Mediformatica's Feeds Aggregator

Rolls-Royce establishes presence in Qatar Science and Technology park

(author unknown) — Sun, 15 Nov 2009 22:25:00 PST

In support of Qatar's mission to create a hub for technology development, education and research in the region, this initiative will provide a focal point for activities to develop intellectual capital.

Mysteriously Secretive Group Running Campaign to Oppose Healthcare Reform With Ties to Legal Firm

The Medical Quack — Sun, 15 Nov 2009 19:20:00 PST

This was an interesting article from MSNBC about a group that is working “under the radar” to oppose healthcare reform. As the story states, there is no listing of sponsors, although the law firm attached to the cause represents many in different areas of healthcare. The Blues in North Carolina have denied any affiliation, but as the article states, their clients include hospitals insurers and other healthcare companies. There is no phone number listed and the domain is hidden. ...(read more)

Blood Clotting Drug Lysteda approved by FDA for Treatment of Heavy Bleeding with Menstrual Periods

The Medical Quack — Sun, 15 Nov 2009 18:45:00 PST

The state 3 trials were just completed. The article said use with contraception pills is also not a good idea. I believe this is one of the first non hormone treatment in a pill format (beyond what Midol can do) that had been approved to treat menstrual period with heavy bleeding. This is the same company that markets Darvon, located in Kentucky. It has been around for a while, but now just refined to address other treatment processes other than those with...(read more)

Caffeine and Booze Don’t Mix Well Says the FDA And Wants Supporting Data and Information

The Medical Quack — Sun, 15 Nov 2009 18:21:00 PST

As the article states, this somewhat started with mixed drinks using Red Bull. Coffee in the morning is enough caffeine for me and with alcohol, other than a coffee drink, what is the purpose of flooding additional caffeine into the beverages? The article states that many of them didn’t have a real good taste either. Here are 2 in Orange County that received letters. Are the beverages creating wide awake drunks with more confidence than one would normally exhibit or...(read more)

Health Insurance Company Offering 20% Discount for Members Who Want DNA Testing

The Medical Quack — Sun, 15 Nov 2009 17:52:00 PST

This is interesting and perhaps a way of both helping educate and help the slow growing genomics testing business at the same time. OptumHealth, a subsidiary of United Healthcare is offering the discount. They are not covering the tests, but if patients want to have their DNA tests done, it’s a chance for a bit of a savings. BD NEW YORK (GenomeWeb News) – Pathway Genomics said today that OptumHealth Allies will offer its members a 20 percent discount for Pathway's Health...(read more)

Should we eat salmon at all? Part 2

Vreni Gurd — Sun, 15 Nov 2009 12:28:42 PST

I went to a very interesting lecture a few weeks ago about the decline of the Fraser River sockeye salmon stocks, presented by Dr. Glenn Crossin from the University of British Columbia. His studies of the Fraser River sockeye implicate climate change as one of the most important factors in their almost complete collapse this year. Ten million salmon that were expected to return to the Fraser River, simply did not show up at all. This disastrous collapse has caused the Canadian Government to launch a public inquiry in the hopes that we will not have a repeat of the cod fishery collapse of the early '90soff the coast of Newfoundland and Labrador.

Don’t drink the Kool-Aid: It’s ok to be afraid of bloated EMRs and ease into medical technology

Shahid N. Shah — Sun, 15 Nov 2009 10:51:56 PST

SoftwareAdvice.com recently posed the following questions to its readers in a survey format: “Are more doctors buying electronic medical records than before? Or, has the Stimulus bill only brought out the tire kickers?“. The results of the survey are available here; while the survey wasn’t scientific and it didn’t have enough participants to draw wide scale conclusions, the results do imply a general feeling of positive momentum towards the purchase and implementation of EMRs.

As an experienced healthcare IT professional I am very happy to see that people are looking towards EMRs and automation to improve healthcare staff productivity. However, I’d like to urge a bit of caution and be sure that buyers don’t jump into the market for the wrong reason. My rule about automation and insertion of software in any workflow process is simple: if you can’t repeat it, don’t bother automating it.

