Future of medicine in the hands of your bank

I am a believer, maybe a visionary, but mostly a pragmatist.

I do see the writing on the wall and it is not hieroglypics…it is the closest thing we have to a market driven solution to healthcare and healthcare technology. William Yasnoff, previously senior advisor in the Dept of Health and Human services is spot on… “If getting an EMR was profitable for doctors, they would all have them” and “Asking docs to pay for something that benefits others will not work”
Further he believes that banks can pay physicians to embrace EMRs….He has proposed several models for financing this…some I don’t necessarily see happening ..
But, here are the reasons why I see this shift inevitably happening…
1. Consumer buy in is easier with banks given that consumers already share their personal information with banks
2. Banks have incentive to provide consumers and physicians these services.
3. Banks have the infrastructure to provide most of the security back bone as well as the access technology backbone to implement this.
4. Consumers already understand how to use online banking for financial purposes…now consumers would just use online banking to transact information rather than money.

So, be aware, as banks and health insurance and health IT converge as a result of natural market forces, (the best type of convergence) to ultimately service the consumer, the physician and to compete in the healthcare IT world…..

Healthcare Technologist's Happy New Year Poem

Twas the night before New Years
And all through the house
Each PC was sleeping including the mouse

And all of the Acronyms,
Lined up through the hall
PHR, EHR, and HIPAA,
Adoption so small.

Healthcare Companies clamoring,
Come one, and come all
Microsoft battles Google,
Steve's Revolution yet crawls.

WEBMD is King
With the most monthly visits,
As competition heats up
Draws away all the people
Including the cynics.

DOSSIA was floundering,
Nearing it’s death
Reinvestment, a lawsuit,
Phrs as an HR benefit
is given new breath.

Consumer Directed,
consumer this and that,
Consumers need money,
Emrs and phrs
Second at bat.

MDVIP and concierge medicine is sprouting,
Discharged uninsured families and children,
without their doctors are left pouting.

Minute Clinics vs. AMA
in a battle of turfs,
Reminds me of court
held by the smurfs.

In the end ,
the new year will inevitably bring,
the promise of better healthcare,
But realistically,
wont change a thing.

PDF Healthcare

PDF is a file format that can be used to send or receive information during the process of the health information exchange. In other words , PDF's are being used in healthcare as "capsules" or "containers" to include or attach images or information for sending or receiving purposes. The PDF Healthcare Best Practices Guide is a result of the a working group, co chaired by INtel and Adobe that has decided to submit PDF Healthcare to the ASTM (American Society fo Testing and Materials International and the Association for Information and Image Management (AIIM)for balloting to demonstrate that it's compatible with CCR (Continuity of Care Record as proposed by ASTM and Health Level Seven's Clinical Document Architecture (CDA).
The best practices guide is tailored to the healthcare industry and describes use of fonts, metadata, security and the way PDF is used. It is generally agreed that PDF is a format this is very consistent with the ultimate goals of standardization. Additionally, security can be enhanced with PDF by embedding paswords and permissions on the dcoument.

Clearly, the advantages are: familiarity, and also that PDF uses XML (extensible markup language) standards, so that you can incorporate xml data into and as a standardized data set within the PDF. So, as a result, it is now being developed and proposed to put the CCR XML inside of a pdf . Thus the pdf can either be printed off in the event the end user does not have EMR (electronic medical records) or if they do have EMR, the emr can extact the CCR XML data to populate the EMR.

This can be used for PHR's and EMR's.

Consumer Directed Healthcare, Continues to Grow

Having been in medicine since I was 17 (over 25 years), I have heard all the talks about how healthcare needs to be fixed. I have been on all sides, patient, provider, and healthcare executive, but nothing is as compelling to me as the consumer directed healthcare movement. I believe it is here to stay (or at least until something better comes along), but, it is the closest concept that I have seen to helping "fix" a broken healthcare system. In short, give the consumer control to decide where and how he spends his healthcare dollar, give him transparence and information, educate him. For whatever the many reasons, medicine and the business of medicine for the last century has been unlike any other market or industry. You basically went to the doctor and didnt care what it cost as insurance covered you..so you had no incentive to do your "due diligence", with consumer directed heatlhcare it is different, and you, the consumer , have incentives to understand where best to receive care, how much to pay, how to prevent, educate , and inform. Your incentive....savings.. The more you save on your healthcare annually the more you save...thus, 87% of healthcare savings accounts roll over..and if you are in an eligible plan, you can use your savings after age 65 just as another retirement account. It makes sense.

