Thursday, July 31, 2008

Special Edition XTRA XTRA!

While I  was gone, my feeds have updated. Lots of interesting news, and opinions.

Let's start with iHealthbeat

150 Billion dollars !! to implement Health IT, says Dr Robert Miller from UC San Francisco

Dr Miller quoted these figures at a recent meeting of The Institute of Medicine

Dr. Miller is a Professor of Economics at UCSF.

Government Health IT  elaborates further on the Feud that is breaking out regarding the ultimate costs of implementing Health IT.

Ladies and Gentlemen.....the ship is sinking, let's not fight over which side of the ship to jump off.


I am going back to my sleep number bed

Another Post with No Title

I need to find another title. One that is catchy and is tagged well so that the search engines rank me up there with The Health Care Blog. How does Matt do it? My ratings have never crashed,, largely because I have never soared into a  gleaming takeover possibility.  I was hoping to become  " a cult blog". Perhaps I need a better research department.  I secretly dream that readers are so enthralled with my writings, and meanderings that they are struck by 'shock and awe' and are dumbfounded into silence. Now and then I find snippets or complete ideas on other blogs several days or weeks after I post the same opinion. Are they reading my blog, and not admitting it?  Is there such a thing as mental telepathy?  I will have my legal department investigate.

Besides I have notice my reimbursement rate has declined much llike my fees for seeing patients. Perhaps a new business model is necessary, such  as:

Besides I started blogging to relax and freely associate with my writings.  Now I have to get up and first thing is read my  'prayer for the day' check the weather forecast to see if it will be 95 or 105 degrees, sunny or more sunny, and read the ozone levels, followed by reading all my relevant blogs.

I am up too early this A.M. The  blog feeds are not in, and this is getting to be too much like med school, and residency. It reminds me of morning rounds at 5:30 am walking around seeing sleeping patients (and nurses), cruising empty hallways.

I am going back to my sleep number bed, I may be back today again.

Quote of the day:
To achieve the impossible dream, try going to sleep. - Joan Klempner

Tuesday, July 29, 2008

A Post with No Title

Quote of the day:
I was born not knowing and have had only a little time to change that here and there. - Richard Feynman


Several comments and studies regarding the National Effort for Health Information Technology.  The Heartland Institute and the Center for Consumer Directed Health Care published an opinion piece regarding how government is failing and will establish a non working and instantly obsolete health IT network.

"Any system that is imposed today will be obsolete in five years," Greg Scandlen, director of the Heartland Institute's Consumers for Health Care Choices, said, adding, "Yet the federal government is woefully incapable of changing or eliminating outdated rules and regulations. So we will be stuck for all time with whatever they come up with today."

The Heartland Institute describes itself as a national not-for-profit research and education group that is unaffiliated with any political party, business or foundation (Monegain

  Many feel the government should perhaps set an interoperability standard, and then butt out.  They and I feel private companies would be better suited in our market to accomplish this task

It remains my opinion from the onset of the furor over EMRs, RHIOs that the best route is to go to those who already know more about networking than anyone else....the telecommunications industry.  The solution is to contract with these entities to set up this network..

Some things are better left to those who specialize in telecommunications.   There have only been a few health entities that have developed regional HIEs that are operating successfully.

Much of the work thus far has been local with "boots on the ground", with voluntary workers. 

boots on the ground

They do this as a "love" effort for health care, knowing this is necessary.  At the end of the day there are few stakeholders.  Yes there are some isolated, disconnected  demonstration projects.

There are also false illusions about making this a patient centric network.  That sounds alluring, and does peak the public interest and involvement.

Let's distill that idea down to the idea of the public setting up and operating there own  ATM network.

Patients do need transparency, should be running the business of your office or your hospital?

If anyone believes the government can or will fund these 'mandates' then I have this bridge I will sell to you for $1.00.

brooklyn bridge


We do need system changes, perhaps EMR and/or RHIOs will play a part.

Monday, July 28, 2008

Health Train Engines

Today's New York Times carries an article by Natasha Singer, "The Price of Beauty".  It points out how this has become the 'Engine for Success" in many dermatology, ophthalmology, and ENT practices. It however failed to point out that this is ocurring in non surgical practices such as family medicine, and yes, even OB/GYN.  Reader's comments range from understanding and commiseration to outright condemnation of these practices.

Cosmetic laser treatments, botox injections, collagen filling procedures, vein removal procedures, ophthalmologic procedures such as laser refractive surgery, premium multifocal intraocular lense cataract procedures offer the opportunity to stay afloat or drown in a sea of rising cost, and reductions in reimbursement.