How to choose the right software and technology

For most potential users of EMRs, EHRs, and other “complex” workflow automation tools you should ease into the technology. What that means is that before you install any new technology, ensure that first and foremost it does no harm. All technology takes time to implement and get significant improvements; what’s important is that while you’re working towards improvement you don’t harm your business in the process. Technology should first and foremost not make a practice, department, or hospital worse off than it was before the technology was introduced. Then, it should start improving or “healing”.

Second, focus on interoperability and best of breed. Our desired tendency is to go for “all inclusive” or “complete solutions” but healthcare is too complex for any single vendor or package to do everything. By focusing on best of breed and interoperability you can grow at your pace and choose solutions that you really need versus those that the vendors think you need.

Third, Ask the right questions of your vendors and staff when they’re selecting any new technology. Don’t worry about features, functions, and technology. Worry more about your business (which is healthcare and patient happiness) by asking questions like this:

Will my patient be more satisfied because I’m using the system?
Will the outcome of care be improved because I’m using the system?
Can I spend more time on my patient’s care versus documenting the encounter?
How many more patients per day will I be able to see because of the system?
Can I go home earlier because the system helps me finish my work faster?
How many fewer lawsuits will be filed because I used the system?

Fourth, make sure the technology fits with your desired outcomes (not tasks). Almost any software will improve some aspects of your business — but, the question is will the software improve the aspects you care the most about? When asking technical questions, start with some of these:

How can I easily transmit my patient’s medical records in a safe and secure manner without spending all day making copies?
How many more lawsuits will I win because I used the system?
How will the system be able to increase my patient population or help me market my services better?
How much faster can I get paid for my services after I’m using the system?
Can I get secure access to my data while I’m away from home or the office?

Fifth, be sure it can handle all the different kinds of data you have. Most vendors or technology providers focus you on what kinds of data they can manage. But, any reasonable office deals with all the following kinds of data and you need to make sure your selection can manage it:

Structured data (fully coded ICD, CPT, etc)
Semi-structured data (machine understandable but with keywords and such)
Unstructured data (natural language)
Images
Faxes
Audio
Video
Chat logs, e-mail logs
probably many others

Most software systems handle structured data quite well. In fact, EMRs are an excellent way to capture structured data but in my experience structured data makes up only a small fraction of healthcare data. Semi-structured data and completely unstructured data along with faxes make up a big portion of data and medical images make up an even larger portion of the healthcare data pie. Video and email, chat, and other upcoming technologies will be taking up larger portions of database space as well.

When you’re choosing a technology, be sure to look at the kind of data you’re capturing regularly and ensure that the vendor you choose and the deployment model you pick are geared towards the data you create rather than the kind of data the vendor can store. Again, almost all vendors are great at structured data but there are very few that are good a non-structured data, faxes, images, and similar information. When looking at “cloud providers” (online software) make sure that the larger data you capture can be fit through your network pipes.

An EMR isn’t necessarily the first way to automate

While most people who are new to healthcare IT or looking to jump in quickly always point to EMRs as the most important application, there are actually many different healthcare IT applications that make up the “industry” as a whole. When you’re dealing with healthcare IT, EMRs might be a good entry point for some folks but it’s actually more likely that EMRs aren’t your first place to start your automation journey. These are some other techniques I’ve used to kick off automation before jumping into full-fledged EMRs:

E-mail (beware of HIPAA, though) — internal office messaging and email is a great place to start. If you haven’t started your office automation journey here you should.
E-Prescribing — e-prescribing is a great place to start your automation journey because it’s a fast way to realize how much slower the digital process is in capturing clinical data. If e-prescribing alone makes you slower in your job, EMRs will likely affect you even more. If you’re productive with e-prescribing then EMRs in general will make you more productive too.
Office Online and Google Apps (scheduling, document sharing) — Google and Microsoft have some very nice online tools for managing contacts (your patients are contacts), scheduling (appointments), dirt simple document management, and getting everyone in the office “on the same page”. Before you jump into full-fledged EMRs see if these basic free tools can do the job for you.
Clinical groupware — this is a new category of software that allows you to collaborate with colleagues on your most time-consuming or most-needy patients and leave the remainder of them as-is. By automating what’s taking the most of your time you don’t worry about the majority of patients who aren’t.
Patient registry and CCR bulletin board — if you’re just looking for basic patient population management and not detailed office automation then patient registries and CCR databases are a great start. These don’t help with workflow but they do manage patient summaries.
Document imaging — scanning and storing your paper documents is something that affects everyone; all scanners come with some basic imaging software that you can use for free. Once you’re good at scanning and paper digitization you can move to “medical grade” document managements that can improve productivity even more.
Clinical content repository (CMS) — open source systems like Drupal and Joomla do a great job of content management and they can be adapted to do clinical content management.
Electronic lab reporting — if labs are taking up most of your time, you can automate that pretty easily with web-based lab reporting systems.
Electronic transcription — if clinical note taking is taking most of your time, you can automate that by using electronic transcribing.
Speech recognition — another “point solution” to helping with capturing clinical notes; you can get a system up and running for under $250.

If you’re a physician or responsible for managing an office or an enterprise the government and vendors of technology solutions will be pressuring you to “jump on the bandwagon”. Tell them that Shahid said you shouldn’t don’t drink the Kool-Aid and that it’s ok to be afraid of bloated EMRs and ease into medical technology.

•Technology should first and foremost not make a practice, department, or hospital worse off than it was before the technology was introduced. Then, it should start improving or “healing”.

Virtual Reality: Establishing Medical Hallmarks

berci.mesko@gmail.com (Bertalan Meskó) — Sun, 15 Nov 2009 11:25:44 PST

Mauroof Ibrahim, an Animation degree student in LimKokWing University of Creative Technology, Malaysia did an interview with me for a research project “Virtual Reality: Establishing Medical Hallmarks”. I asked him to publish the comprehensive results in a well-structured form on Scribd. Enjoy:

View this document on Scribd

Guest Article: Open Source EMRs for free clinics

Shahid N. Shah — Sun, 15 Nov 2009 09:46:21 PST

Kevin Clifford and I were chatting about his experiences in taking a Michigan-area free clinic live on an open source EMR and I was very interested to share it with others. Kevin said he volunteered at the free clinic because he wanted to serve his community and said that there are many other such free clinics in need of IT improvements in Michigan and elsewhere. I asked him to write a quick summary of what he did and how it worked. What Kevin is doing is an excellent example for other IT firms looking to break into healthcare IT — use open source and other free tools to help your local community clinics and physician offices. Here’s what Kevin had to say about his experience:

I recently started volunteering at a free health clinic in Pontiac Michigan. The clinic has 30 doctors and dentists that volunteer their time seeing 500 to 600 uninsured patients per month. The clinic has an in-house pharmacy and three full time employees. I have an I/T background so my original intent was to help the clinic with any technical issues they may have such as setting up their website and network. Once I started working at the clinic I noticed they were having trouble keeping track of patient files and were making all appointments on paper. In addition they had to go through all their files monthly in order to track specific patient categories and follow-up on missing information.

I suggested to the clinic that they try OpenEMR, an open source EMR system. They liked the demo I showed them and I started the installation. I installed the OpenEMR appliance which runs on the VMware virtual server, the appliance allowed me to run the LAMP version of OpenEMR on a windows machine. I then configured the appliance so it would use a static IP address.

Once the program was up and running I changed the layouts and added fields for specific information that the clinic needed to collect. The most time consuming and labor intensive part of the install was in transferring all the patient records over to the program. Through the PHPMyAdmin part of the tool I was able to create the SQL queries that allowed the clinic to run the specialized reports that they needed. Our plan at the clinic is to continue exploring the capabilities of OpenEMR in order to improve the clinics efficiency even more.

The program has allowed the clinic to:

Schedule patients and doctors electronically
Manage patient encounters
Save time by running reports on patient data

Due to the current economic environment the number of patients seen at the clinic has risen dramatically over the last year and there is currently a waiting list. There are a number of similar clinics located throughout the country that could improve efficiencies by installing an open source EMR system. I would like to expand the service on OpenEMR implementations to free medical clinics and am looking for thoughts and advice from the community.