It makes so much sense it is bipartisan swinging from Hiliary to Newt. Consumer directed healthcare plans are now growing 7-8% annually and it is predicted by 2010 that 27% of all insurance plans will be a derivative of this. Minute clinic is a fall out of this as is MDVIP (concierge boutique medicine) though on 2 different ends of the spectra. An industry is burgeoning with solutions to help the consumer execute, understand, educate and more...Doctors on Demand is an offshoot of this as well...

I support it...give the consumer control, intelligence and let the natural market forces that affect every other industry or sector, that we consumers participate in...naturally correct the inefficiences..I do think we are on the right track.

RFID Implant cancer questions concerns patients

In the News Update: RFID implant cancer questions concern patients


News that radio frequency identification (RFID) implants could pose dangerous health risks -- even cancer -- has the healthcare and personal health records (PHR) industries wondering how to provide medical professionals with vital patient health records in case of emergency.
A simple, free and non-invasive alternative already exists. Consumers can use Web-based services, CD-ROMs and simple paper-products designed to hold critical data that can be easily accessed or carried, said Steven M. Hacker, M.D., founder and CEO of PassportMD Inc., a leader in consumer-managed healthcare products.

"It's a twist George Orwell couldn't have imagined -- that some 'big brother' computer chip injected under the skin may jeopardize your health," Hacker said. "Products like PassportMD provide a safe, secure and non-invasive alternative. It's free and the information is immediately accessible without access to a phone or Internet connection."

Glass-encapsulated RFID transponders from companies like VeriChip are implanted under the skin. A special scanner must be used to reveal a 16-digit code that's then entered into a Web database to retrieve the patient's medical information. Earlier this month, it was reported that some lab animals implanted with chips developed cancer and sarcoma. Other possible adverse effects include tissue reactions, migration of the implanted chip, Magnetic Resonance Imaging (MRI) incompatibility, electrical hazards, infection and even compromised information security. Already used to identify lost pets, some 2,000 people worldwide have RFID chips implanted for PHR applications.

Products like PassportMD.com provide safe and secure access to patient records. Subscribers can create a free personal health record by following a simple, 10-step tutorial. The PHR can be printed on a wallet-sized card or can be accessed anytime through a password-protected Website. Unlike chip-based solutions, PassportMD allows subscribers to store, access and print living wills or advance medical directives. By upgrading to the premium service, subscribers can use PassportMD's unique "Doctors Notes on Demand" service that lets consumers easily request, receive, store, print and access their doctors chart notes.

"Life-saving access to personal health records should be the solution to a medical problem -- not the cause of one," said Mitch Bernatsky, President of PassportMD, Inc.

http://www.passportmd.com/

Secure email is preferred

A recent study published in the American Journal of Managed Care… Patients with online access to an Electronic Health Records are choosing to use secure email to communicate with doctor or doctor’s office…The study showed that secure email linked to an Electronic health record.. decreased annual adult primary care outpatient visit rates by 7-10% and led to 14% fewer phone contacts..The study demonstrates that email is more convenient and efficient for both the physician and the patient for non urgent concerns..

Ben and Jerrys Aisle 5, Hot Pockets Aisle 3, Nurse Practitioner Aisle 1. A double standard for doctors that want to dispense…

Times they are a changing….
Revolution Health buys Minute Clinics to reach customer in pharmacies. Express Care and ShopRite partner to provide health care in ShopRite super markets…
It is happening everywhere…
Here is an interesting thought.
Pharmacies can employ healthcare clinics and nurse practitioners to get more customers into their pharmacy …and sell them other items as well as pharmaceuticals and “healthcare”. Pharmacies don’t get it why AMA and doctors protest … and yet is it not a double standard though..when doctors want to sell pharmaceuticals to their patients…. Here the pharmacies protest that the doctors have a conflict of interest..and should not dispense from their office…
In both scenarios..if you boil it down , it is about… a bigger piece of the pie…pharmacies want to participate in the upside of medicine under the guise of convenience and affordability for their customers… and doctors want to participate in the upside of dispensing under the guise of convenience and affordability for their patients..meanwhile they both scream "holier than thou" in their efforts to keep either one from pursuing each other… the irony..both might be providing convenience and affordability in the midst of clear conflicts of interest, self referral abuses, stark law issues…

Another Bill, Another Day, Another Dollar

This Bill is not the one you receive in the mail from the cable company.