For most physicians who practice without these cosmetic procedures, it is an easy step into this realm, at first noting that the economic pressure is reduced, then gradually it begins to take over the practice....It is not an admirable occurence, and those who do it cringe at what they have become.

There is no doubt that the 'engine for health care' should and must be caring for those who are ill.  When and if money is removed from the equation is a very doubtful prospect....communism tried it.....and failed.  Would socialized medicine, or universal payor solve the problem? 

Friday, July 25, 2008

Sights, Sounds and ......

Quote of the day:
That which has always been accepted by everyone, everywhere, is almost certain to be false. - Paul Valery

Today I discovered while editing my blog that my list of blog links over to the left sidebar was totally missing. 

I spent part of today re-posting it, and it looks a bit ragged, but I will clean it up later this week. 

You may note I have a new link on the left sidebar

Mike Miller M.D. contacted me via Sermo.  After reading several of his posts I can recomend  him without hesitation for quick and pithy observations that are not verbose and to the point.

Mike, thank you for contacting me.

My brain is tired tonite. It's been a long week.  I have added some video and sound links to the site as well.  Let me know if you experience problems.

Wednesday, July 23, 2008

Toot-Toot on the Health Train Express

embargoed until  July 24,2008
Quote of the day:
My definition of an expert in any field is a person who knows enough about what's really going on to be scared. - P. J. Plauger

The horns are blowing at the health train express hurtles down the track, first leaning to the right, then the left travelling along tracks laid in 1960 or even further back than that.

Who is blowing the horns? Is it the government, health insurance plans, consumer advocacy groups, employers, or some hidden

demonic forces


Here are several relevant news articles in regard to health information technology.

iHealthbeat reports the following:

PHR Networks Better Model Than RHIOs To Exchange Health Data

Speakers at the Third Annual Leadership Summit on the Road to Interoperability in Boston on Tuesday said personal health record networks likely will provide a better model for health data exchange than regional health information organizations, Healthcare IT News reports.
R. Tim McNamar -- founder and CEO of e-certus, a software company, and former member of the Reagan administration -- said PHR platforms offer hope for the exchange of health data sooner than could be achieved through RHIOs. McNamar criticized President Bush for not pushing interoperability. He added, "There's no viable model for RHIOs."
David Kibbe, senior adviser to the American Academy of Family Physicians, said, "We can't expect government to build a network. Government didn't build the Internet. Government didn't build PCs."
Vince Kuraitis, a lawyer and principal of Better Health Technologies, predicted that companies would begin developing applications for PHR platforms such as Google Health, Microsoft's HealthVault and Dossia (Monegain, Healthcare IT News, 7/23

There actually are models for RHIOs, that will work. The technology is there, but the financing is not. I am not at all sure how consumers, or employers or whomever are going to build a PHR  that would work for providers, or hospitals.  PHRs as they now stand do not address the issue of P4P, management of chronic diseases and many other important issues. 

This is a little like asking the consumers to design their own ATM network for banking , or a computer inventory system for their local supermarket.

iHealthbeat goes on:

House Committee Passes Revised Health Care IT Legislation

Today, the House Energy and Commerce Committee approved health IT legislation (HR 6357) aimed at driving widespread adoption of electronic health records, Health IT Strategist Alert reports.
The legislation also is intended to strengthen federal patient security and privacy laws.
The bill would authorize more than $560 million in grants and loans for health care providers (Health IT Strategist Alert, 7/23).

Changes to Bill

On Tuesday, House Energy and Commerce Committee Chair John Dingell (D-Mich.) and ranking member Joe Barton (R-Texas) released a revised version of the bill.
According to CongressDaily, the lawmakers significantly changed the legislation's information-sharing and privacy provisions to address recent concerns from health care, high-tech and consumer advocacy stakeholders (Noyes, CongressDaily, 7/22).
Under the revised bill, patients would give their consent only once to health care companies that want to access health care records without identifying information for HHS-approved purposes, such as hospital audits or fraud and abuse allegations. The bill previously would have required patient consent each time the records were accessed.


Mary Grealy, president of the Healthcare Leadership Council -- who on Monday sent a letter to Dingell and Barton stating her concerns about the proposed bill's effect on the Confidentiality Coalition -- said, "They did make improvements in those provisions we had some concerns about, so I do feel like we're making progress." However, she added, "Do I think they have completely addressed all the issues? No" (Young, The Hill, 7/22).
A spokesperson for America's Health Insurance Plans said the provision that would allow patients to access their medical records and require them to provide consent for third-party access could restrict health care providers from developing wellness, disease management, quality assurance and other essential programs (CongressDaily, 7/22).
A spokesperson for Patient Privacy Rights said the revised bill is being reviewed and declined to comment (The Hill, 7/22).

