Social Media ROI

Information Technology gurus often talk about Return On Investment or ROI. The term is used to assess the worth of IT investment, it's increase in productivity, or efficiency and it's long term ability to save on costs.  It often is focused on the fixed capital investment and ongoing maintenance cost of purchasing and maintaining such systems. Web-based Health 2.0 offers an immediate ROI.  ROI should be analyzed on the basis of what it does for you, the physician and your patient, not just a number based on dollars spent/dollars returned.  The numerator in that equation is close to if not zero. If you substitute time as the numerator and results as the denominator it becomes even more apparent what health 2.0 offers you...

Read more »

Coalitions of Collective Intelligence

Thanks to the marvels of the internet and webinars I was able to attend the ACE  2010 event in Chicago from my well worn desk chair in my  den here in California.  Glen Tulman, CEO and extrovert of Allscripts was very good at analogizing much of health care with other industries, for example, Education. Mr. Tulmann led off with the well worn exclamation that "Health is not a Commodity", but rather a "Community", which he compares to a coalescence of a collective intelligence. During the webinar I was interrupted by a telephone call from "Dr Chronos", a new iPad EMR vendor. I will return to that a bit later. Mr. Tullman compared the manufacturing of a pencil with that of a computer.  It seems the pencil requires a significant amount of 'collective intelligence to bring...

Read more »

US Healthcare vs UK N.H.S.

  Recent reports from the UK indicate changes that will decentralize control from it's present organization and distribute accountability and decision making authority to physicians. This story represents when individuals have little or no control over their working environment.   Oxford hospital child heart ops 'should stay suspended' The report cleared consultant Caner Salih of any wrongdoing Child heart surgery should remain suspended at Oxford's John Radcliffe Hospital where four babies died until improvements are made, a report says. Surgery was suspended when four children died between last December and February, after being operated on by consultant surgeon Caner Salih. The report found the deaths were not due to errors...

Read more »

Competition for Medi-Cal Patients

  Although many physicians do not accept medi-cal as compared to private insurance, there is a trend toward accepting medi-cal patients. Strange as it may seem, a recent analysis of the number of physicians accepting Medi-Cal is on the rise. Physician Participation in Medi-Cal, 2008 (1.12Mb) Physician Participation in Medi-Cal, 2001 (800k) Physician Participation in Medi-Cal, 1996-1998 (402k) Read more: http://www.chcf.org/publications/2010/07/physician-participation-in-medical#ixzz0v6FET6U4   Although these statistics seem to fly in the wrong direction, especially since physicians are so opposed to government intrusions into medical care there may be reasons this is occuring 1.The development of Managed Care Medi-Cal programs....

Read more »

It Takes a Village.....

Recently I was sent an email regarding the development of "Healthy Howard".   No, it's not the "Truman Show".   Tech Firm, Howard County Partner to Help Uninsured BETHESDA, MD (July 22) -- Howard County, Maryland, has enlisted local technology firm Healthcare Interactive to help manage its Healthy Howard program for uninsured residents. "We're thrilled to count Healthcare Interactive among our partners in delivering critical healthcare services to Howard County residents who need them," said Liddy Garcia-Bunuel, Executive Director of Healthy Howard. The program -- the first of its kind in the nation -- provides basic medical services at low cost to Howard County residents who cannot afford or obtain health insurance. For...

Read more »

What tha !?

    Seems like Don Berwick was preaching to the wrong choir several months ago when he addressed an audience in the U.K. Today, The New York Times announced,   LONDON — Perhaps the only consistent thing about Britain’s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.   The new British government’s plan to drastically reshape the socialized health care system would put local physicians like Dr. Marita Koumettou in north London in control of much of the national health budget. Even as the new coalition government said it...

Read more »

More Transparency Hospital Comparisons

HHS has released the latest comparison of hospital statistics website with searchable data on outpatient surgical infections, heart attack treatment success and more." Data released Wednesday "appeared to bolster that argument, at least for heart attack patients," which showed "a drop in the national 30-day mortality rate for heart attacks of 0.4 percent to 16.2 percent for the three fiscal years of 2006-09." Also, the new healthcare law will "likely" give the comparison data "even greater weight" because some of the information may be used to calculate hospitals' reimbursements after 2013.  The Hospital Compare website was created through the efforts of the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S....

Read more »

The Gloves are Off

The gloves are off!!  I have always been a moderate politically and at times liberal in my thoughts about improving society with some radical ideas about poverty, homelessness and other important human issues.  Despite the fact we are the most affluent country in the world we see signs of 'slippage' in our respect from the rest of the world. We have always been the most generous country offering aid to other countries in times of crisis.  That is why I am particularly disturbed that our administration refused aid from other nations at the beginning of the crisis.  What was that all about? Was it our pride about needing, or asking for help? The Norwegians who have much experience in deep water drilling in a much harsher environment offered help immediately.  Who ever...

