Docs adopt and adapt, yet still cling to old ways

ATLANTA – The technology takeover has begun, and physicians nationwide are acclimating one step at a time, a new physician survey reveals. Laptop, smartphone and iPad usage is increasingly common among U.S. physicians, but the report finds old-fashioned methods of communication continuing to stand their ground.

The second annual National Physicians Survey, conducted by the little blue book and Sharecare, polled 1,190 U.S. practitioners representing more than 75 medical specialties. It reveals physicians' perceptions about the ongoing changes in the healthcare system and how those changes are impacting their daily practices as well as their ability to provide optimal patient care. 

Two out of three physicians (66 percent) say the integration of electronic medical records (EMRs) is among their practice challenges. Despite that, most doctors (66 percent) acknowledge EMRs will at least improve or have a neutral effect on their future business.

Almost one out of three doctors (30 percent) are using laptops regularly for e-prescribing, EMRs and more. Almost a quarter (20 percent) are using smartphones, and 12 percent use iPads, for clinical needs.

Additional survey highlights:

Peer-to-peer communication is occurring via email – despite not being a "secure channel."Thirty-four percent of physicians communicate with other clinicians via email – not defined as a "secure channel" by HIPAA.Telephone (95 percent) and fax (63 percent) are still the primary forms of communication.A dinosaur in most other office environments today, the fax is still king with physicians, supporting hand-written notes, insurance forms and lab test result transmissions.Fifty-eight percent of doctors communicate with peers in person.Five percent use social networking sitesDoctor-to-patient communication remains fairly traditional, with some online inroads.The majority of physicians (91 percent) talk with patients via phone, 84 percent in person, 20 percent via email, 8 percent via personal health records (PHRs) and 6 percent via text.Few physicians are opting for solo practices these days -- a good portion are "employed" by hospitals, large practices or accountable care organizations (ACOs).Twenty-two percent of physicians are in ACO talks, up from 12 percent last yearOf those who said they were aware of ACOs, 37 percent stated that they would participate as a member of a group practice, 27 percent as a member of a physician-hospital organization, 10 percent as a hospital-employed physician.Only 17 percent of the respondents were unfamiliar with the ACO term, down from 45 percent last year.

Doctors say new patients find them via:

Word of mouth (71 percent)Practice networks referrals (33 percent)Print directories (29 percent)Internet searches (22 percent)

Despite an onslaught of healthcare regulations and requirements and shrinking practice margins, physicians are finding some advocates.

Forty-one percent say their state medical organization/society advocates for them. Thirty-nine percent say their national medical organization/society does.But 40 percent report "no one."

Still, overwhelmingly burdened by obtaining reimbursements from insurers (81 percent) and patient approvals (77 percent), most doctors (71 percent) believe the quality of healthcare will deteriorate over the next five years.

Fifty-five percent fear they aren't spending adequate time with each patient.Thirty-eight percent are concerned they aren't seeing enough patients in a day.

"Physicians today are practicing in a healthcare environment that they never could have predicted much less prepared for," said Keith Steward, MD, senior vice president of medical affairs at Sharecare. "This year's National Physicians Survey provides valuable insight into the frustrations and opportunities of the day-to-day management of practices, administration tools doctors use, and how communication with both colleagues and patients is evolving.

"Arming doctors with innovative solutions to ease administrative burdens is a top priority for the healthcare industry," he adds. "Doctors need to get back to what they were trained to do – provide their patients with the best care possible."

[See also: Docs believe EHRs safer than paper, but patients still ambivalent.]

St. Paul Regional Labor Federation Endorses HR 676

From Unions for Single Payer Health Care –

The St. Paul Regional Labor Federation, AFL-CIO, is the latest labor federation to endorse HR 676, Congressman John Conyers� single payer healthcare bill.

Robert �Bobby� Kasper, President of the St Paul Federation, reports that delegates unanimously endorsed the Conyers bill at their regularly scheduled meeting on Wednesday May 9th. The resolution to support HR 676 was brought to the Federation by Mike Madden, Chair of the Chisago Labor Assembly, AFL-CIO, and a representative of IAMAW Local Lodge 112.

The Federation represents 117 local unions with over 50,000 members in Chisago, Southern Dakota, Ramsey, and Washington counties of Minnesota.

