The Healthcare Information Systems Blog

I've Moved

2010-04-25T21:39:00.003-04:00

This blog is no longer being updated. I've begun a new blog, Wellness & Technology.

CDHPs No Longer a Euphemism for Cost-Sharing?

2009-02-24T21:48:00.001-05:00

Three fiscal quarters into my new role at work I am pleasantly surprised to discover that CDHPs have quietly evolved from a disingenuous cost-sharing scheme foisted on workers by employers (see the Pollyannaish video, below) to a proactive, multifaceted approach intended to achieve “a pluralistic system that empowers patients and demands accountability from individuals and the health system, while adequately supporting the needs of the disadvantaged.”

Moreover, the criteria for determining whether or not these lofty goals are met are both simple and progressive:

Consumer-driven programs must encourage and attract enrollment from the sickest members as well as the healthy.
Consumer-driven programs must work for those members who don’t want to get involved in decision-making as well as for those who do.

Granted, the above is only Wye River Group’s take on the matter, but given that it comes directly from their An Employers’ Guide to Healthcare Consumerism which was published in 2006 I am inclined to take them at their word and note this as a sea change in suppliers’ attitudes towards the healthcare crisis in this country.

What Wye River Group refers to as healthcare consumerism is a synthesis of old and new ideas as well as delivery and payment models in the healthcare market. It encompasses consumer-driven health plans, value-based benefit design techniques, and good old-fashioned managed care (as opposed to managed access and/or managed costs).

Despite its name, healthcare consumerism isn’t mutually exclusive of government involvement. Indeed, the techniques it espouses could go a long way towards making the already superior healthcare model in place for US military veterans that much more cost-effective and efficient – not to mention portable to state and local governments and private industry.

There are few people as skeptical of for-profit payers as I am, but in light of this evolution of thought in the consumer-driven healthcare space I am open to – and hopeful at the prospect of being – proven wrong.

Election Results and Their Healthcare Implications

2008-11-05T07:05:00.008-05:00

Last night's historic election of Barak Hussein Obama as the 44th President of these United States isn't just a watershed moment in American history, the U.S. civil rights movement, and world affairs; it also signals the turning of a new page in the realm of U.S. healthcare policy.

How many pages will be turned remains to be seen at the federal level, but here in Michigan two ballot proposals passed that will have immediate implications for those of us with an interest in health and wellness.

Proposal 1, legalizing medical marijuana use at the state level passed with more than 60% of the vote.
Proposal 2, which would allow the donation of unused embroyos from fertility clinics, passed by a more narrow margin, but passed nevertheless.

Both proposals were met with stiff and frequently hysterical and baseless opposition. Proposal 2 opponents wanted to see Michigan's ridiculous existing laws that punish researchers who utilize discarded human embroyos with a $5 million dollar fine and prison time remain on the books.

Proposal 1 opponents thought they knew better than Michigan's healthcare professionals and the patients themselves about the benefits and risks of medical marijuana use. They were wrong, the prohibition against medical marijuana use was wrong, and last night Michigan voters showed them just how wrong they were.

The era of politically sanctioned stupidity appears to be over - for now, at least. The triumph of reason and rationality over fear and ignorance in Michigan appears to have been replicated around the country. Also worth noting last night:

Colorado's "Personhood" initiative that would repalce the science of pediatrics with one small group's narrow interpretaion of Christian scripture failed. (I can't help but point out that the initiative's "leading proponent" literally sat on the floor at a man's feet while watching the election returns - this picture pretty much sums-up where this sort of proposal comes from and where it ultimately leads to!)
South Dakota's back-door attempt at setting up Roe v. Wade to be overturned failed. Again. Leaving a woman's right to choose where it belongs - in the capable hands of the woman herself and her doctor.
In California, Proposition 8 is still too close to call. Given that homosexuality clearly exists in nature, I can only hope that Californians aren't duped by religious bigots peddling hate - and that when Proposition 8 fails, gay men and women are smart enough to treat the institution of marriage with more deference and respect than their heterosexual counterparts do. Clearly, America has come a long way towards waking itself from its self-induced eight-year nightmare, but it's equally clear we still have a long way to go.

Still, for the first time in a long time, we have something we haven't had to support us along the way: hope!

Gay Men, Straight Women Have Similar Brains; Pat Robertson to Advocate Forced, Publicly Funded Lobotomies

2008-06-16T23:10:00.010-04:00

Actually, I made that last half of the title up, but it wouldn't surprise me if he did.

National Geographic News reported today that heterosexual men and homosexual women, and their respective opposites, share significant physiological and neurological similarities in their brains.

Differences both in the brain activity and anatomy were observed in a study involving 90 men and women, including homosexuals and heterosexuals of both genders.

The researchers monitored neural activity in the brain by charting blood flow.

The scans were carried out when the volunteers were resting and exposed to no external stimuli.

Researchers focused in particular on the amygdala, an almond-shaped structure inside each brain hemisphere associated with processing and storing emotions.

In homosexuals, brain activity most closely matched that of heterosexuals of the other sex.

Source: Gay Men, Straight Women Have Similar Brains

While the full implications of the study aren't yet clear, interesting observations were made that would seem to explain the origins of stereotypes about gay men being inherently more creative and "artistic" than their straight counterparts, and gay women so often being "butch:"

[T]he study found that straight men and gay women are both wired for a greater "fight or flight" response than gay men or straight women, the team reports this week in the journal Proceedings of the National Academy of Sciences.

Also, homosexual men and straight women showed significantly more neural connections across the two brain hemispheres than heterosexual men did.

ibid.

Of course, these are stereotypes. There are boorish, slovenly, aggressive and abusive gay men (I know, I've dated a couple of them) and there are "lipstick lesbians" who are indistinguishable from heterosexual "babes" except for their taste in men (which is to say, it's completely absent). Still, stereotypes, like myths, often have their basis in fact, however distorted or misunderstood those facts may be.

The study also doesn't do much to shed light on the (again, stereotypes) similarities between homosexual men and women and their heterosexual counterparts. For example, many biological determinists have posited that heterosexual males are driven by biology to copulate with as many partners as possible to propagate their genes. Assuming there's any validity to this argument at all, if gay men are "wired" like heterosexual women, where do the incidents that underlie the stereotype of the unfaithful, promiscuous gay man come from? Why "behave like a man," if you're "programmed" like a woman?

Conversely, if gay women are "wired" like heterosexual men, why aren't lesbians disproportionately more prone to violence and criminal behavior when compared to gay men the way that heterosexual men are when compared to heterosexual women?

While incidents of heterosexual women abusing their heterosexual male partners are almost certainly higher than reported numbers would indicate, males are more violent than females. Yet same-sex couples of both genders show the same levels of domestic violence as their heterosexual counterparts; how can this be if homosexual males are supposedly genetically predisposed towards flight and homosexual females are predisposed towards fight?

While I think the science of sexuality is interesting, I also think it's rather pointless because ultimately what it comes down to is what two (or more if that's your thing) consenting adults are comfortable with. Whatever that might be, if you've got a problem with it, it's your problem.

"Diabetes Reloaded," a Health 2.0 Montage that Joseph Conn Would Love

2008-06-15T14:30:00.007-04:00

Props to Richard MacManus at ReadWriteWeb for highlighting this YouTube video in a post entitled How the Web is Enabling Consumer-Driven Healthcare.

While I don't think Diabetes...RELOADED actually explains how the Web is enabling consumer-driven healthcare, I do think that it presents a great thumbnail sketch of the Health2.0 paradigm that Joseph Conn so eloquently explains in his December, 2007 post Health 2.0: The next generation of Web enterprises at Modern Healthcare Online.

