - a great tool for patient education

I have always been fascinated by how effectively graphic designers can use pictures to communicate effectively. Unfortunately, I am graphically challenged, but am always willing to learn ! I found this great website, www.toondoo.com which allows people like me to make their own cartoons online - and publish them stat ! What a clever tool to help doctors to educate
patients !

Get well fast: Store clinics both a symptom, solution | Chron.com - Houston Chronicle

Get well fast: Store clinics both a symptom, solution | Chron.com - Houston Chronicle: "The clinics' most lasting impact, ironically, could be the change they are forcing on mainstream medicine. Cheap and accessible, they do a public service by diverting patients with minor problems — a rash, a prescription needing a refill — from overburdened emergency rooms. Pressured by the competition, some doctors are also starting to keep offices open later, and reserving appointment times each day for walk-ins. The clinics also use electronic medical records, a thrifty and responsible system that lets health care providers easily share patient data. Doctors have balked at this upgrade for years. Now the market may goad them into it. The quick-clinic model is flourishing for one legitimate reason: Its prices and availability serve a yawning need. Rather than fighting it, physicians and policymakers should ensure these clinics are reliable contributors to our health system. And they should take a hint from the clinics' brilliant responsiveness to patient needs."

Action Plans for Health Literacy - IHA Institute for Healthcare Advancement

Action Plans for Health Literacy - IHA Institute for Healthcare Advancement: "Action plans also teach problem-solving skills,' she said. 'What we should be doing is spending time to help patients enact behavior changes,' said Dr. Seligman. 'Patient-generated behavior changes are best.'

The action plan has three critical components.
It has to be:
· patient generated (self-managed),
· easily achievable (increases confidence), and
· highly specific (what, how much, when, how often).

A study assessing clinician satisfaction with action plans showed clinicians rated 75% of the talks with patients more satisfying or equally satisfying than previous talks. The majority of clinicians - over 80% - said they would continue having discussions about action plans with their patients even after the study concluded. Many of the clinicians in the study also agreed that primary care clinicians should be trained in using action plans. Dr. Seligman noted that action plans have a very high success rate overall - 83% of patients will complete them. Three weeks after starting an action plan, 79% recall making the plan, while more than half recalled the details and made behavior changes consistent with that plan."

Partitioned Process of Patient Communication

Partitioned Process of Patient Communication : "Some weeks ago, one of the problems under discussion was the short time doctors often have to communicate with patients during their visits to the clinic. Also under discussion was the communication skill of health care professionals, especially in relation to patients with limited literacy skills. We would like to share with you the way that one clinic addresses these problems. This large free clinic recognizes the communication - time problem, and has partitioned the process of patient communication. The examining doctor provides the patient with the most critical information and explains its importance to the patient. The patient returns to the waiting room and then is called for additional discussions with a health care coordinator who has the patient's medical record with the latest comments from the doctor. Communication methods involve teach-back, demos and 'what if' questions. The partitioning seems to be satisfying to patients, but the process does take longer. I do not know of data that compares patient comprehension and compliance for this two step process with the one step 'doctor only' instruction.
Partitioning makes sense because the high value doctor's time doesn't need to be used for much of the communication content and feedback. Sure, it would be nice to have the docs do it all, but not in today's economic environment. Some entrepreneur could provide this service so that any clinic could do the partitioning even if they don't have a coordinator to take up the communication tasks delegated by the doc. This work can be out-sourced to teams of skilled, but lower cost health practitioners; here or abroad. (When I call up for computer tech support, I usually wind up talking to someone in India.)"

The Guide to Community Preventive Services

The Guide to Community Preventive Services : "The Guide to Community Preventive Services (Community Guide) serves as a filter for scientific literature on specific health problems that can be large, inconsistent, uneven in quality, and even inaccessible. The Community Guide summarizes what is known about the effectiveness, economic efficiency, and feasibility of interventions to promote community health and prevent disease. The Task Force on Community Preventive Services makes recommendations for the use of various interventions based on the evidence gathered in the rigorous and systematic scientific reviews of published studies conducted by the review teams of the Community Guide. The findings from the reviews are published in peer-reviewed journals and also made available on this Internet website."