The St. Paul Federation is the 141st Central Labor Council/Area Labor Federation and the 592nd union organization to endorse Conyers’ “Expanded and Improved Medicare for All” legislation.

See the full text of the resolution here.

California voters narrowly reject $1-per-pack cigarette tax

SACRAMENTO, Calif.(AP)�A California initiative to increase the tax on tobacco to pay for cancer research has failed by less than a percentage point after remaining too close to call for more than two weeks.

With about 5 million votes cast, "no" on Proposition 29 led by about 27,000 votes with about 105,000 left to count. The Associated Press analyzed areas where the uncounted votes remain and determined Friday there were not enough places where "yes" was winning to overcome the deficit.

The plan to add $1 to the cigarette tax was led by cyclist Lance Armstrong, a cancer survivor. Tobacco companies, led by Philip Morris, poured millions of dollars into an ad campaign that whittled away support. Polls showed approval peaked around two-thirds in March but had fallen dramatically by the June 5 balloting.

Support for the initiative was strongest in the San Francisco Bay Area, while more conservative places like Southern California's Inland Empire opposed it.

Proponents said they would be back.

"This came so close, I think this is worth another try," said Stan Glantz of the University of California, San Francisco's Center for Tobacco Control Research and Education. "I think it would be horrible if Philip Morris and Reynolds get away with this."

He suggested tobacco foes might turn to the Legislature, though lawmakers routinely reject attempts to raise tobacco taxes.

The opposition campaign will wait until all the votes have been counted before declaring victory, spokeswoman Beth Miller said.

Opponents of the measure raised $47 million to fight it, a huge sum even by California standards. By comparison, Jerry Brown spent about $36 million in his successful 2010 bid to become governor of California. Wisconsin Gov. Scott Walker and his allies spent $47 million to beat back his recall challenge on June 5.

Armstrong and a coalition of anti-smoking groups raised about $12 million to bolster the measure, including $500,000 from New York City Mayor Michael Bloomberg.

While raising the price of tobacco has been shown to reduce smoking rates, especially in young people, campaign ads sponsored by tobacco companies focused on pocketbook issues. The ads noted money would be raised in California through the tax but wouldn't necessarily stay in the state for research, and raised the specter of an out-of-control bureaucracy that would be set up to oversee collection and distribution of the money.

The strategy didn't just stir doubt in the minds of voters.

Several major newspapers, including The Los Angeles Times, opposed the measure while expressing general support for such sin taxes and reluctance to side with tobacco companies. They argued that the revenue should go directly to the state, which now faces a $15.2 billion deficit.

The result was reminiscent a 2006 California cigarette tax measure that led by wide margins in early polling until tobacco companies spent $66 million to defeat it with ads featuring physicians.

California was once at the forefront of smoking restrictions and taxes, but the famously health-conscious state has not raised tobacco taxes since 1998. If the new tax had passed, California would still have had only the 16th highest tax rate in the nation.

Some smoking foes said they are weighing the idea of tackling the issue in the state Legislature.

The overwhelming majority of recent tobacco taxes across the nation have been approved in statehouses, not at the polls. But in California, where new taxes require a two-thirds vote in the Legislature, lawmakers have defeated more than 30 attempts to raise tobacco taxes in the last 30 years.

Missouri voters are expected to weigh in on a tobacco tax increase in November and similar taxes are working their way through the legislative process in the Rhode Island, Massachusetts and Illinois.

Dementia Complicates Romance In Nursing Homes

Enlarge iStockphoto.com

Holding hands is the easy part.

iStockphoto.com

Holding hands is the easy part.

Relationships are never easy.

If the partners in love happen to be living in a nursing home, there are even more challenges. And if they're showing signs of dementia, then things get really tricky.

Although no law forbids intimate relationships between people with dementia in nursing homes, staff and family members often discourage residents from expressing their sexuality, says a recent report in the Journal of Medical Ethics.

Sexuality might be an uncomfortable topic for some families to discuss, but sex is a matter of dignity for many older people, says Dr. Laura Tarzia, lead author of the report and a researcher at the Australian Centre for Evidence Based Aged Care.

 

Older people who live on their own continue to enjoy romantic relationships, even if they are in the early stages of dementia; the trouble begins when they move into a facility for care.