In his piece, Conn restates the seven elements of "Web 2.0" as they apply to healthcare, with an emphasis on the first three:

Web 2.0 products improve as more and more people make use of them.
Web 2.0 products must "harness collective intelligence," i.e.: leverage "the wisdom of the crowd."
Web 2.0 products take the outcomes of harnessed collective intelligence and enhance them with specialized knowledge, then return these enhanced outcomes back to the crowd - and the cycle repeats.

They say a picture is worth a thousand words; Diabetes...RELOADED summarizes the very abstract concepts that make up Health2.0 in 3 minutes, 12 seconds; it's more than worth your time and attention.

I've Been Shmapped!!

2008-06-13T15:10:00.007-04:00

Please excuse me while I pat myself on the back over this...

Hi Jeff,

I am delighted to let you know that your submitted photo
has been selected for inclusion in the newly released
second edition of our Schmap Northwest Guide:

Whidbey Island
http://www.schmap.com/northwest/water/p=302080/i=302080_8.jpg

If you like the guide and have a website, blog or personal
page, then please also check out the customizable
widgetized versions of our Schmap Northwest Guide, complete
with your published photo:

http://www.schmap.com/guidewidgets/p=79461431N00/c=SG33032501

Thanks so much for letting us include your photo - please
enjoy the guide!

Best regards,

Emma Williams,
Managing Editor, Schmap Guides

Here's the photograph in question:

Picture 057 by Jeff O'Connor

I am not a professional photographer, or even an amateur photographer except in the most literal sense of the word, so I feel very good about being included in the Shmap!! Guide. Although my photographs are not uploaded to Flickr under a Creative Commons license, I do make use of Creative Commons-licensed images in my freelance Web work; I feel like I've given something back.

Related posts:

Liars, Damned Liars, and the Heartland Institute, Part I of III

2008-06-10T06:54:00.017-04:00

Just as The Heartland Institute purports to be a non-partisan think-tank, so, too, does the monthly rag it puts out every month purport to be news, specifically, Health Care News.

It ain't so.

Every first-year high school debate student learns about fallacious arguments. It's a requirement and something you had better learn well unless you want your argument to fail, your proposal to lose, and what little social standing there is to be had from membership on the debate team to be negated by having your ass publicly handed to you by an even bigger geek at a public (albeit most likely unattended) public event.

I speak from experience here.

As the saying goes, things change.

In our modern era of corporate media, where a powerful and wealthy few dictate what constitutes both entertainment and news, as well as their bastard offspring - infotainment, the validity and coherence of one's argument doesn't matter; volume does.

Volume can be measured in decibels (talk radio), eyeballs (Drudge Report), Nielsen Ratings (Fox News, Desperate Housewives), circulation (The National Enquirer), or some combination thereof. Health Care News apparently knows how to pump-up the volume: according to their masthead they reach 53% of all healthcare professionals.

I know that healthcare is a business, and that even the most selfless non-profit organization has to figure the bottom line into the equation somewhere, but it is my sincere hope that when most healthcare professionals and the organizations they work for need to get a feel for the pulse of the nation on important questions of the day, they'll keep in mind that Charmin is a better quality paper than The Heartland Institute's propaganda organ is.

Why am I being so hard on Health Care News? For starters, they have a widget on their site that is a consistent part of their navigational structure that declares Crichton is Right! This is a reference to science fiction author and 2006 American Association of Petroleum Geologists Journalism Award-winner Michael Crichton, whose novel State of Fear denies the science of the greenhouse effect and slanders The New Republic Senior Editor Michael Crowley.

With both John McCain and Barack Obama in favor of joining some version of the Kyoto Protocols and enacting some sort of carbon cap-and-trade system, this ranks The Heartland Institute right up there with holocaust deniers and The Flat Earth Society in my book.

Is this unfair of me? Am I painting with an overly broad brush? Am I resorting to unjustified Ad Hominem attacks and throwing the baby out with the bathwater just because I think Michael Crichton is a despicable human being and corporate drama whore who is trading on name recognition in lieu of long-since-gone talent?

I don't think so.

Here's a critique of their three-article, red-letter Single-Payer expose'.

Read it.

Better yet, read the original articles independently of my critiques, and decide for yourself.

Meanwhile, I will be tackling all three of Health Care News' extremely fallacious and biased articles one-at-a-time over three posts. First up:

Russia's Failed Universal Health Care Program Exposes the Perils of Single-Payer Systems

This article attempts to paint a picture of what universal healthcare in the United States will look like by describing in lurid detail what's going on at the bottom of the barrel in Russia's healthcare system.

For this article alone, the fallacies include:

If you look at the subheadings in this article, two of the three read like they're straight out of the tabloids:

Awful Facilities
Rampant Corruption
Proposed Solutions

Now sing along withe me:

One of these things is not like the others,
One of these things just doesn't belong,
Can you tell which thing is not like the others
By the time I finish my song?

Did you guess which thing was not like the others?
Did you guess which thing just doesn't belong?
If you guessed this one is not like the others,
Then you're absolutely...right!

The first section, Awful Facilities, is clearly an Appeal to Fear as it describes Russia's hospitals in the following manner:

Many state-run hospitals, particularly in remote areas, do not have hot water, and some do not have running water at all. Even the most basic medicines are often in limited supply.

This is an attempt to form a Post Hoc fallacious argument. It fails in this regard, however. Awful Facilities actually Confuses Causes and Effect - the Russian Federation is the successor to the collapsed Soviet Union and the product of more than a decade of economic decline before its recent economic stabilization. Consequently, it's healthcare infrastructure isn't a shambles because the country's national, single-payer healthcare model is a failure; the country's national, single-payer healthcare model is a failure because the country's healthcare infrastructure is a shambles!

The article then tries to draw a direct linkage between these sorts of conditions and not just healthcare reform in general in the United States, but healthcare reform originating with one particular political party:

Healthcare is far too important to leave to politicians - be the autocrats or Democrats [sic]," said John R. Graham, director of health care studies at the Pacific Research Institute.

Did you spot the Ad Hominem fallacy? It's tricky because it's also an example of Guilt by Association. In the above statement, the poor state of the Russian healthcare system is the fault of the autocrats, who are synonymous with Democrats! Since all Democrats are autocrats, and autocrats can't be trusted to administer healthcare, then obviously neither can the Democrats.

Finally, with the Democratic Party poised to increase its congressional majority in November and favored to win the White House as well, a Slippery Slope is hinted at: if Democrats are autocrats, and autocrats believe in large, ineffective healthcare bureaucracies, then putting Democrats into power will increase the likelihood and speed at which the U.S. healthcare system will come to resemble the failed healthcare systems in states run by autocrats (i.e.: the U.S. will be just like Russia if the Democrats get their way).

Though I can't imagine why, the author goes on to further develop the linkage between Russia's incredibly corrupt and byzantine bureaucracy and government healthcare by painting the faithfully terrifying picture of government bureaucrats picking the pocket of ordinary tax payers and giving them absolutely nothing in return - a Hasty Generalization if ever there was one:

"The Russian 'free healthcare for all' system is nothing of the sort," said Jeff Emanuel, research fellow for healthcare policy at The Heartland Institute and managing editor of health Care News. "Instead, it is simply another program built on governmental taking of taxpayer fund and mismanagement of the services it promises to provide."

You see, in the neoconservative fantasy land that Jeff Emanuel lives in, any single failed government program from any government anywhere is proof that all government programs from all governments everywhere will fail! And be sure to take a good look at just who Jeff Emanuel is: the editor of the very publication the article appears in! While this isn't a logical fallacy, it certainly makes him a less than objective - and therefore credible - subject matter expert for this particular piece.