Read more »

Docs4PatientCare's message warns of "Medical Dark Age"

...

Read more »

SEARCH THE HEALTH TRAIN EXPRESS

  You may notice a new SEARCH ENGINE WIDGET ON THE LEFT HAND SIDE OF THIS BLOG. THIS IS A HEALTH TRAIN EXPRESS ONLY SEARCH ENGINE.   ...

Read more »

Doctor 2.0

The recent Health 2.0 conference in June of 2010 had a diverse collection of participants. The comments from these younger physicians emphasizes the true basic nature  of medicine, and the common thread of passion and enthusiasm of these internet ennervated physicians to use these tools to practice medicine. Doctor 2.0 is a video dialogue with several physicians and how they have transitioned their practice(s) into the modern era. Dr Jay  Parkinson Dr. Enoch Choi are well known enthusiasts for blending their medical expertise, caring manner with the tools of the time. We need to look at adopting these ideas in all our practices, be leaders to move forward, and stop looking at all the negatives. My favorite saying has...

Read more »

The Next Generation of Doctors

    The Next Generation of Doctors, is a topic which is timely for all of us who are past the age of 55, or so.  Whether we like it or not, we are on the 'way out'. Given the average age of 28-30 when we completed our training (if we did not stop along the way to breathe, or entered medicine as a second career, our days are numbered. Like it or not I noticed when I reached age 55 I was definitely not the human being I was at age 25,35,or 45 years of age.  Despite the best of my intentions the last ten years and especially the last five  years gave me a clue that things had changed.   The development of information technology and EMR as one example sharply punctuates generations of  physicians. B.EMR, and A.EMR (before & after) clarifies the pre-internet...

Read more »

Bundle your cable TV, Internet and Phone Service with Health Information Exchange

    VERIZON LAUNCHES NATIONWIDE HEALTH INFORMATION NETWORK   It ran through my mind about six years ago when this whole thing about RHIOs , EMR and Health Information Exchange began. There were multiple attempts at forming business entities which were sustainable. Millions of dollars were spent setting up 'pilot programs'.  Attempts were made to reinvent the wheel.  There was more time and money expended setting up committees, seeking stakeholders and the like. Redundant non profit entities were required to access precious grant money to start some of these entities. Most failed miserably. Even now in California there are multiple entities circling the wagons around each other.  (CAEC, eHealth, CALIPSO)...

Read more »

If Lawyers worked like Doctors

Dr. Wes in a column from October 2009 writes a 'parody' on attorney billing. If you read it, you will chuckle.... I have a few other 'regulations' for attorneys. Pass the Affordable Plaintiff and Defendant Act. Establish legal preferred practice patterns Establish evidence based legal decision making Establish quality review and payment guidelines for outcomes. Establish "never events" which allow clients to refuse payments to their counsel. Incentivize attorneys to utilize legal information technology with decision making algorithms. Encourage further the development of 'managed judicial organizations (MJO) and/or accountable judicial organizations (AJO) Establish a sustainable growth rate formula (SGR).   This would include a built in 5% a year decrease in reimbursements,...

Read more »

Washington and the Parasitic Economy

Following in the distinguished footsteps of Microsoft and Google, Apple is the latest innovative company to be targeted by politicians and regulators for being too successful. Will it be sucked into Washington's "parasite economy"?  Has medicine become a part of the government's parasitic economy? David Boaz of the CATO Institute explores the history of success in America. For more than a decade, Microsoft went about its business, developing software, selling it to customers, and — happily, legally — making money. Then in 1995, after repeated assaults by the Justice Department's antitrust division, Microsoft broke down and started playing the Beltway game — defensively at first. Washington politicians and journalists sneered at Microsoft's initial political innocence. A congressional...

Read more »

Bad Medicine

In a white paper written by The Cato Institute, Bad Medicine...A Guide to the  Real Costs.....elaborates on the true cost of the health reform act, and it's secondary consequences: Simply having insurance is not enough to satisfy the mandate. More than 2/3 of companies could be forced to change their insurance coverage Some of the mandated changes may have unintended consequences. As many as a million workers could lose their health insurance coverage they have now. Tennessee's experience with TennCare gives a precautionary tale. The phase-out of these benefits imposes a high marginal tax penalty All together these changes produce an enormous increase in the welfare state Plans offered through the exchanges...

Read more »

Health Train Express Resumes Publishing

Things seem to be working again. I spent the greater part of the past two days getting things back up and running. After my blog platform disappeared from my menus and a number of dead desktop icons, several freezes, virus scans, and other disconnected events, and after removing several programs, re-installing several programs, which failed to load, defragmentations, etc I did a restore to several weeks ago and all is fine. It interrupted my writing schedule and diverted my attention, worrying all the while if it could be fixed, how much data I would lose, etc and  even the fear of having to replace it with  a new system.  '   Fortunately for me I had a disaster plan....I had an external drive with backup and also...