PHR: Critical Challenges for the Federal Government

PHR: Critical Challenges for the Federal Government: "What is the government's vision for empowering consumers, and how will it be translated into policies and programs? * Empowering consumers for health self-management The personal health record is just part of a much broader trend in policy, technology and health care toward greater attention to and responsibility by the consumer. While PHRs may be an instrument to achieve many governmental goals—quality improvement, cost savings and system reform, to name a few—above all our interviewees stress their importance for helping people manage their health. PHRs are envisioned as the gateway and organizing application for all of consumers' personal health management activities. Importantly, these activities transcend the medical model and the relationships between the consumer and the health care system. They also encompass consumers' decisions and record-keeping about health behaviors, prevention activities, chronic disease, health-related administrative and financial matters and more, for themselves and their families. Most observers believe that the personal health record cannot be detached from these broader personal health management functions. "

Expanding the Reach and Impact of Consumer e-Health Tools - Executive Summary

Expanding the Reach and Impact of Consumer e-Health Tools - Executive Summary: "e-Health tools offer consumers a broad range of integrated, interactive functions including those listed below. Most tools support several of these functions, generally structured around a primary purpose such as disease management.
* Health information—either a spectrum of searchable information or more narrowly defined content
* Behavior change/prevention—support for a specific behavior change such as smoking cessation
* Health self-management—tools for achieving and maintaining healthy behavior in lifestyle areas such as diet and exercise
* Online communities—Internet-based communities for interaction among consumers, patients, or informal caregivers about shared health concerns
*Decision support—structured support for making treatment decis
ions, choosing and evaluating insurance programs or healthcare providers, or managing healthcare benefits
* Disease management—monitoring, recordkeeping, and communication devices for managing a chronic disease, usually in conjunction with healthcare providers
* Healthcare tools—means of maintaining or accessing health records and interacting with healthcare providers."

Health Literacy Studies

Health Literacy Studies: "Teaching Patients with Low Literacy Skills can be read and downloaded here. The book is now considered a classic text in health literacy. The authors, Ceci and Len Doak, are often introduced at health literacy conferences as 'the grandparents' of health literacy. Indeed, their contribution to the field and to our understanding of clear communication principles has been profound. The book's popularity has grown amongst health educators, health communication specialists, and health care providers. The text provides insight for all of us concerned with improving health communication."

About Patient Visit Redesign

About Patient Visit Redesign: "There's a lot for patients to dislike about going to see the doctor these days. It often begins with the frustration of an impersonal, incomprehensible auto-attended phone system and being put on hold when the patient finally reaches a real person. Then there's the interminable waiting—for a convenient and timely appointment, for registering after arriving for the appointment, as well as the big wait before seeing the clinician (finally!). All for fifteen minutes of face time with the doctor, on average, who is trying hard to listen but is frequently interrupted by other staff and distracted knowing that other patients are waiting to be seen. But it doesn't have to be this way. It's not just patients who are frustrated. Clinicians are frustrated by processes and systems that stymie their quest for quality patient care. Clinic staff members are numbed by all the rules, policies, procedures, forms, papers, and hierarchy that stifle creativity and individual effectiveness. Patient Visit Redesign is about work process design and teamwork. It is focused on the end-user of your services—the patient—though the benefits of redesign are reaped by the staff and the organization as well. The goal of redesign is to virtually eliminate patient waiting. "

Using pictures to improve health communication.

