Health Train Express

Mobile Technology Is Transforming The Health Industry

2012-01-18T11:06:00.000-08:00

Mobile Technology Is Transforming The Health Industry, But To What Extent?

Dave Chase

Technology is in the process of bringing change to every piece of the health industry — wellness, fitness, healthcare, medicine — you name it. And as it always seems with introduction of new technologies, it’s awe-inspiring how quickly they can transform entire industries yet, at the same time, make us realize just how far we have to go (or how far behind we really are). The health industry has been touched (and defined) by cutting-edge technology for years, yet its relics, legacy infrastructure, paper-pushing, and archaic procedures are as obvious today as ever before.

Mobile Technology for health can be classified in two categories:

Physician oriented: Apps designed to access reference materials, calculators, formularies, eRx, EMR remote access, Social Media, Calendaring, email, Video Conferencing, Algorithms

Patient oriented:Health Knowledge Base, Remote monitoring sensors, like Basis’ heart and health tracker,Lark, Fitbit, and Jawbone’s Up.

Some mobile apps interface patient and physician, Mobile devices will also change the way that we communicate with our doctors, as physicians may help describe possible treatments or procedures to patients on an iPad using multimedia, visual cues, genomic/anatomical maps, etc., prescribe post-treatment apps to our smartphones so that treatment doesn’t end once you walk out the door of the hospital, or become a conduit for modern communication platforms, a la Skype, that will facilitate remote checkups, treatments, diagnostics, through the phone, or over video. Got a strange looking rash? Take a picture, or scan it on this app. Telemedicine is there in a pinch!

All this has developed almost spontaneously with the development of competing hardware devices and software which is open source. and at affordable prices given the size of the patient market. The primary ingredient is innovation, entrepreneurial spirit, and with little governmental funding and/or intrusion.

Contrast this with the stuttering acceptance of EMRs and HIEs with government mandates, artificial support with incentive subsidies to support the HIT vendor market. The real beneficiary for CMS’ incentive program are the HIT vendors, not patients, not doctors nor insurers. The data collectors will benefit from the system which will be mined for the benefit of cost containment and perhaps better outcomes.

del.icio.us Tags: health 20,mobile apps,mobile technology,emr,hie,hit

Social Media in a Hospital Bed

2012-01-17T10:49:00.000-08:00

No this post is not about pubescent hormonal hyper sexuality nor the story about the sex life of fan boys or fan girls, G+strings,, or tantalizing twitter tweepes. It is a story about Fred and Regina Holladay and their experience (bad) when Fred was diagnosed with advanced Renal Cancer.

Dr. to Dr.

View more presentations from Regina Holliday

The program is self-explanatory and does not require expansion here.

del.icio.us Tags: hospitals,social media,healthcare,cancer,twitter,facebook,Google plus

Bold New Approach to Funding Medical School Tuition

2012-01-17T06:09:00.000-08:00

Over the past ten years both college and medical school tuitions have increased in some cases four times. This has effected college graduates and physicians. Tuition at the state run UC system in 2001-2002 was $ 3429 and has risen to $13,200 per year. This places an extraordinary debt burden on students at a time when they have little income.

In California which has faced the perfect storm of decreasing revenues in the face of economic distress Chris Occasion, President of the FixUCR movement at the University of California presented a manifesto

Their manifesto is the UC Student Investment Proposal, which calls for eliminating the upfront costs of college and having working graduates pay 5 percent of their salary back to the system for 20 years.

The idea was conceived by students, and although designed for the UC system could very well be adapted to other states and private universities.

The investment proposal concept has captured the attention of the Board of Regents of the UC system and was a concept previously studied and discussed by Robert Reich former Secretary of Labor under the Clinton Administration. He presented a similar idea in 2008 for California’s mounting fiscal stresses. Economists at the time termed the financial plan feasible however it was deemed politically undoable. This would not be the same for privately funded schools of higher education.

A similar perfect storm has developed in health care and medical education which is even more expensive and extended eight years up to twelve years. And while college graduates may complete undergraduate education with a $100,000 debt load, some physicians will exit from medical student and

training with up to $ 250,000 debt.

Health reform promises two events, more insured patients, decreased reimbursements and a shortage of primary care physicians (family physicians).This will decrease ability for physician graduates to repay education loans. Adjusting payment rates as a percentage of income adjusts for future changes in income.

Many well qualified students rule out medicine as a career because of it’ prospect of prolonged poverty and what often appears to be insurmountable debt. Some highly qualified students will change career goals

ref: Zimmerman, Riverside Press Enterprise.com

del.icio.us Tags: college,tuition,loans,debt,primary care,physician shortage,education loans

5% of patients account for half of health care spending

2012-01-13T06:12:00.000-08:00

USA TODAY reports that 22 % of healthcare spending is from less than 1% of patients.(2009).

That's about $90,000 per person, according to the Agency for Healthcare Research and Quality. U.S. residents spent $1.26 trillion that year on health care.

Five percent accounted for 50% of health care costs, about $36,000 each, the report said.

Why is this number so important? According to AHRQ the report showed how a tiny segment of the population can drive health care spending and that efforts to control cost should focus on this segment to improve efficiency using new technology, outcome studies,

About one in five health care consumers remained in the top 1% of spenders for at least two consecutive years, the report showed. They tended to be white, non-Hispanic women in poor health; the elderly; and users of publicly funded health care.

•Sixty percent were women

•Forty percent were 65 or older.

•Only 3% were ages 18 to 29.

•Eighty percent were white.

•Only 2% were Asian.

The found that Hispanics, 16% of the population in 2009, spent less on health care. Twenty-five percent of Hispanics were in the bottom half of health care spenders, the report showed, while only 7% of Hispanics were in the top 10% of spenders.

Next, Cohen plans to look at whether cost-cutting measures make a difference. Beginning in October 2012, the government has told hospitals with Medicare patients that it will no longer pay for patients who are readmitted to hospitals for the same condition soon after being released. Cohen said he'll look at whether that will change the spending averages for people in the top health care cost brackets.

Another way of stating this is, “unmarried women” (uninsured) (or Medicaid) and old people on Medicare

del.icio.us Tags: health consumer,medicare reform,medicaid,usa today

C.E.S. & Health Train Express in Vegas

2012-01-10T20:04:00.000-08:00

Monday January 9 2012 marked the opening of the Consumer Entertainment Show in Las Vegas.

Among the carnival-like presentations both on the exhibit floor and in conference were many medical applications in hardware and software. After all,, medical practices and physicians are consumers.

Connectivity is high on the list of presentations.. Physical security of the mobile hand held devices was important, however the real value is the software and data in the device.

Consumer oriented health monitors were also on the list:

This one is from Zensorium. and intended for iOS. (iPhone)

RFID for security is available with small tags on laptop cases, smartphones, iPads and the like “Tags” are available for pets and even children to keep them from wandering off. It could even be used for ‘colleagues’ and peers to keep from losing each other even significant others or spouses. (in an extreme case).The potential for use in hospitals is great to locate patients who may be roaming to special testing. Physicians hate going to an empty room when they expect to see the patient.

Digital healthcare was no stranger at the CES. From Panasonic to Allscripts medical applications are being mainstreamed even in the consumer retail market place. COSTCO offers the Allscripts My Way EMR which can be purchased at any Costco warehouse.

In addition to mobile apps and advances in display technology the merger of automobile connectivity within the vehicle and also externally for safety features are being emphasized as selling points for vehicles

Ford, Microsoft, Healthrageous and BlueMetal Architects announced an alliance to research technology to help people monitor and maintain health and wellness while on the move during the “Doctor in Your Car” keynote address at the Digital Health Summit at the 2012 International Consumer Electronics Show (CES).

An interesting statistic (Pew)

More people now visit online health sites than go to the doctor’s office, making health and wellness the most popular activity on the Web after email and general searches.

Social media was also a large component of the CES. Reporters, presenters, and observers were all well connected via email, im, twitter, FB and Google +. Multi-tasking was a necessity on the floor and in the booths. The infrastructure to support this seemed to be better than in most previous CES’ The learning curve from previous event was obvious and the ‘show’ ran smoothly There appeared to be little difficulty with broadband access nor bandwidth. Convention centers seem to have caught up with the never ending growth of demand for wider ‘pipes’.. I watched much of #CES from the comfort of my desk , at C-net, Ustream.tv and Techcrunch,and Twit.tv .

It eliminated the challenges of air travel, TSA and DHS.

del.icio.us Tags: #hcsm #fordsync,#digitalhealth #healthit #ces

Senior Citizens on the Health Train

2012-01-10T08:08:00.000-08:00

GeriPal (blog)
POGOe – Portal of Geriatric Online Education (clinical resource)
Geriatric Nursing (podcast)
CareGiving (community site)
The American Geriatrics Society Like (Facebook group)
Wen Dombrowski MD (Twitter)
American Geriatrics (Twitter)
GeriPsych Consult (mobile app)
Health AGEnda (blog)
John A. Hartford Foundation (Youtube)

Senior citizens are getting much attention from politicians and health care professionals. Deservedly so since they are the unfortunate who are involuntarily ‘consuming’ health care. It’s the nature of aging and human life.

No one wants to be ill or infirm. The term “consumers of health care’ implies that healthcare is produced, or that health itself is produced. Perhaps that is what preventive medicine, healthy diets, exercise, stressful living and a good quality of lifestyle is all about.

The list of links at the start of the article is for mature adults and their caregivers. (credits to Bertalan Mesko MD and Webcina. I recommend giving it to you patients.

del.icio.us Tags: medicare reform,seniors,webcina,healthtrain express,mesko,geriatrics,nursing

Is 2012 The New Era for Health Train Express?

2012-01-07T22:20:00.000-08:00

Val Jones MD, perhaps the empress of health social media, and Better Health has announced her discontinuation of posting blogs on Better Health LLC. She however indicated the continuation of the brand as a platform for Grand Rounds and for her use of it as her personal consulting platform.

Dr Jones, along with others, has been a visionary and developed considerable credibility with early backing from Revolution Health and Steve Case’s interest in health reform. Her success required considerable investment of time, resources and the generous support of many silent investors, physicians, nurses and medical journalists. She innovated aggregation of gifted medical writers into a visible public platform for medical news.

There were and are a central core of respected experts contributing to Better Health and these contributors will continue to create content in their own spaces.

Thank you to Val Jones M.D. for her effort and success in opening a new vista in communication for patients and providers. I will miss her cartoons.

The range of contributors to Better Health include:

David Harlow, Dr Wes, Dr. Mike Sevilla, Kevin Pho MD,Lucy Hornstein M.D.,Nicholas Genes M.D.,Steve Novella M.D.,, Tony Brayer M.D., Jeffrey Benabio M..D.,

Better Health was and is more than a blog. It matured into a digital form of a medical journal, branding itself as an online media company. It has served it’s purpose and will continue in the digital health space, not to be left behind.

Many new entities are evolving, such as Social Media Today, Health Works Collective, and many others as the niche matures.these follow the early leadership of iHealthBeat, and California Healthline.

Social media in medicine is evolving quickly and in order to continue our success we must all evolve as it morphs into new delivery methods.

I am sure we will hear much more from Val Jones MD

Thanks Val.

Health Train in the Sunlight

2012-01-07T12:25:00.000-08:00

The Health Benefits of Sunlight

Researchers have started recognizing the importance of sunlight for a healthy lifestyle, recent studies reveal that sunlight renders many health benefits. Apart from Sunlight maintaining temperature and humidity, sunlight plays a significant role in nourishing and energizing the human body. It is also vital in order to get the full nutritional value from food that you consume and it has been proven that getting sufficient sunlight aids in preventing chronic ailments such as seasonal affective disorder (SAD), osteoporosis, mental depression, type 2 diabetes, and cancers affecting the bladder, breasts, cervix, colon, ovaries, prostrate, and the stomach. To put it more succinctly, sunlight serves as the perfect medicinal pill in promoting a healthy lifestyle.

One of the prime benefits of sunlight is that it supplies the body with Vitamin D, which not only promotes the absorption of calcium in the gut but also transfers calcium across the cell membranes. This in turn provides strength to the bones as well as contributes for a healthy nervous system by increasing the production of endorphins in the brain. Usually, deposits of cholesterol-like substances known as ergosterol can be found beneath the skin, which gets converted into Vitamin D hormones when the sunlight penetrates the skin.

Vitamin D also helps to lower the level of cholesterol in blood, and sunlight can even prevent the growth of cancerous tumors. Studies show that exposing your face to sunlight for 10 minutes every day can provide your body with the Vitamin D that is required for the day. A lack of Vitamin D is associated with a host of autoimmune ailments such as Crohn’s disease, multiple sclerosis, rheumatoid arthritis, and thyroditis.

Another significant benefit of sunlight is that it helps in the prevention of infections resulting from bacteria, molds, and viruses. The health benefits of sunlight include the enhancement of the immune system by increasing the count of white blood cells as well as gamma globulin, which is beneficial in warding off viruses and germs and it enhances the capacity of red blood cells in carrying oxygen.

According to certain studies, getting adequate sunlight serves as the perfect exercise for the heart, as it enables the body to lower the resting pulse rate and decreasing hypertension, thereby making the heart healthier. Sunlight also provides resistance power to the skin, by avoiding skin diseases such as psoriasis, eczema, and acne problems. Further, getting sunlight is also correlated with the stimulation of the pineal gland, which produces such vital chemicals as tryptamines.

Other health benefits derived through the exposure of sunlight are:

Strengthening of cardiovascular system
Normalizing blood pressure as well as blood sugar
Increased metabolism
Aiding in weight loss
Ensuring proper functioning of kidneys by eliminating wastes
Enhanced liver function
Improved digestion
Above all, sunshine has that magical power to alter your moods and cheer you up, thereby preventing anxiety and depression

Despite its advantages, excess exposure to sunlight may be sometimes destructive, as it can lead to ailments such as eye damage, melanomas, and skin cancer. Likewise, over exposure to sunlight may sometimes result in a change in the color as well as the size of the skin, appearance of irregular spots on the face, and itchiness or tenderness to the skin.

In other words, benefits derived from the sunlight depend upon its usage. Methods such as sunbathing and sun tanning are considered effective for getting adequate sunshine, but make sure that you are using a quality after-sun lotion in order to moisturize your skin after sun tanning. Likewise, put on such clothes that cover your arms as well as legs after sunbathing, which in turn safeguard you from further exposure. However the most important thing to remember that an excess of anything, including sunlight, can be damaging to your health.

del.icio.us Tags: vitamin d,sunlight,cholesterol,hormones

Health Train and Winter

2012-01-07T10:21:00.000-08:00

Mobile apps are the big items this year, not only in health care, but in a multiplicity of other niches.

When a powerful blizzard ripped through North Dakota last winter, hundreds of drivers were stranded as white-out conditions shuttered interstates statewide.Even in large metropolitan areas sudden and large snow storms can paralyze drivers with other cars close by. The recent Chicago Lake Shore drive emphasizes the fact that this does not occur in only North Dakota.

That convinced two local software developers to create the Winter Survival Kit app.

North Dakota State University's Bob Bertsch and Jake Joraanstad came up with the free program for iPhones and Android smartphones to help motorists prepare for winter driving and when things go badly.

One app available through the iTunes app store is a crossover, linking mobile apps for driving and prevention of possible frostbite and even death if isolated by blizzard conditions and being stranded in your car.

The application “Winter Survival Kit” can be downloaded for FREE at the iTunes app store. It will function on the iPhone, iPad and also on Android Phones

This app will help you find your current location, call 911, notify your friends and family, calculate how long you can run your engine to keep warm and stay safe from carbon monoxide poisoning.

Version 1.3 update December 2011, and all reviews give it a 4-5 star rating.

The application provides instructions for preparations for cold weather survival and what to do if stuck in your car.

It also functions as an emergency 911 alert and will supply geolocation information to emergency dispatchers.