This is a bill introduced and has some bi-partisan support, it is called the "The Independent Health Record Trust Act, which was introduced into Congress in mid-July by Rep. Dennis Moore (D-Kan.) and on last count this week has bi-partisan support from 49 House members, aims to create independent health record trusts, or IHRTs, that would manage the electronic medical records of patients upon voluntary participation by consumers signing up for these electronic accounts." as reported by Marianne Kolbasuk McGee in InformationWeek .

I dont know about you...but most patients and people I know.. are not going to jump to give their personal medical information to the government to control. What an interesting name the bill has though... "trusts", this should conjure up images of George Orwell smirking over us.

Patrick Kennedy also introduced a bill earlier this year to incentivize doctors to adopt electronic medical records. So, our politicians are taking heed.

Unintended consequence. It does serve a greater and grander purpose ;the so called unintended consequence. This is the unintended consequence for the overall good, (not Marxist, I promise) but, educating and raising the bar on awareness of the need for people to generate their own Personal Health Record or PHR.

In the end , the PHR will be the stimulus for healthcare revolution. A revolution that will not take place until control of healthcare information and the healthcare dollar is given to the people, "the masses"...so, in my eyes, this is a good thing.

Control of your healthcare information is the "opioid of the masses", just watch.

should Doctors withhold a patient's record?

Doctor's receive requests for their patient's records every day. This is part of their practice and in fact, some doctors, have staff to just perform the function of copying and sending their notes to their patients or to the insurance companies, lawyers, or other doctors that request their notes.

Can doctors refuse to transfer or release their patient's medical records?

No, it is un ethical for a doctor to refuse to promptly respon to a valid request for a record transfer. So, if your doctor is not complying with your request, then you might want to have a discussion with him.

I think most doctors are aware of this and I am unaware of doctors that intentionally withhold their patietns medical records. It should be emphasized that most states allow for doctors to charge a reasonable fee for the work and costs associated with releasing, copying, and sending records.


Here is some shameless self promotion... webservice like PassportMD.com , makes it easy, in a Hipaa compliant fashion, to request , receive and automate the process of getting your doctors records, notes, charts , etc and store them in a centralized, secure environment that can be accessed from anywhere and printed off from anywhere.

E health project that is failing, clearly a bigger Personal Health Record (PHR) is not better

When we first read about Dossia's intentions we applauded it. Now, we see the realities of multi-corporate "cooperation".

It is easy to see why large initiatives fail...widespread usage of a commodotized PHR will be inevitable , but , will probably be through slow adoption, acquisition and mergers rather than super large initiatives. Large government initiatives or large multi corporate partnerships are good in theory, but , practically speaking, precedents suggest otherwise..

Read the recent article entitled: Another E-Health Project In Disarray
Partners in initiative known as Dossia squabble over money, deliverables. Will the health industry ever get this right?
in http://www.informationweek.com/news/showArticle.jhtml?articleID=201001393
and I quote "An ambitious program to provide electronic health records to more than 2.5 million people is starting to unravel, as the partners in the multimillion-dollar initiative turn to legal action against each other."

Hurricane Season is here, have you done your PHR?

As we approach the time of year that hurricanes pay us visits... all of us in geographically susceptible regions, must be thinking about preparation.

Personal health records should be atop the list of "first aid" preparation particularly the elderly.

Think about it.. a hurricane hits, your pharmacy is closed, you dont recall your medication list, interactions, dosages and more. You need to have this information accessible. If Katrina taught us anything, it was preparedness makes a difference. Several doctor's offices were closed, people could not reach their doctor's for help regarding their history. Additionally, most doctors have paper based charts, and those in the wake of Katrina, lost many of their files... This was part of the problem that was brought to the forefront of the medical community's attention. It was a precipitant to wake up and move towards an electronic patient record.

A new interesting website hosted by the American Red Cross is http://www.Safeandwell.org , this website was created to help natural disaster victims get updates on the status of family members, friends and loved ones and to potentially communicate with those involved in rescue efforts.

Is there any reason to not take the time to sign up for a phr? I dont think so, privacy perhaps is the biggest concern, but most phr's are committed to not sharing personal health data.

As you know , we have a free phr service located at http://www.PassportMD.com and although there are many others that are very good as well, I can speak to the purpose and success of PassportMD. It is free and you can print off your medication list before any natural disaster and keep it in your wallet or with you at all times.