The article fails the Biased Sample test because it holds up Russia's national, single-payer healthcare systems up as the only example of a national, single-payer healthcare system. Moreover, by sensationalizing this small sample, the article is guilty of Misleading Vividness, as the statistical evidence doesn't bear out the original premise.

Despite the fact that there is currently no legislation before Congress to institute a national, single-payer healthcare system, nor a presidential candidate from either party intending to introduce one (a Factual Error), even if universal coverage and a national, single-payer system were the same thing (which they are not), citing only Russia as a representative example of such a system is not only a Biased Sample fallacy, it also grossly distorts the success of the many other national, single-payer healthcare plans of every other industrialized country, all of whose citizens enjoy a comparable or superior degree of health and wellness than the average American does from healthcare systems that universally consume fewer resources and produce comparable or superior outcomes to our own.

(It is also insulting to the intelligence of anyone who has been paying attention since 1991 and knows that for all of our problems, the United States and the keystone republic of the former U.S.S.R. have about as much in common as William McGuire and Mother Theresa when it comes to infrastructure and other assets to bring to bear on their respective national healthcare concerns!)

In fact, according to the CIA World Factbook, as of 2007, per capita GDP in the Russian Federation was $14,600 - less than .33% (one-third) of per capital GDP in the United States of American ($46,000) during the same period!

Despite the enormous differences between the two counties, the average life expectancy at birth for all Russians is 84.5% that of their American counterparts, a difference of only 15.5%. Based on these numbers, if the United States were to adopt the horrific Russian healthcare system in its current form in its entirety tomorrow, but maintain current U.S. healthcare spending levels, median life expectancy at birth for all Americans would exceed 129 years!

Life Expectancy at Birth	Russian Federation	United States of America
Total population	65.94	78.14
Males	59.19	75.29
Females	73.1	81.13

Life expectancy: Russian Federation and United States of America as of 2007

Source: CIA World Factbook

Now, I know that this is a Misleadingly Vivid example, but then again so is Health Care News' representation of the Russian healthcare system as a legitimate cautionary tale for healthcare reformers in the United States looking to implement some form of universal coverage or otherwise assure care is made available to nearly 50 million of their fellow uninsured citizens.

As I pointed-out above, Rina Shah bases her entire article on a Factual Error when she presents the situation in Russia as an example of a failed universal healthcare system. However , Russia's implementation of universal healthcare is a national, single-payer universal healthcare system; there are no proposals for implementing such a system in the United States from either political party or presidential candidate.

I would argue that the entire article is nothing but a Strawman, but the second section, Rampant Corruption, is particularly egregious. In two paragraphs, the article's author serves up all of the quantified data in the entire piece, but they have nothing to do with single-payer or universal healthcare plans; on the contrary they have everything to the country's overall poor standard of living and lack of effective regulation and oversight of the Russian healthcare market. According to the article:

Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.

Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care.

Do you see the Strawman here? The figures presented above only proves that Russia's healthcare market is inadequately policed; it doesn't prove that universal or single-payer healthcare systems are inherently corrupt or result in substandard wages for healthcare professionals. The average pay of Russian healthcare professionals is also something a Red Herring: compensation of individual healthcare practitioners is not an indicator of the likelihood of an overall healthcare market's ability to function efficiently, as the performance of healthcare markets from Canada to Cuba clearly show.

The article's concluding section, Proposed Reforms, is nothing of the sort. Instead, it merely serves to Poison the Well:

Reforms drafted this spring by the Russian Federal Assembly include placing higher emphasis on primary care, shutting down numerous substandard hospitals, scaling down the scope of free medical assistance guaranteed by the state, and increasing physician salaries by reimbursing doctors according to the number of individual treatments given instead of by the number of hours worked.

"Instead of forcing people to pay into this failed program, Russia's government should allow the market to influence the health care system, which it can begin to do by allowing its citizens to choose how their own health care money is spent," Emanuel said.

So-called "universal" health care does not actually exist, says Graham.

Do you see what's going on here? The reforms proposed by the Russian government are never addressed. Instead, they are summarily dismissed.

That's the the set-up; here's the pitch:

"At best, in a functioning democracy like Canada or Britain, it results in unequal access to health care by government rationing, lack of investment in innovation, and shortage of medical professionals," Graham pointed out. "At worst, in a country with little democratic bona fides, it results in the situation we are seeing in Russia."

The author has taken great pains to paint an unfavorable, ugly, and frankly prurient (from a healthcare policy perspective) picture of Russia's national, single-payer healthcare system. Having savaged the concept generally (i.e.: Poisoned the Well), Rina Shah sees no reason to bother backing up the claims made in the concluding paragraph about the failings of universal healthcare systems in functional democracies, which are better and more realistic models for potential universal healthcare solutions in the United States. Which was clearly her intention all along.

Next up: My adverse reaction to Universal Health Care is the Wrong Prescription

Federal Appeals Court Justice Dispense a Little Justice for the Blind

2008-05-20T13:48:00.012-04:00

It took eighteen months, but my stance on the Bush regime's refusal to accommodate the blind in the midst of numerous coin and paper money redesigns - along with those who were being discriminated against by the regime's callousness - has been vindicated!

In a ruling made today, a federal appeals court concluded that the United States refusal to design its paper money in such a way that the visually impaired can determine its value violates the Americans with Disabilities Act. In a snarky summation that I wish I had thought of when I first posted about this in December, 2006, the court held that the government's position that the blind should count on the kindness of strangers - and credit card companies - is bullshit.

The government might as well argue that, since handicapped people can crawl on all fours or ask for help from strangers, there's no need to make buildings wheelchair accessible, the court said.

Justice delayed is justice denied; get to stepping, Mr. Snow!

Related posts:

"Compassionate Conservatism" Rings Hollow with Bush Regime's Approach to, Well, Everything

DC Comics to Children with Cancer: Drop Dead!

2008-05-16T07:47:00.014-04:00

It's not often, if ever, that I post something that would expose a deep, dark secret about my personal life on The Healthcare Information Systems Blog, but this story is forcing me to come out of the closet.

Yes, it's true - I am a comic book fanboy.

Admittedly, I don't actually purchase comic books. Thanks to the magic of the World Wide Web and Border Books and Music's browser-friendly policies, I don't have to buy the books to keep up with the exploits of my favorite characters (who, being the Marvel Family, means there's usually very little material for me to keep up with).

But I digress.

The reason for this post is to publicly shame the over-stuffed suits at Time-Warner for pulling the plug on an eBay auction of original comic book art featuring their trademarked characters that was intended to benefit Candlelighters, a charity for children coping with cancer.

From BoingBoing:

Thomas Denton of comic blog Say It Backwards has a nephew who was diagnosed with cancer. A charity called Candlelighters helped his family out. Thomas decided to use his connections in the comics world to organize some charitable auctions featuring original artwork by various artists to give something back to the organization. Apparently Time Warner (who own DC comics, who in turn own Superman, Batman and most of the cool superheroes who wear capes) objected to the selling of the pieces featuring their copyrighted and trademarked characters on eBay, specifically Superman from what I understand.
Using characters owned by the major comic book corporations is pretty common in charity auctions at comic book conventions. This is not to mention that if you go on eBay right now there are a lot of auctions for artwork featuring those same characters, none of which Time Warner seems to be going after.
Thomas has posted a statement apologising to everyone involved in the affair (artists, bidders), but it doesn't seem right that he's been left holding the bag for trying to something for sick kids. Some letters to Time Warner's PR department might make them think twice about sending out cease and desist orders so wantonly, and who knows, might even prompt them to kick some cash Candlelighters' way.