Using pictures to improve health communication. Communication between health professionals and patients is inherently problematic. Professionals want to communicate clearly, but tend to use technical terminology because it is precise, because it is familiar, and often because there are no exactly equivalent non-technical words available. Furthermore, they often try to communicate more information than patients can process. Patients, even those with well developed language skills, find it difficult to process medical information because they are unfamiliar with medical terminology, because they are preoccupied with their symptoms, and because they are upset which makes concentration difficult. While people at all literacy levels have problems understanding and using health information, people with limited literacy skills are especially in need of help. They need help in understanding written information and, because they place more reliance on spoken explanations, they need help in remembering what they hear.

This paper discusses how combining pictures with spoken or written text affects health communication. Four aspects of health communication will be discussed: (1) drawing attention to the materials or message, (2) helping people comprehend the information being presented, (3) increasing recall of the message, and (4) increasing the likelihood that people will act in accordance with the message (adherence).

Playing Digital Storytelling in Public Health | storybuilders

Playing Digital Storytelling in Public Health | storybuilders: "Public Health professionals have put digital stories to work, using them to improve provider knowledge and to help communities talk about health care issues. As part of a grant to investigate maternal depression among the Cambodian population in Lowell, MA, for example, Storybuilders has worked with graduate students from the Boston University School of Public Health to gather stories from Lowell community members about the causes of their depression and their strategies for negotiating this depression. Stories like Courtney's can teach health care providers about the culturally-complex causes of depression. These stories are also valuable as outreach tools, and have been used to get groups of women in the Lowell community talking about depression, which is a hidden and seldom-discussed topic."

This is such a great idea ! Patients can use the cameras on their mobiles to tell their own digital stories ! I am sure many of these would be eye-openers for doctors !

Health Insurance will change the Indian healthcare industry !

I recently attended the Health Insurance Summit 2007 organised by the CII ( Confederation of Indian Industry) in Bombay. This was the first conference on health insurance in India , and was quite an eye-opener ! It was sponsored by Swiss Re, and there were over 300 people in attendance. Such a good turnout means this is a “ hot area” which is attracting lots of interest.

The first thing which struck me was that not a single doctor was invited to give a lecture ! There were lots of MDs giving presentations, but most of these were doctors who were now working as managers in corporate hospitals. Doctors have become marginalized and are now inconsequential in the big-picture as far as the healthcare industry goes. I think this is true worldwide – and is becoming increasingly so in India. This is sad , because medicine is a service industry, and its foundation is the doctor-patient relationship. However , not only are patients not invited to participate, neither are doctors ! Policy decisions are made at “high levels” – and the doctor’s job today is just to implement them. It’s not surprising that so many doctors are burnt out and no longer want to practice medicine . Being a manager for a healthcare company or a HMO CEO is much more lucrative – and far easier ! Doctors are to blame for this state of affairs – we have abdicated our responsibility and have marginalized ourselves.

There were lots of very interesting presentations. Everyone wants to get into the business , because they see a huge money-making opportunity. Health insurance in India has now been opened upto the private sector; and it has been de-tariffed, allowing private companies to be innovative and design and sell clever new health insurance plans. What was formerly a loss-making business is now seen to be the “next big thing” in this field with the potential for health insurance being even bigger than life insurance ! When you count the huge number of Indians who earn a decent income because India is “shining” and income levels are rising; that healthcare insurance penetration at present is only 3-4 %; and that healthcare costs are going up rapidly, it’s simple mathematics to conclude that this is a huge billion dollar market waiting to be tapped ! The premia collected on health insurance policies has increased five-fold from Rs 675 crores in 2001 to Rs 3200 crores in 2006 – and this is just the beginning !

Health insurance will change the way healthcare is financed and delivered . Will this change be for the worse ? or the better ? Most probably, a bit of both, depending upon who you are and where you live ! It will help to provide 5 star care for rich Indians and enable corporate hospitals to attract patients from all over the world. What will happen to the poor in the villages ? Will they remain neglected ? Should medical care be determined by market forces ? or should it be a public service which the government provides ? This is a vexed issue . Even doctors are ambivalent about this, so it’s hardly surprising policy makers are confused too. Talking about 5-star care which exceed global standards and “ healthcare for all “ in the same breath makes both speaker and listener schizophrenic !