It is apparent there are many hands in the cookie jar. Health data exchanges will undoubtedly be heterogeneous and probably never be fully integrated, nor should they be.



This phrase from Star Trek, and others such as "More power to the warp engines, Scotty", might also be applicable to health care.


Although we can't quite de-materialize and rematerialize elsewhere, the advent of telemedicine, email, and some forms of HIT does allow us to be intellectually present in two places simultaneously...

I was reading several blogs yesterday and came across several eponyms, EBM (Evidence Based Medicine) and Ix.  Ix really threw me.  I thought I was fairly current on my blogging CME but apparently I am lagging.  I think we should all received CME credits for our work in the blogosphere.  I wonder what Edwin Leap or Kevin MD think about that one.  They have been off at summer camp, hiking or some other non-productive activity while I have been chained to my keyboard. At least Dr Reece at Medinnovation has been at work.....but then who can call it work when one lives in Old Saybrook, CT.


If I remember correctly from a far distant place Old Saybrook is where the movie  summer place " was filmed.

This epic cult film from the early 1960s portrays a young Sandra Dee playing the role of the weekend or summer fraternity party, frolicking at the beach and other pursuits of the androgenous and estrogenic late adolescent phase of life in college.  During my more youthful days I made several attempts to duplicate "Summerplace" one week when I was in charge of social activities for my  fraternity.  I was quite successful from what I can remember.

Anyway, back to Ix....This eponym coined by Josh Seidman stands for Information Therapy, not to be confused with IT.

Ix logo

Josh Seidman and his Center for Information Therapy  (Center for Ix) form a focus group 

"  The Center for Information Therapy (IxCenter) is an independent, 501(c)(3) tax-exempt, not-for-profit that aims to advance the practice and science of information therapy to improve health, consumer decision making and healthy behaviors.

Information Tx

The Ix Center acts as a catalyst for health care delivery innovation by diffusing Ix strategies through research, education and collaboration. A core function of the IxCenter is engaging with Ix proponents and industry leaders through its IxAction Alliance. "

Well, if you have followed my "drift", then set a course at warp 9  for Omicron 9 and make it so.


That being said, and also that it is quite a mouthful I would recommend clicking on my link to the source.

Monday, July 21, 2008

Congressional Health IT Legislation


from:  iHealthbeat

Prospects for Passing House Health IT Legislation Unclear

The House Energy and Commerce Committee is expected to vote this week on legislation aimed at creating a nationwide system of electronic health records and protecting patient privacy, but the bill's fate remains unclear, CongressDaily reports.
In June, the House Energy and Commerce Health Subcommittee approved the bill, sponsored by Energy and Commerce Chair John Dingell (D-Mich.) and ranking member Joe Barton (R-Texas), by voice vote. Since then, staffers have been negotiating language with industry and consumer advocates, but some individuals involved in those talks say the chances of passing the bill get slimmer as more time passes.
Barton and Energy and Commerce Health Subcommittee Chair Frank Pallone (D-N.J.) say the negotiations largely are related to privacy.


Rep. Henry Waxman (D-Calif.) wants the bill to include language that would allow state attorneys general to sue on behalf of residents over security breaches because thousands of complaints about HIPAA violations have been ignored, he said.
Rep. Mike Rogers (R-Mich.) has said the bill's patient consent provision is too broad and would impose regulations on top of what is already required by HIPAA.
Pallone said, "This bill, unlike others, still has the potential of being passed in both houses and getting to the president's desk." He said he still hopes to move the legislation through the House and Senate and to the White House this year.

However, Dave Roberts, a lobbyist for the Healthcare Information and Management Systems Society, said he believes the House has "achieved what it's going to achieve" this session in regards to health care IT. He said a provision aimed at encouraging doctors to use electronic prescriptions that was included in the recently passed Medicare physician payment bill was a good first step (Noyes, CongressDaily, 7/21).



The American Economist web site offers this pessimistic view on what is happening to our health care system.

My response is at the end.

"If you haven’t read Alvin Toffler’s book, Powershift, you probably have no idea what has happened to us in the last decade with regards to the information era. In this historic book, Toffler talks about the “Powershift” which is the information era and how knowledge and information will be the most valuable currency in the world. While traditional economic transformation progressed from agrarian to industrialized societies, the next wave was the information era. “Third World” economies could actually leapfrog the industrialized economy from a rural/agrarian one to an informational society with the advent of computer networks and the internet.