Now, despite the fact that the only reason Superman hasn't entered the public domain is because Congress consists almost entirely of whores willing to lie on their backs and take it (corporate largess) at the expense of the common good, Time-Warner hasn't made much of a fuss about artists selling original works featuring their characters - including Superman - until now.

Hmm... Maybe it's not such a shocking development after all...

So what is it about cancer-stricken children that Time-Warner's corporate ass-clowns hate so much? My money says it's their resemblance to Lex Luthor what with the hair loss and all, but what the hell would I know since I actually value the health and wellbeing of children over making another buck off of a character whose generated billions of dollars in revenue for his faceless corporate overlords, yet whose creators almost died penniless?

So if you agree with me that Dan DiDio and the rest of DC Comics senior executives are a bunch of douchebags who should be ashamed of themselves, please feel free to contact their corporate offices and wish them a speedy trip to hell. Here's the contact information:

DC Comics Inc.
1700 Broadway, 7th Fl.
New York, NY 10019-5905
NY Tel. 212-636-5400
Fax 212-636-5481

Better yet, put your money where your heart should be and boycott The Dark Knight.

Personally, it will be a cold day in hell before I put another dollar into Time-Warner's pocket when they're turning four-color comic book heroes against terminally ill children!

I Have a New Position

2008-05-09T07:46:00.008-04:00

Effective May 25, my position will change from Lead Systems Analyst, Information Systems to Market Research Manager, Corporate Product Development at the managed care organization I work for.

I still intend to maintain The Healthcare Information Systems Blog; it's my hope that this change will help breathe new life into it as I will be dealing more directly with the business of healthcare and not just the technological underpinnings of the particular healthcare organization I am employed by.

As I have in the past, I thank you again for your patience as I try to balance my desire to contribute in a meaningful way to the online discussion of the future of healthcare and my off-line responsibilities.

The Virtual Doctor's Dilemma – Short-Term Pain for Long-Term Gain

2008-04-03T09:16:00.010-04:00

I heard on NPR this morning as I showered that Aetna and Cigna would begin paying for online healthcare; Medical News Today confirms the story.

Apart from the obvious implications for EMRs (the adoption of online healthcare should stimulate, indeed - necessitate - their development), this is the part that I find particularly interesting:

Cigna members will contribute their usual copays, and physicians will be paid $25 for a Web visit, compared with $65 for an office visit. Aetna pays physicians $25 to $35 for a Web visit, compared with about $35 to $100 for an office visit. Aetna members contribute the same copay for either type of visit, and high-deductible plan members pay the whole fee.

In the United States, an "office visit" is usually defined as a six-minute period of interaction with a ~~customer~~ patient. A common complaint about the U.S. healthcare system is the feeling of disconnect between patients and doctors, and the fact that health insurance companies usually only pay for six minutes of a doctor's time regardless of how much actual time is spent with each patient goes a long way towards explaining why the typical doctor-patient relationship is about as intimate as Elliot Spitzer's marriage.

Under the payment schemes outlined above, a Web visit pays about half of what an office visit does, but there's no guarantee that the amount of time involved in reading the patient's email, consulting his or her history, and generating a response will take less time than an actual face-to-face visit with a physician. Therefore, there's no guarantee that a doctor can make up in volume what he or she stands to lose in the way of in-person patient consultations. Even if they did, it's highly unlikely that physicians themselves will be sitting down in front of a keyboard and entering direct responses to their patients; that's something they'll have to pay clerical staff to do - an additional cost.

I don't know what the future will bring, but I do believe that as the Web becomes more ubiquitous, efficient, and interactive, online healthcare will eventually become common and profitable - the keyword being eventually.

In the near-term, however, an aging population that uses the Web disproportionately for health and wellness information, a medical establishment that is infamous for being technologically inept and therefore unprepared for the demands about to be placed on them by Web-saavy baby boomers, and a lack of standards for everything from EMRs to Internet accessibility will result in online healthcare being an overall burden on healthcare providers that reduces their compensation and further erodes the already tenuous doctor-patient relationship.

This Isn't Supposed to Happen on Facebook

2008-03-24T20:39:00.011-04:00

Rather than take the time to describe what I've been dealing with at Facebook since the beginning of the holiday weekend, I am simply going to re-post the email thread between myself, Facebook, the Attorney General of Massachusetts, the Barack Obama campaign, the Boston Globe, the Congressional Black Caucus, a number of prominent bloggers active in the social media space, and the Boston offices of the Clinton campaign and the NAACP.

I have removed one link because I am not certain that the Web page it leads to correctly identifies the perpetrator of the vile, racist, hate-filled messages I received.

Facebook's decision to reinstate my account was better late than never. Their final decision along with the entire email chain follows:

Hi Jeff,

Your account was disabled because you took repeated actions that could be construed as spam. For instance, it is a violation of Facebook's Terms of Use to repeatedly send the same message or to make the same post. Facebook prides itself in protecting users from spam, and we take this standard very seriously.

However, after reviewing your situation, we have reactivated your account, and you should now be able to log in. Please refrain from sending the same message or repeating the same post, as further violations of our Terms will result in your account being permanently disabled.

Please also be aware that when a warning message appears on your home page, it will generally be displayed for 24 hours. It can be displayed for longer, however, if you continue to perform these actions. We appreciate your cooperation going forward.

Thank you for reporting this potential abuse on our site. We will review the reported material and remove anything that violates our Terms of Use. If warranted, we will either warn or disable the user.

In the future, please feel free to use the "Report" links located near most pieces of content on the site to report offensive material to Facebook. If you are not able to use the "Report" links for any reason, please write to us at privacy@facebook.com with a link to the offensive material and a description of the problem. We will then review this material and take the appropriate action. Please be assured, these reports will be kept confidential.

Thanks for contacting Facebook,

Leslie
User Operations
Facebook

-----Original Message to Facebook-----
From: Jeff O'Connor (jtoc72@yahoo.com)
To: naacpbostonbranch@verizon.net
ArrayCC: info@facebook.com, warning@facebook.com, cdoten@hillaryclinton.com, letter@globe.com
Subject: [SPAM] Fw: Harassment, Racial Slurs from Clinton Supporter to Obama Supporter at Facebook.com; Facebook Closes Obama Supporter's Account

Dear Sir or Madam:

I would appreciate the support of the Boston office of the NAACP in petitioning Facebook to do the right thing and bar Marian Shaffer from the site for life, as well as restore my account.

I would also appreciate it if the NAACP could investigate Marian Shaffer's relationship with the Clinton campaign, if any.

Thank you for your support.

----- Forwarded Message ----
From: Jeff O'Connor <jtoc72@yahoo.com>
To: ago@state.ma.us
Cc: info@facebook.com; warning@facebook.com; cdoten@hillaryclinton.com; letter@globe.com
Sent: Sunday, March 23, 2008 5:05:55 PM
Subject: Harassment, Racial Slurs from Clinton Supporter to Obama Supporter at Facebook.com; Facebook Closes Obama Supporter's Account

To the Honorable Martha Coakley:

On the morning of March 22, 2008 at 11:06 AM I received the following email through the service provided by the social networking site Facebook.com from a woman identifying herself as Marian Shaffer of Boston, Massachusetts:

GO FUCK YOURSELF, NIGGER LOVER!!!

Shortly thereafter, I received a second message, this one stating:

your little boy sucks cock

- a reference to my one year old nephew, whose pictures I keep in my online photo album.