Take a few moments to do this and to tell your friends about this, it is very important.

If you do not feel comfortable being prepared for disasters using a phr, let me know why so we can address those concerns and correct them if they are an issue with our service.

Toward Electronic Patient Records

After a decade of debate, electronic records for patients through their doctors is gaining acceptance. EMR's have arrived. I think that it is generally now a "given" about electronic records that it is no longer "if" but now is "when" will my doctor, my hospital or "myself" be a participant in the electronic and digital revolution that is encompassing all of healthcare.

I spent two days touring TEPR2007, the annual trade show for EMR vendors and came to the conclusion that there are a myriad of choices from software vendors, middleware and hardware. The paradigm shift is inevitable and in full swing. EMR's are being standardized and as a result commoditized. Bells and whistles unique to particular vendors but at the end of the day, they all do the same thing.

Certification of vendors as long as not costly prohibitive to prevent creative development by smaller vendors is a good thing. Standardization is a must.

I predict XML will be the winner as the standardization tool with integration and flexibility to maintain CCR, HL-7, X12N, NCPDP and I also think PDF's will move to forefront of medical information sharing capabilities.

Key concepts in the PHR world will be access audit trails and transparency of data, 2 factor authentication and exciting work will be developed as a result of RHIO's and Markle grants.

Where does the future need to take EMRs and PHRs?

As pioneers in the EHR and PMR industry, we have the unique perspective and opportunity to be involved in the "revolution" of healthcare delivery... Are we too early? or Are we too late?

Healthcare is a large continuum that snags and encircles many components from the business end to institutional interests, government, payors, providers, internet "dot commers", web 2.0 , and ultimately consumers... For all of these interested parties to change the accountability, delivery, recording, accuracy, safety, efficiency, there has to be market profitability. The best business minds will win this battle. The best business models understand the unique interactions and behavioral patterns of both physicians, patients, hospital administrators, and third party payors...Physicians with a business acumen may be the most appropriate to head these initiatives...

How does the internet and the digital age impact doctors and patients at the end of the day? How should it impact doctors and patients?
Will doctors adopt and will patients utilize?

How can we make doctors more rapidly adopt? And equally important how can we get patient "buy in" and utilization?

What needs to be done.....

1. Decision support capabilities with alerts and reminders
2. Using clinical data to support research and P4P
3. Phasing in personal health records
4. Improving access, connectivity, data entry, data retrieval and utilization for docs, patients and payors
5. Incorporating medication management
6. Remove cost barriers and time barriers
7. Better interoperability amongst data systems
8. Incentivize, Incentivize , and Incentivize

did you do your cosmetic surgery homework?

A woman having a procedure performed in a California beauty salon died after being injected with "cooking oil" according to American Society of Aesthetic Plastic Surgery recent issued warning about the need to do "homework" before having a cosmetic procedure done.

I just heard recently how a "nurse" injected a patient with a "filler" at a bathroom at a car dealership in Florida.

Excessive numbing creams , like that used after laser hair removal, has been reported to caused deaths of 2 twenty year old women. The FDA has issued a warning about excessive use of this cream as in can lead to irregular heartbeats, seizures, and even death.

With "quick fix" cosmetic surgery on the rise... more and more fraud amongst practitioners is happening...

what stories or advice can you give to others?

Breast Cancer Myths

According to a recent article by Mindy Bohrer, MD in Good Health News, here are 5 myths regarding the most common non skin cancer in women and the second most deadly, Breast Cancer.

Myths about Breast Cancer
1. Having Breast Cancer means Death. Actually 80% of women will live at least 5 years with this diagnosis.
2. Breast Cancer is preventable. Actually, Breast Cancer is not preventable and early detection is critical.
3. Need a family history to develop breast cancer. Actually 80% of women with breast cancer have no family history.
4. A lump in the breast means breast cancer. Actually, 80 % of lumps in breasts are not cancer.
5. Abnormal calcifications on a mammogram means cancer. Actually, 80-90% of biopsies for abnormal calcifications are benign but biopsies are still necessary to rule this out.

Obesity tends to rise and at what costs? What is the thinnest state in the country? Is obesity "all in the family"?

According to a recent article, in HealthLeaders Medica, the cost of obesity extends beyond the condition itself as obese individuals have a increased risk of multiple medical conditions such as hypertension, diabetes, and heart disease.