Other information it can calculate is time until your fuel runs out, and to remind you to check your exhaust every 30 minutes to prevent asphyxiation from carbon monoxide.

The application was developed by Myriad Devices and financial support from a grant from USDA National Institute of Food and Agriculture Smith-Lever Special Needs grants.

HealthTrain Express assesses this device as a mandatory one for anyone who drives in a cold weather climate. It’s usefulness may be restricted in areas that do not yet have cell phone availability. If you are on one of the U.S.National Defense Highways (Interstate Highway System) it’s a fairly safe bet you will have cell coverage.

The only thing it does not seem to do is make hot coffee….perhaps in version 2.0

Remember also that if cell phone strength is week text messaging may still function….use Twitter, SMS or IM.

del.icio.us Tags: winter,survival,mobile apps,iPhone,android,smartphones,911,geolocation,prevention

California Health Budget Slash

2012-01-06T12:34:00.000-08:00

Governor Brown surprise budget announcements.

Major revisions will be made to California’s health safety net, with reorganization and downsizing big government. No doubt this will be unpopular in some circles. This is further complicated by federal mandates for health insurance exchange formation and proposals to use Medi-Cal as a vehicle for uninsured, uninsurable, and poor.

Expect Chaos

del.icio.us Tags: medi-california,budget,Governor Brown,Health Insurance Exchange

Unprotected Sex and Fellatio

2012-01-06T07:02:00.000-08:00

Warning: This post may not be appropriate for readers under the age of six.

The article is not intended to be discriminatory in terms of sexual preferences, race, creed, color or political preferences.

I am expanding upon an article read in the WSJ Health Blog today.

A recent study reported in the WSJ Health blog discusses the overall slight decline in rates of cancer with an uptick in certain types of cancer.

Among the small increases are the incidence of oral cancers (HPV papilloma of the posterior pharynx, malignant melanoma, thyroid cancer, Although the decline in smoking should decrease this incidence it appears that ‘oral sex’ increases the rate for practitioners of this art of karma sutra.

I have given up cigarettes, alcohol, marijuana, meth,cocaine but I will not have oral sex withdrawn (pun intended) from my repertoire of pleasurable activity.

Several important features of the study were missing, male vs. female rates, unprotected vs. protected sex and whether the study was separated into homosexual encounters or heterosexual encounters.

The CDC and Public Health Service have been allotted ten million dollars for this anti-motivational poster, seen on the left below which is somewhat akin to the anti-smoking images seen below as well

P.S Smoking is banned on the Health Train Express, Oral fellatio? That depends….

The entire post is offered (tongue in cheek). Oh there I go again with my oral fixations this morning I am having oatmeal with bananas (cut up for those of you with dirty minds…). Hope you enjoy your coffee !

del.icio.us Tags: fellatio,oral sex,carcinoma,smoking,public health,cdc

The Dangers of Social Media and Self Diagnosis

2012-01-06T06:20:00.000-08:00

I have been a proponent of social media and it’s use to improve healthcare and improving accessibility for patients to clinicians and hospital resources, there are certain caveats and precaution are advised when attempting ‘self diagnosis’

In the past ten years innumerable web sites have become available for patients.. Remembered that these sites were never meant to be used in an isolated fashion for self diagnosis. They are meant to be educational and as a supplement to professional office or clinic visits.

Entering or searching for symptoms both physical or emotional into a web site will list many answers, some irrelevant. These sites can be accessed either before a visit or after a visit to assist you in discussing your condition with your health provider.

Today’s both physicians and patients are faced with decreased face-time during the visit. Web sites are a positive influence for both physician and patient when used properly.

They provide the patient an opportunity to ask appropriate questions for the health provider on initial visits, and for follow up education especially if the provider educates his patient as to what sites are credible sources as a supplement to the office visit. Patients should discuss their sources with their doctor.

Social media also provides relevant and usually accurate information about health information technology advances, not only in EMRs, HIEs but the explosion of mobile apps for their use in non clinical settings, home monitoring and accessing insurance information, geolocation services for emergencies, hospital and offiice wait times, and drug information.

2012 promises to be another innovative year of HIT and Health Reform.

del.icio.us Tags: self diagnosis,internet health,social media,patients,physicians

It’s In Your DNA: Social Media

2012-01-03T09:09:00.000-08:00

Take a look at the Info graphic below…. This is taking place in a single minute — every minute — of most everyday within the digital world….

Still think it’s a passing fad?

Still think you do not need to establish some form of digital presence on the healthcare social media stage?

—Think again —

http://goo.gl/Bwz1d By: Shanghai Web Designers

Howard J Luks M.D. points out the reasons why physicians should participate in the landscape of social media in his recent post via Summify.

Dr Luks message and articulation of the message is so well put that I repeat it here, and give him full credit for this information. It bears repeating in my blog(s).

I happen to agree with him. Issues surrounding health care and health reform have become much more public, open and transparent. Physicians must use the medium which is presently gaining momentum to replace printed and rapidly becoming obsolete magazines, newspapers and other forms of advertisement.

Let’s face it most studies and experience show the decline of ‘established newspapers, and journals. This is even more apparent in the under age 50 demographic.

Dr. Luks points out:

50% of the world’s population is under 30.
They do not communicate via e-mail or telephone.
Generation Y and generation Z consider e-mail passé.
The fastest growing segment on Facebook is women over 55 years of age.
SMS, direct messaging, micro-blogging and digital media is fast becoming the chosen communication standard.
Drug/Medical related “Likes” on Facebook have skyrocketed.

Dr Luks goes on to elaborate:

50% of the mobile Internet traffic in most countries is for Facebook. One on five patients flock to Facebook for healthcare information. Imagine what this means for a bad patient experience? The world has gone digital —social media is here to stay. 1 billion people simply cannot be wrong. 85% of people log onto their Facebook account every single day.

Any news media presently in business already has built or is building a social media presence. Twitter, Facebook and Google + seem to be in the lead of popularity and each has it’s own model which changes almost daily in an effort to capture the most users.

Recently I have been in several hangouts on Google + where people have asked for my medical opinion in the hangout. Each of them has expressed their willingness to “waive their privacy rights'” under current HIPAA laws.

Physicians are entrenched in patient privacy and confidentiality by their own training and ethics long before HIPAA was passed. Despite this restriction, many patients already waive privacy when they allow their story to be told at grand rounds in presentations, for testimonials regarding treatments, in other media and for other purposes. Does this carry forward for social media?

I would like to ask the readership their opinions and experience in this matter? How many of you have been asked this same question, and what have you advised? Would a verbal waiver be adequate or would you require it to be in writing?

What most physicians recognize is that access to a physician (and almost any physician) is restricted by time and distance. Patient abhor our new systems of telephone trees and triage. Numerous times potential patients express their desire to interact on social media or email with their physician even preferring to leave a ‘message’ via email, twitter or Google plus.

With the enormous increase in ‘Boomers’ our system is about to be stressed beyond it’s limits unless some creative steps are taken by universal acclaim. We cannot wait for governments to solve problems that physicians and patients are able to address together. The perfect storm of limiting reimbursements, and increasing benefits, and access threaten our health system. The first step has already taken place by eliminating pre-existing conditions, and extending eligibility of children under the age of 25 under their parent’s policies.

Physicians should start thinking about setting aside fifteen to thirty minutes a day to devote to patient care via social media. Some are already doing this via secure email or built in secure messaging in their electronic medical record systems. However not all EMRs are created equal and most do not afford this feature.

Most patients no longer find a physician through the yellow pages..they search on Google. Google also indexes social media, and blogs. Their entrance to your practice (other than an insurance roster) is already via a search engine, be it BING, YAHOO, or GOOGLE, Twitter and Facebook. Patients can even invite you to a Google Plus Hangout. And these can be one on one.

Internet social media is only beginning and will be adapted in ways we cannot yet even imagine. It has already become a commonplace feature of broadcast television, anchor news, and international links between non major news sources for direct news bypassing conventional syndicated news sources such as CNN, FOX, ABC and NBC. It may become a primary source for professional journal news releases.

The American Medical Association has published a statement regarding physicians’ use of Social Media

Stay tuned…different place, different station and at any time.

del.icio.us Tags: news,socialmedia,googleplus,twitter,facebook,internet,summify

Resolutions for 2012 on Health Train

2011-12-30T14:18:00.000-08:00

New Year's Resolution(s)

The words I will try to never use in 2012.

Transparent,Open Source,Actionable,Ground breaking,Serial entrepreneur,Pioneer,Visionary, Futurist, Venture Capitalist, Killer-App, G4,LTE, Cloud, Outsourcing, iOS, WebOS, Apple, Microsoft, Windows 8, Virus, Trojan, Worm, Ver.n, Friend-unFriend, Timeline, Circle-Uncircle, Social Media, Klout Score, Mashable, Scobleizer, Timeline, Google, Facebook, Twitter, IPO, Start-up, Kindle, Kindle-fire, I (anything),Smartphone, QR codes, Work from Home, Tablet PC, Groupon, Virtual Machine, Wireless, Youtube, Online/Offline, Chrome, Extensions, Add-ons, Hot Tech Trends,

Outcomes, Meaningful Use, Incentives, ICD-10, SGR, Disruptive innovation, Physician pioneer, :Physician champion, ONCHIT, HIE, RHIO,

Things I will try to do:

No more than 6 #tags, No more than 5 @s, No more than 3 hyperlinks/blog post, Clean my gmail archives, review my Facebook app authorizations, Defragment my hard drives, Not update Windows 7 to Windows 8 for at least one year after it is released. Replace my aging router. Replace my aging laptop. And add an iSomething or other.

Spread cheer, humor, understanding and humility to all friends, love my enemies, obey my spouse, try to understand my children (now young adults) and remember that was me 40 years ago.

There are many more do not does and does, but I have a hand cramp.

I declare tomorrow December 31, 2011 as the last day of 2011 (by the powers vested in me?)

del.icio.us Tags: resolutions,do's and don't's,new year

Study Predicts Growing Use Of Social Media In Healthcare

2011-12-30T14:04:00.000-08:00

Facebook study reveals deeper penetration of social media into healthcare than most would have predicted.

Patients seem more willing to adopt social media platforms that healthcare professionals.

It seems that patients will classify certain health related problems according to social acceptability, fears of retribution by friends, or employers or merely embarrassment.

STDs appear to be highest on the list followed by cancer, neurologic problems such as aging, dementia, or mild strokes and/or memory loss. Some parents do not want their children to know about serious or potentially fatal illnesses..

During my own social media contact with people (not my own patients) they will often inquire about their illnesses and express a desire to contact their physicians office for an initial encounter, even before a telephone contact.

Their may be several factors operating.

1. It offers bypassing clerical personnel, either by shortcutting a wait on the telephone, via telephone triage. It also offers after hours communications.

2. It depersonalizes the initial contact with a non-medical person, who they do not want to know about a personal problem.

3. Some have expressed a brief social media contact with the doctor would alleviate anxiety while waiting for an appointment.

4. Some perceive a professional social media contact as an act of caring and would offer a means of expressing anxiety, which might facilitate an earlier office visit.

5. The acceptance of these forms of communication have been limited by the feds. Ethics have been replaced with law.

6..Google + hangouts it turns out is not a secure platform, nor would an application on top of it be secure.

7.others

del.icio.us Tags: Google plus,twitter,facebook,social media,#hcsm

Going the Distance

2011-12-28T21:37:00.000-08:00

It is more difficult to maintain your privacy if you use the internet, even for something seemingly as benign as email or Google.

Google is more ubiquitous than the yellow pages and is far more accessible.There are many analytics engines sweeping Google, twitter, Facebook and other social media for statistics and trends in internet use ranging from your network size, who influences you,who you influence, your areas of expertise and other unmentionables. Klout is one site that you can access to have some idea of what analytics is capable of assessing about your internet usage. Most of these programs are free with limited functionality but for a price a much more invasive biopsy of your presence is available.

Caseblogs, Medical and Dental Health Blog has a check list for you to accomplish at least three or four times a year.

Here is his recipe for minimizing damage to your online self

Connectivity

Real WIMAX, (not 4G that delivers speed but not distance) may deliver on broadband health IT in remote and rural areas of the United States.

The FCC (Federal Communications Commission) is in the process of releasing “white space”, the television analog frequencies abandoned by the fiat of the FCC several years ago. The white space will be used for ‘Wi-Max” a wide area VHF wireless technology that has the potential for a 60 mile radius with one or several broadcast points. While the power limitations are very low and the speeds are low, it will enable much better coverage in rural areas at much lower cost. The adapters are simple and quite inexpensive, the first rendition that has been approved is from Koo Technologies.(KTS) I believe this will enable rural providers and hospitals to tie into the NHIN easily. The first test markets are in Delaware and Washington, D.C., and rural Virginia. Spectrum Bridge is an early provider for the technology.The technology requires a database search for unused spectrum so that it does not interfere with other users in that portion of the radio spectrum. More details here (download).

The innovation will have a great effect on healthcare, as much as scientific advances in medicine. Connectivity has been rated in the top 10 of the best advances in medicine by USA News.

Health Train Express Ends 2011

2011-12-28T21:36:00.000-08:00

No, Health Train Express is not ending in 2011, rather is signals the time for the annual wrap up on 2011’s big news, small news, and no news.

All of this information need not be regurgitated here, but for those of you who automatically check here daily, I than you.

I have posted a number of links that will feed your never ending quest for information:

General News from the U.K.

Social Media in Medicine: The Answer to the Doctor’s Lounge

Best Hospitals 2011-2012 The Methodology

Best Hospitals 2011-2012

Top 10 Medical Breakthroughs: This one is a little more difficult to list. There are a number of determinants, such as basic science, specialization, public health and others which will effect efficiency and cost savings.

Listed in reverse order starting with:

10. Genetically Modified Mosquitoes to Reduce Disease Threat
9. Novel Diabetes Therapy: SGLT2 Inhibitors
8. Harnessing Big Data to Improve Heath Care
7. Active Bionic Prosthesis: Wearable Robotic Devices
6. Implantable Device to Treat Complex Brain Aneurysms
5. Increasing Discovery with Next-Generation Gene Sequencing
4. Medical Apps for Mobile Devices
3. Concussion Management System for Athletes
2. CT Scans for Early Detection of Lung Cancer
1. Catheter-Based Renal Denervation to Control Resistant Hypertension

You are free to chose a list from:

The Top List of Everything from Times Magazine

Social Media in the Health Train

2011-12-27T16:04:00.000-08:00

It seems no matter where you look on the internet the buzz this year has been about social media. Health care is no exception and there are many beating the band how valuable and perhaps essential it will become in the future.

Much of it will be dependent upon users preferences for efficiently using limited resources, the most important of which is time.

For physicians personally time is the most critical limiting factor. The use of social media is financially negligible unless one chooses a social media manager to direct it’s operations. The necessity for this is dependent upon how much resource your organization has to handle this task.

The capital investment is close to zero.

Physicians can easily acquire the knowledge on how to limit breaches in privacy and confidentiality, and that can be passed on to workers in training.

There is some reason to believe that social media adoption may be approaching it’s limits due to time constrictions for employed people. And doctor you fit in to that equation. Your best income producing time is in the clinic seeing patients, or in the surgery doing procedures.

Hands on marketing for professionals between professionals is best done hands on face-face, in meetings, making rounds, lecturing for CME, taking an ER patient that is difficult or challenging due to insurance issues. The referring physician will forever be grateful, you will help a patient (even if you have to later refer him to a public facility later) and you may get some patients from the source that is insured or will pay a reduced fee.

So in reality you are already in social media….the difference is social media is also on the internet..digital social media.

Most users already are aware of many forms of social media, the most common ones being twitter, and Facebook. These two are unique and function differently although the same information can be exchanged in different ways.