I do not know nor have I ever met Marian Shaffer, I have never spoken to or about this person, and I have never participated knowingly in any online forum that she is a member of, although given the size and nature of the Facebook online community it is very possible that she's a member of one of the political discussion groups that I am a member of.

I was briefly able to access Marian Shaffer's profile, with the intent of filing a complaint with Facebook about her. During my brief period of access, I was able to see two images posted on her profile - one of a young woman, presumably her, standing next to Hillary Clinton, and another of Barack Obama with the word "NOPE" under it.

Marian Shaffer blocked my access to her profile shortly thereafter, effectively rendering her invisible to me on the site. However, I work in information technology and have helped develop a number of prominent online commercial sites, so I knew enough to be able to view the images in my browser even after she took this action.

I cannot be totally certain, but the woman in the picture with Mrs.Clinton bears a striking resemblance to the person identified as Marian Shaffer in the photograph on this site:

[ REMOVED ]

Because I believe that the same social norms that apply in offline society are applicable online, I took it upon myself to report this person and to re-post her message to me on several social networking, political action, and race relations groups throughout Facebook. This is the exact message that I posted:

This morning I received the following email from Marian Shaffer in my Facebook inbox.

I have never met this person, don't know her, and am not in any Facebook-sponsored groups with her. Therefore, I can't be totally certain, but believe that this was prompted by my being an Obama supporter:

Between You and Marian Shaffer

Marian Shaffer
Today at 11:06am
Report Message
GO FUCK YOURSELF. NIGGER LOVER!!!

Marian Shaffer is from Boston, MA.

This is the link to her profile:

http://www.facebook.com/s.php?k=100000080&id=514286617

Like a true racist coward, she has blocked my access to her profile, so I cannot see it. However, I have notified Facebook and am asking anyone who thinks that this sort of conduct is inappropriate to do the same and request she be banned from this social network.

Thank you for your time.

Because of my efforts to draw attention to this sort of behavior within the Facebook community, Facebook has locked-out my account.

I am not an expert in Internet law, but I believe that if I were to receive harassing letters in the mail from someone I would have the right to make the nature of the letter's content public along with the identity of the sender and seek some sort of criminal and/or civil penalty in the courts if that person were stupid enough to make themselves known to me, as Marian Shaffer was in this case.

I also believe that there are laws against using email and electronic bulletin boards to transmit threatening, racist, and obscene materials. I believe "nigger lover" qualifies, as does the assertion that my one year old nephew engages in fellatio. Finally, I believe that the political context of the email in question runs afoul of federal election laws, especially if Marian Shaffer is involved in some sort of official capacity with the Clinton campaign.

I am asking the office of the Attorney General to investigate this matter and determine what laws, if any have been broken and what course of action I am entitled to in pursuing civil and/or criminal charges against Marian Shaffer and compelling Facebook to disclose her identity to law enforcement or my attorney.

Thank you for your time, I look forward to hearing your reply.

Sincerely,

Jeff O'Connor

p.s.- I attempted to cc: the Obama campaign this email, but all of their Web sites use forms rather than emails for contact. So at the instruction of a staff volunteer, I cut-and-pasted this message into the email form on the Barack Obama campaign Web site here: http://my.barackobama.com/page/s/contact2

-----End Original Message to Facebook-----

I am quite sincere in my desire to see Marian Shaffer prosecuted for violating whatever laws are applicable, and would like to find out just what her relationship, if any, is to the Clinton campaign.

If anyone has any information in this regard, please contact me and cc: The Honorable Martha Coakley at ago@state.ma.us

Lastly, I have to thank Jeremiah Owyang for his support and advice in dealing with this matter. Although I've never met him personally, I am very glad that he has put so much work into Web Strategy by Jeremiah, through which I had come to learn of him and respect his opinion.

Freelance Web Development has Intruded on My Love of Healthcare IS

2008-03-19T08:40:00.007-04:00

No one will ever accuse me of being underfed, but at the end of the day a boy's got to eat.

As I mentioned in my last post, I have been doing side work for an old friend, developing the Web sites for his company while teaching myself more about ASP.NET and boning-up on my XHTML, CSS, and rudimentary graphic design skills. My customer is happy and my friends and coworkers range from impressed to not turned-off. As for me, I second something Jack Nicholson once said:

I don't know if it's art, but I like it!

The hardest part about the site that I just redeveloped - Inoculaid.com - was the color it had to be built around. Inoculaid is a natural, organic product that helps retain water and improve the fertility of plants through the production of natural sugars it excretes. The sole aspect of the Inoculaid brand that I had to work with was the color of its label, which is a light shade of purple.

My friend runs his family business, which is really split between the sales and distribution of this product, and a more general tree appraisal and mitigation service in Florida. The businesses are complimentary to each other, and I am trying to represent that by building a "family" of Web sites that are similar to one another in structure and appearance using the Yahoo! UI Library and ASP.NET.

The mold for these sites was set by AEMicrobiology.com. Initially, I thought it would be a good idea to tweak each site to give it its own identity. I had also fallen in love with a set of images that were reminiscent of DNA helixes that were available for commercial adaptation, and tried to incorporate them into a site that would be able to stand on its own from AEMicrobiology.com and yet still bear enough of a resemblance that the "family of Web sites" approach would work.

As you can see from the first two mock-ups I created, this didn't work so well. The sites were too loud and implied an artificialness about the product that didn't ring true to a completely organic, 100% natural microorganism.

A friend of mine who critiqued AEMicrobiology.com while I was mocking-up the new version of Inoculaid.com contacted me and pointed out the similarity of purple to green in terms of color usage (he referred to them as "royal colors"), and that's when it hit me: I realized all I had to do was swap out my two shades of green from the AEMicrobiology.com palette for the corresponding shades of purple - which happened to match the Incoulaid label's color - and it all came together.

At least, I think it does; fortunately, so does my customer.

It needs a few tweaks yet - a couple more images on the Benefits tab, the replacement of one of the eight rotating masthead images (the bananas, specifically - great image, looks like crap with the site's dominant purple and blue color scheme).

Lastly, I also found out the hard way that between Microsoft Visual Studio and Microsoft Expression Web, the registered trademark code keeps getting overwritten with a sans-serif character that causes "Big Circle R" issues. Microsoft designed these two products to work hand-in-hand, so there has to be a way to make the two applications stop performing an automatic search-and-replace in this manner; if anyone knows what it is, please tell me because I am really getting sick of doing it by hand!

Don't Embrace the Silence

2008-02-22T09:03:00.010-05:00

It's been nearly a month since I last posted, and despite the best of intentions there is a lot that I had hoped to accomplish by now that I haven't: a detailed analysis of Microsoft HealthVault and the HealthVault SDK; transcribing and uploading my EMR to HealthVault; a wildly successful reconditioning effort that would let me engage in long-distance running again; etc.

It hasn't been a total wash for me, though. Work is not only keeping me busy, but is actually going very well. My employer is about to make some major investments in the department I primarily service, which is another plus that can't be understated when you live in Detroit, the "most miserable city in the United States."

I've also been busy with side work, having recently completed v.1.0 of AEMicrobiology.com for a customer in Florida, who also happens to be my best friend from childhood. AEMicrobiology.com is the first site that I've built using ASP.NET and the Yahoo! User Interface Library, and it's intended to serve as the template for additional work, including upgrades to two of my friend's other Web properties.