In the healthcare system, such a “powershift” is occurring within the walls of hospitals. Archaic hospital systems are using paper charts and paper prescriptions. Physicians must hand sign an order book which then gets faxed to the pharmacy. A courier then runs up the medicine to the patient’s room. All charting is done on paper and record keeping rooms are enormous. Medical transcriptions are done on a typewriter and placed in the patient’s paper chart.

In the second wave of medical informatics, the electronic network came about. Orders were allowed to be filled electronically. Medical transcriptions of dictations were outsourced to transcription companies who typed these out and they appeared electronically. Physicians could edit, verify, and sign electronic records and transcriptions. Computerized vending machines on the hospital floors could electronically document the use of supplies for the indicated patient. The second wave of medical informatics cuts costs and dramatically improved things and brought us out of the dark ages.

It appears that we are starting the third wave of medical informatics. “Going Live” is the concept where the electronic record is completely “live” and “online” and always being edited. Laboratory and diagnostic results appear real-time; doctors dictations, nurses notes, medical orders, and prescriptions are all done online and appear real-time. Transcription software allows the physician to dictate his note which uses voice recognition and speech transcriptions software to transcribe the note instantaneously where the physician can edit. If he so desires the doctor can electronically type his notes if he likes. There is no paper chart.

“Going Live” is the third wave of medical informations. Gone are the outsourced medical transcription companies. Gone are the paper charts. Gone are the electronic notes that indicate that a dictated note is “pending.” There are no gaps in the care or documentation of the care of the patient. The laptop or PDA-toting physician is here to stay.

As in the global powershift, hospitals and healthcare systems who “Go Live” early on will win more business and thrive. They will be more profitable and be more efficient and thus more effective in the delivery of healthcare.

If you’re interested in other works by Alvin Toffler, read Greg Beatty’s review of Revolutionary Wealth: How It Will Be Created and How It Will Change Our Lives by Alvin and Heidi Toffler.

medical informatics, health care economics, health care, alvin toffler, powershift, electronic medical records, electronic health records, medical IT, health care IT, health care informatics

Tags: electronic health records, medical industry, medical informatics

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One Response to “The Future of Healthcare Is Here”
  1. 1 Gary Levin M.D., on July 21, 2008 at 10:00 am, said:

    Alvin Toffler also authored “Futureshock”, the story of how human beings and society can only absorb certain rates of change, then become overwhelmed and dysfunctional leading to deterioration of coping mechanisms.

    We see this occuring in health care for the past 20 years, some of it driven by technology innovations, but much of it from outside bureaucracy in it’s mis-directed attempts to control cost escalation. Managed care has been a misnomer for managed costs, and control of health care by non medical personell (ie, physicians). Physicians have been wrongly held accountable for ordering too many tests, too many treatments,while paradigm shifts occured without benefit of careful evaluation by physicians of their net effect, other than to reduce reimbursements, decrease access,, increase administrative paperwork and overhead.

    Health information technology is the next “Pandora’s Box” currently being promulgated by political leaders, insurance companies and the massive bureaucracy now surrounding your visit to the provider’s office (used to be’s office)….Patient’s are now called “consumers”.

    Most physicians remain highly skeptical of Health IT.
    Most younger providers look forward to adapting it to their practices, because they have grown up in a school system that now promotes IT for everything, examinations, applications, research, The word processor has replaced script. Email and the web are replacing the telphone call to make an appointment at the office. Economics and time factors are credited with this new shift.


    Economic change is driven by these evolutionary and revolutionary sea-changes..

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Sunday, July 20, 2008

Fueling the Health Train Express

Quote of the day:
Where all think alike, no one thinks very much. - Walter Lippmann

Home health agencies, hospice services are feeling the effects of rising fuel prices, and in some cases workers and agencies are considering withdrawing from far flung rural locations that requiring long drives.  In some cases companies issue pre paid gas cards to employees as a perk.  Mileage allowances by the IRS now are far outdated, and medicare reimbursements for home health care do not consider regional differences nor the expense of transportation for home health care workers.

ALBANY, N.Y. (AP) — Stethoscope? Check. Bandages and medications? Check. Money for fuel? Uh-oh.

U.S. home health care workers, particularly those in rural areas, are suffering from financial headaches caused by the escalating cost of transportation, forcing some to borrow cash from co-workers in between paychecks and others to consider leaving the industry altogether.