Yes, these are mind-boggling challenges , but what struck me was the huge amount of optimism and confidence that these can be met. Today, these are seen as opportunities – not as
problems ? Indians in 2007 have a “can-do” approach and are willing to take on the world. Being able to provide telecom services to practically every villager has been an inspiring ( and extremely profitable !) success story and many entrepreneurs are willing to duplicate this in other sectors which are equally lucrative.

I found it very interesting that the conference was sponsored by Swiss Re , one of the world’s largest reinsurance companies. Most doctors are blissfully unaware of the insurance business and cannot imaging the financial clout which reinsurance companies wield. Even though Swiss Re does not provide health insurance directly itself, it has a huge role to play in underwriting and enabling health insurance companies, which means that it is acting as a catalyst to shake up the entire sector !

The fact that health insurance will change the way healthcare is financed is a given. What I find even more intriguing is the possibility that it may change the doctor-patient relationship for the better as well. Health insurance companies have deep pockets – and they have a major incentive to want to educate patients. Not only does this provide them with a great return on investment ( by reducing unnecessary surgery and the claims ratio), it’s very useful as a marketing tool as well, since it’s a service patients value and want. Educated patients behave as consumers and ask questions and choose for themselves – they do not blindly follow doctor’s orders !

Which way are we headed ? Will we learn from the mistakes the US has made ? Or will we find ourselves in the same mess, because we are a capitalistic society too ? Will we move to “managed care” and HMOs because it’s much easier for MBAs to manage these – or will we have the creativity to craft our own path ?

Now you know why companies don't invest in the health of their employees !

PureWellness : The #1 online Wellness Plan for Fitness, Nutrition and Diet.

PureWellness : The #1 online Wellness Plan for Fitness, Nutrition and Diet.: "The demand for wellness services are growing by over 80% per year, on account of the ever increasing costs of health care. You can help your employer organizations and expand your service options quickly and easily with the PureWellness eWellness platform. We boast the highest ROI in the industry on account of our internet based delivery and scalable platform. The PureWellness eWellness platform is optimized to quickly and easily deploy for your member companies. Commencing with our online statistical HRA, PureWellness doesn't just assess the health of your insured population, but also provides the tools to help mitigating health problems and prevent them from entering into a disease state. We want to catch them before them become a disease management case. How our Application Benefits Benefit Administrators, EAP providers, TPA's PureWellness provides custom tailored online programs to help employees live fitter and healthier lives. From creating better employee moral, and increasing productivity, to reducing turnover and sick days, our approach to wellness benefits all participants. The biggest reason to partner with us isn't just to benefit your employees though, but the ultimate goal of getting a handle on and reducing escalating health insurance costs."

PureWellness : The #1 online Wellness Plan for Fitness, Nutrition and Diet.

PureWellness : The #1 online Wellness Plan for Fitness, Nutrition and Diet.: "The PureWellness eWellness Platform is a full service online solution focused on proactive behavioral health change for any given population. Created by our own staff wellness experts and approved by medical practitioners, dietitians, and personal trainers, our solution combines robust web based tools such as an individual HRA, baseline health assessments, diet analysis, fitness planning, and on-line expert advice, to help anyone move toward a more fully health based lifestyle. Our proven system works for many reasons, not just because of its convenience, and support network, but because of our proprietary assessment, planning, tracking and motivational tools for our end users and site administrators."