Twitter has become a means of announcing and reporting medical meetings broadcasting tweets using a hashtag assigned for that particular meeting, as I have previously reported in a previous blog. It may be advisable for those developing annual meetings to assign a # such as AMA11 to designate a 2011 American Medical Association meeting, then changing it to AMA12 for next years meeting. Different Academies may also use their abbreviations as such but should take care to be certain it has not already been pre-empted or users will receive some unwanted tweets.

So who owns your twitter account? That depends, as revealed in recent case law that is pending

Case in point. Your employee who has been handling your social media leaves and takes with her social media information which may be proprietary in nature or take with him (her) the following they have developed in your social media stream. Who owns the content? That may depend on the nature of the conversation? Was it friend to friend or was it medical, marketing or financial information belonging to the medical practice.

Legal counsel may be advisable and also a clear guideline in your employee manual in regard to content using your identification on Twitter, Facebook, Google + or any of the social media platforms

Courts Says Employer's Lawsuit Against Ex-Employee Over Retention and Use of Twitter Account can Proceed--PhoneDog v. Kravitz

Jeremiah Owyang ( A Web Strategist) of The Altimeter Group states the golden age of tech blogging may be over.

New models to emerge, long form content not the only way

Bloggers themselves know that relying on a single tool isn’t effective, they need a series of tools to use; “blogging isn’t dead. it may have gotten a LOT more social, and it may be less frequent now for those of us who also use Twitter / Facebook / Tumbler / YouTube for other distribution efforts, but the overall impact from these platforms together is BIGGER than ever before (and i maintain, also EASIER than ever before if you build it right).”

del.icio.us Tags: social media,blogging,twitter,facebook,google plus,social media liability

Health Train Express Enters The Village with Sexuality Discussion and Google Plus Hangout

2011-12-22T20:05:00.000-08:00

“It takes a ‘village” to raise a child” according to Hillary Clinton.

Amazing as it seems the latest survey reveals that up to 80% of physicians use one form or another of social media to interact with patients. This despite precautionary warnings about patient privacy and confidentiality.

The study did not reveal what form of social media they use; email, instant messaging, twitter, Skype or secured Google cloud documents. Google Cloud documents can be locked except for the intended readers.

Business uses the cloud for secure transactions and sensitive data, and there will be no shortage of offerings for medical applications. In fact, the cloud may offer a more cost effective and usable platform for a national health information exchange rather than re-inventing the wheel.

Now there is a new fast growing platform, Google + and even more revolutionary is Google + Hangouts.

Google plus Hangout and Sexual Ambiguity

The following topic was discussed on a public hangout broadcast by a public television station, KOMU TV in Colombia, Mo. Anchorwoman Sarah Hill is a pioneer in the convergent media space. She discusses a personal sensitive issue with Maya Posch born as a hermaphrodite. You will notice the film strip below the large screen of the Hangout participants. The ability to express herself with support from a public audience obviously gives this person hope.

Part I Interview with Maya Posch

Part II Interview with Maya Posch

The scope and power of social media cannot be underestimated among patients who share serious medical issues with like individuals. Caution, the content may be offensive to non-medical viewers. As mentioned in a portion of the video civil rights are part of the challenge in sexual ambiguity.

Please pardon the commercial message at the start of the video.

KOMU Live Stream Hangout Video

The New Google Health Village

Health care is now much like a village, or perhaps a group of villages which need to communicate. The convergence of the internet and television, have created a new milieu. Internet or streaming video may replace classical Television much like over the air TV was replaced by satellite or cable.80% of cable television users also hold a hand held device in their hands while viewing news or entertainment programs. They are frequently polled while watching, straw votes are taken during election campaigns.

The potential is great for social media for two way interaction with doctor and patient using interactive teaching sessions for patients from your office, or clinic regarding diagnoses, treatment course and for monitoring patient compliance.

With the support of Health Train Express Google product developers will develop a new platform, an API dedicated to a Google Medical Application, yet to be named.

Google, in it’s infinite wisdom designed the Google+ platform to be secure on a one to one circle share. It is possible to telehealth one to one. Images are of high quality. The medium is extremely cost effective, free for the moment.

The project will take several months to complete, and you may read about it here when it is ready for a beta release. Please subscribe to Health Train Express or use an RSS feed to see the announcement.

We are looking for suggestions and contributions about what functionality you would like to see in the new Google Medical API. Please tweet me @glevin1 or email me at riversideeyemd@gmail.com

del.icio.us Tags: social media,#hcsm,#healthit,#healthreform,hangouts,sexuality

Window’s Notification Alert !! bong!

2011-12-21T08:40:00.000-08:00

Today’s wake-up alert from The Washington Post

“The Obama administration Monday named 32 health care systems across the country as “Pioneer” ACOs. These will be the first places to test out the new payment model; they’ll provide a bit of a sneak peak at what it could mean for the rest of the country. In other words, we may soon see our first unicorns.

Unicorn, or not it is interesting that they chose 30 health systems which are already business entities and well integrated health systems. They are also located in unique health care markets.

Jim Hinton, President and CEO of Presbyterian Health System (one of the lucky 30 chosen makes these remarks in the Washington Post article authored by Sarah Klif.

“Jim Hinton: Health care has grown up in a fee-for-service system, and it’s also grown up with a system where the primary unit is an individual doctor taking care of an individual patient. At Presbyterian, we’ve been working on making care more integrated for 20 or so years now and have been able to do a lot by operating our own health plan..

A lot of what [the Accountable Care Organization model] does is build a system of care where there’s a safety net and we can help advocate for the patient. We’re looking at how can we do more with nurses and other advance practice professionals. How can we use technology? How can we change the visit model so its not one patient with one doctor every 15 minutes?

He offers some creative solutions for extending benefits such as home health care by up regulating it to a ‘home hospital’, reducing the cost of in patient hospitalization, but increasing the amount of home health care. To me this just seems to be cost shifting and would require major re-designs of accounting for the ACO.

All of these proposals are well hidden in the PPACA and the net effect is going to take a decade or more to be studied.

We’re experimenting with some group visits with doctors, and also another program where we hospitalize people in their homes. One good metaphor is thinking about it as if you were going to remodel your house. If you had a plumber, carpet-layer and someone putting down tiles not talking to each other, the house might not turn out very well. The idea is to anchor all the care in one place, where there’s a lot of coordination.

Mr Hinton summarizes it well for the rest of medicine.

““SK: As you mentioned earlier, your health system has been working on moving toward more integrated care for over 25 years now. What about the health care providers that haven’t been working on this stuff? How well do you think they’ll be able to use these new incentives?

JH: My colleagues who come from systems that have not owned managed care organizations are trying to assess how they can accelerate into this mindset. Most hospital systems today have some experience employing physicians but I think there are still two big barriers in going towards more integrated care. One is bringing an insurance perspective to populations, where you’re managing care and managing risk. The second is a cultural one. Many health care providers have fee-for-service as one of their core business models. It’s hard to get away from this notion that doing more health care means earning more money”

I do not see ACOs catching fire in much of medicine. In fact I predict that smaller towns will continue on their current merry way. Some ACOs may very well have to contract out some professional services depending on the willingness of the physician community to forfeit freedom and independence. This will invoked the laws of secondary consequences with it’s attendant unforeseen challenges.

Physicians resistant to ACOs may very well boycott a local ACO if given that alternative.

Nothing for sure is certain.

del.icio.us Tags: aco,accountable care organization,incentives,outcomes,hhs,medicare reform,ppaca,integrated health systems

The Issue in Health Care is NOT Money

2011-12-19T17:19:00.000-08:00

Contrary to what poor or affluent people think, money does not solve all problems of health care, and it will never stop the issues of caring for one another in a health system.

I believe the entire national budget could be thrown at health care and there would still be a problem of ‘not enough money’. There is more than enough funding to maintain good health, wellness and treat those who are no longer healthy and/or well.

Precious resources are expended on studies, fighting fraud and abuse, having analysts draw graphs that either intersect dangerously at some time in the future, or have in the past. My favorite one is the exponential graph rising vertically into infinity.

The issues are much like the impasse about the debt ceiling. Political expediency and prostituting opinions for votes. We ask politicians to make decisions from false economics, and figures that may be highly inaccurate, against a setting of voting on issues they know nothing about except how it affects a state or federal government.

Case in point is the current conflict about mandated insurance coverage.

Much has been said about using the current medi-caid system to fill in the blanks. This is a more than stupid idea for many reasons.

1 The current system is not designed nor can it accommodate more patients.

2. The current system in many states do not have enough providers to service the huge increase in patients.

3.. The current system is not designed to care for patients. It is cumbersome and designed to deny care for any possible reason, financial, missing paperwork, or a vacant modifier in the billing codes.

4. The current system does not respond to market indicators, and reimbursement methodology is byzantine.

5. The current system needs to be “occupied”

del.icio.us Tags: reimbursement,money,occupy

Ticket Price Increases on the Health Train Express in a Time Calling for Austerity

2011-12-17T11:54:00.000-08:00

Like the airlines, who are not too big to fail, medical practices will need to find ways to increase revenues. It’s too bad our patients don’t carry baggage into our offices so that we could have a surcharge modifier such as –0000 for each item.

However physicians can emit a sigh of relief with the announcement from on high at HHS, as brought to us by the American Medical Association, in AMED News. Included in that news are:

Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses. The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. ( Who cares what Obama thinks about goodwill? The AMA ?)

True to form modifications are being made to the calendar for implementation-incentive reward-penalty dates because the initial proclamations and mandates were poorly planned. What we have in the federal government is a group of “cheerleaders’ encouraging the workers how much health IT will improve patient care. Even the AMA buys into that.

No Doctor Left Behind ? This sounds much like the Bush Plan of No child left behind.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

It takes a lawyer to make the following statement,

“

“There are several takeaways for physicians from Sibelius' announcement,” said Stephen Bernstein, an attorney who is the international head of the health industry practice group at McDermott Will & Emery in Boston. In general, more physicians are adopting EMRs and using the technology to improve their practices.

“HHS also is sending a message to physicians who are undecided about whether they should make a significant investment in electronic recordkeeping”, Bernstein said. “The agency will work with physicians to help them adopt EMRs”. He suggested that doctors get in touch with one of 62 federal regional extension centers that have been established to help physicians, in particular small primary care practices, adopt EMRs.

"The main message is that there are federal government programs out there to help physicians, and the federal government isn't going to stop offering help," he said.

“It’s okay, we are here from the government to help you.” (author)

Bernstein added that a robust EMR system is needed to participate in new Medicare payment models, such as accountable care organizations. If CMS wants physicians to participate in these initiatives as well, it must do everything it can to encourage doctors to use EMRs, he said.

It’s a bundled plan, just like reimbursements. Step C is dependent on steps A and B. (If they work in the first place)

Clearly it is disruption disrupting disruption. Even chaos theory fails to keep up with these advances in advanced health care physics.

The incentive program is clearly aimed at primary care MDs, and the recent statistics reveal it.

Specialty # Participating in Bonus

Family practice 1,216

Internal medicine 1,198

Cardiology 517

Podiatry 378

Gastroenterology 232

Orthopedic surgery 201

General surgery 197

Urology 197

Nephrology 174

Neurology 148

Other 1,347

What Medicaid Paid for EMR Bonuses

Physician 6,609 $138.5 million

Nurse practitioner 1,463 $31.1 million

Acute care hospital 607 $483.9 million

Dentist 333 $7.1 million

Certified nurse midwife 172 $3.7 million

Physician assistant 107 $2.3 million

Children's hospital 15 $45.1 million

What is even more worrisome is the profound recession we are experiencing, the HHS emphasizes the ARRA and Hitech have produced 50,000 job…a mere drop in the bucket. Our budget deficit is crippling planning at the federal and state level….

More than incentives we need austerity.

Stay tuned for more modifications

del.icio.us Tags: medicare reform,incentives,primary care,hitech,arra,papca,sibelius,hhs,obamacare,ama,amednews

Touchfire with Health Train Express

2011-12-14T21:08:00.000-08:00

Another bold innovation (and why didn’t I think of this before?) The beauty of this is that it offers another functionality to the iPad form factor. without the burden of extra parts. Although the iPad offers a keypad feature, users complain there is no tactile feedback which touch typists use unconsciously to type. And the addition of an external keyboard adds to more clutter.

This flexible plastiform rubberized overlay is held in place by magnets which attack to the border of the iPad’s frontface. It gives the user tactile feedback much like a normal keyboard. It also has other features attaching it to iPads official cover.

All in all a dandy device for the clinic, by the bedside or in the hospital.

Health 2.0 in Social Media

2011-12-13T20:23:00.000-08:00

Monitoring the social media stream today in #hcsm #medicine #healthreform and find that Facebook will offer a page and/or referral to FBers who are depressed and suicidal. Is this the first step into Health 2.0 and is social media going to bypass formal developments in the Health 2.0 Challenge?

Mobile apps already support API for all the social media platforms, twitter, facebook, and Google +. Twitter is very restrictive as to which APIs can use twitter’s API however health 2.0 would gain them many more users that do not compete with Twitter’s plans.

I predict that Social media will bypass the present vision for formal health 2.0 apps, and developers should re-think their game plans or be left behind even before it happens.

G+ offers the potential for telehealth with video and it should not be hard for programmers to build a secure encrypted API to comply with HIPAA. It is accessible on smartphones, iPads and many tablet PCs.

I held a G+ hangout on Tuesday night at 6PM. The attendance was zero. A big disappointment but not a surprise at all. Not many MDs and few #hcsm users are on Google + Experience reveals it takes about one month for the stream to capture interested social media participants.

Google + has a predominance of artists, performers, and photographers. Even if you don’t want to hangout in health care…it is a broadening experience and revealing as to how much talent there is besides American Idol and the network cable offerings.

Health Train is the most prominent MD and health related +er on Google.

You can find Health Train’s profile on Google + at the Google ID. Join and put me in one of your circles. Hope to see you all there.

del.icio.us Tags: social media,#hcsm,#medicine 2.0 conference,Google +,twitter +,Facebook,Google+hangouts,telehealth,health 2.0

And The Webcina Winners are:

2011-12-12T12:22:00.000-08:00

Webcina announced it’s winners for their contest for social media participants. Although Healthtrain Express failed to make it to the podium I enjoyed participating and ‘spilling my beans”. My reward was to be able to read these fine stories..Stories that should excite all of us in social media.

I read the winning blog posts, and found them all to be far better in appeal and content than my illiterate meanderings.

Here they are:

The Tap Code by Katherine Leon

Transient Global Amnesia and Social Media by Susan McKinnon

Suzanne Ezekiel’s Journey Her contribution includes her vivid youtube video portraying the effects of her disease. It is one of the most telling and vivid descriptions that leaves the observer breathless and battered. It probably should receive some type of award in videography and story content.

Take My Body Away

Thank you Webcina !!

del.icio.us Tags: webcina,motor neuron disease

G+ Hangout with Health Train Express

2011-12-12T08:44:00.000-08:00

At 6 PM PST/ 9PM EST on Google + Hangout please join us tonight December 12, 2011 for a discussion on health care and reform.

Proposed agenda:

1. Effect of social media on medical practice and business. Do you use it for; marketing, communication, patient care.

2. Will Obama care be repealed? totally or partially

3. Will SGR formula be enacted or put on hold again this year?

4. Will you become part of an accountable care organization

5. Bring your own topics.

6. Discuss selection of special invited guest as ‘keynote speaker” for next week’s hangout to be held on Tuesday December 20 2011 at 6PM PST.

BruceGarber.tv

On next Tuesday we will host a special invited guest, +Bruce Garber, whose interests are in video production and the use of Google hangout for medical conferencing and telemedicine.

Link to my stream to join hangout:

Join HealthTrain Express Google+ Hangout December 12, 2011 6 PM Pacific time 9 PM Eastern time.

Accessible with iPhone iPad as well as desktop or laptop.

See you then:

No Ticket Required on Health Train Express

2011-12-11T11:44:00.000-08:00

Just like my office walk ins are always accepted. The same here on the Health Train Express….my plan for a subject often changes drastically when I surf the web, check my tweet box, Facebook, and Google +.