Providers of home care in New York, California and other states are doling out prepaid gas cards, rental cars and other perks in an effort to retain their workers, who care for roughly 12 million elderly and disabled patients nationwide and drive an estimated 5 billion miles a year, according to a recent study by the National Association for Home Care and Hospice.

The industry is also contemplating abandoning uneconomical home visits in far-flung locations, and increasingly checking patients' blood pressures, heart rates, blood-sugar levels and other vital signs via remote monitoring systems, which many companies previously deemed too expensive.

Industry officials said they had not heard of any instances where a patient's care was compromised by the high cost of getting a health care professional to their home, though they are worried it could happen. After some home health providers threatened earlier this year to cease operations in rural parts of South Dakota, Democratic Sen. Tim Johnson said he would push Congress to revamp the Medicare payment system to account for the industry's rising fuel prices.

Donald Wagoner, a nurse who travels up to 100 miles a day traversing New York's Adirondack region, said his newest professional challenge these days is simply not running out of fuel. "I've come close a couple of times," said Wagoner, who drives a Saturn Vue SUV that gets around 25 miles to the gallon

These new economic pressures may allow remote monitoring information technology a more competitive edge.

For its part, the Home Care Technology Association of America is lobbying Congress for changes in Medicare to allow companies that use remote monitoring systems to get reimbursed for it — a major reason more companies haven't embraced the technology

Home Health Care figures

Each year, U.S. home care workers...
• Care for about 12 million patients.
• Make 428 million visits.
• Drive nearly 5 billion miles, a distance about the same as going 192,920 times around the Earth

Saturday, July 19, 2008

Too many Cars on the Health Train??

Quote of the Day:
Injustice is relatively easy to bear; what stings is justice.
--H.L. Mencken

I go to my CVS pharmacy quite often because my wife, myself and one of children have chronic medical conditions. My son has cystic fibrosis, and that is another story in itself.

About 8 months ago several aisles were cleared near the pharmacy and a sign went up.  "Minute Clinic coming to serve you, soon."  The space remained vacant for several months.

Eventually construction crews arrived, taking about two months to build the clinic, with two rooms and a computer kiosk at the entrance for patients to register, and enter a brief intake history.

Several months later it opened for business.  In the interim there were multiple newpaper ads, cable news ads, and mailers sent to the neighborhood.  There were even five or six chairs set up in the pharmacy as a waiting area.

I will give them CVS is located in an area with plenty of doctors (in Southern California).

I observed their operations from a distance and noted that 90% of the time there were no patients in the clinic, and a lone NP,, usually reading the computer.  On three occassions there were two NPs present, with no patients, and one time one NP was examining the other one.

After about six months on one day it seemed unusuallly busy. As I walked by there were five people in one room.  All of them had laptops, PDAs and/or cell phones.  One had an obsolete yellow legal pad and a yellow number 2 pencil. Three of them were "suits".  This was obviously their semi-annual review and performance reports. 

My estimate is that they perhaps saw two patients a week. Not a bad investment of at least 100,000 dollars in tenant improvements, computers, equipment and personell costs. I guess CVS needed a write off.

Perhaps in some rural communities this new paradigm might have something useful to offer, but not in a typical urban or suburban area. 

Maybe I could open a lipo or vein and tattoo removal service. I hear the space is up for rent.

What's your opinion??

Wednesday, July 16, 2008

Part II RHIOs Progress and Evolution

Quote of the day:
The nice thing about standards is that there are so many of them to choose from. - Andrew S. Tanenbaum

Opinion: Physicians' Resistance to EHRs Could Be Changing

Health care has lagged behind nearly every other industry in transitioning to computer record keeping, St Louis Post-Dispatch columnist Mary Jo Feldstein writes.
Physicians have been reluctant to invest in electronic health record systems because of the cost, integration challenges and concerns about the technology becoming obsolete, according to Feldstein. However, "waves of successful early adopters" could be "changing [the] tide," she writes.
A recent New England Journal of Medicine survey found that of the 83% of physician respondents without an EHR system, 16% said they had purchased a system but had yet to implement it and 26% said they planned to purchase an EHR system in the next two years.
Scott Anderson -- president of KIG Healthcare Solutions, an EHR vendor -- said he believes that most physicians are "over the hump" and know they need to invest in EHRs (Feldstein, St. Louis Post

E-Prescribing Provisions

The new law will provide Medicare physician incentive payments of 2% for e-prescribing in fiscal years 2009 and 2010, 1% in FY 2001 and 2012, and 0.5% in FY 2013. In addition, Medicare payments to physicians who do not e-prescribe will be reduced by 1% in 2012, 1.5% in 2013 and 2% in subsequent years.
The new law also requires the reporting of e-prescribing quality measures established under Medicare's physician reporting system.
The e-prescribing provisions only apply to physicians participating in Medicare, but other health plans often follow Medicare's lead and implement similar policies, according to Health Data Management.  At the same time there was a 'veiled threat", that those providers who did not adopt e-prescribing would be penalized.  The AMA cautioned that standards for e-prescribing were not yet solidified, which would delay implementation of e-prescribing.