"You get couples who have been living together for 50 years and then they move into a residential care facility. Suddenly they have to have separate beds, and that can be quite distressing for them," Tarzia tells Shots. "But I think it's even more difficult for people who form new relationships in a residential care facility, because then staff don't really always know how to deal with it and sometimes families have objections."

Many residents who have been diagnosed with dementia rely on family members with power of attorney to make important decisions. Tarzia says that decisions about intimacy shouldn't rise to that level.

"Sexuality shouldn't be categorized as a high-stakes decision, like, say, a will or a major financial decision where you really need the capacity to consent to things," says Tarzia, "We're saying that sexuality is different and the way to establish consent should be different."

These decisions don't come without risks, and Tarzia says it's important that staff in care facilities be willing to discuss the use of condoms for the prevention of sexually transmitted diseases.

Tarzia and her colleagues are currently working to create a self-assessment tool for residential care facilities to audit their sensitivity to these important issues. "[Facilities] can go through a checklist, and it covers a lot of areas like policies, education for staff, families, and residents, and facilities can kind of monitor how they're going, in terms of addressing sexuality," Tarzia says.

Issues with privacy and sexual freedom exist in American nursing homes too, gerontologist William H. Thomas tells Shots. "There are laws about consent for sexual activity, by state, but there's no top age on those laws," Thomas says.

Thomas said that we need to see a shift in our society's understanding of aging. "We need to normalize the idea that older people are human beings," he says. "They have the same needs and same desires they had before. Age changes those needs and desires, but they are still there."

He recommends that adult children talk about the issue of sexuality with their aging parents in nursing homes. "They never thought that Mom would have a boyfriend at the nursing home, but it's true," he says. "As we become an older society, this is something that we need to learn to better address."

If Health Law Falls, Coverage For Young Adults Gets Tricky

Enlarge Courtesy of June Blender

Jackson Cahn, who graduated from Whitman College in Walla Walla, Wash., is one of the 3 million young adults the Obama administration says would have risked going without insurance if the health care law hadn't allowed them to stay on their parents' policies. Because of the law, his mother, June Blender, was able to add him to her insurance.

Courtesy of June Blender

Jackson Cahn, who graduated from Whitman College in Walla Walla, Wash., is one of the 3 million young adults the Obama administration says would have risked going without insurance if the health care law hadn't allowed them to stay on their parents' policies. Because of the law, his mother, June Blender, was able to add him to her insurance.

When it comes to health care, even the seemingly easy things become hard.

Take coverage for young adults under the Affordable Care Act.

It's one of the most successful � and popular � provisions of the law that have taken effect so far. Earlier this week the Obama administration announced that between September 2010 and the end of 2011, more than 3 million young adults under age 26 who would otherwise have gone without insurance gained coverage by remaining on their parents' health plans.

Last week, major health insurance companies, including United Healthcare, Aetna and Humana, announced they would continue to offer the benefit even if the Supreme Court strikes down the law when it issues its ruling, which is expected next week. Even some Republicans say they support the idea of letting young people remain on their parents' health plans.

But it turns out that might not be so easy.

 

"This could have adverse tax consequences, both to the employee whose child is on the plan and to the employer, for purposes of payroll taxes," said James Klein, president of the American Benefits Council, which represents large-employer health plans and companies that provide services to those plans.

How's that? Well, says Klein, the problem is that lots of those young adults are no longer dependents of their parents for tax purposes. So if the employer continues to provide coverage to that adult child, the value of that insurance could be considered taxable income to the parent. Under the health law, such coverage is not treated as taxable income.

As an example, he says, "if the value of adding a child onto your policy is $500 a month, that's $6,000 a year. So that's $6,000 of extra income on which you would be taxed, plus the payroll taxes that you the employee and the employer would be paying on behalf of that $6,000."

And while that could be a lot of money for some people, he says, the money is only part of the problem.

"It's the utter confusion that this would cause for employers. Because after all, there would be some 24-year-old kids who are legal dependents, for whom there would be no income tax owed," Klein said. "And then there would be others for whom they're not legal dependents and so there would be tax that would be owed. It would be extraordinarily confusing."

Then there's the question of whether workers and employers might owe back taxes for coverage that's been provided already. Klein says the Obama administration could theoretically take care of the problem by having the IRS issue some sort of clarification. But he worries that like everything else to do with the health law, even that could get caught up in partisan politics.