AEMicrobiology.com has been a real boon to me professionally, giving me a real project to apply C# programming and ASP.NET coding techniques to. Before this project came along I had never done code-behind programming or done any substantial work with .NET namespaces. Now I know how to parse the DOM of an .aspx page and alter its appearance and content on-the-fly based on the page's title attribute, for example. This is probably small potatoes for a real ASP.NET programmer or full-time Web application developer, but for a systems analyst with a small side business, it's something to crow about.

I am also preparing to go back to graduate school. The bad news is that nearly fourteen years later, my original GMAT score and dozen or so post-graduate study credits have expired. The good news is that I'm taking the GMAT again tomorrow, February 23, and reapplying to the same university that my late partner's spinal chord injury forced me to drop-out of all those years ago so that I could serve as caretaker and household bread-winner.

Better late than never!

All this having been said, I still plan to do the things that I've discussed. I will be working with Microsoft HealthVault and the HealthVault SDK eventually; I will continue to fight the never-ending battle of the bulge and try to get back into running again and post my progress here; I just can't vouch for when I'll actually get around to doing it.

Fund-raising for the upcoming Heart Walk is going well enough, but can always be improved on. Please consider making an online donation and helping me reach my $1,000 fund-raising goal. I'd appreciate it, the American Heart Association will appreciate it, and - most importantly - the men, women, and children that the AHA help beat heart attacks and strokes will appreciate it.

Also, I match up to $100, in addition to my own personal donation. So if you can't find any other reason to support the American Heart Association, you can do it to stick it to me in the wallet.

Finally, a very quick happy impending first birthday for my nephew and godson, Brad.

Happy birthday, pookie-boo - your uncle loves you!

Related Posts:

Just Call Me the Amazing Kreskin...

2008-01-11T20:41:00.003-05:00

Future of IT Health reports that the technology to translate an EMR into a 3D model of the human body is already being tested.

I haven't much time to write today, but I absolutely had to let you know about this article from the January issue of IEEE Spectrum: Visualizing Electronic Health Records With "Google-Earth for the Body":

Andre Elisseeff leads a research team at IBM’s Zurich Research Lab that in September demonstrated a prototype system that will allow doctors to view their patients’ electronic health record (eHR) using three-dimensional images of the human body. Called the Anatomic and Symbolic Mapper Engine, the system maps the information in a patient’s eHR to a 3-D image of the human body.

Source: IEEE Spectrum: Visualizing Electronic Health Records With "Google-Earth for the Body"

I totally called this! Damn, I'm good!

(And I sound like Reese Whitherspoon in Legally Blonde all of the sudden.)

Related posts: Medical School Comes to Second Life, This is as Close as I Get to Being a Hard Core Gamer

EMR Update, Doctors as Technocrats

2008-01-08T12:38:00.002-05:00

I have received a partial, printed hardcopy of my EMR from my PCP.

I am insured through the same managed care organization I work for, and the hospital system of which it is a part is a leader in the area of EMR use.

Even so, getting this information wasn't easy and the format that I have received it in isn't particularly useful. To the credit of my PCP, he did offer to try to get a more complete, albeit still paper-based, set of records for me, but warned that there would probably "be a fee."

While I am a big believer in EMRs as part of the solution to America's healthcare problem, I don't think their full potential will ever be realized as long as providers continue to see them as something other than the patients'.

Healthcare has traditionally bucked the established pay-for-services model that the very idea that EMRs and their contents belong to the patients, that patients have a right to them, and that providers have a responsibility to provide them as a matter of course is going to severely impede their adoption in the short-term, in my opinion.

It's worth noting the role that my PCP played in this process. In addition to being my doctor, he's also the gatekeeper of my EMR data, though I doubt he thinks of himself that way. Dr. Eike-Henner Kluge touches on this topic in his essay Resource Allocation in Healthcare: Implications of Models of Medicine as a Profession, where he states:

[F]rom a process perspective, it is the healthcare professionals who function as gatekeepers to the material resources that are in short supply. They are, so to speak, the choke point in the access and distribution systems. That is why how they function determines what shape the resource allocation issue will ultimately take. This is not to say that the status of the material healthcare resources – whether they are treated as social goods or as commodities – is unimportant. Clearly, that would be a mistake.

Unfortunately, while Dr. Kluge discusses the practice of medicine in terms of Hippocratic, social services, and business models, he doesn't directly address the issues that application of consumer electronics technology (i.e.: the Internet and portable, digital media) raise in regard to the allocation of healthcare resources - which is at the heart of the problem that EMRs are seen as a large part of the solution to: namely, costs.

On the plus side, Dr. Kluge promises subsequent essays that will propose solutions to the problems he identifies with the aforementioned models. Since he hints at the topic, I'm hoping he addresses it and have bookmarked the site for future reference.

Related post: All I Want for Channukah is my EMR

Someone Slap George Will

2008-01-07T14:30:00.002-05:00

I really do try to keep politics out of this blog, and when I find myself unable to I usually try to keep my posts relevant to healthcare and/or technology, but there are some things that are just so outrageous and preposterous that I can't contain myself.

Thanks to ajfortin.com for pointing-out today's example:

Thanks to the Daily Dish, this quote from George Will no less:

Barack Obama, who might be mercifully closing the Clinton parenthesis in presidential history, is refreshingly cerebral amid this recrudescence of the paranoid style in American politics. He is the un-Edwards and un-Huckabee — an adult aiming to reform the real world rather than an adolescent fantasizing mock-heroic “fights” against fictitious villains in a left-wing cartoon version of this country.

Source: George Will Quote on Obama et al.

George Will is a putz.

Seven years into the farce that the corporate media refers to as "the Bush presidency," he's got the gall to talk smack about "mock-heroic 'fights' against fictitious villains in a *left-wing* cartoon version of this country?!"

What the hell planet has he been living on since 2000?

Oh, I remember now: the right-wing fantasy-land that all the neocons, their reptilian masters, and corporate media whores inhabit where 9/11 occurring on Bush's watch is somehow Clinton's fault; record deficits and debt are "fiscally responsible;" "Terri's Law"and domestic spying programs that were initiated before 9/11 is representative of smaller, less-intrusive government; expanded SCHIP "isn't fair to the insurance industry;" oil companies enjoying double-digit profits measured in the billions get equally large tax breaks because they "need the money;" and the Christian God of the Air Force Academy can (and will) beat-up the evil god of Islam and marginalize the less-important god of Judaism.

Someone, please slap the living sh*t out of Mr. Will; it'll do he and I both a world of good!

Medical School Comes to SecondLife

2007-12-20T01:52:00.002-05:00

Several months ago I posted a review about the book Swords & Circuitry: A Designer's Guide to Computer Roleplaying Games and my motivation for reading in. I believed then, and believe now, that the underpinnings of computer roleplaying games have a direct application to Health2.0, and that one day EMRs and the like will create compelling new ways for people to understand and become engaged in maintaining their own health and wellbeing.

I also suspected (but only hinted at) the possibility that the technology that has brought games like Grand Theft Auto and Halo 2 to life would also enable virtual representations of patients with real-world conditions to be diagnosed and treated online. In game-speak, one day computer roleplaying game technology and techniques will transfer Health2.0 from a first-person shooter to a MMPORPG.

What never occurred to me was that this sort of application was well underway, until I came across this article at JuniorDr.com:

One of the earliest projects is the Ann Myers Medical Center - a virtual medical school - where medical education gets a unique opportunity to find new ways of training medical students. It was created to test the possibilities of virtual training for real world medical and nursing students. There are dozens of physicians, medical students and animators behind this unique project who pledge their sparetime and money to this idea. AMMC currently has a voluntary staff consisting of consultant specialists, medical students and several nurses. The founder, Doctor Ann Buchanan (Second Life name), a US physician, envisions a hospital where medical students and nurses could be trained. Currently participants focus on patient history, physical examination and telemetry. A virtual mentor gives the students a disease process with which to familiarise themselves and they have to present it to the physician.