In most cases, the U.S. health care system does not provide incentives for physicians or hospitals to share clinical data with other health care providers, raising barriers to widespread adoption of the technology, Computerworld reports.

Charles Jaffe -- CEO of Health Level 7, which develops data standards for health care organizations -- said, "The problem we have in this country is a lack of business reasons for integrating." He added, "What is the business case for two competing hospitals to share data? None."
For example, five major hospitals in San Diego held a series of meetings about three years ago to consider sharing information stored in their respective EHR systems.
However, the hospitals decided not to pursue the plan because economic benefits were inadequate.
Joshua Lee, medical director of information services at the University of California-San Diego Medical Center, said, "The financial and oversight responsibility would fall on the medical centers, even though it's a very intangible benefit to the medical centers."
Although studies show that EHRs, computer physician order entry and other technology applications can improve the quality of health care, health care providers generally are not compensated for improvements to care, according to John Quinn, chief technology officer for HL7.

John Halamka, CIO at Harvard Medical School and Beth Israel Deaconess Medical Center, said, "The provider bears the cost, but most of the benefits accrue to other parties," particularly insurers and other health care payers.  Shaun Grannis, a medical informatics researcher at the Regenstrief Institute in Indianapolis, said that Regenstrief is working to develop an economic model for health information exchanges that would be sustainable over the long term, but he said that such projects continue to rely on "a patchwork of funding" (Mitchell

Tuesday, July 15, 2008

RHIO Progress

Quote of the day:
For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled. - Richard Feynman

At times I have been disappointed in the slow progress of NHIN and RHIOs.  However I think about the development of other communications systems. Our national and international telephone networks evolved over many decades, using now obsolete switches, wiring and non digital systems. 

The most recent reports reveal some progress and growth of functioning RHIOs even though about seven became defunct in the same time period. 

WASHINGTON - Regional health information organizations and health information exchanges may not be the answer to a nationwide network, according to David Westfall Bates, MD, an internist at Brigham & Women's Hospital in Boston who teaches at Harvard Medical School.

Bates, who serves as medical director of clinical and quality analysis of information systems for the Partners Healthcare System (of which Brigham & Women's is a part), says the process of creating and sustaining statewide and regional exchanges has been too slow.

Will RHIOs be able to fulfill the vision of electronic health information exchange across the country? That I think remains to be seen. I think the model is working, but I think the successes have been modest," he said.

Bates spoke Thursday at an online forum organized by eHealth Initiative, a not-for-profit organization that promotes quality care through use of IT. Technology companies 3M and ICW, which work with data exchange organizations, sponsored the forum.

The discussion highlighted early findings of eHI's 2008 survey on health information exchanges. The survey compares the state of exchange organizations in 2007 with 2006.

Jennifer Covich Bordenick, vice president of eHI, told the audience the survey shows there were 32 operational organizations across the country in 2007 compared with 26 in 2006.

Fully operational organizations exchange data on outpatient episodes, lab results, inpatient episodes, radiology results, information on enrollment and eligibility, dictation and transcription, pathology and emergency department episodes.

"There's really exciting stuff happening in these mature organizations," Bordenick said.

The data exchange organizations also reported on the most difficult challenges. At the top of the list - as in 2006 - is developing a sustainable business model.

Most organizations - 53 percent - are receiving funding from hospitals. Forty-four percent say they have funding from the federal government, and 43 percent from state government. Thirty-two percent derive some funding from payers, and 31 percent from foundations and other philanthropic organizations.

Start-up funding is usually less than $200,000.

"Hospitals continue to be a big funder," said Bordenick."They continue to step up and play a major role here."

Westfall said it's possible that hospital funding could "slow things down."

"Enabling clinical data exchange could hurt them competitively," he said.

West raised the possibility of providing more public funding, since RHIOs and HIEs are being created for the public good.