Read more »

Non Publishing Notice

Due to technical difficulties Health Train Express will not be publishing for the next 48 hours.  I know you will all be broken up about missing one of my rants.   Blame it on 'Window...

Read more »

Re-distribute the Wealth

  Don Berwick's commandered appointment to be head of CMS seems to have only caused a flicker of congressional shock. Some of this may have been their own reticence to start the confirmation process, because Max Baucus had not yet scheuled the hearings.  Perhaps the Republican leadership should learn that political stalling and meandering only lead to surreptitious acts. The Republicans are not alone in this form of political extortion and deal making. Berwicks' candid and open opinion that health care  reform should 'redistribute wealth, and that is one of it's primary missions".  (See The Video, below) That statement  is one that neither I nor most doctors have ever heard from a highly appointed M.D.  I can accept that health reform should 'transform,...

Read more »

Team NY TIMES

Finally, a Medicare/Medicaid Chief Published: July 7, 2010 The New York Times  Op - Ed, today   "President Obama made a sensible move Wednesday when he bypassed the Senate and appointed Dr. Donald Berwick, an expert on reducing health care costs, to oversee Medicare and Medicaid. Republican senators had made it clear that they would use confirmation hearings to distort his record and rehash their arguments against the recently enacted health care reforms, mostly to score political points for the November elections. By using his power to make recess appointments while the Senate is on vacation, Mr. Obama put Dr. Berwick in a position of vital importance in implementing the new reform law. His appointment will run until late...

Read more »

Your Health on the Ballot Box

So, how are you going to like your health care on the ballot? Would you like a Republican diagnosis, A Democratic diagnosis, or perhaps the Libertarian or Independent opinion?  Worry not, no matter what the decision it will take months to implement, if it is funded, at all. The situation in Massachussetts is dire. Mitt Romney signs health-care reform into law as Ted Kennedy (third from right) looks on, April 2006. U.S. President Barack Obama (C) is applauded after signing the Affordable Health Care for America Act during a ceremony with fellow Democrats in the East Room of the White House March 23, 2010 in Washington, DC.  And in large measure Obamacare is on the same path. Rago of the Wall Street Journal has this to say:...

Read more »

Wellness Wiki.....What is?

About five years ago I was asked to participate in the founding of the "Wellness Wiki".  This was during the dawn of the age of HIT. Several luminaries participated in this early talk about wellness, and health care transformation. Welcome to the Wellness Wiki! We offer this wiki to help clarify the complex problems plaguing the U.S. healthcare system and develop sustainable ways to improve the health and well-being of all people. This virtual encyclopedia of the healthcare crisis and potential remedies. We welcome your comments! To become a contributor, please contact Dr. Beller The program of which I was privileged to have my name put on it (with little real contribution, other than an enthusiastic "go for it" from me) now is on...

Read more »

Hospital Staff Priveleges:

Why I no longer belong to hospital staffs: The Happy Hospitalist explains the byzantine maze required to see and treat patients. A medical license has always been an earned privilege. We are given the privilege of hospital staff memberships. However things have taken a terrible turn for the worst. At this point the hospitals should consider it is their privilege to have me on their staff. I agree with Happy that there is now a lot of “crap” in the system. Someone has made or is making a lot of $$$ producing software, and/or meetings for medical staff offices to ‘automate” their credentialing system. A great deal of information requested is repetitive and could easily be stored in a central location for medical staff credentialing purposes....

Read more »

Blogs | Reporting on Health

Blogs | Reporting on Hea...

Read more »

Happy Independence Day

The freedoms to practice medicine........................... It's that time again, the anniversary of the "birth" of our nation. The 4th of July means many things to many people. For our warriors away from home it memorializes what our country is all about. "FREEDOM"  When I was younger I did not appreciate fully how challenging it is to establish and maintain "FREEDOM'  The seed must be planted in  fertile ground, watered and fertiilzed.  Neglecting the plant and not watering it will result in withering and death. One of the best fertilizers for "FREEDOM" is the diversity, discourse, and  strong disagreements among it's citizens.  Just like the first law of thermodynamics, organizations tends to descend...

Read more »

Primary Care--What are the Barriers?

Last week I was invited to join Hope Street Group 2.0 which is focused on economic opportunity for professionals and practitioners. It covers a variety of areas.  One of them is health care. They posed this question: Re: What do you think is the biggest barrier to innovation in primary care? Aaron Doty and Sarah Steinhofer  enumerated the following: (Hope Street 2.0) "It is possible to point to a  number of barriers that limit the spread of innovation in primary care  (see some examples below). Examples  of barriers to innovation in primary care Variations  across states in scope of practice regulations Reimbursement  rules and lower earnings overall limit the attractiveness of primary ...

Read more »