Source: "Virtual Doctors: Medical Training in Second Life"

If you think that this is all pie-in-the-sky B.S., think again. Advanced computer graphics are enabling the creation of 3-D models of DNA, internal organs, the human nervous system, and so forth that - while note quite photo-realistic - are for more "real" than two-dimensional cut-away drawings or text descriptions. The collaborative nature of Second Life also makes for a more dynamic and compelling learning experience than is possible even in real-world classrooms; where else can doctors and medical students from six continents diagnose the same patient?

It would seem to me that the next logical step would be to find a way to translate an EMR into a "character sheet" for patients, so that healthcare in Second Life can make the jump from theoretical and didactic to practical and applied. As anyone who has ever played RPGs generally knows, there are a number of models for doing this already - some better-suited to real-world application than others.

From CAD prototyping to accounting the translation of real-world science into mathematical abstractions that have real-world applications is already well underway; it seems to me that as Second Life-like online experiences become more and more common, it is just a matter of time before the line between online gaming and online healthcare disappears altogether.

Related Post: This is as Close as I Get to Being a Hardcore Gamer

Glow-in-the-Dark Kitties: Science, Silliniess, or Just Plain Scary?

2007-12-13T07:30:00.002-05:00

Through genetic manipulation, South Korean geneticists have been able to not only "turn-on" the fluorescence protein in cat embryos, but have also successfully cloned the animal.

A team of scientists led by Kong Il-keun, a cloning expert at Gyeongsang National University, produced three cats possessing altered fluorescence protein (RFP) genes, the Ministry of Science and Technology said.

Source: South Koreans Clone Cats that Glow in the Dark

While the ability to glow-in-the-dark in and of itself isn't a significant medical advancement, the ability to clone genetically altered animals is. This is big news in the fledgling field of genetic medicine, as it is now possible to create the ultimate control group for testing: exact copies of animals afflicted with diseases that humans suffer from (cats and humans share more than 200 of the same afflictions).

Other applications of the technology:

genetically engineering livestock that emit less methane
cloning endangered species, slightly reconfigured to adapt to altered or new habitats
designer pets and flourescent foodstuffs

Some would argue that all of these possibilities raise important ethical questions, but I would counter that the overall question of whether or not genetic engineering is ethical has been settled since humanity first started to selectively breed livestock, pets, and produce; the rest is just details.

Consider what happened when transgenic artist Eduardo Kac commissioned the engineered breeding of Alba, a glow-in-the-dark rabbit from French geneticists. A firestorm of protest by animal rights activists who dubbed the process "abusive" caused the French team to renege and keep the animal rather than turn the rabbit over to Kac.

Whether or not living out her life in seclusion (Alba is not accessible to the general public and whether or not the animal is still alive is unknown) as a lab specimen has given Alba a better quality of life than she would have had otherwise is a very poignant - and, to date - unanswered question. Because Alba isn't accessible to the public, whether or not she suffered any ill side effects from the genetic manipulation that made her glow in the dark is also unknown.

Given that Kac intended the animal to be the family pet and to showcase his family's relationship with the animal as a form of artistic expression, my personal opinion is a resounding "no." While it may well be true that the science used to create Alba could have been better applied elsewhere, the effort expended to protest her "abuse" would have been better spent protesting Kentucky Fried Chicken, veal producers, or some other enterprise that engages in the industrialized abuse of animals.

Bah Humbug and a Lump of Coal in Your Lung, Too!

2007-12-12T13:32:00.002-05:00

Source: Bush's Bedside Manner by M1khaela

George W. Bush, a man who has never had to work - much less succeed - at anything for his entire life, is set to stuff the collective stockings of Big Tobacco with another veto aimed squarely at the nation's must vulnerable citizens: its children.

President Bush on Wednesday was ready to veto legislation that passed with bipartisan support to dramatically expand government-provided health insurance for children.

It would be Bush's seventh veto in seven years — all but one since Democrats took control of Congress in January. Wednesday was the deadline for Bush to act or let the bill become law. The president also vetoed an earlier version of the health insurance program.

"This Congress failed to send the president legislation that puts children first," White House press secretary Dana Perino said. "Instead they sent, for a second time, one that would allow adults onto the program, expand to higher incomes and raise taxes."

The bill passed the Democratic-controlled Senate by a veto-proof margin, but the same was not true in the House. As a result, even after the bill was approved, negotiations continued on a compromise version.

A major point of contention with the White House was Bush's demand that nearly all poor children eligible for the program be found and enrolled before any in slightly higher-income families could be covered.

Source: Bush to Veto Kids Health Insurance Bill

With one-in-ten of the nation's juveniles uninsured, cold weather setting in, and home heating fuel prices set to spike, who can argue with Mr. Bush's logic that those hanging on to their middle class financial status by their fingernails need to be protected from the specter of "socialized medicine?"

Moreover, why provide financial incentives for people to live healthier lifestyles and increase state revenues in an era of record-busting deficits when you can help line the pockets of cancer-peddlers who are still targeting - you guessed - disproportionately uninsured and under-insured children?

Increasing cigarette taxes is a WIN, WIN, WIN solution for states - a health win that reduces smoking and saves lives; a fiscal win that raises revenue and reduces health care costs; and a political win that is popular with the public.

Source: Higher Cigarette Taxes Reduce Smoking, Save Lives, Save Money

One of the tobacco industry's most outrageous new tactics is the introduction of candy-flavored cigarettes and smokeless tobacco (View advertising examples):
R.J. Reynolds - the same company that once marketed cigarettes to kids with a cartoon character, Joe Camel - has launched a series of flavored cigarettes, including a pineapple and coconut-flavored cigarette called "Kauai Kolada" and a citrus-flavored cigarette called "Twista Lime." In November 2004, they introduced Camel "Winter Blends" in flavors including "Winter Warm Toffee" and "Winter MochaMint" (see Campaign statement).
Brown & Williamson has introduced flavored versions of its Kool cigarettes with names like "Caribbean Chill," "Midnight Berry," "Mocha Taboo" and "Mintrigue."
The U.S. Smokeless Tobacco Company is marketing spit tobacco with flavors including berry blend, mint, wintergreen, apple blend, vanilla and cherry.
Source: Big Tobacco Still Targeting Kids

Uninsured and under-insured children and low cigarette taxes are the gifts that keep on giving for the nation's cancer-pimps:

It's well documented that increasing the price of cigarettes keeps some teen-age smokers from getting hooked. Of course, the money will be needed to fund health insurance for kids. The same companies that get so many kids sick when they grow up wants to keep them from having health insurance when they are growing.

Source: Is Big Tobacco Stealth-Lobbying Against Children's Health?

Low-income smokers — and their families — would enjoy the lion’s share of the economic and public health benefits from a tobacco tax increase. Since three out of every four smokers expected to quit because of the tax increase would be low-income, most of the economic and health benefits of quitting would go to low-income families. By spending less money on cigarettes (including the taxes on cigarettes), those low-income families with an individual who stops smoking would free up funds for family needs such as child care, utilities, and food. Quitting smoking also improves a person’s health and reduces the harm that secondhand smoke inflicts on his or her family.

Source: Expanding Children's Health Insurance and Raising Federal Tobacco Taxes Helps Low-Income Families

Maybe the Australians got it right. Maybe when Santa says "ho-ho-ho," he's not being festive; he's really commenting on Bush, his Congressional allies and their relationship to the tobacco lobby.