If you have any suggestions or are interested in working with me on this endeavor please provide feedback here on Shahid’s site via comments if you want to speak publicly or if you prefer private communication you can contact me at kclifford@gmail.com.

Most Insurers in Massachusetts Still Posting Profits – One HMO Loses Money

The Medical Quack — Sun, 15 Nov 2009 09:29:00 PST

As everyone is probably aware, Massachusetts is the only state that has required consumers to have health insurance and has been discussed in depth many times. Their model could be a partial model for our care in the US, but there are still discrepancies and problems that live in their system too. One item addressed by Paul Levy, CEO of Beth Israel Deaconess Hospital suggests part of the problem is a lack of competition. That issue is not unique to Massachusetts as other states...(read more)

Remote Area Medical Holds Free Healthcare Clinic in Union County Tennessee

The Medical Quack — Sun, 15 Nov 2009 08:58:00 PST

I think we all remember when Remote Area Medical came to Los Angeles. I was busy here posting updates on the free 8 day medical clinic that was held at The Forum. Tennessee is the only state that allows doctors to cross state lines, thus of course it is a popular location for the clinics. Insured and uninsured are driving from as far away as New Jersey for care. The lines are long and the wait time is worth it for no strings attached care offered for the day. In...(read more)

Google Flu Shot Finder

berci.mesko@gmail.com (Bertalan Meskó) — Sun, 15 Nov 2009 08:54:50 PST

Google is now trying to collect information about flu shots across the USA. Here is an example featuring where you can find seasonal (red) and H1N1 (blue) flu shots near New York.

An excerpt from Google Blog:

You can check out the flu shot finder at www.google.com/flushot. The same tool will also be available shortly on www.flu.gov and the American Lung Association websites. It’s important to note that this project is just beginning and we have not yet received information about flu shot clinics for many locations. In addition, many locations that are shown are currently out of stock. We launched this service now in order to help disseminate information about locations where vaccines are available, and also to make more vaccine providers aware of the project so that they can contribute.

It’s a shame it’s only avaliable in the US at the moment.

FDA Panel Looking at New Type of Flu Vaccine – Using Genomic Technology

The Medical Quack — Sun, 15 Nov 2009 08:25:00 PST

We have all been looking for more flu vaccines and the companies seem to not be able to meet the demand, which is big. Now the FDA is looking at an alternative solution which appears to be gnomically based. One of the benefits here is the time it takes to manufacture, FluBlok can be made in two weeks where the one we use now which is made from chicken eggs takes more time. The government back in June has already provided a grant for it’s production. This process is using worms...(read more)

Red Cross to Use Text Messaging

The Medical Quack — Sun, 15 Nov 2009 08:13:00 PST

The Red Cross will allow those wishing to donate to receive text messages when it is time again to donate. When blood levels are down potential donators will be sent a reminder message. BD The Red Cross Blood Services, South Central Division has implemented a mobile media program offering people the opportunity to sign up for text alerts on blood inventory levels, receive educational information about donating blood, make their next donation appointment or locate the nearest...(read more)

Leavitt Retiring from CCHIT

The Medical Quack — Sun, 15 Nov 2009 08:11:00 PST

CCHIT, the certification for electronic medical records and standards has been in the news quite a bit lately, even with a company in Texas making the offer to certify records. As technology gets more complicated and certification of the algorithms used for records gets more complicated, so goes the processes too. We have been seeing many in key positions lately retiring or leaving and one question that comes to mind is how much stress and pressure goes along with these key positions...(read more)

Mercy Medical Center in Baltimore – Employee Allegedly Stole Patient Information

The Medical Quack — Sun, 15 Nov 2009 07:48:00 PST

We talk about privacy all the time and here’s one more case where an employee took information to use for personal gain. This one appears to be strictly financial with the focus on credit cards. BD City police are investigating a former employee at Mercy Medical Center. He's accused of stealing personal information and using it to apply for credit cards and loans. Going to the hospital is often painful enough. Learning personal information may have been stolen by an employee...(read more)

European Personalised Medicine Diagnostics Association

berci.mesko@gmail.com (Bertalan Meskó) — Sun, 15 Nov 2009 05:22:05 PST

We all know about the Personalised Medicine Coalition:

The Personalized Medicine Coalition (PMC) is an independent, non-profit group that works to advance the understanding and adoption of personalized medicine for the ultimate benefit of patients. Our diverse members work together to educate opinion leaders and the public about the issues that will shape how personalized medicine develops — and how quickly all of us can benefit from it.