"More organizations are sustaining themselves," Bordenick said. "It's definitely a positive trend. It's slow, though."

next issue:  funding for RHIOs and sustainability

Monday, July 14, 2008

Prayer for The Day

Each morning when I arise the first thing I do is go to my home page to read the "prayer for the day".  I do this no matter what urgent thing of the day is it a crisis bill to be paid, a sick wife, child, patient or something else deemed to be the most important item of the day by someone else. Having accomplished this, I can move on to the rest of the day with renewed energy and faith to carry on.

Quote of the day:
When you look at yourself from a universal standpoint, something inside always reminds or informs you that there are bigger and better things to worry about. - Albert Einstein

There used to be a time when one thing was fairly certain,  your doctor and his caring manner and most of the time the ability to support you through whatever it was you were going through, emotionally, physically and otherwise. And these were during times when things were much more uncertain. The government, nor the payors are our problem.  To these folks it is always about the bottom line, not your  health or welfare. They will manipulate the system to  make their books balance and/or have a budget item that the OMB can justify.  Not only are we fighting a "war on terror" and a "war on  drugs" as well as a "war on illegal immigration".  During a Presidential election year is a very bad time to make a long standing decision about our health  care system. Believe it or not, those in decision making roles know bupkas about healthcare.

This is why it is critical for all physicians to become active in setting policy and aggressively as individual advocates for our  patients.

The Health Care Blog, written by Matthew Holt, describes several issues that are current.  He quotes Bob Laszewski in his BLOG about the SGR and the 18 month hold of fee reductions, only to rear it's head in 2010 with a 21% fee cut. Sounds like poker to me...."double or nothing".

As Bob describes it is the SYSTEM, not the fees and this is an issue only physicians can work out....this cannot be a 'divide and conquer' issue for  us. Without going into great detail here check out my links.

Saturday, July 12, 2008

Passing of Michael Debakey M.D.

Quote of the day:
The beginning of knowledge is the discovery of something we do not understand. - Frank Herbert

Dr. Michael Debakey, a true pioneer of cardiac surgery, statesman, innovator and teacher passed away yesterday.

His memories and stories will linger amongst his students.

Michael Debakey records of accomplishments, honors, and humility stand alone.

The world has lost a great human being.

Friday, July 11, 2008

Special Trains for Special People

Quote of the day:
Everyone is as God has made him, and oftentimes a great deal worse. - Miguel de Cervantes

Today on California Healthline, the following information:

Prison Health Receiver Moves Ahead on Plans for Three New Facilities

On Thursday, the court-appointed receiver for California's prison health care system signed construction design documents to commit the state to spending $2.5 billion on three new health care facilities for inmates with chronic medical and mental health conditions, the Ventura County Star reports.
J. Clark Kelso was appointed by Federal District Court Judge Thelton Henderson to bring the state's prison health care system up to constitutional standards after a class action lawsuit found that state officials failed to improve conditions at the facilities.
Kelso said he filed notices under the California Environmental Quality Act to evaluate the construction projects at two planned facilities in San Diego and Stockton. He said he has not yet filed notices for a third site, potentially in Camarillo.
Each of the three health care facilities will contain 1,500 inmates.

Now I am not against adequate health care for incarcerated patients, and adequate facilities for prisoners. I imagine these prisoners might qualify as part of the 'underinsured'  It is interesting that the state may be willing to spend 2.5 billion dollars in capital alone to build the new hospitals. Factor in cost overuns and the eventual operating expenses, new salaries and it will probably run into more billions of dollars for tax payors.

This comes at a time when our Governor terminator is attempting to cut billions of dollars of insurance coverage for poor or uninsured citizens of the state.  We live in a egalitarian society...where health care for prisoners overides healthcare for children, and people who cannot afford health insurance for one reason or another.  I think I will go out and rob a bank.......three squares a day, health insurance and a nice bed....I may even get some tatoos.  And besides I can dance!

Monday, July 7, 2008

Compensation Packages for CEOs

I found that one of my posts here did not appear. Must have something to do with the 4th of July.  Or perhaps it is much like our disappearing reimbursements.  This week we are facing the lastest 'crisis' contrived by our inadequate incompetent legislators and administrators.  They never seem to be in sync.

It now appears that many physicians have announced they will not be accepting new medicare patients as of July 1st. This is the annual battle of the SGR formula. If you don't know what that is, I am sure you can google it. That would be a better learning experience than my giving the answers away here.

The lastest evaluation of CEOs reimbursement packages  for Payors revealed the following


When: 2007
How: Based on analysis of compensation of top executives of S&P 500 companies. Median total compensation was $8.8 million for executives overall, and $9.1 for CEOs of six publicly traded health plan CEOs.