Translation: Increased health care services and higher costs on a wide scale.

Interesting Notes about obesity:
1. The thinnest state in the country is Hawaii yet more than half of adults are considered overweight or obese.
2. Medicaid children have six times the rate of obesity as compared to private insurers... leading some to speculate that obesity disproportionately affects those who are least able to afford care.
3. Four times as many obese adults report a family history of obesity as compared to non obese adults.

Advice to your Grandkids when Skateboarding

Here are some simple "dos and donts" from the American Academy of Pediatrics that make your grandkids slightly safer when "sidewalk surfing"...

when skateboarding...
1. do wear a helmet, knee pads, wrist braces
2. do wear closed toe , slip resistant shoes
3. do ride on smooth surfaces, avoid dirt and gravel

4. Dont ride skateboards during night, dusk or bad weather
5. dont ride near traffic
6. dront practice tricks unless in designated skateboarding areas.

Health Savings Accounts by American Express?

Now American Express is getting in the act.

What do you think of their new "high deductible health plan"? Is this the answering to our growing problems associated with the cost of our healthcare delivery system?

American Express HealthPay Plus is a payment solution from American Express that works alongside a health plan and includes, surprise, surprise, a "low interest" optional credit line with "no annual fee" from American Express.

Is this a solution or part of the problem?
Ultimately, I think that when market forces are allowed to really dive into our healthcare delivery system.. we will have a better shot at fixing it.. there is no doubt it is broken now.. with 46 million uninsured and corporations unable to continue to afford to foot the bill of increasing costs for their employees..

health savings accounts are growing and may represent a partial fix, let me know your thoughts?

Medical Identity Theft , A Real Issue

Medical theft - an underreported aspect of identity theftAccording to Mark Stalcup, staff writer at the Daily World...he writes
"Imagine a trip to the hospital gone horribly wrong: a patient given the wrong blood type because information is stored incorrectly on his medical records.That scenario has happened, the result of identity theft that allowed thieves - often illegal aliens - to procure medical treatment by assuming someone else's name.Typically, scams begin when someone's driver's license or Social Security card are stolen, then duplicated and sold on the black market. The buyers then assume those identities illegally.Often, these sales are made to foreigners living in the country illegally, said identity theft expert Scott Jennings, who visited Linton this week in an effort to make residents more aware of the dangers that their good name could be stolen.The buyers of these illicit identifications may not even know they're doing something illegal, Jennings said.The altering of medical records is a life-threatening and underreported aspect of identity theft, and strikes victims in the one area where they may believe their personal information is better protected than anywhere else."

This is a real issue and companies like PassportMD are committed to protecting your identity, whether it be medical or anything else. In either case... or scenario, identity theft is a growing , serious and scary reality...
keeping track of your doctors notes, hospital records, physician visits, etc.. makes it easier to protect against this growing threat. Thus mechanisms, like PassportMD or KeepSeniorsHealthy.com, that automate this process make it easier to track and discover if you should fall victim...

Look Before You Leap...Medicare HMO's

HMO's are advertising machines... appealing to the desperate need of the healthcare consumer and preying on the vulnerability of fixed income, financially strapped seniors.... Universal Healh care has a medicare HMO plan advertised as "Any, Any, Any"...advertised that so that it appeals to every senior and apparently claims that they can visit any participating provider and that accepts Medicare. These claims just are not true and physicians are very reluctant to participate with this program.

Last year, Bob Archer, then Pasco-Pinellas coordinator for a program that advises Medicare beneficiaries on insurance options, was so frustrated with Universal's handling of one member's problem that he took the unusual step of reporting the case to the Florida Department of Elder Abuse.
"Universal is light years ahead of everybody in terms of the quantity of complaints," said Archer, who was unable to get Universal executives to return his calls directly. "We seldom get complaints about other Medicare HMOs."

Universal currently needs to ante up additional funds by March 23 2007 or the state will suspend this medicare plan.

If Universal fails to come up with the required reserves, the subsidiary that operates the Any, Any, Any plan will be liquidated and put into receivership by the state sometime next week. State and Medicare officials emphasized that in such an event, members would have the option to move to another private Medicare plan or back to traditional Medicare.

Even without state mandated liquidation, this example speaks to the very cautious nature seniors must approach what appears to be a HMO fix to a broken healthcare system... seniors may go from bad to worse...

so tread carefully if choosing to opt out of a health plan that seems to be working reliably for you or your family members... thoughts?