Now I was glad to see the European Personalised Medicine Diagnostics Association just launched as reported by GenomeWeb.

Made up of biotechnology firms, academic and institutional researchers, small and large businesses, and patient advocacy groups, the European Personalised Medicine Diagnostics Association (EPEMED) announced its board of directors this week. Included on that board are executives from Ipsogen, Genzyme Genetics, Oncomethylome Sciences, the Personalized Medicine Coalition, BioMerieux, Theranostics, and Novartis Molecular Diagnostics.

EPEMED says its central goals are to move personalized medicine forward throughout Europe through targeted education, idea-sharing, and business models, and to promote harmonization in Europe’s approach to personalized medicine.

Sharjah Art Museum organises breast cancer awareness lecture

(author unknown) — Sun, 15 Nov 2009 06:19:24 PST

UAE. Eman Mahmoud, health education specialist, led the lecture, which focused on the early detection of beast cancer, how to self examine, and ways to manage the disease condition.

SAE Institute celebrates 20 successful years in Singapore

(author unknown) — Sun, 15 Nov 2009 06:19:24 PST

INTERNATIONAL. SAE Institute Singapore opened its new campus at the prestigious The Riverwalk Galleria as it celebrates 20 years of providing quality creative media education.

Market failure --> New entrants?

noreply@blogger.com (Paul Levy) — Sun, 15 Nov 2009 03:45:00 PST

This story by Rob Weisman in today's Boston Globe is about large insurance rate increases being faced by small businesses in Massachusetts. But, it is really about the lack of effective competition in the Massachusetts health care market, both on the provider side and the insurer side.

Although there are many contributors to rising health care costs in the state, one major one is the fact that the largest provider system is paid rates that far exceed the rest of the industry. This is the result of its market power and leverage over the insurance companies during rate negotiations. Yes, part of the problem is a fee-for-service payment regime that encourages overuse; but that is compounded when the dominant system's FFS rates are very high relative to the market. Why? Because it enables that system to recruit community physicians into its network at higher salaries, away from other systems. Those local doctors, in turn, refer their patients to the higher priced hospitals in that same network. This is a vicious cycle of higher rates, leading to network growth, leading to still more bargaining power, leading to higher rates.

Why do the insurers put up with this? Because there is a public perception, unsupported by clinical outcomes data, that the dominant provider must be part of any insurance plan's network. The plans, therefore, are afraid to leave those hospitals out of their insurance products. They also seem reluctant to create a market for insurance products that would charge customers a higher co-pay or add other features that would encourage the patients to go to lower-priced facilities.

The result: Utilization in the network served by the dominant provider grows at a rate exceeding the regional average. And because that utilization is reimbursed at a higher differential rate, the insurance company sees a huge cash outflow, and feels it necessary to raise rates -- especially to the market segment that has the fewest choices.

The second problem is a similar lack of competition in the insurance market itself. In any other industry, a competitor would enter the market and create a niche product -- a plan for small businesses and individuals, based on a limited high-quality, low-cost provider network.

National insurance companies have had a very small market presence in our state. Those who have thought about expanding their share of the Massachusetts market are probably concerned about the relative costs of doing so or about the ability of the insurers in this state to simply underprice their products. Well, we now see evidence that even the dominant insurer might feel it cannot afford to respond competitively to a new market entrant. That insurer, along with the others, is so persuaded of the market power of the dominant provider that it has been reluctant to take on that provider by leaving it out of its product mix or by including it at the premium price necessary to cover its costs.

A new entrant might feel differently and focus its efforts on a vulnerable market segment, one that would find a high-quality, low-cost network attractive. When you are fighting for your financial life as a small business or individual purchaser of insurance, you are more willing to make different kinds of choices. And, as a small business, you can more easily explain to your employees why you have done so.

To me, this seems like an opportunity for competition.