Where: Everywhere there is concern among stockholders that compensation may have no relationship to performance. So far in 2007, publicly traded HMO stocks are up about 15%, from a mean of 53 to a mean of 61.

Who: Total compensation is said “not to be out of line by Wall Street standards,” and included the following health plan CEOs.
• H. Edward Hanway, Chair and CEO, Cigna, $25,839,777
• Ron Williams, Chair and CEO, Aetna, $23,045,834
• Dale B. Wolf, CEO, Coventry Health Care, $14,889,823
• Stephen Hemsley, $13,164,529
• Mike B. McCallister, President and CEO, Humana, $10,312,557
• Angela F. Braly, President and CEO, Wellpoint, $9,094,771
• Jay M. Gellert, PRESIDENT AND ceo, Health Net, $3,686,230


The WSJ states that these figures are not out of line when compared to other industries.  So medical and hospital care is just another industry.  Personally I cannot compare a pencil pusher that sits at meetings, gives speeches and worries more about his companies profit figures and equate it with a surgeon's worth, or a primary care provider's abilities to care for patients.

Next time you want your hernia repaired or your cataract removed, or your heart defibrillated....make an appointment to see the payor's CEO.....(don't trip over the golden parachute on your way in.

Sunday, July 6, 2008

Physician Signatores of the Declaration of Independence

Quote of the day:
Character is what you have left when you've lost everything you can lose. - Evan Esar

The 4th of July seems a good time to reflect upon our liberties and also to reflect upon what physician's contributed as well

Matthew Thornton practiced for years in rural New Hampshire. When he went to Philadelphia for the Continental Congress, he had himself innoculated against smallpox and wrote of the ensuing ordeal. His satire described a Dr. Cash (”we saw no more of him, till I paid his bill of 18 dollars”); Dr. Critical Observer (”told me he would critically observe every stage … came once in two or three days, and stayed about a minute”); and Dr. Experience (”a merchant, who had the Small Pox, visited us every day, and gave a much truer account of the Small Pox, than all the doctors.”)

Josiah Bartlett was a practicing physician who became governor of New Hampshire and was one of the framers of the Constitution. But the practice of medicine remained important to him. In 1793, two years before he died, he wrote a letter to the New Hampshire state medical society (which he helped charter) expressing his hope that the group would crack down on quackery by “discouraging ignorant & bold pretenders from practizing [sic] an Art which they have no knowledge.”

Lyman Hall worked as a minister until, for reasons unknown to history, he was charged with “immoral conduct” and dismissed. He became a doctor, left his native Connecticut and ultimately landed in Georgia, where things seemed to improve for him — in 1783, he became governor of the state.

Oliver Wolcott was the son of a Connecticut governor who trained as a physician and may have practiced briefly, but spent most of his life in public office. For a while, he held the appealing sounding title of “high sheriff” in Litchfield County.

from the WSJ  July 3, 2008

Friday, July 4, 2008

That's My Opinion

Quote of the day:
Look for the ridiculous in everything and you will find it. - Jules Renard


It's the 4th of July, so I am kicking back, firing up the barbecue, putting on the sun block and writing today's episode.

It is only early July and my wonderful spouse just told me she has heard enough about the Presidential candidates. I guess that means no more newspapers, FOX news, MSNBC, CNN, etc etc. I will take those off my FAVs on the cable remote.

We live right by a national cemetery and there will be a procession of cars, and flags.  Living here it does not take a special day to remember how our country was won, and how it has been maintained.  Yes, we are guilty of many atrocities, stealing lands and lives from native Americans as our country expanded westward. Liberals will be quick to point that out, but they forget their ability to speak out has been bought with the blood of their fellow Americans.  I can see both sides of this argument, however when compared to the rest of the world I leave the final judgment open.

At one time I was a liberal, some new things and some changes are for the better, and some things are better left alone. The liberal establishment has left the tracks.  Conservatives too, have left the tracks.  Both sides seem to be missing the point.

I digress here (too many beers, I suppose).

We may examine and compare our health system to other countries reflecting on statistics which must be placed in the framework of our culture and history.

I do not believe important decisions regarding our health system should be made during an election year. We don't need medical decisions influenced by black and white  yes's or no's. Health care is too important to mix it in with liberal vs. conservative issues, national defense, the price of oil, mortgage crises., gay marriage, tax cuts and/or tax increases.   Politicians will be pandering to their constituents to become elected. Do you really want a politician making your  healthcare decisions?


I leave you with this:  Happy Fourth of July

Stars and Stripes Forever

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