Healthcare is not all that unique. I find similar challenges in business on Google +, Facebook, LinkedIn and Twitter. Business is also perplexed just what to do with social media. In healthcare there remains a large part of the workforce that are neophytes with health information technology and how to use it. Questions arise about return on investment with EMRs, Health Information Exchanges, Outcome studies, and Analytics. The jury will be out for several or more years for many reasons. Statistics have a way of flowing in slowly however with the modernization of systems and new software that will take a set of tables, and charts and transform them into an easily understood graphic understanding sheer numbers may turn into a video-game like presentation.

As in healthcare business is challenged as to what portion of social media to exploit, where, and how much. Like electronic medical records the work force must be trained in social media.

del.icio.us Tags: hcsm,social media,google+,twitter,facebook,linkedin,urgent care

Health Train Conductor

2011-12-10T14:14:00.000-08:00

Do you remember in days of old the train conductor would come by and punch your ticket. The shape of the punch hole looked quite a bit like # .

# now represents the hashtag on twitter as well as other social media platforms.. Speaking from my anecdotal story of one in the cohort, I found them to be confusing at first, especially if there was a hashtag salad of multiple #s.

The Hashtag Project. Hashtag Project is organized and administered by the Foxepractice.com Consulting Firm. In addition to their epractice modules and advice on Web 2.0 they provide a full menu of services. If you don’t have time yourself to dive into social media (and few doctors do) they can set you up and your staff can do the daily operations. Put your efforts into your own area of expertise.

The proper use of a hashtag allows others to search the twitter stream for your subject, #hcsm is the most often used tag for medical issues, and there are also specific hashtags for medical meetings. ( a topic I covered in one of my recent blog posts).

Recent analysis of social media in medicine reveals some positive dividends and a return on investment, according to FiercePractice Management. One primary care physician attributes 30 new patients/month from social media engagement prior to an office visit, conservatively estimating a $125,000 annual return on his $60 investment.

According to the update from online physician learning collaborative QuantiaMD, 87 percent of physicians make personal use of social media, while 67 percent use it professionally.

The QuantiaMD report also indicates that most physicians using social media are heeding to best practices, with 75 percent of those who've received friend requests from patients saying they declined. While challenges persist in navigating the best ways for physicians to use sites such as Facebook, Twitter, Google+ and the like, some doctors who've dipped a toe in the water report unexpected advantages.

Natasha Burgert MD, a pediatrician committed to one year of social media with surprising results as published at Pediatric Inc

On Monday evening, 6PM PST December 12, 2011 there will be a Google + Medical Hangout. If you would like to attend send me an email gmlevinmd@gmail.com or tweet @glevin1

del.icio.us Tags: social media #hcsm,quantiaMD,hashtag

HealthTrain RaP

2011-12-09T13:29:00.000-08:00

Some of you already know about Zdogg and Dr. Harry, so this may seem lame, but for those of you who have not seen them, they are the “rappers” of medicine.

On another front, today I held the first Google + Medical Hangout with a friend +Bruce Garber (with his waiver regarding HIPAA). He had an eye problem which I was able to diagnose using Google + Hangout with an ordinary webcam. If your webcam is good enough with HD and you have a good video graphics card, it works well.

I hope you will all join me tonite at 5PM PST for my medical hangout on Google +. Let me know what prominent doctors you would like to be in the hangout and I will invite them for tonite or next Friday nite. You are all invited to participate. Admission is FREE !!!

del.icio.us Tags: Google Hangout,Medical Hangout,ZdoggMD,#hcsm

Health Train Hangout with Newt Gingrich

2011-12-09T11:17:00.000-08:00

I spend an inordinate amount of time on social media, Google + and Google Hangout in particular. Most of the time on sites relevant to healthcare and medicine. I also attend events worldwide on SM in general, research large business consulting firms such as Forrester. Now and then I bump into a Presidential candidate. Watch this one, and you might see me.

Speak withi a Presidential Candidate from the comfort of your Couch at Home

Facebook and Twitter serve some specific needs that I use for messaging and communicating one on one. Many of my followers are not at all familiar with Google +

I am here visiting the LeWeb Conference in Paris France. This is the Euro-Web event.and my G+Stream as well as Tweetdeck.are busy. I also am using a social media browser, RockMelt which aggregates twitter, facebook, and several of my favorite RSS feeds.

Rockmelt also facilitates customization of website you visit frequently. The page is simplistic with most of the desired links on the left banner. I can switch from web sites to a social media site very quickly.

Is all this social media relevant? I think it is, as a tool and for some as a revenue stream, and information stream.

The roster of presenters reads like the Who’s who of software application developers and famous internet entrepreneurs.

Today at the LeWeb Conference, Marisa Meyer (Google +) pointed out that Social Media is “green”. Conferences and social media interact to decrease travel to meetings, Forrester Gartner, business consultants predict that social media is running out of time (limits of time available), and running out of people…Social Media is in a bubble. SM will have to be more efficient…the next wave will be faster, easier to use and have a higher value per unit of time.

In the Enterprise (Hospitals, Integrated Health Systems, Universities) tremendous growth is taking place, newer platforms, and for professional services. SM will become the central hub with radiating spokes to the cloud, to mobile apps and classical desktop services. These changes are taking place rapidly in business, healthcare is a laggard (as usual).

Anyone who attends a social media event comes away excited, either because of the energy of the presenters, or because of the ideas for applications in health care, which at present remain unfulfilled.

In a parallel universe the occupy movement reflects the earliest indicator of looming change for business, government and healthcare. The old paradigms will disappear with the ineffectual systems we now use.

Is healthcare boring? No, but healthcare systems are staid and about to face the apocalypse of Armageddon.

All experts advise not rushing in to social media where only fools dare to tread. Adequate preparation, education and training are essential to prevent damage to your brand or reputation. The analogy is ‘screaming in the middle of the room to get attention”.

It is very much like choosing an electronic medical record…choosing the wrong one or how to use it can be a disaster and have a negative effect.

And that’s all I have to say about that ! I can be reached at twitter @glevin1

del.icio.us Tags: healthcare hangout,twitter,social media,#hcsm,Gingrich,LeWeb,Google +,Rockmelt

Social Media Lawsuits??

2011-12-07T18:10:00.000-08:00

Is it safe to socialize?

It seems bloggers are not immune to large legal settlements. A judge decided that bloggers are not journalists.

(from Mashable)

In a case that’s sending a frightening message to the blogger community, a U.S. District Court judge ruled that a blogger must pay $2.5 million to an investment firm she wrote about — because she isn’t a real journalist.

Judge Marco A. Hernandez said Crystal Cox, who runs several blogs, wasn’t entitled to the protections afforded to journalists — specifically, Oregon’s media shield law for sources — because she wasn’t “affiliated with any newspaper, magazine, periodical, book, pamphlet, news service, wire service, news or feature syndicate, broadcast station or network, or cable television system.”

The Obsidian Finance Group sued Cox in January for $10 million for writing several blog posts critical of the company and its co-founder, Kevin Padrick. Obsidian argued that the writing was defamatory. Cox represented herself in court.

The judge threw out all but one of the blog posts cited, focusing on just one (this one), which was more factual in tone than the rest of her writing. Cox said that was because she was being fed information from an inside source, whom she refused to name.

The debate over whether bloggers are journalists has been going on for years, but the consensus has been largely settled — on the opposite side of what Judge Hernandez has ruled. Attorney Bruce E. H. Johnson, who wrote the media shield laws in next-door Washington State, told Seattle Weekly that those laws would have protected Cox had her case been tried in Washington.

Will Medicare sue a blogger? How about Aetna, or Humana, or Blue Shield?

Are your tweets protected information, or your Facebook comments?

del.icio.us Tags: social media,legal,settlements,journalism,bloggers

Social Media and Art Galleries

2011-12-06T09:03:00.000-08:00

Regina Holliday brings to life in her art work much of the confusion in healthcare and the misery and heartache it brings to patients.

If you have been to a medical meeting she is the lady in the back intently painting her reaction to the subject of the meeting. I’ve known about Regina Holliday for several years. Although we have never met, I hope someday to meet her, I feel I know her well and her family as well.

I want to share her latest art work which she has shared on her Facebook pages.

Here are some of her paintings, and her comments:

Halloween night:

“I boarded an Airplane at 7:30pm at Regan National on October 31^st still wearing my Wizard’s Robes. I spoke the next morning before the folks at OCHIN. My Presentation was called Trick or Treat, and I wove references to Halloween throughout the speech.

I then began to paint. I painted in two sessions in the morning. The painting is called: “50%.”

I saw the first presentation “Integrating Mental Health into Primary Care,” delivered by Tami Hoogestraat, Psy. D., M.B.A. and Demetrio Sanchez, MSW-OHSU, Richmond Mental Health Integration Team. I was very impressed by their slides. An early one really caught my eye with its statistic: “50% of mental health problems are missed in primary care.”

“In this painting the patient is divided in half just like our statistic. Half in darkness half in light he clutches his medical home. The medical home is colored like and reminiscent of a Monopoly house. It is an ideal but will not work without a supported reimbursement model. “

To the left of our figure the spider web diagram of integrated care places the patient in the center. But this no comforting circle enclosing clinical text. Here the patient looks up staring at the viewer whilst frightened. Practitioners that are trying to care for him surround him. I added other threads crossing the path of the diagram to the other care agents and detriments in the man’s life, be they friends, foes or family.”

Here patients race up a stairs trying to make their appointment time. A mother glances nervously at her watch as she hurries her child up the stairs. A doctor waits at the top reaching out to the registered patients with one hand. In the other he hoists a rope that ends in a watch. A patient in an examination robe strenuously climbs the rope. She is not scheduled but direly needs care, and the doctor is trying to fit her in, hence the term advanced access.

I decided to take the OCHIN logo and modify it to a Meaningful Use Sun image. So a logo tree becomes the tree of knowledge, weighted heavily with apples. Surrounding this tree are dots. But these dots have become faces, just as much as data points and statistics represent real people. These are the patients and providers creating the workflows for Meaningful Use.”

All are Vivid paintings in which many issues are illustrated, and which actually don’t require words for the admirer to understand. It speaks to me.

Regina’s work can be found on Flickr

LiveJournal Tags: regina holliday,meaningful use,medical home,artists

Health Reform Politicization

2011-12-05T16:44:00.000-08:00

Those of you who read Health Train know that I invite others to post here. Since I am a physician I cannot write as well as some devotees to journalism. I have many other sources listed on the blog in the lower portion of the right hand banner.

Later this week I will be featuring a new source.”Reforming Health” written by Naomi Freundlich an award-winning journalist, policy wonk and health advocate with over 25 years experience writing and thinking about health care, medicine, and the absolute necessity of creating an equitable, affordable and high-quality health care system that offers coverage to all who need it.

The discussion of health reform and policy must be in an open and transparent forum which Health Train Express attempts to encourage. The diversity of opinion will strengthen and increase chances for a successful outcome.

Health reform has already fallen victim to politicization and radicalized thinking which benefits no one. If it fails, everyone loses. No party will be immune from criticism and will suffer the consequences of irresponsible positioning and stereotyping the opposition.

Don Berwick Controversy

2011-12-04T11:47:00.000-08:00

Dr Don Berwick resigned from his position at CMS this past Thursday.He resigned with little chance of being approved by congress in a long delayed hearing process. President Obama doomed him to failure with the ‘rush’ to appoint him to the position as head of CMS while Congress was not in session. Dr. Berwick is an outstanding physician and analytical expert, His experience and record as President of the Institute of Medicine (I.O.M.) portended significant accomplishments at Medicare and HHS. He is such an individual with strong convictions and integrity. He is now the first to admit the difficulty and challenge of framing and implementing changes in not only HHS,CMS but our entire Federal and State systems of government.

In a world of politics where there are no shades of gray, but only the rigidity of black and white differences of political opinion he was faced with his own unintended skeletons. In addition to his own opinions he was sabotaged by President Obama,, himself in the manner of his appointment, perceived by congress as a detour around the process. Congress had some serious questions to ask Dr Berwick, and had he the chance to answer critics, Obama may not have faced the intense resistance to implementing Obama care. In return Congress made it clear he would not be permanently appointed.

Deep partisan divides have stopped Congress from confirming Berwick since mid-October 2006, creating instability in the agency that oversees the Medicare and Medicaid programs. Obama installed Berwick in July 2010 as a recess appointment, which was heavily criticized by Republicans who accused the pediatrician of favoring health care rationing -- a charge Democrats dismissed as nonsense. (Senior Journal.com).

Those of you who read my opinions know that I was not a Berwick fans. However in his departing commentary he pointed out,

“The extremely high level of waste,” as exemplified by overtreatment of patients, failure to coordinate care, administrative complexity, burdensome rules, and fraud.

• “Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”

• “I came with an agenda, I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

• It’s a complex, complicated law. To explain it takes a while. To understand it takes an investment that I’m not sure the man or woman in the street wants to make or ought to make.”

• “We are a nation headed for justice, for fairness and justice in access to care,”

• “We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that’s compelling.”

• “Government is more complex than I had realized. Government decisions result from the interactions of many internal stakeholders — different agencies and parts of government that, in many cases, have their own world views.”

• “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

• Berwick added, “Republicans have completed distorted my meaning. My point is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

In another ‘interim appointment’ President Barack Obama is nominating Marilyn Tavenner (Washington Post Wonkblog) to succeed Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services.The current political climate on Capitol Hill may mean that Tavenner is just as likely to see her nomination stall.

del.icio.us Tags: berwick,tavenner,cms,hhs,medicare reform,papca

My Webcina Story

2011-11-30T12:39:00.000-08:00

Things my father never taught me about social media…thus HealthTrain Express was born.

I still feel privileged to know I was there at the birth of medical social media. I remember the strange looks I was given when I talked about it at meetings and used it to develop my blog as a form of newsletter (for free) when I was investing time into developing health information technology.

My entrance into social media in 2004 was at a time when only some heard of social media. At the time there were far fewer bloggers and most had to have some level of nerdiness and geek quality to even know how to blog. The popular platforms such as blogger, wordpress, Drupal, and offline clients like Windows Live Journal were not much in use. To be a blogger took gumption and significant time. It was more difficult since the smartphone revolution and the iPhone in particular was not available.

Social media allowed my expansion into health organizations from Harvard, where I mixed with the Chief Information Officer of the University, and Patient advocacy groups. It empowered me to be on the patient side of the health care equation. I met artists who used their talent to create artwork at meetings based upon the topic of the meeting. One of my favorites is Regina Holladay, who was unknown at the time. I can see how SM has made her well known.

I have always been one of the USB people…I like to ‘plug and play’ and fortunately I found blogger very early on. It was not sophisticated, and I learned as time went along how to modify templates, themes, insert HTML, videos, images, and how to insert hyperlinks into my text.

My first platform, “ Inland Empire Regional Health Information Organization” blog was a newsletter for a newly forming Health Information Exchange. The readership was limited to less than 100. It was focused on our fledgling health information exchange as a source of knowledge regarding medicine and electronic medical records, and government grants to fund their implementation. It also served to connect with other HIEs and the California State-wide HIE. It was read by the Department of HHS and the newly appointed head of the Office of The National Coordinator for Health Information Technology (ONCHIT). We stimulated vision, education and eventually dug the foundation for the stimulus packages in HITECH and ARRA.

My social media experience with twitter and Facebook were non-existent. About one year ago I began tweeting and learning about hash tags. I began posting on Facebook as well to drive traffic to my blog and other publications.

Somewhere in the middle of all of this I began to freelance write, it evolved from the fact that I did not think I was a very good writer. My ideas were good, but putting it down on paper lacked the polish I saw in other spaces. I had been spending a great deal of time blogging without compensation. I decided to discover free lance writing to learn and earn online. I was compensated for researching financial news about mergers and acquisitions in the social media space publishing on Next.Inc.in . I learned to feed my blog(s) with twitter, Facebook links and now Google + links. The advent of the Google + Hangout looms large for me.