Microsoft Unveils Consumer Health Vision, Launches Technology Platform to Collect, Store and Share Health Information: Company and industry leaders ra

Microsoft Unveils Consumer Health Vision, Launches Technology Platform to Collect, Store and Share Health Information: : "Joined by nationally recognized medical providers, health-management device manufacturers and patient advocacy organizations, Microsoft Corp. today launched Microsoft® HealthVault, a software and services platform aimed at helping people better manage their health information. The company outlined its vision for ways that HealthVault can bring the health and technology industries together to create new applications, services and connected devices that help people manage and monitor their personal health information, including weight loss and disease management, such as for diabetes. “People are concerned to find themselves at the center of the healthcare ecosystem today because they must navigate a complex web of disconnected interactions between providers, hospitals, insurance companies and even government agencies,” said Peter Neupert, corporate vice president of the Health Solutions Group at Microsoft. “Our focus is simple: to empower people to lead healthy lives. The launch of HealthVault makes it possible for people to collect their private health information on their terms and for companies across the health industry to deliver compatible tools and services built on the HealthVault platform.”"

Microsoft HealthVault : Applications

Microsoft HealthVault : Applications: "Online Health Management . Be well. Protected. With HealthVault, all of your health information is in one place that you control. Created in cooperation with leading privacy advocates, respected security experts, and dozens of the world's leading healthcare organizations, HealthVault was built on the principle that you should control your own health records."

Google Health Advertising Blog

Google Health Advertising Blog: "What did we find? Online research brings consumers into the health system and effects change. We found that after gathering health information online, consumers take action! * Some 40 percent of consumers interact with their doctors after looking for information online * 78 percent take action within a month's time because of what they found online. * 31 percent of consumers notice health ads online while searching for information on a health question. These findings underscore the importance of the Internet as a marketing channel."

Making Health Communication Programs Work - National Cancer Institute

Making Health Communication Programs Work - National Cancer Institute: "This book is a revision of the original Making Health Communication Programs Work, first printed in 1989, which the Office of Cancer Communications (OCC, now the Office of Communications) of the National Cancer Institute (NCI) developed to guide communication program planning. During the 25 years that NCI has been involved in health communication, ongoing evaluation of our communication programs has affirmed the value of using specific communication strategies to promote health and prevent disease. Research and practice continue to expand our understanding of the principles, theories, and techniques that provide a sound foundation for successful health communication programs. The purpose of this revision is to update communication planning guidelines to account for the advances in knowledge and technology that have occurred during the past decade.

Collaborating to enhance patient education and recovery

Collaborating to enhance patient education and recovery: "The paper describes a collaborative project between librarians and health care staff to enhance patient recovery by distributing educational videos and evaluating the acceptability of this “information intervention.”

Background: On inpatient units, nurses experience decreased time to teach patients. Text handouts do not include multimedia information, and reading levels may limit comprehension. Because the postoperative period is not the optimal time for patient instruction, another format and opportunity for postsurgical instruction was needed.

Methods: Nurses, therapists, educators, and librarians partnered to select a video designed for home viewing by discharged patients. It was added to the existing text-based educational program for coronary patients. An evaluation component was incorporated into this collaboration.

Results: The library's role extended to all aspects of the program's implementation and management. The library's circulation system was used to coordinate borrowing with minimal loss. Ongoing preparation of the video materials for distribution and return remained a library function, and the evaluation component showed patients' positive reception of the video.

Discussion: Patients received a greater amount of information to enhance self-care during the recovery period without consuming more nursing time. Video circulation and reuse enhanced cost effectiveness of the program, and patients benefited from the library's resources.

NEJM -- 2015 -- The Future of Medical Libraries

NEJM -- 2015 -- The Future of Medical Libraries: "Despite ubiquitous access to electronic information, however, the 'library as place' is still highly valued and heavily used (unless the facility is physically decrepit, outmoded, or inconveniently located). Users flock to library buildings and spaces that are attractive, centrally located, technologically current, and arranged to meet the needs of groups as well as of solitary users.1 In addition to serving coffee, the best facilities support small-group study and larger-group training, provide well-wired space for interdisciplinary collaboration involving complex electronic data sets, and welcome those seeking temporary work space, individual assistance, or quiet places away from wards or waiting rooms. With no printed Index Medicus and fewer physical volumes, there is more space for people. Our future library's 'virtual' collection — the set of electronic information it makes available — is much vaster than the physical collection owned and housed in library space. By 2015, many publications are issued only in electronic form, thousands of back runs of journals have now been digitized, and electronic copies of books, manuscripts, and images abound. Many libraries store and manage access to electronic scientific and health-related data. The flood of patient-specific data generated by large-scale"