Merry Christmas!

All I Want for Chanukah is My EMR

2007-12-12T12:53:00.002-05:00

It's been a hellish holiday season for me thus far, but things are starting to turn around effective today, the first day of Chanukah. I find this particularly ironic considering that I'm Unitarian Universalist and my significant other is Muslim, but why look a gift horse (or eight of them) in the mouth?

Happy Chanukah, everyone!

Anyway...

I met with my organization's AVP of IT Purchasing in late October, shortly after the launch of Microsoft HealthVault and discussed with him my intention of using it as a personal health management tool and a case study for potential use by our subscribers.

Since my organization is part of a larger healthcare system, I figured it would not only be possible but easy to get my EMR from the system in electronic format and begin my personal adventure with Microsoft HealthVault.

Well, I was partially right: it is possible, but not necessarily easy. Above and beyond the chaos of open enrollment followed by the death of a very close family member through October and November, it turns out that while there is an EMR report that patients can request be run for them by their PCP, its format is either PDF or hardcopy, neither of which lend themselves to easy conversion to a delimited format (at least not that I am aware of, and I readily admit I know next to nothing about the underpinnings of the PDF format).

This morning I sent an email to my PCP who, being technically a coworker, is accessible through our email directory. Here's what I sent (please keep in mind that names have been changed to protect the innocent - and my job!):

Dr. Strangelove:

Attached please find a series of emails between myself; Bill Gates, AVP of IT Purchasing, and Dr. Zhivago, People's Glorious Proletarian Health System. To summarize, I am trying to get a copy of the HAL 9000 EMR Report for myself so I can upload it to Microsoft HealthVault and begin working with the technology on my home system to see if there are any practical applications for People's Glorious Proletarian Health System.

I had hoped to make this request in person yesterday at my physical, but had to cancel due to scheduling conflicts. My next appointment with you isn't until February, and I don't want to wait that long to begin.

If at all possible, can you email me this report as a PDF or, if you're not comfortable/unable to do that, call me (either on my cell phone - 555-867-5309 - or the number provided in my signature block) and let me know when I can pick it up as a hardcopy?

Thanks!

Jeff O'Connor
Lead Systems Analyst
Applications Development
People's Glorious Proletarian Health System
(555) 976-4769

More to follow.

Happy holidays!

A Month or So of Silence

2007-11-14T08:04:00.002-05:00

I have to offer-up another apology for not getting the rest of my review of Microsoft HealthVault up. In fact, I haven't done much of anything since Oct. 8, and I don't see that changing until after the Thanksgiving holiday.

Just as my open enrollment-related work was winding down, I've had a death in my family to contend with and some major technology-related issues at home that have eaten into time I would otherwise devote to The Healthcare Information Systems Blog.

I thank you for your patience to-date, and would ask that you indulge me in a bit more until I have made it through the gauntlet of funeral preparation, family mourning, and what is bound to be a melancholy Thanksgiving.

Pardon the Interruption...

2007-10-22T19:03:00.002-04:00

I haven't accomplished much in the past three weeks.

Work has been grueling because of open enrollment and its impact on our online quoting application, the update of which I am managing for the first time since I began working at my place of employment nearly five years ago. I have been assured that this is probably the most difficult open enrollment overhaul we've ever attempted, so I suppose there's some solace to be found in that.

I have also had some other family issues to deal with that have taken away from my already diminished free time. I've missed the gym steadily the past two weeks, my weight has plateaued, and I appear to have caught a cold.

At this rate, I don't plan on posting again until the end of the month or possibly sometime during the first week in November. I'll be devoting a great deal of attention to Microsoft HealthVault at that time. Meanwhile, I would be remiss if I didn't point out several excellent reviews of Microsoft's EMR entry:

John Sharp's eHealth - Microsoft HealthVault PHR and Search and More on HealthVault
John Moore's Healthcare IT: Analyst's Views - Digging Into Microsoft's HealthVault series (terrific!)
Bill Crounse's HealthBlog - Microsoft HealthVault: A Place to Search, Store and Connect Health Information for You and Your Family*

For those of you as interested as I am in this technology who are eager to jump in feet-first, be sure to check out the following:

I also want to point out with all humility that this blog has been added to the ZDNet Healthcare Blogroll recently. I am honored, flattered, and frankly a little intimidated, but one thing is for sure: you can bet I'll be back at this blog again - and soon!

Before I hurt myself patting my own back,big kudos for Bill Scott, formerly of Yahoo! and now of NetFlicks. Bill was nice enough to invite me to the Yahoo! campus last year, though I haven't made it there yet (hopefully he left someone a note or something).

Bill was Yahoo!'s AJAX evangelist, and as a semi-professional Web developer, I can honestly say that the Yahoo! User Interface Library has changed my (geek) life for the better.

Congratulations, Bill!

* Bill Crounse, MD is Worldwide Health Director, Microsoft Corporation

Review: Microsoft HealthVault Public Beta, Part 2

2007-10-08T07:32:00.002-04:00

Note: I started this post on Monday, October 8, but didn't publish it until today. Some of the information below may be out-of-date. Also, I don't have nearly as much personal time during the week to devote to this series as I would like, so there will be a number of "parts" to this review that collectively will constitute a greater whole.

The interesting thing about beta releases of online applications is that you can never be sure how much of what you're seeing will make it into the v. 1.0 release. This is especially true of Microsoft lately, as a comparison of Longhorn and Windows Vista attests.

As it turns out, the site that I was looking at last week was, in fact, the Microsoft HealthVault search page, which explains why the product seemed to be so search-centric. As of this morning, there's quite a bit more to healthvault.com than a redirect to health.live.com.

As you can see from the screen captures below, HealthVault is not an online EMR; it is a PHI repository whose collective content, along with Live.com search history constitutes a de facto online EMR.

This distinction between EMR and online healthcare records storage is important, and something I will discuss in greater detail later.

Review: Microsoft HealthVault Public Beta, Part 1

2007-10-05T14:38:00.002-04:00

Microsoft HealthVault is a new member of the Windows Live family, recently released as a public beta.

As an advocate of EMRs and a self-proclaimed Microsoft enthusiast (though I am not nearly as enthusiastic about Live.com and MSN as I am about Yahoo! - but that's another story for another time), it is my intention to review this product in detail here, using my own personal health search history and associated data set as a test case. That having been said, I'll only be revealing enough about myself to facilitate an ongoing review; most of my personal healthcare issues are and will remain my business.

The primary function of HealthVault appears to be that of an online bookmarking tool:

Microsoft HealthVault Search needs to store your scrapbook links in a Health Record in your HealthVault account. The scrapbook lets you privately keep track of the useful health information you find with HealthVault Search.

The site is accessed by way of your Windows Live ID (formerly Microsoft Passport). However, if your Windows Live ID password doesn't meet Microsoft's "strong password" criteria - NLT seven alphanumeric characters of mixed case and/or punctuation symbols - you cannot create a HealthVault account to tie to your Windows Live ID. Once you enter a sufficiently "strong" password, HealthVault gives you the option of forcing it to expire and requiring a reset every 72 days if you so choose. This is an interesting feature for network security generally in my opinion, and is something that other online sites should offer.

The main page is very sparse and clean - lots of white space, which seems to be the new norm for pure-play search sites since you-know-who made Web minimalism chic.

I'll go deeper into the HealthVault over the next several days (Friday is still a work day, after all); meanwhile I would love to compare notes with anyone else who feels like creating an account and taking this new offering public.