My network has expanded to artists, musicians, videographers, poets, and more, all of which I will integrate into scientific presentations for a change of pace, entertainment and to maintain interest in my audience. I see social media as a picture book of conversation and social intercourse.

I spent much time surfing blogs, and websites in addition to writing my own blog.

My life as a physician was very interesting although a bit cloistered revolving around patient care, medical technology and research via the internet. Academic search engines such as PubMed, and Web-based data repositories along with specialized references played a large role in the latter years of my surgical practice. I was an early adopter of electronic prescription writing and was a beta tester for a well known eRx program that exists today. It was featured on a now dead platform, the Palm Pilot, the ancestor of the current smartphone (without the phone).

Like social media, the hardware platform evolves with the software platforms. Which comes first? The chicken or the egg? Without a suitable platform software dies unused, and without suitable software hardware quickly becomes a useless 'brick”.

Form and function go hand in hand and in today's world PC ethnology has developed into tablet PCs and smartphones for convenience and mobility. As I predicted in my early blogs the development of EMR and HIT in medicine would lag until the mix of hardware and software allowed for a physician patient encounter face- to- face and not face- to -keyboard/monitor.

The social media millieu has followed this path to it's current position with multiple platforms accessible from a single client API.

My progress in social media has followed this same pathway. My blog at Health Train Express travels my route since 2004. It's been a self taught journey. Writing and producing content is only a small part of the journey.

Social media participants are not static...we evolve. The power of innovation and entrepreneurship has driven many bloggers, Facebook users and twitters' to monetize their publications.

Although I have been tempted to veer off in that direction my main source of income has always been medicine. I never felt the necessity to derive income from social media and enjoyed it for the chance to develop writing skills, learn more about communication and media and the use of internet technology to make my voice and opinions heard. I developed new friends in areas where I had no previous experience. The curiosity was latent, only waiting for social media to shake it into the open.

As time went on I became immersed gradually in social media, first in Facebook, twitter, and by perm linking to other blogger's spaces. Early on the comment box of a blog was a form of chat room for bloggers like me. IM chatting never caught on with me, however Skype video intrigued me early on. We reciprocated our blog popularity with a blog roll banner on our blogs.

Medical bloggers developed the “Health Care Code of Ethics for Bloggers”. The code was revised in May 2007 when HIPAA regulations became effective regarding patient privacy and confidentiality matters. The new law also encompassed health information technology electronic medical records, Health Information Exchanges

Awards and Recognition were given for the best health blog. Some bloggers aggregated other blogs into theirs and offered guest blogger positions. There was pride and esteem in the ranks. The social health blog was a very personal environment with writers respecting one another and their opinions.

Social media websites began to emerge that were limited for physicians only, SERMO, iMedExchange, and Ozmosis exist today. These sites require authentication with a state medical license which must be verified. SERMO boasts of itself as the leading Social Media Platform for doctors. It is even divided into specialty niches.

Social media sites are invaluable to large organizations in healthcare such as the Mayo Clinic and small entities such as small group practices and even solo practitioners. It is limited only by imagination, and a willingness to step off and possibly receive some criticism. It is buoyed by freedom of speech and a huge collective of supporters who headed in the same direction. It is a place where diversity is magnified and exploited for the best outcomes.

Social media lays bare the ugly side of some issues and the results produce a real electronic freedom of expression and a hope for betterment of our species. Would the Arab Spring have evolved differently without social media?

My blogging and social media content and direction not only served to satisfy me, it also provided a catalytic platform for disruptive technology in a previously “cottage industry’ of healthcare.

Social media, Health Information Technology, and mobile applications are the “perfect storm”in health related business and medical practice.

Prizes are awarded each year for the best health blog. Some bloggers aggregated other blogs into theirs and offered guest blogger positions. There was pride and esteem in the ranks. The social health blog was a very personal environment with writers respecting one another and their opinions.

Social media websites also emerged that were limited to physicians only, SERMO, iMedExchange, and Ozmosis exist today. These sites are password controlled require authentication with a state medical license which must be verified. SERMO boasts of itself as the leading Social Media Platform for doctors. It is even divided into specialty niches.

My discussions developed ”out of the box” ideas and found many shared these ideas and empowered me to share them with anyone who would listen.

My own point of view is not to blog or comment anonymously. My attitude is that anonymity dilutes the writers 'integrity' and the power of the message. Then again I don't have an employer who might look aghast at some negative commentary about the business or attitudes that run contrary to the employer or corporation's interest. Thus far I have not been stalked. However in social media that is a risk.

Google + and Google Hangouts have afforded me the ability to be broadcast on live Television News programs where the anchor person interfaced with other + Hangout-ers, and to watch artists develop paintings, share portfolio, watch and hear new budding musicians form their craft, meet with fellow hobbyists from far and near. I have even had my caricature drawn live.

Gary M. Levin M.D.

by Cliff Roth

Earlier this month I saw the Webcina offering for a contest about stories in social media. I was not sure I had much to offer, until only tonite less than 24 hours before the deadline on November 30th.

By late afternoon my daily events convinced me that I must share my story.

In my early morning hours I check my gmail accounts. They are linked to comments and posts on Google +. I receive emails from Summify which aggregates many of my networked blog feeds. I use Feedjit which details all those who come to my blog and from which countries. Social Media today sends me a report of aggregated blogs, and a summary of blogs that I have written and have been networked by Health Works Collective. I spend about fifteen minutes on tweet deck and search for #hcsm, #meded I look for medical meetings and attempt to find the suitable #tag. I use Tweetdeck and Hootsuite for posting on multiple platforms simultaneously. I find this advanageous rather than repetitive because my audience uses different platforms, few have time to read or post to all. My object is to reach the largest audience. I look at my Klout Score once a month. My progress seems to be measured as improving from a 18 one year ago to a 48, not a world record but reasonable for a single person not into marketing. (Watch out Britanny Spears and Jolina I am on your heels.

Social media is the electronic version of ‘word of mouth’, powerful and very underestimated in all fields, yet intensely personal and usually credible amongst close friends. It functions as the ‘whisper’ form of the ‘banner ad’.

Currently I am publishing a directory of #tags for medical meetings and encouraging attendees to tweet, or post on facebook and/or open Google + Hangouts for those who cannot attend important meetings.

Twitter enters Health Care Conferences: For me this is one of the most useful ideas in SM for medicine. You’re attending a healthcare conference and have one of those moments where something of real value to you was said. Or perhaps you’re attending one of these special unconferences that spur incredible creativity and innovating thought. In both cases, two issues often pop up.

“I need to make some good notes of this”, and “more people should have been here right now to hear this stuff”. The conference participants have, perhaps somewhat unconsciously, been functioning as Trojan horses. In their pockets are hidden iPhones and Androids, loaded with Twitter clients, instantly both recording what they perceive are the greatest thoughts from the conference and sharing it to the public. Information wants to be free.

Social media, like the internet in general has become a relatively free open source of information changing journal publications, and accessibility to expensive closed conferences.” (Foxepractice.com )

Eventually meeting attendees will habitually utilize social media streaming during a meeting for each speaker regarding the high points of their topic.. It will require some pre-meeting organization and direction to assign appropriate hashtags for specific meetings. Some used thus far in 2011 have been #mayoragan #aao11, #ismppem11. Tweeting and/or Myspace can be used for more than meeting at Starbucks, and/or travel advisories.

I could not have predicted in 1984, 1994 what would happen. What will it be like in 2024? I hope I am still here. I will only be 87.

I picture me sitting there with several of my great grandchildren, asking me what it was like in 2012…my answer will be “you kids are spoiled, the only things we had were the internet, smartphones, twiitter, facebook, Google + and Mark Zuckerberg. Why I can remember when Steve Jobs started Apple.

Their response: Steve Jobs? Who was that?

Its’ all relative…my parting words.

The uses of social media are only limited by your imagination.

del.icio.us Tags: #webcina,social media,twitter,hashtags,facebook,google plus,google hangouts

LiveJournal Tags: #webcine,social media,twitter lists,hashtags,facebook,google plus,google hangouts

Technorati Tags: #webcina,social media,twitter,hashtags,facebook,google plus,google hangouts,klout

The Rise of Google + and Hangout in Healthcare.

2011-11-29T17:37:00.000-08:00

Imagine this if you will (and this is not imaginary). I am sitting at home quite comfortably on a Google + hangout and suddenly a window appears from a Live newscast in Colombia Mo.

Suddenly I am in the midst of a live news program where I am asked a number of questions about medicine, health and reform.. Sarah Hill (an Emmy Award Winning News Person is one of a few broadcasters who use Google + Hangouts regularly during their broadcast day to obtain opinion and comments from viewers like you and me. My sense this is just the beginning of a new iteration of social media.

Social media in general and healthcare in particular has reached a significant audience, and even more important, active participants. The rise of the hash tag and understanding of how it works and is used makes the millions of seemingly endless tweets somewhat more organized according to readers’ interests.

Hash tags are really quite simple and they allow a selective view of recent tweets according to your interest. The challenge is identifying the best one(s) for your search. There are some directories available. In healthcare the Foxegroup has a good resource for #hcsm (healthcare in social media). A Google search for hash tag ((N) where N is the area you are interested in will bring up some other resources. That is for the incoming stream you read.

When posting you can also identify the general group you target in addition to using the @ sign. You can use multiple hash tags. It is also possible to search for an individual twitter stream such as #glevin1. Try that to follow my stream of unconsciousness on twitter.

I have been accused of being a hash tag scrambler using multiple tags. One must be cautious to leave a space between the tags otherwise the software will concatenate your hash tags into a meaningless string of words.

Hash tags can also be added to Facebook entries, Google+ entries as well as tweets.

Each week I read more and more about the growth of social media in healthcare and medicine.

The addition of Google + and the Google + Hangout adds a new dimension to social media in terms of intimacy and face-to-face-time in a way that Facebook failed to capitalize upon.

My Google + Stream will soon offer the “Medical Hangout” on Thursday evenings, 6PM PST. I am looking for outgoing visionaries in the Health 2.0 space from an international audience. I am certain you have something to offer, even if it is a negative opinion.

If you are reading this, place me in your Google + circles to receive an invite to my hangouts.

Meanwhile I have just realized it’s time for me to submit my social media story to Webinar. I might win a prize if I win the contest.

LiveJournal Tags: blogs,twitter,facebook,webcina,G+ #hcsm

del.icio.us Tags: blogs,twitter lists,facebook,webcina,G+ #hcsm

Social Media Update for HTE

2011-11-26T15:10:00.000-08:00

Update on the Blog Format and Widget Add-ons:

Readers may notice I have re-instituted the “Feedjit” feed. I did not realize how useful it was in tracking who tracks me. I have missed it. It opens a new social media tool for true personal communications with those with similar interests. I do attempt to reply to all who email, tweet, friend, circle me on G+. During December I will be filtering my responses to those who have not responded to me in the past year. I know how busy you all are, and I am sure those readers will not miss me. If you have followed me in the past six months and want to be retained contact me.

2011 has been an eventful year, like 2010,2009, and beyond. For those of you who blog and/or do SM it is never a dull moment. For me it is a breath of fresh air to belong to the SM stream. (it saves a lot on gas). Look for me on my favorite venue, Google Hangouts. I can be found almost at any time between patients, surgeries, and my regular time is at 6PM PDT Thursdays.

Googlel + Hangout Example: Live Stream from KOMU Lecture at University Journalism Class

I can also be found frequently on KOMU’s NBCs news casts with Sarah Hill each morning. Circle Sarah Hill or Me on Google + and receive an invite to attend and/or participate. (only 9 get in so join early as soon as you see the invite. I try to post the hangout a few minutes early on twitter. Search for my tweet at #glevin1 If you cannot join the hangout there is often a live stream on #glevin1

This year I will continue my ‘rants” on healthcare reform, and introduce new media for bloggers, a series of Google + hangouts which will include several prominent health bloggers. I also invite you to apply to participate in this ground breaking health cares social media #chasm on twitter.

Topics may range from health reform to expert opinions on patient advocacy, participatory medicine, and we also may introduce a ‘TED SM

In all it will be another exciting year in #chasm. I am looking for a global presence in participation.

del.icio.us Tags: social media,google hangout,G+,#hcsm

LiveJournal Tags: social media,google hangout,G+ #hcsm

Happy Thanksgiving Health Train Express

2011-11-24T16:00:00.000-08:00

It is a Happy Afternoon here after Tom Turkey has donated a mega-dose of tryptophan to me and I descend into an endorphin sea of pre-somnolent horizontal meditation. As I pass from consciousness a stream of thought occurs about the past years blogs, social media and how to wrap up 2011, and worse what planned and unplanned revolts, reforms, recalls, and revolting decisions will affect medicine and health care.zzzzzz in 2012.

Wake me up when the pie is ready.

Tomorrow the “Elephants” and “Asses” can resume hostilities while the country burns.

LiveJournal Tags: gop,democrats,congress,thanksgiving,deserts,elephant in the room,turkey

The Farmer’s Donkey & The Well

2011-11-22T19:29:00.000-08:00

One day a farmer's donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn't worth it to retrieve the donkey.
He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone's amazement he quieted down.
A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing. He would shake it off and take a step up.
As the farmer's neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!
MORAL :
Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells just by not stopping, never giving up! Shake it off and take a step up.

What is that all about here on the Healthtrain Express? Who is in the well? Patients? Doctors? Bureaucrats? Government?

Perhaps we all are and should be shoveling the dirt underneath us and not at each other.

LiveJournal Tags: donkey,patient,doctor,bureaucrat,government

A Lesson from Richard Feynman

2011-11-13T15:18:00.000-08:00

Some of you may recognize this man, as well you should. Feynman was a well known physicist who often thought out of the box. Feynman was a powerhouse in the world of theoretical physics, During his lifetime, Feynman became one of the best-known scientists in the world.

Feynman was a keen popularizer of physics through both books and lectures, notably a 1959 talk on top-down nanotechnology called There's Plenty of Room at the Bottom and The Feynman Lectures on Physics. Feynman also became known through his semi-autobiographical books (Surely You're Joking, Mr. Feynman! and What Do You Care What Other People Think?) and books written about him, such as Tuva or Bust! (wikipedia)

What does any of this have to do with Health and Medicine and Doctors?

The Map of the Cat Conundrum:

Anyways. As any Feynman fan will remember, he decided to drop out of Physics for a while and check out BiologyThe story goes something like this:

“A map of the cat, sir?” she asked, horrified. “You mean a zoological chart!” From then on there were rumors about some dumb biology graduate student who was looking for a “map of the cat.”

When it came time for me to give my talk on the subject, I started off by drawing an outline of the cat and began to name the various muscles.

The other students in the class interrupt me: “We know all that!”

[Now THIS is my favorite part!]

“Oh,” I say, “you do? Then no wonder I can catch up with you so fast after you’ve had four years of biology.” They had wasted all their time memorizing stuff like that, when it could be looked up in fifteen minutes.

This is the harbinger of what is occurring in healthcare and many sciences as well. No longer are we required to fill our cerebral cortices with dribble that will mostly be lost in time. Our efforts will be toward truly cognitive skills developing constructs with analytics. There will be few places without access to terabytes of stored data, tables, charts, algorithms, transforms, calculus, spreadsheets and the like.

The stigma of referring to a database in front of the patient will turn to “doctor aren’t you going to look that up to be sure it is correct?

Referring to a social media hash tag or a Google circle for an instantaneous second opinion from a #hcsm or #ophth or #intmed friend will become common place.

And that my friends is the power of how social medial will transform your daily dabblings in healthcare

LiveJournal Tags: Richard Feynman,physics,emr,health,doctors,socialmedia,facebook,twitter lists,G+

Wal-Mart and Your Health Care

2011-11-12T15:41:00.000-08:00

It’s just a matter of time. As you exit your local Wal-Mart or SuperWalmart notice the Optometrist and the Optical Shop.