"I'm just afraid that rather than a quick resolution that provides clarity, both sides could arguably use this for their political benefit," he said.

FDA regulators face daunting task as health apps multiply

Want to monitor your blood pressure and sugar level? Eat healthier meals? Screen yourself for depression? Find out if you need glasses? Now you can do it all with apps on your smartphone.

In fact, there are 40,000 medical applications available for download on smartphones and tablets � and the market is still in its infancy. But that growth is in the cross hairs of new regulatory efforts from the Food and Drug Administration.

Medical apps offer the opportunity to monitor health and encourage patient wellness on a moment-to-moment basis, instead of only during the occasional visit to the doctor's office. Some even replace devices used in hospitals and doctor's offices, such as glucometers and the high-quality microscopes used by dermatologists to examine skin irregularities.

"There's a lot of enthusiasm now for the ability to use design and to use consumer technology to help improve people's health at the ground level," says Andrew Rosenthal of Massive Health, a mobile health app company in San Francisco.

But so far, the market has been unregulated; for both doctors and patients. It is difficult to know which apps actually live up to their health claims or provide accurate information.

Last year, the FDA began to lay down the law. The agency released a first draft of guidelines that require mobile apps developers making medical claims to apply for FDA approval for those applications, the same way that new medical devices must be proved safe and effective before they can be sold. But that process can be both time-consuming and expensive.

.va{border:none !important;}

Some app developers are bristling at the thought of a rigid regulatory structure, which they fear will stifle innovation in an industry known for rapid growth and flexibility.

"The FDA's current regulatory process was created when the floppy disk was around" � ancient history in the tech world, warns Joel White, executive director of the Health IT Now Coalition, which includes the computer chip maker Intel, pharmacy benefits manager Medco, Verizon, Aetna and the U.S. Chamber of Commerce.

According to the Government Accountability Office, the FDA takes about six months to approve a medical device that is similar to an existing product and 20 months to approve a brand new device. That's simply too slow, White says.

Top Paid Medical Apps for iPhones (from the iTunes store)

1. Pill Identifier ($0.99)

Developer: Drugs.com

Pill Identifier allows you to identify more than 10,000 different over-the-counter and prescription pills based on their appearance. Search by imprint, size, shape or color.

2. Pregnancy ++ ($2.99)

Developer: Health & Parenting Ltd.

Pregnancy ++ tracks the course of your pregnancy, including your weight, diet and exercise. It also includes HD fetal pictures, a kick counter and a contraction counter.

3. Baby Connect (Activity Logger) ($4.99)

Developer: Seacloud Software

Baby Connect tracks your baby�s everyday activities (including feeding, sleep, growth, health and vaccines) and creates graphical reports and trending charts. The information can be shared between parents, nannies and other child care providers.

4. Instant ECG: An Electrocardiogram Rhythms Interpretation Guide ($0.99)

Developer: iAnesthesia LLC

Instant ECG is an app for health care professionals, which teaches the basics of reading electrocardiograms (ECG). The app offers video demonstrations of 30 different arrhythmias to teach and then test a provider�s ability to diagnose irregularities.

5. MedCalc (medical calculator) ($0.99)

Developer: Mathias Tschopp and Pascal Pfiffner

MedCalc gives health care professionals access to more than 200 different diagnostic formulas, scores, scales and classifications that help measure a person�s health.

6. Pill Reminder by Drugs.com ($0.99)

Developer: Drugs.com

The Pill Reminder App keeps track of all of your medications, vitamins and supplements. Set up reminders to take your meds or refill a prescription, and check for drug interactions, dosage information and possible side effects.

7. Anatomy 3D: Organs ($1.99)

Developer: Real Bodywork

Anatomy 3D: Organs teaches users about structure and function of internal organs using 3D models, videos, audio lectures, diagrams, quizzes and a glossary.

8. Diagnosaurus DDx ($1.99)

Developer: Unbound Medicine, Inc.

Diagnosaurus DDX helps health care providers accurately diagnose patients quickly at the bedside. Providers can search over 1,000 differential diagnoses by organ system, symptom and disease, and use a special feature to consider alternative diagnoses when multiple conditions are possible.