Consumer Reports Medical Guide - How to make the best decisions about treatment

Consumer Reports Medical Guide - How to make the best decisions about treatment: "Every treatment has trade-offs. The best treatment for you may be different from the best treatment for your friend or neighbor. We all have individual needs, and different things are important to each of us. If you play a part in making decisions about your treatment, you are likely to recover quicker than if you do not.1 It is even more important to take part in making decisions when doctors do not know which treatment is best for you. Doctors should base their treatment decisions on what the research tells them. If your doctor knows what the research says about how to treat a condition and uses this information to make decisions about treatment, then he or she is practicing evidence-based medicine. This is a good way to practice medicine because it means your doctor is using evidence from medical studies that have looked at what happens to many thousands of people. Key points to remember when choosing treatments
* Check out all your choices.
* Make sure you understand the risks and benefits of treatments or of doing nothing.
* Make sure you understand how the risks and benefits will affect you specifically.
* Make sure you have enough information to make a choice."

Consumer Reports Medical Guide - Shared decision-making: Working with your doctor

Consumer Reports Medical Guide - Shared decision-making: Working with your doctor: " Key points about making decisions with your doctor

* Even with the best evidence from research, no one can tell you what treatment is best for you.
* You should feel OK about asking your doctor questions.
* You may find it helpful to take a friend with you when you go to see your doctor or to write down questions before your visit. *
You should ask your doctor what the research says about treatments for your condition.
* You should ask whether researchers studied people like you (for example, were they the same age).
* Sometimes no one knows what the best treatment is for a disease.
* There are a lot of 'don't knows' and uncertainty in medicine.
* You should work with your doctor to figure out which treatment is best for you."

The Health Care Problems Archive

The Health Care Problems Archive: "The health care system in the United States is broken. Proposed fixes abound. But in order to fix the system successfully we must first understand how, why and where it's broken. Imagine you have a sore knee. You go to see an orthopedist. The orthopedist asks you how the injury happened, how severe the pain is, in what way does it hurt (burning, sharp pain, aching etc.). The orthopedist pushes and pulls your knee into positions you never thought possible. The orthopedist may order x-rays and/or an MRI of your knee. Only after all information from these diagnostic steps has been assembled does the doctor fully understand the problem. Only then can he or she make a diagnosis and prescribe a treatment plan. The Health Care Problems Archive is dedicated to gathering information for the same purpose the orthopedic surgeon gathers information: to make possible diagnosis and treatment of a problem. Unlike the doctor, however, The Health Care Problems Archive does not attempt diagnosis or prescription. That's left to the reader. The Health Care Problems Archive does the first part of the surgeon's job. It collects information and assembles it for study. You can participate in two ways. First, you can share your experiences of shortcomings with the current health care system. Your writing will be identified only by your state and your profession. "

This is a great way to create a community to identify what's wrong. Of course, fixing it will be much harder !

Victory! Pro-consumer reforms in drug safety bill

Victory! Pro-consumer reforms in drug safety bill: "Nearly three years to the day Vioxx was removed from the market, Congress has completed a major drug safety reform bill that will give FDA the power to hold pharmaceutical companies accountable for safety problems, and help ensure industry can’t keep drug risks hidden from the public, Consumers Union said. “Congress is about to give the President legislation that should end the secrecy and foot-dragging when it comes to letting consumers know about unsafe medicines,” said Jim Guest, president of Consumers Union, publisher of Consumer Reports. “These reforms have been anxiously awaited by the millions of consumers who take a prescription drug every day and wonder if they know the truth about its side effects.”"