Fairly soon you may also see ‘The Medical Clinic”adjacent to the ‘eye department’ with Dr Joe Smith’s name plate inserted in a sliding name holder.

Wal-Mart wants to be the nation’s largest primary care provider. And no doubt, unless the public refuses to use it, that will come about.

At the moment it is easy enough to walk into any Rite Aid or CVS pharmacy to obtain flu inoculations. They will even bill your insurance. The CVS Urgent care clinic has a better EMR than many primary care physicians.

Have you noticed when calling for a prescription from Rite Aid the telephone voice tree gets in a ten second spot announcement for it’s lineup of immunizations. I have even had an automated telemarketing machine call me at home to get a flu shot scheduled at CVS soon.

Wal-Mart's public comments revolve around lowering their own employees health expenses. We used to do that in “occupational health”, an internal department of most industries.

“Analysts said Wal-Mart is likely positioning itself to boost store traffic – possibly by expanding the number of, and services offered by, its in-store medical clinics. The move would also capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance.”, so says Julie Appleby and Sarah Varney in The Health Care Blog

Wal-Mart distributed an RFI (Request for Information) recently to determine how vendors could be used to lower health care costs. Wal-Mart's request goes even further, asking possible partners to provide information on how they would oversee patients with complicated chronic conditions, including asthma, HIV, arthritis, depression and sleep apnea.

LiveJournal Tags: cvs,minute clinic,walmart

Occupy Health Care

2011-11-11T11:40:00.000-08:00

The #“Occupiers” of healthcare also need a medical home and/or a primary care physician. Despite the government (state and/or federal) push to form accountable care organizations (ACOs) this will be very difficult to accomplish.

Ignoring the very real barriers to #ACOs (except for some large healthcare entities like Mayo Clinic, Henry Ford Hospital, Cleveland Clinic and Kaiser Permanente) the shortage of primary care physicians,is the leading challenge for this “homeless person”. i(e GPs Family Doctors and some internists as well as Ob/Gyn and Pediatricians which may also be counted as primary care,)

If this person has a smartphone he can indulge in participatory medicine and social media in medicine #hcsm via facebook, twitter and G+, ask questions of friends and communicate with some care providers.

The concept of “Occupy Wall Street carries over to health care, with the same outrage as those demonstrating in all the cities, where the healthcare issues also reveal huge disparities in healthcare availability and affordability.

The situation now approaches a critical mass with each section of society claiming “I pay enough, not me !) Unions want more, employers want less, employees circle the wagons with the latest demonstration project, Medical Savings Accounts, HMOs and empty promises by all concerned.

Several aspects of Obama care have already gone into effect, however there remains a real possibility large portions will be rescinded.. The law was written with a non-severability clause, ie, all or nothing. That’s a huge CATCH 22.

Although many states and others have raised issues, including constitutional law it appears that the judicial branch of the U.S. thus far has offered little if any relief from Obama Care. It will undoubtedly make it’s way to the Supreme Court of the land.

Prominent congressional representatives are offering measure to repeal all of part of the Patient Protection and Affordability Act

LiveJournal Tags: PAPCA,Obamacare,Supreme Court,Repeal Obamacare,Occupy Healthcare

The End of Medicine as We Knew It, R.I.P.

2011-11-06T12:49:00.000-08:00

Does the message here operate when we face unwanted or unexpected changes. Do we grieve for that which we use daily and come to ‘love’.

Am I sticking my neck out? Don’t shoot the messengers

Am I a messenger or a heretic? Perhaps a little of both. I am always open to changes, however my first reaction to a new idea or product is enthusiasm tempered by a bit of hesitancy until I see which way the wind will blow. My decisions inevitably depend upon a proven technology and adoption. Too many times I have invested in great possibilities that can not or are not self-sustaining, become obsolete, old in short time, or created more problems than are solved.

This applies to technology in diagnostic and therapeutic machines, as well as cost containment, HMOs, PPOs, ACOs Machinations about EMR, HIT, incentives and penalties, deadlines for adoption that are never realistic, and all the machinations of a far distant decision making process inside a ‘beltway’.

Despite serious reservations and outright negative commentary, physicians see some or all of these adopted, and continue to practice medicine, with each change creating more frustration built upon previous layers of negative results, and negative ROI.

Does it really matter? Can medicine as we know it survive or do we just let it R.I.P. ?

Perhaps this is just my Sunday morning ennui

LiveJournal Tags: change,obsolesence,R.I.P.,HMO,ACO,technology,emr,hit

The Integration of Social Media and Participatory Medicine: The Meaning of the ePatient Movement: Part I

2011-11-05T09:53:00.000-07:00

A key component of cost containment in medicine and healthcare is wellness and compliance with treatments using educational courses, advocacy in groups of specific illness and support organizations to encourage patients with or without devastating illness. This is particularly true in orphan diseases where a disease is uncommon or even rare, and chronic illnesses such as degenerative neurologic diseases, inherited diseases and cancer.

How can social media platforms such as twitter, blogs, facebook and G+ contribute to this effort?

Hospitals are integrating these functions into their web sites

“As units of analysis, the authors first identified different types of online media formats utilized by each hospital (eg, blogs, instant-messaging, audio clips, and video clips etc.). After identifying media formats, patient health information content (eg, disease information, symptom checkers, and health education) was identified within each media format.”

In a recent study of 14 hospitals:

‘The 14 hospitals, ranked in order, include: (1) Johns Hopkins Hospital, Baltimore; (2) Mayo Clinic; Minnesota; (3) Massachusetts General Hospital, Boston; (4) Cleveland Clinic; (5) Ronald Reagan UCLA Medical Center, Los Angeles; (6) New York-Presbyterian University Hospital of Columbia and Cornell; (7) University of California, San Francisco Medical Center; (8) Barnes-Jewish Hospital/Washington University, St. Louis; (9) Hospital of the University of Pennsylvania; Philadelphia; (10) Duke University Medical Center, Durham, N.C.; (11) Brigham and Women’s Hospital, Boston; (12) University of Washington Medical Center, Seattle; (13) UPMC-University of Pittsburgh Medical Center; and (14) University of Michigan Hospitals and Health Centers, Ann Arbor.[13]”

(author)

This study in The Journal of Participatory Medicine is heavily skewed with major academic hospitals already ranked in the upper echelon of hospitals and all in major metropolitan areas, and the results do not truly indicate the overall adoption rate throughout the country. However since hospital web sites are online the information is easily accessible to the public.

The study also emphasizes the importance and necessity for broadband internet access throughout the country as a major public health imperative. It should also serve as a driver for either federal or state funding from public health agencies as part of their operating budget. The use of internet media and social media may serve to decrease public health education using other media.

Blogs:

Social Media:

Analysis of Social Media Platforms used by surveyed. Hospitals

Broadcast media:

Web Enabled Communications

Mobile Apps

Citation: Gallant LM, Irizarry C, Boone G, Kreps G. Promoting participatory medicine with social media: new media applications on hospital websites that enhance health education and e-patients’ voice . J Participat Med. 2011 Oct 31; 3:e49.

Physicians should note that Social Media is here, and most likely will stay. The APIs (Application Platform Interfaces) are designed for users to layer their own specific software needs over the social media websites. It would seem that hospitals and physicians can easily integrate a social media site into their EMR. EMR vendors may choose to integrate SM into their products as well, with special attention to HIPAA regulations.

Next on Health Train Express:

All about ePatientDave

LiveJournal Tags: dalai lama,epatientdave,social media,participatory medicine

Social Media? The Answer to the Doctor’s Lounge

2011-11-02T20:01:00.000-07:00

Patients and hospital staffs alike, as they walk by the Doctors lounge must wonder what transpires in those cloistered spaces, somewhat akin to boardrooms, VIP lounges, and even without “Private” or “Do not Enter” signs, the unwritten social understanding is this is a special place for a select few.

Social media is the opposite, where anyone can enter unless a specific block is used for a message. Pandora’s box has been opened, and not all the things which come out are bad.

Humans have a primitive need for social contact. We even see this in higher species of the animal kingdom, grooming, verbalization, family groups, mourning, hunting and more.

In fact when denied this contact humans undergo mental and behavioral changes that become destructive. Studies have shown that restricted social contact and/or isolation at critical stages of development create the inability to relate to others.

There appears to be no danger of social isolation among twitter, FB and G+ fans. The phenomenon carries over to medical meetings and the use of smartphones for mHealth apps

It is just about time for the annual mHealth Summit near Washington, D.C. The event will feature keynote speakers, such as John Stratton COO of Verizon Wireless and Qualcomm CEO Paul Jacobs

The inclusion of these notable executives illuminates the importance of reliable mobile access and the improvement of smartphone speed such as LTE and 4G to facilitate the transmission of medical images. Because cellular phone technology is not secure this will require new encryption software, possibly similar to that used by the military to ensure compliance with HIPAA regulations.

del.icio.us Tags: twitter,facebook,google +,verizon,qualcomm,mhealth

Public Health and Nutritional Supplements

2011-10-31T09:07:00.000-07:00

del.icio.us Tags: public health,apha11,nutritonal supplements,pom,weight loss,youth,celebrities

The American Public Health Association is meeting today in Washington, D.C. Public health has taken on a new meaning, with much more visibility and a proactive campaign which has captured the market place. Many entrepreneurs see the opportunity for profit in marketing healthy foods.

Nutritional supplements are one area of much controversy. For healthy people there are few dangers except for overdoses of Vitamin A and Vitamin D.Nutritional supplements are very loosely regulated and patients cannot be certain of what or how much “active ingredient” is present in a dose.

One spin off that is beneficial is the mindset of those using supplements and the associated discipline of a healthier life style, exercise and weight loss. One cannot rule out the psychological factors in operation by using a supplement. Is this a form of hypnosis?

Some celebrities offer this as their recipe for youth, good looks, or weight loss, muscle building, and increased stamina. Their ‘celebrity’ often increases their reach and ‘credibility’ no matter if they are an actor, sports figure or successful entrepreneur.

You can follow the tweets from the meeting at #apha11.

Me, I am going to drink my carrot juice, and later have a POM wonderful !

Healthy People.go offers this list of Leading Health Indicators

Valley of The Dry Bones

2011-10-29T19:05:00.000-07:00

The View From Here

Valley of the Dry Bones??

2011-10-29T18:28:00.000-07:00

Today I am redirecting Health Train Express to “The View from Here”, another web site which I reserve for opinion on current events in medicine and in other socio-political controversy. Join me in a different kind of rant.

The fork in the road leads us the choice of which desert landscape we will proceed to from here. In the far distance lies the mountain,

This photograph was taken in 2003 while residing near Palm Springs in Desert Hot Springs. It was a unique time in my life while recovering from a heart surgery and a spine problem.

Disconnected from most concerns of modern times it brought me back to pioneer times. There were several old abandoned miner communities where we lived in a primitive cement block house on a sand dune.

Dry Gulch Road Desert Hot Springs, CA 2003 Lower House

The View From Here

My spouse called this place “The Valley of The Dry Bones” (Ezekiel, 37:1-14)

Is America, like Israel in the Valley of the Dry Bones ?

No one can quite explain why we are in this place of dysfunction and chaos despite what some of the supposedly brightest men who speak without wisdom tell us.

The problems are deeper than financial balance sheets, or political correctness. The Occupiers on Wall Street seem to know this to be true. So our educational system despite critics must be doing something right, or perhaps they are so ineffective in brainwashing our young people that their common sense can tell them right from wrong.

Health Train Express cannot exist in the present economic morass and social upheaval of “Occupy Wall Street” and the events of the past decade leading to our present stagnant economy and our morale, without rendering an opinion of an ‘old physician"’

The opportunity to introduce and give a head start to my other blog from Health Train Express is important because regardless of mandates by Obama care it is doubtful the mandates can or will be implemented in full.

Commodization of EMR

2011-10-29T09:21:00.000-07:00

EMR has reached the point of retail commodity. Costco’s online website is offering the Allscripts My Way and PHR for $499 / month. It was not clear if this was a ‘cloud’ solution, although it did state it was a ‘hosted’ EMR.

Costco has teamed up with Etransmedia, a Premier Plus Allscripts Partner, allowing them to offer this EHR and PM solution to Costco members.

My Way is the product of the purchase of Misys, a former competitor of Allscript, and is not truly the Allscripts EMR.

The COSTCO web site elaborates further on federal incentives of $44,000 dollars for adopting EMR.

The advertisement appears on a ‘redirect’ to Etransmedia’s website, not an uncommon practice for Costco Online offers.

No mention is made of whether the offer applies to in store purchase.

Algos in the Health Care Equation

2011-10-29T09:06:00.000-07:00

“Many problems in society are just poorly designed algorithms”

According to Bill Gates at a recent University of Washington talk, He posits that:

“The Miracle Of Availability” And Applying Computer Science To The World”

is certainly the case now with mHealth in all shapes and forms, Android devices iOS devices and Windows 7 phones.

He admits to not being able to think in terms of terabytes and petabytes in this age as compared to his boyhood days of being happy with kilobytes and rarely a megabyte. Programmers were spartans in that age, and there was no room for ‘bloat’. Gates admitted that he simply isn’t ideologically suited for allocating terabytes and petabytes.

His comments regarding health care:

When the most controversial bill of a political era (Obama’s health care bill) is over four thousand pages long and totally unreadable by the average voter, how is that effective?

“I like hash tables and I dislike malaria”

He then moved on to the question of poverty and disease. His primary insight came when he was working with researchers to create a stochastic model of “one of my reactors.” It was immensely complicated but the computing power at their disposal made it possible. He thought, if we can model a reactor, with all these forces and materials, why can’t we model disease, including the mosquitos, the people, the environment, the solutions?

So they worked at it and eventually came up with an immensely complex model for disease vectors, weather, vaccines, life cycles, seasons, and everything else. They compared it with real statistics and it checked out. He said with confidence: “The world effort to get rid of malaria will be based on this model.” And the modeling approach to problems, now that we have the computing power to simulate the world with some precision, is just as important to apply elsewhere. Whether it’s malaria, polio, crops, nuclear reactors, sanitation, or education, “it makes you so much more rational in terms of what you do.”

Statements such as these empowers those in healthcare who want more algos and clinical decision support. The question arises as to who is going to be the testing and certifying authority for these systems? Will it be a subcommittee of the medical board in the department of consumer affairs, or perhaps a new ANSI board. Will there be a liason between these disjointed organizatons?

del.icio.us Tags: algorithms,ansi,models,mhealth,gates

Weight Loss on the Health Train Express

2011-10-27T12:04:00.000-07:00

According to the California Health Care Foundation which publishes California Healthline,

The number of weight-loss surgeries performed at California hospitals increased by nearly 7% from 2005 to 2009, but deaths associated with the procedure have remained relatively low, according to a report by the Office of Statewide Health Planning and Development, the Riverside Press-Enterprise reports.

OSHPD examined five types of weight-loss -- or bariatric -- surgery, the safety of the procedures and the number of surgeries carried out at hospitals (Hines, Riverside Press-Enterprise, 10/26).

The report found that 94 hospitals in the state performed weight-loss surgeries in 2009.

Hospitals performed 13,500 procedures that year, up by 6.8% since 2005, the report found.

Mortality rates associated with the procedures remained low, according to the data. Between 2005 and 2009, 40 patients died in surgery and 79 died within 30 days of surgery.

Researchers found that the lowest-risk surgery was laparoscopic adjustable gastric banding -- or Lap-Band surgery -- which involves inserting an inflatable ring at the top of the stomach.

The highest-risk procedure was biliopancreatic diversion, which involves bypassing the small intestine and removing part of the stomach. This procedure usually is used for morbidly obese patients who have not had success with other surgeries, according to state officials.