9. Everyday First Aid ($0.99)

Developer: Portable Monster LLC

Everyday First Aid offers users information on how to handle an emergency. The medical information is based on guidelines from the American Red Cross and other health organization, and tells you how to handle situations including choking, wound cleaning, jellyfish stings, tick bites and heart attacks with illustrated training guides.

10. Drugs & Bugs ($5.99)

Developer: Haymarket Media

Drugs & Bugs is an app for medical students and health care professionals who care for patients with infectious diseases. It provides information on more than 100 antibiotics and nearly 200 bacterial pathogens, and allows providers to compare the effectiveness of various drugs.

"We're seeing mobile apps updated and created on a daily basis," he adds. "The life cycle is dramatically different."

It's also expensive: The cost of getting FDA approval for a standard medical device is about $24 million to $75 million, according to a Stanford University report.

The health app market currently is worth about $718 million and is expected to double by the end of the year, according to Research2Guidance, a global mobile research group.

Alain Labrique, who directs a project at Johns Hopkins University dedicated to mobile health technology, says that although the FDA guidelines could delay some tech development, they are an important consumer safeguard.

Labrique argues that many apps are "a lot of hype and very little evidence." While apps offer an exciting new opportunity in health care, "We also want to protect the public and be sure that medical claims are supported by data assessment and some comparison to a gold standard."

In particular, he warns that commercial interests and "the tendency to capitalize on the next big things" may lead app developers to overstate what their products can accomplish. "Making sure the public's best interests are met is not always the most expedient process."

The FDA expects to release final guidelines on mobile health apps this year, but some app developers aren't waiting. Many companies have started the formal application process, and the FDA has already approved a handful of apps.

White says that many app developers are not opposed to regulation, but they believe that the FDA process doesn't fit the industry. He suggested that the government set up a new regulatory framework for mobile health � something like the National Transportation Safety Board� to accommodate the speed, flexibility and innovation of this new marketplace.

Orrin Franko, 29, is part of a new breed of doctor-innovators in the mobile health industry. He's an orthopedic surgery resident at the University of California San Diego and runs a website called TopOrthoApps.com, where he reviews orthopedic apps for doctors and patients. He is also developing several of his own.

Recently, he invented a plastic attachment that works with an app that allows iPhones to measure the curve of the spine to test for scoliosis. It mimics a medical device called a Scioliometer, which is used in nearly every hospital across the country. The Scoliometer costs about $100 and was cleared by the FDA in 1983; the iPhone app costs 99 cents and Franko says his plastic attachment could be sold for about $10.

But he also knows that his device will have to be approved by the FDA, requiring a significant capital investment. He's planning to apply, he says, but with so many new apps coming on the market "there's no way the FDA is going to keep up."

Instead, he predicts, app developers with products that are not strictly medical, such as a healthy eating app, may avoid making medical claims in their marketing in order to skip the FDA process and will rely on good user reviews instead to generate publicity.

While the FDA sorts the process out with developers, Franko isn't wasting any time. In January, he helped launch the peer-reviewed Journal of Mobile Technology in Medicine to help doctors make sense of the bonanza of medical apps.

Franko's goal is to make sure doctors and patients know what they're getting as quickly as possible. "These apps already exist," he says, "and people are using them in hospitals to make medical decisions, but no one knows if they're actually doing what they claim to be doing."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

6 points with regard to regulatory threats and mobile health IT

Not long ago, the American Enterprise Institute (AEI) hosted an event titled, "There's a medical app for that – or not: Regulatory threats to mobile health information technologies." It was an extension of a recent Wall Street Journal article, focusing on the FDA, medical apps and the future of mobile health IT.

"All eyes are on the Supreme Court – everyone's starting at the Supreme Court, but that's not the only healthcare news in town," said J.D. Kleinke, resident fellow at AEI and healthcare business strategist. "An attempt has been made by the FDA to expand its mission to one of the more dynamic and important issues happening in healthcare and that's health IT generally, but more specifically, mobile applications."

"For the most part, health IT is a politically neutral zone," he continued. "People from the right and the left agree a computerized healthcare system makes more sense. It's a bipartisan idea, whose time has not just come but is long overdue."

Kleinke and Joel White, executive director of the Health IT Now Coalition, outline five points to consider with regard to regulatory threats to mobile health IT.