New Services Help Unsnarl Medical Bills

New Services Help Unsnarl Medical Bills: "Two years ago, medical-equipment salesman Stephen Girdley had to take his 2-year-old son, who was experiencing development problems, to roughly four doctor appointments a week. After each visit, Mr. Girdley was inundated with health-care bills and 'explanation of benefit' statements. The confusing mass of paper made it difficult for him to answer questions about his deductible from his insurance company. 'If you get a lot of medical bills, wow, that can be really confusing,' says the Atlanta resident. To get a handle on the paperwork, Mr. Girdley shelled out $25 for MedBillManager, an online tool from health-care services company Change:Healthcare LLC that helps users organize their medical bills. He says the tool helped him to get organized and provided him with a single summary of all his bills, which made talking to his insurance company easier. MedBillManager is one of many online services popping up to help consumers take a more active role in their medical care. Intuit Inc., maker of the Turbo Tax software, offers software called Medical Expense Manager to help consumers deal with their medical expenses, for a cost of $50.

ICE First™ - Product Features and Benefits

ICE First™ - Product Features and Benefits: "A visit to your child’s pediatrician. An emergency for you or a family member. Your parent’s doctor who calls with questions. There are so many instances in life when access to important medical information is crucial. With ICE First™, you’ll have peace of mind because you will know you are prepared for any possibility. ICE First is a web- and mobile phone-based software application that allows you to quickly and easily store and manage emergency medical information and contact numbers right on your mobile phone, with a copy of your data on a secure web database. On most mobile phones, the software is automatically installed using an over-the-air method once you complete your ICE First purchase. What makes ICE First so easy and convenient to use is it that it allows you to input and maintain your information using your computer and transfer it wirelessly to your cell phone.

Here are some more important features and benefits of ICE First:

* Provides a web-based interface that can be accessed from any computer, which allows the user to easily update and sync information with the handset
* Generates automated reminders to subscribers to update their information, and displays a clear message on the phone about how current the information is (for emergency personnel) "

Firm offers mobile disease management platform

Firm offers mobile disease management platform : " San Francisco-based mobile applications developer BeWell Mobile has partnered with Indian technology firm Wipro Technology to offer cellphone-based disease management services. The platform includes a provider interface allowing clinicians and other professional users to set up individual patient applications, and a separate patient interface integrating a diary, reminders and reports. BeWell is currently conducting an asthma management pilot with the San Mateo Medical Center and Clinics and a diabetes management pilot with Kaiser Permanent. As of June, San Mateo had seen no ER visits by teen asthma sufferers, as compared with the norm of 25 visits per 10,000 children."

Report: Smartphone Use among U.S. Physicians Accelerating

Report: Smartphone Use among U.S. Physicians Accelerating : "Smartphones are rapidly emerging as the “black bag” of the new millennium, according to a new report issued by The Diffusion Group. The percentage of active physicians using Internet-enabled smartphones is expected to increase from 49% in 2006 to 70% in 2011, a net growth of 51% during the forecast period. According to Alex Kasten, consulting analyst with TDG and report author, the growth of smartphone use among physicians is strongly correlated with the emergence of compelling applications, solutions often defined and developed by physicians themselves. “There is no doubt the mobile eHealth market is application-driven,” notes Kasten. “While a specific segment of doctors can be characterized as early adopters, most physicians are incredibly pragmatic about incorporating new technologies into their professional lives,” said Kasten. "

Canadian Patient Safety Institute

Canadian Patient Safety Institute: "It’s clear that patients need to be active partners in their care to stay safe in the healthcare system. To help you ensure that the care, advice and treatment you’re receiving is suited to your needs, and that you’re the properly equipped guardian of your own best interests, many organizations have created safety tips Patients need to be active partners in their care to stay safe in our healthcare system. To help them navigate safely, many organizations have created safety tips to assist patients and their families in this journey. As we believe patient safety efforts need to be facilitative and without duplication, we would like to nationally recognize their efforts."