Rather than becoming an elective surgery it is now on the list of acceptable alternative treatment methods for morbid obesity

Public health proponents and scientific data corroborate higher rates of breast cancer, heart disease, hypertension, osteoarthritis, hip disease, and other chronic diseases which increase the financial burden on health plans, medicare and private insurers. Insurers are now much more likely to pay for these procedures if less drastic measures such as exercise (often very difficult for morbidly obese patients) and nutritional modification. The lap band procedure gives the patient satiety after only eating a small amount of food.

Faced with increasing medical expenses the elimination of treatable disease with proactive preventive measures such as weight loss, control of hyperlipidemia, and consumption of highly processed food becomes essential as the population ages.

Present projections of ‘bankruptcy of the Medicare system’ do not factor in improved general health and wellness, and lower incidences of these chronic ailments. The projections also do not factor in upcoming radical advances in chemotherapy, immune diseases, nor the possibility of an early detection and/or treatment of Alzheimer’s Disease (TEDMED presentation, 2010 David Kamen)

del.icio.us Tags: lapband surgery,bariatric,public health,obesity,tedmed

Health Train Express 2011

2011-10-26T12:00:00.000-07:00

The time of year is approaching when change and snow are in the air. We are approaching Health Train’s 7th Anniversary. During the next several weeks Health Train Express will be redesigned with new cars, engine and perhaps add a caboose. We are eliminating the many distractions on the side banners and also eliminating our blog roll. Readers will be left with social media buttons for Facebook, twitter and G+

Gone will be the other links such as These were far more useful in past years prior to the explosion and common use of social media. Health Train is based upon fact and opinion. Our mission is to put it out there, and there are better internet businesses that focus on distribution, networking and building a following.

With that the Health Train Express Design Template will also change.

A helpful effect will be faster page loading times.

In a continuing effort to make the pages attractive, capture attention and readable I will continue to include links to videos, and some images, although there will be far fewer to keep loading times to a minimal amount.

I will continue to include appropriate links for those who wish to deep dyve into a particular section.

Thanks for travelling thus far with me on the train..

LOL

del.icio.us Tags: social media,blogs,healthtrain express

Social Media TEDMED and Health Train Express

2011-10-25T11:24:00.000-07:00

TEDMED

“ Intellectuals solve problems… geniuses prevent them “ (Albert Einstein)

One of my favorite pastimes is reviewing TEDMED’s videos. Frankly it is not cost-effect to attend these meetings at a cost of 4-5,000 per TEDMED.

However in the scheme of things a delay of several months or even year (in the scheme of things) is not terribly significant. In fact the delay serves to allow the ideas and projections to mature with the curing effects of time.

One of my favorite TEDMED presentations is from Dean Kamen who invented the original infusion pump, the Segway, and now works on cyborg-like prosthetics, as well as cost-effective water purification equipment usable in third world countries.

Dean Kamen and TEDMED

This presentation is from TEDMED 2010. It comes at an opportune time since TEDMED 2011 has just begun.

In addition to the ‘science” and/or innovative ideas one comes away from a “TEDMED” with the excitement and ‘prescient; feeling that humanity will survive and overcome obstacles to better itself.

Physicians usually emphasize prevention and Dean Kamen is high on prevention. He points out that the current mindset about healthcare costs bankrupting our system are faulty because measures such as improved diet, healthier life styles, prevention of diabetes and chronic heart disease and perhaps prevention of Alzheimer’s disease will result in reduced health spending. Hopefully fewer people will require expensive chronic disease care. The gradual increase in preventive measures will ‘bend the cost curve” in a way much more effectively than all the information technology in which we are now investing.

He correctly points out that some of the most destructive industries can offer ways of delivering beneficial products. He tells the story of how inventing his purification system was the simple side of developing and distributing it to the world.

Coca-Cola a company that thrives on the demand for a processed sugar drink that increases the risks of poor health, obesity, diabetes also has the largest distribution system in the world for it’s products, and a means of delivering the drinks. Dean coupled his invention with the Coca-Cola soda dispensing appliance (that you see in almost every fast food restaurant) with his water purification system, and the means to deliver his water purification system to third world countries such as Bangladesh, India, where a simple thing such as clean water actually is a medical device to prevent infectious disease and/or toxic contaminants in the water system.

The use of social media in health care may have the same outcome if it’s utility as a communication system is linked to the messages of preventive health. Social media serves the youngest portion of our demographic in many ways previously not possible.

Here is a “springboard” of Social Media’s rapidly growing potential for good in healthcare.

Health Care and Social Media

del.icio.us Tags: social media,healthcarebluebook,facebook,twitter lists,G+,TEDMED,Dean Kamen

Google + and Health Train Express

2011-10-24T10:28:00.000-07:00

Health Train Express will soon have a direct link with Google +. The link is in place but not yet functional.

For those familiar with Google + the functionality will be identical to G+ that you now access, including social groups (Circles) over which you have complete control. Our readers will be encouraged to set up a “Circle” named “Health Train Express” There you may ‘friend’ others who read our blog and/or other social media in medicine. The site has the capability of back linking to any of our archived and current posts. Images can be uploaded and you will also be placed in our circle of readers. A key feature is Google Hangout where uses can video conference with nine other readers for discussions on Health Care and Social Media #HCSM.

Google + readership now exceeds 50 million individual users, growing from zero to it’s present size in only 90 days.

Readers will notice that Health Train has shifted it’s focus recently to social media. The reasons are obvious because Social Media has become an influencer of the healthcare community. #hcsm now links to many websites, patient education products, links to other medical professionals and a form of communication between medical conference participants. Google hangouts offer an unsurpassed window to online video conferences with up to ten participants.

Health Train will utilize #hcsm to convey and make relevant announcements as well as hosting Google Hangouts which will be announced here.

Google + like Twitter offers a search engine like feature using hash tags.

Gunter D.Fuchs, Senior Partner, The Fox Group

Foxe practice.com/healthcare-hash tags offers a directory of # tags. It is regularly updated and a good starting point for research.

Physicians would be advised to open a Google + account, which does not require a profile. This allows user access to all of it’s functionality. It requires an email account on Gmail.com

Our next post will revert to healthcare policy, HIT, EMR or other topics in health care.

del.icio.us Tags: social media,#hcsm,Google plus

How to use Social Media at Meetings

2011-10-21T12:44:00.000-07:00

Recent analytics reveal that over 65% of MDs use social media. There remains much controversy about using SM in patient communications. However, SM offers many functionality for socializing online at meetings, and broadcasting events in your area. (meet me at Starbucks, where you are now, conference attendees, and many many others.) I am a relative newbie and learn things daily. Thousands of application developers add value to each platform, such as Tweet deck, Hoot suite,

Twitter is very useful at meetings. The key ingredient is how to use hash tags.

Hash tags allow users to ‘search’ for relevant tweets. For instance, #aao_ophth will display all tweets about the American Academy of Ophthalmology. The sender must insert #aao_ophth in his tweet along with the rest of the tweet. When sending the tweet if you leave off the @ all your followers will receive it, or if you want one or more recipients add @ with their twitter id. For instance: @glevin1 #aao_ophth Hey this meeting is great ! will send the tweet to me alone. Hey this meeting is great #aao_ophth will send it off to everyone on your follow list and to anyone who search with the #aao_ophth hashtag.

Lesson learned:

This week I ‘attended multiple medical conferences on the same day on opposite coasts, from home, using the following Social media tools and twitter hashtags

Twitter: #mayoragan, #aao_ophth #mccsom #health2.0 #hcsm #hachat #aamc11

You can also upload pictuers to Yfrog, twitpics.

For a more complete list of medical meetings hashtags:

Google + is the new social media player. In less than three months the user base went from zero to almost 50 million at last count. There are several key features that I enjoy. Circles…you can start your own circle according to category. Hangouts…for me this is a thriller conferencing with up to nine other geeks, girls, meeting attendees, etc. The hangouts can also be ‘live streamed across the internet on Ustream.

If you use Google Chrome go to the Google Web Store and add the G+.chrome extension. Otherwise try plus.google.com. It is now open to the public.

Google Plus Tips

Hangouts work well on iPhone and iPads and Android devices.

del.icio.us Tags: G+,hangout,facebook,twitter,socialmedia,#hcsm

Corporate Medicine and HealthCare

2011-10-20T19:49:00.000-07:00

The Startup Health Roundtable held last Thursday in Mountain View, CA was attended by over 300 people and was watched by hundreds more on the Live Stream Channel . It featured Wired Editor, Thomas Goetz, author of ‘The Decision Tree ‘ Bob Kocher, and Steven Klein. Each came to the table with ideas about bridging the gap between Health and Wellness Entrepreneurs and Investors.

Business speak is very different from health speak. Many entrepreneurs have flailed at applying investing theory and startup theory to health ventures..

Despite many efforts to corporatize medicine, physicians remain hesitant and unconvinced.

del.icio.us Tags: corporate,medical,entrepeneurs,investors,startup health

The New Networks

2011-10-17T13:55:00.000-07:00

During the past ten years we have witnessed exponential growth in networking, social media, medical connectivity, remote telemedicine and video-conferencing.

This is only one of the major changes in the business of practicing our ‘craft.Passivity in adopting new technology is never a good thing, except if one is less than five years from retiring in a solo practice, and even then adopting modern technology adds value to a practice sale price, or recruiting young physicians. Young physicians are trained in EMR and are facile with digital media and communications and wish to practice in an EMR setting.

Soon, not having an EMR will be a bit like still using a rotary telephone. The usual and customary communications will be digital using an EMR, Health Information Exchange and internet for routine tasks.

For those who have not adopted EMR, there are already portals for eRx, Laboratory results, Remote scheduling, telemedicine.

The human-machine interface is transitioning from keyboards and laptops to tablets,, which are hand held, and use voice recognition. Each iteration of these devices adds more features and more powerful processors.

My analysis is that even solo practitioners need to invest in EMR. It will form a cohesive network between your practice and the rest of medicine, hospitals, and referring sources.

Health Information Exchanges are coming to fruition in many areas, and the combination of EMR users now makes these networks necessary to complete the loop.

It has been a long journey beginning back in 2005, but as the years go by much has happened.

Private medical practice will survive and those who adapt early will insure their survival by doing so.

What is absolutely essential is that physicians become proactive and lead the movement, otherwise we will see what has happened with health care reform will occur with electronic medical records, and health information exchanges.

Governance and interoperability standards and certifying bodies are now in place. Meaningful use is here and now meaningful usability is critical for further adoption. Whatever gain in effectiveness using EMR can be diminished by inefficient software and hindrance of usual and customary workflow.

del.icio.us Tags: emr,hie,hit,tablet pc,laptop,desktop,interoperability,new networks

Enter the Macintosh

2011-10-12T05:45:00.000-07:00

This week’s events over the past ten days since Steve Jobs left this earth brought back memories to me during the early years of my private ophthalmology practice (1979-1984). I had determined that I would become one of the first small practices to use personal computers to manage the business and billing side of my medical practice. At the time there were a handful of PC based programs and perhaps only one Mac medical application. If I remember correctly it was called Media-Mac. Today it probably would have been named iMedic.

I went the PC way and my partner decided to go Medi-Mac. My associate was not a techie kind of doctor, he just knew it was intuitive to use and got the job done. Many of my doctor friends used Macs at home, for teaching, and giving presentations. It was great for graphics, photo cataloguing from the get-go. I don’t know if his system ever crashed.

I started off with a system from vector graphics (Z80 Vector 3) using CPM and later MSDOS when I switched to a PC from my older system which ran on a Z80 (8 bit system, if I remember correctly.

My first iteration was a single user system. The Vectorgraphic 3

Eventually I needed multiple workstations and found a vendor that set up some type of multi-user system with dumb Wyse terminals. The really dumb thing was that I tried to use a terrible system. It cost me dearly over the next several years.

Apple’s designs and their software apps were intuitive, and just worked out of the box…almost forever, or until a new version was introduced not because of problems with the older version, but because Steve Jobs found a better way to do the same thing.

It’s been awhile so I had to do some research on wikipedia and also found the original vector web-site. Looking back I actually made a wise technical choice for the times, but had no prescience for what would come with Apple, IBM, and the explosion of PC clones (as non-IBM machines would come to be known). Steve had forged an agreement at the time with IBM to produce the original IBM PC’s OS known as PC-OS.

In those days main frame computers were the pinnacle of the art. Numerous iterations of PCs, and networking systems, like Novelle, Windows Server,and others would gradually chip away at mainframes, replacing them with larger and larger networks, eventually coming around full circle to today’s Cloud Computing with huge server centers dwarfing mainframe facilities.

What goes around come around.

del.icio.us Tags: vectorgraphic,z80,cpm,msdos ibm,emr

Retraction Attraction on HealthTrain Express

2011-10-12T05:39:00.000-07:00

Not much of what I write about is original, rather I hope to select important blogs and select items of interest to my readers for a fresh perspective and change of pace.

Such is today’s topic

RETRACTION WATCH is such a blog written by respected journalists. There are more instances of scientific publishing gone awry, and this site purports to alert us of these happenings.

The Logo stands for : ‘Natural Sciences and Engineering Research Council (NSERC)

I know of no related sites for medical research.

Why write a blog about retractions?

For that answer we must listen to Adam Marcus and Ivan Oransky and listen to what people are saying about Retraction Watch.

Your physician may have been treating you with misinformation for five years until the deficiency is noted. Perhaps he is still treating you with misinformation….What we need is a watchdog registry as a central reference for disproven health and/or scientific publications.

del.icio.us Tags: retraction blog,nserc crsng

The Threat to Legalized Cannabis

2011-10-08T08:45:00.000-07:00

The Threat to Legalized Marijuana:

Associated Press writers Lisa Leff in San Francisco and Catherine Tsai in Denver contributed to this report.

Some states have legalized the growth of marijuana for medical purposes. Other states have bills proposing the same laws.

Sources, including the AP are reporting the Department of Justice plan to shut down many growing and sales operations of Marijuana Dispensaries in California. In some cases the process has begun with warning letters sent to landlords threatening seizure of property (forfeiture) in an effort to dissuade owners from renting to marijuana businesses.

The marijuana businesses operate within the limits of California law, employing people, paying taxes, renting property that would likely be empty in the current economy. Estimates are that California's Marijuana industry supplies the nation

This is a never ending story (much like 'right to life') issues, homosexuality laws as a civil rights issue, and abortion. The pendulum swings both ways.

There are many arguments on both sides regarding the issues of whether marijuana should be legalized.

The California Board of Equalization has estimated medical marijuana generates between $53 million and $104 million in annual sales taxes on sales of between $700 million and $1.3 billion. This is a significant cash flow and tax base for California sales taxs. and the Federal government in the form of income tax. And this in a state where the economy is terrible and the state is bankrupt.
There are no facts given by federal officials regarding whether or not the sale of medical marijuana has resulted in an increase in serious crime or even misdemeanors.
Obtaining a medical marijuana card is very easy. While it does require a doctors authorization for a referral to a dispensary there are no specifics in regard to documentation of a reason for this treatment. Merely a prescription for the individual to obtain medical marijuana (there is no such thing). There are no laws or regulations certifying strength of the marijuana. Most users are sophisticated and recognize plant types, such as and chose accordingly. Dispensaries have these plant species separated and are sold according to the client's needs and their effects, which differ significantly from patient to patient.
Some (most) physicians who prescribe marijuana do so without documentation of a proper medical history and/or physical examination. And there are adequate laws in that regard to enforce more restrictions in the sale of marijuana. Most physicians have little background or experience in prescribing marijuana. The Board of Medical Quality Assurance has strict rules in regard to prescribing which include examinations and documentation and continuing follow-up of patients prescribed medications. Many physicians have had their medical license suspended and/or revoked for violation of those requirements. Physicians must take a proportional responsibility for this situation. If current regulations were enforced the prescription rate would drop precipitously due to the increased time and effort required for physicians to comply with the law.