1. The FDA has taken an interest in mobile apps. In July of last year, the FDA issued its Draft Guidance on mobile medical applications. "So increasingly, we're seeing that in the market place, as more consumers become comfortable with IT and doctors use apps to treat patients, the FDA is looking at these technologies and have been for some time," said White. "IT is rapidly advancing, and they had to think about the advancements and how that'd fit into a regulatory framework." Essentially, he said, the Draft Guidance for mobile apps does a couple things. For instance, it makes it so apps fall under FDA regulatory authority as medical devices and would be classifies as Class One, Class Two, and so forth, based on what the app does in conjunction with diagnosing the patient. "It would have to go through the regulatory structure for approval," said White. "And if [the app] isn't considered a mobile device, it wouldn't have to go through this process."

2. Issues arise with mobile apps and the 510(k) process. Devices are now classified under the same risk structure as the 510(k) process, which "isn't known as a rapid process," said White. "If you think about the life cycle of apps and software, generally, it is very rapid. So that change in the actual app may trigger some change in the regulatory structure if they go through the 510(k) process." He added that although the FDA does have an "appropriate role to play" in ensuring the safety and effectiveness of these apps, according to the IOM, the 510(k) process has significant issues, most notably, the length of time to get approval. "Most poignantly, the IOM said last year in a report, that the process wasn't working well for the industry or for patients," he said. "So clearly, the process has some challenges."

3. Risk factors do exist when it comes to mobile apps. An IOM report, which was released last November, did confirm three serious issues that exist with regard to mobile apps. "A panel of experts looked at issues of health IT and patient safety, and they concluded serious risk factors," said White. "Errors with how IT operates, errors with how physicians use IT, and information asymmetry issues, or information about a patient or care treatment protocol that wasn't available when using the technology in ways it was intended." What IOM concluded, he said, was there wasn't coordination across agencies, where these issues touch base in jurisdictions. "None of the agencies have resources at their disposal in terms of expertise to address some of the follow-ups in regard to patient safety."

Continued on the next page.

Tele-ICU initiative improves care, increases employee satisfaction

HIGH POINT, NC – High Point Regional Health System has seen big benefits from a three-year tele-ICU pilot with St. Louis-based Advanced ICU Care, officials say – improving care while alleviating clinicians' workload.

High Point's intensivist-led team is based in the Advanced ICU Care Monitoring Center and receives constant information on the patient’s condition through sophisticated software that notifies them of any change in the patient’s health that might require immediate intervention, officials say.

Two-way video in the patient’s room can be activated to conduct a conference between the bedside care team and the Advanced ICU Care team at any time of the day or night. This constant surveillance improves patient safety and health outcomes by avoiding complications and adverse situations with prompt, proactive interventions.

Key to the High Point collaboration is the strong alliance between its staff and the Advanced ICU Care team, officials say. During the three-year partnership, this team has successfully implemented quality care initiatives for better patient management and safety measures to avoid potential complications that can occur in an ICU, such as blood clots, deep vein thrombosis, gastric ulcers and sepsis. A significant achievement is the implementation of an innovative “patient cooling” process for people with cardiac arrest. Patients who have received this treatment have awakened after the arrest with no cognitive impairment.

“Three years ago, we partnered with Advanced ICU Care to bring around-the-clock intensivist care to ICU patients in our community,” said Greg Taylor, MD, High Point's COO. “From a seamless implementation to the quality enhancements we continue to achieve, the collaboration between our hospital staff and Advanced ICU Care has been a success. We are able to offer our patients the highest level of care available in the ICU today and to continue to improve on that level of care every day.”

Research has shown that patients in intensive care do better when they are monitored around-the-clock by intensivists, physicians specially trained in critical care medicine. Constant surveillance by these specialists is now the recommended standard of care for hospital ICUs.

But a severe shortage of intensivists means it’s simply not possible for most hospitals to meet this standard and have intensivists on staff at the hospital at all times. Advanced ICU Care, the nation’s largest independent provider of tele-ICU programs, helps hospitals overcome this barrier and achieve optimal care in the ICU through a tele-ICU program combining sophisticated telemedicine technology, 24-hour-monitoring by Board-certified intensivist physicians and continuous quality improvement initiatives.

In addition to quality patient care initiatives and protocols, staff satisfaction and working conditions have improved since the implementation of the tele-ICU program, and High Point has seen a reduction in nursing turnover, officials say.