Physicians such as oncologists and some pain specialists will resort to marijuana to control nausea, pain, anxiety, and anorexia. A new specialty has developed. The marijuana doctor who hands out prescriptions for marijuana to almost whoever enters their office asking for one. The users know well who these physicians are in their community. It is also a well known fact that some physicians will work part time in a marijuana clinic, employed by the growers and/or dispensary.

The marijuana business is 'cash and carry'. and it cannot be regulated through the customary process of insurance restrictions.

In most cases an ethical physician will refer a patient to a dispensary after attempting to control symptoms with accepted medications, acupuncture, physical therapy or other mode. Marijuana now is accepted as an alternative treatment method, however regulations are side-stepped and ignored in regard to customary medical practice guidelines.

Demand is no excuse for not enforcing regulations, and this falls at the foot of organized medicine, peer pressure and the State Medical Board of California.

If medical marijuana is a controlled substance tracked by DEA numbers on prescriptions prescribers can be tracked, identified and enforcement can proceed through the established methods used for over prescribing of any controlled substance such as Vicodin, or Demerol.

Current law allows for revocation of a DEA license and Medical license, and provides for a very significant ability to control this issue at the source.

The Justice Department's enforcement “nuclear option” is a poorly conceived method when a tactical strike with a smart bomb targeted at the source....physicians who are breaking the law set forth by medical boards.

Assemblyman Tom Ammiano said the crackdown "means that Obama's medical marijuana policies are worse than Bush and Clinton. It's a tragic return to failed policies that will cost the state millions in tax revenue and harm countless lives." Once again Obama does a one-eighty on his policy toward marijuana since election.

"I don't understand the politics of it, and certainly if we haven't learned anything over the past century, it's that Prohibition does not work," added State Sen. Mark Leno, who has worked to safeguard and regulate medical marijuana in California.

del.icio.us Tags: marijuana,cannabis,california law,obama,justice department,dea,state medical board,marijuana dispensary

Apple on the Health Train

2011-10-06T14:01:00.000-07:00

Steve Job’s life and death have had a deep impact here on earth. His accomplishments rival those of Thomas Edison, Henry Ford, Andrew Carnegie, Richard B. Mellon, Rockefeller, Harvey Firestone, John D. Rockefeller, J.P. Getty,

Who would have known what transpired between these two photos of Steve Jobs at the extremes of our lives. It is almost as if his physical being was transformed into his inventions.

Bloomberg’s Business Weekly tells the story of Jobs from 1955-1985.

ABC News perhaps gives the best video-documentary of Job’s Professional Career.

As his life progressed he gave much of himself, 101 % to his family and community and will leave a legacy to the city of Cupertino with the new Apple Campus.

Steve Jobs will be remembered for many things His famous quote at Stanford University's commencement address in 2007, “Stay hungry, stay foolish”. will most likely go down as the most memorable spoken word of Jobs.

Steve was an artist in form and function for his numerous devices. He was the master of ceremonies for each introduction of a new revolutionary gee- whiz device, each one of which changed millions of lives, and spun off new companies, fueling entrepreneurship.

Steve (many felt comfortable enough with him, to call him that) even if they were not close friends.

Job’s impact on healthcare is now becoming apparent and although Apple was a late entrant into HIT, the iPhone and iPad have produced the most useful human-machine interface to work flow in medical practice at the bedside, office, and for remote work from home, in a car, on a lake, and at times in the air. Numerous medical calculators, Medical search engines, journals, Continuing medical education podcasts also are readily available from iTunes.

Jobs left a legacy for healthcare, in a cost effective IT device. The iPhone and IPad have spawned a niche for remote monitoring, imaging, and Facetime has a secure video capability that will stimulate remote office visits.

The R&D at Apple must have been enormous. Jobs was a revolutionary at project management, coordinating production and manufacturing and assembly of Apple’s devices. Steve recognized the time involved in product development, working on many devices, many of which we probably will never know about.

Steve Jobs had the next two generations of inventions’ already planned and designed when he launched any Apple product.

His designers not only designed functional electronics, but delivered them in a unique refined manner, much like a piece of expensive jewelry or perfume. The interior design of the package was designed and produced as carefully as the internal electronics. Much of the joy of buying an Apple Product was the artistry and almost magical process of unpacking “the Apple”. Whenever you bought an Apple Product…it was Christmas time. The “fruit” of his inventions was the apple, the much maligned object of man’s downfall. However this Apple was not denigrated as the one in the Garden of Eden.

Apple is a huge company, yet he somehow managed to inspire complete secrecy in his employees, going far beyond the written contract between him and employees. Not much detail was known about the final release of a product until the day of launch. It is safe to say that if the U.S. government could keep a secret, Jobs could do it one better.

At the same time as we idolize and perhaps magnify his life, Steve Jobs was loved by his wife Lauren and their three children Eve, Erin and Reed. They supported him and stood by him as he battled cancer and though they no longer have a father, they'll always have his legacy. and children must share a deep personal loss sharing his end.

His personal life had the normal ‘tragedies’ of any life, which fade into ghostly events as life goes on.

R.I.P. Steve Jobs

del.icio.us Tags: Apple Inc,Steve Jobs,iPod,iPhone,iPad,HIT,EMR

In Training for Health Train Express

2011-09-27T17:38:00.000-07:00

The Enterprise Medical Center announces new EBM guidelines, questionable guidelines for outcomes and failure to meet JCAH standards.

EMC also failed to qualify for incentive payments because EMC did not meet meaningful use requirements.

Health Train Express thanks ZdoggMD for his intepretive potentially Emmy award winning video on the pitfalls of medicine in the space age.

In space, no one can hear you code. We boldly probe where no finger has probed before

Something smells bad here.

del.icio.us Tags: zdogg,space age,meaningful use

Social Media for Hospitals and Clinics

2011-09-26T08:54:00.000-07:00

Mayo Clinic has established a formal Social Media Department to enhance patient care and educational needs.

Lee Aase (@LeeAase) created this slide share presentation which is also available online There is also a presentation transcript, if one scrolls down the page.

Lee Aase is the Director, Mayo Clinic Center for Social Media. (#MCCSM) THIS IS THE EPONYM FOR TWITTER SEARCHES

5-plan-1050-Aase

View more presentations from med20su

For those of you who could not attend, Click Stanford Summit + Medicine 2.0 @Stanford. for the agenda.

Health Train continues to believe that social media will expand and flourish not only in the business world but also will change the game in healthcare, as much as EMR and HIE, and in a much more effective manner as it builds from the ground up.

Next Healthtrain will be Google +, a fast moving high speed maglev vehicle with enormous potential for health institutions and clinic communication.

del.icio.us Tags: mayo clinic,social media,google +,hangout,lee aase,health2.0con,asco,robert miller,medicine 2.0 conference,Stanford,Larry Chu

Who Came First on the Health Train? The Chicken or The Egg

2011-09-24T09:42:00.000-07:00

Caution Lights down the Track

2011-09-24T02:04:00.000-07:00

A troubling report from the U.K.

Trouble Down the Tracks

U.K. Health Service To Dismantle Nationwide Health IT Program
Read more:

Health Secretary Andrew Lansley said that the National Programme for Health IT, which launched in 2002, "let down the NHS and wasted taxpayers' money" (Press Association, 9/22)

iHealthBeat:

It is now almost ten years since beginning their National HIE in a country much smaller than the U.S. Certainly their software designs are obsolete and not industry current.

Lansley said, "We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernized NHS" (Beckford, London Telegraph, 9/22).

Because most healthcare transactions take place in regions and not nationally it seems reasonable that the nationwide network should be built last. The interoperability standards have been set…things may evolve and what is the rush? How many patients receive treatment in LA, Chicago, and NY? Few travel that distance for routine treatments. The number of patiens who can afford national expeditions for treatment are limited.

So far HHS has dispensed over $ 600 million dollars in incentives, according to

The Federal Government Has Distributed $653M in EHR Incentive Pay

The CMS data also show that:

$262.2 million in Medicaid incentives have been paid to 294 hospitals registered as eligible for both the Medicare and Medicaid incentive programs;
$226 million in Medicare incentives have been paid to 114 hospitals registered for the Medicare incentive program;
$93.9 million in Medicaid incentives have been paid to 4,463 physicians and eligible health care professionals;
$38.3 million in Medicare incentives have been paid to 2,129 physicians and eligible health care professionals; and
$32.9 million in incentives have been paid to 15 hospitals registered solely under state-administered Medicaid incentive

del.icio.us Tags: emr,hie,incentives,cms,medicare,medicaid

galeslifethoughts

2011-09-23T10:32:00.001-07:00

galeslifethoughts

Free Riders on Health Train Express

2011-09-23T08:50:00.000-07:00

TGIF. Many things happened this week which may impact many of us in the world of technology and internet applications.

Hewlett Packard replaced Lou Apotheker with Meg Whitman in the wake of the discontinuance of the HP Touchpad, the announcement of HP disbanding or selling their HP consumer product line (apparently their printer division will still continue, since it is the dominant printer manufacturer, and also produces significant revenue for HP.

The demise of Apotheker comes not so much from his decisions to make strategic changes, but his poor communication and people skills in dealing with his Board of Directors and the Stockholders. It must have seemed heavy-handed and the investors voted with a 50% reduction in stock price as many unloaded their shares in the weeks since the announcement was made. This came after only 11 months of Apotheker’s reign (apparently of terror). Reports were that Apotheker lacked some leadership abilities critical to management of a diverse HP enterprise.

On the internet side and Web 2.0 Social media announced the expansion of SM with Google +, Google Hangouts and several new versions all within the past three months. Google + gained 45 million new users in less than three months and the growth is still exponential. While Facebook states it has over 600 million users it is 6-7 or more years old. Analysis shows that FBs growth has stagnated. Users of both platforms have a diverse opinion of how G+ stacks up against.

There is a dichotomy of opinion. Many FB fans are intensely loyal and are vocal about G+s failings while some have willingly jumped the FB ship, announcing how ‘lame’ FB has become.

Google + has loosened it’s ban on pseudonyms for user names, but remains a non-commercial platform.FB remains the dominant marketing SM tool. Many enterprises have just adopted SM for marketing and G+ does not as yet have a significant user base (45 million for G+ vs. 600+million for Facebook.

In the past several weeks this writer spent about six hours a day on Google +. Part of it was a learning experience. I learned much about Hangouts.. Health care has much to learn from and use in Hangouts.

I held an ophthalmology video conference based upon a user list serve for ophthalmology which is international in scope well respected and attended daily. Users who usually only communicate in writing and once or less a year at meetings were able to see and talk in real time to discuss interesting cases, display images with the restrictions in place by HIPAA. I was able to share the HIPAA 18 never say data as a document during the conference.

What are it’s other potentials? Everyone will figure out a way to use it…patient education in small groups seems the first item, and communication of physicians in regard to operations of the practice (business) or associates and other practices. How about a section meeting of the medical staff. Multiple concurrent Google hangouts can be run with different Gmail addresses. (You will need a high performance graphic card or multiple display card) or separate PCs.

President Obama hold a five way Hangout (notice Harry Reid’s one finger salute to the Chief)

Google+s hangout offers a 10 way audio-video conference with the capability of sharing documents, screens, and videos. It seems to offer new functionality every day. It runs well in all the browsers. I have used it in Firefox, Chrome and even Safari (on a PC) Interesting that Safari which normally loads very slowly and has slower screen web page changes on my PC yields the best video performance on my laptop. Some of this may have to do with how video is rendered with the laptops meager video resources and memory sharing for video graphics.

FB countered in the past weeks with several new applications and major changes to the interface becoming much more visual with alterations in the “white space’ of their web pages. Zuckerberg announces TIMELINE.

HIPAA violations !!

And finally this news. Neutrino found exceeding the speed limit of light.

See what I mean? TGIF now maybe I can get back to work !!

del.icio.us Tags: google plus,facebook,google hangout,timeline,hp,hewlett packard,lou apotheker,meg whitman,video conference

Sea-change on Health Train Express

2011-09-21T16:18:00.000-07:00

I have read that medical blogging has changed. The bloggers posting clinical cases and clinical information have declined, many (like life imitates art) are retiring, conflicted about HIPAA and privacy requirements.

Caseblog points out the 18 “never say'” items similar to the old bad 8 words of the 70s on television.

They are:

List of 18 Identifiers: (some of these were new to me)

1. Names;
2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
4. Phone numbers;
5. Fax numbers;
6. Electronic mail addresses;
7. Social Security numbers;
8. Medical record numbers;
9. Health plan beneficiary numbers;
10. Account numbers;
11. Certificate/license numbers;
12. Vehicle identifiers and serial numbers, including license plate numbers;
13. Device identifiers and serial numbers;
14. Web Universal Resource Locators (URLs);
15. Internet Protocol (IP) address numbers;
16. Biometric identifiers, including finger and voice prints;
17. Full face photographic images and any comparable images; and
18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep.

Count them, there are (bleep) 18 !

Are the standards different for small practices and large institutions? Reality suggests this to be true:

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Social Media in Medicine is particularly prevalent in the Emergency Department. Perhaps this is what ED physicians do during a quiet moment, between entries in the EMR. This should not be surprising since ER medicine reflects reality. The interface of what we plan and what happens in life while we plan it. Dramatic, crises, no one goes to an ER willingly, to wait, to see an unknown doctor unless uninsured or by other circumstance unable to make it to the doctors office during regular hours, due to transportation problems, and a simple fact that most ERs will see you no matter what to determine if it is safe to send you home. Most ERs are on a public transportation route.

Whether you are a blogger or a reader, perhaps these features will keep you focused on the never say words, or who is blogging, why and where of it all.

del.icio.us Tags: blogger,social media,emergency department,hipaa

Doctor Only Social Media Sites

2011-09-21T06:32:00.000-07:00

Kent Bottles gave a presentation at #med2 describing the deficiencies in medical social media networks. He described them as too complicated and not easy to use.

SM sites are individuals or small groups.

Typical posts:

Do you use Social Media in your practice:?

Answer:

“Angry and probably not the kind of doctor you should go see” (Kent Bottles)

On the other hand 90% of Social Media is just showing up. Here is a bit from 33charts.com

SM is a great medium for research. Ask questions. Use #tags, Twitter is a great medium for just in time information.

Patient Advocacy:

Other Trends in Healthcare:

Electronics and Medical Monitoring:

Simulated Environments for Psychotherapy with Avatars:

More Trends to Watch:

What do Leaders Do?

Shameless Shout out for Kent Bottles, MD

Some typical professional “Social Medical Networks:

Doctor’s Hangout MomMD Doctors Lounge DocGreet

Ozmosis

Sermo

Facebook, Twitter, and Google + each have their own way of developing lists, groups and circles for groups, however none of them are secured by passwords for healthcare providers. It should also be noted that although the doctor only social networks are not HIPAA compliant….private and confidential patient matters should be de-identified.

del.icio.us Tags: kent bottles,mecical social networks,sermo,ozomosis,socialmd,doctornetworking doctoshangout mommd doctorslounge docgreet

Health IT Confusion and Clarification

2011-09-15T17:46:00.000-07:00

This is National Health IT week, if you did not know that already. It runs from September 12th-16th. President Obama declared it in an official Proclamation and a Senate Resolution (at least they agree on something).

Official Press Release:

ONCHIT is celebrating by announcing a new website for providers and professionals. It’s a bit more readable for both groups.

Health Information Technology and ONCHIT are becoming synonymous as Federal incentives drive electronic medical record adoption by providers..

Anyone reading a government website knows they do not use smart graphics design. Even HHS admits this since they have started a new website, more oriented to reader understanding.

The old website is still available.

Two Websites, One Message

ONC’s existing website will remain housed at healthIT.hhs.gov. The HHS site will become more policy and program-focused, and HealthIT.gov will serve as a primary resource for providers and patients who are interested in learning more about how health IT can help improve their health and health care. The new website provides access for patients as well as providers .

del.icio.us Tags: health information technology,hit,hit.government,hhs,incentives