“Our nurses have really embraced this program," said Cindy Stewart, RN, director of critical care and cardiovascular services at High Point Regional. "Being able to speak with Advanced ICU Care in the middle of the night has improved employee satisfaction among our nursing staff. We find that when we recruit, many nurses have heard of remote monitoring, and they’re excited to learn something new.”

Physicians at the hospital say they're comforted that their ICU patients have an intensivist-led team available when they are not in the hospital, making sure their care plans are followed and available should any situation arise that needs immediate attention.

“The Advanced ICU Care program relieves the pressure of having to perform around-the-clock ICU coverage by existing staff and avoids burnout,” said intensivist Peter Brath, MD, medical director of High Point’s Intensive Care Unit and Respiratory Therapy. “There are more doctors available to provide weekend and night backup coverage. From a quality of life standpoint, it’s wonderful.”

“High Point has been a great partner and we are very excited by the strong results that we have been able to achieve together,” said Mary Jo Gorman, MD, CEO of Advanced ICU Care. “We feel very confident the hospital will continue to see additional benefits stemming from our collaboration, from improved patient care to staff satisfaction.”

CaringBridge: 15 years of connecting caregivers

Fifteen years ago, before there was a Facebook, Twitter or even MySpace, Sona Mehring turned to social networking to get the word out about the challenging health condition of a close friend's new baby.

Brighid Swanson was born almost three months early to JoAnn Hardeggar and Darrin Swanson. Mehring, then a website designer in Eagan, Minn., decided to create a site to post progress reports about the baby.

During the baby's brief life � she died after nine days � "I had this incredible experience of being able to bring these caring social networks together for my friend and the baby," Mehring says.

Today, Brighid's legacy lives on in CaringBridge, the not-for-profit site Mehring launched in 1997 so others can easily create private Web pages during a medical crisis.

Adding a new service

Since its inception, more than 400,000 personal CaringBridge pages have been created. Every day, 500,000 people visit the site, which today celebrates its birthday and branches out with a new SupportPlanner feature.

The service gives users a place to "coordinate care and organize helpful tasks" � making and bringing meals, providing child care during appointment times, caring for pets, or doing household chores.

CaringBridge is also unveiling a redesigned website, which features a new "Amplifier Hub" to encourage and support volunteer efforts.

The site, which does not accept ads, is supported largely by individual donations, Mehring says.

About 8% of its budget comes from foundations and in-kind gifts.

CarePages, a similar health-focused social network that launched in 2000, does accept advertisements.

Both "provide a good service in that they enable the loved ones or caregiver to update the site once to tell a lot of people who care what's going on," says Lee Aase, director of the Mayo Clinic's Center for Social Media.

"It really does help relieve a burden" of constantly having to call or text, he says.

Another area of support is available from a growing number of online health communities, such as PatientsLikeMe.com, the American Cancer Society's Cancer Survivors Network, MyAutismTeam.com and connect.mayoclinic.org, that allow people having a health challenge to reach out to others facing the same condition.

Finding 'prayer warriors'

Facebook users, of course, regularly share information and post the latest news about family and friends' health events.

Like many CaringBridge users, Natalie Bushaw of Eagan, Minn., often links her posts to her Facebook page to tap into her Facebook friends. It comes in handy, she says, when she needs "a lot of prayer warriors."

Bushaw's 8-year-old twins, Owen and Logan, were born with multiple congenital defects. Although both are doing much better now, there were tough times, including 18 surgeries between the two by the time they were 4 years old.

"We have family and friends who care so deeply about their well being," Bushaw says. "CaringBridge gives us a way to keep those people who are vested in our lives informed."

Pills On The Job: Companies Add Prescription Services

Enlarge iStockphoto.com

On-the-job filling of prescriptions is becoming more common.

iStockphoto.com

On-the-job filling of prescriptions is becoming more common.

Nearly everybody has to fill a prescription now and then. For a lot us, there are several to fill each month.

To make it easier, some companies are adding drug dispensaries to their on-site health clinics. Others offer concierge services that deliver drugs right to workers' desks.

Now, it's true that people could also fill their usual prescriptions by mail, something many employers and managers of pharmacy benefits encourage with lower copays.

But there are some potential advantages to the on-the-job approach. "One benefit of an on-site pharmacy is that employers can couple it with education," says Julie Stone, a senior consultant with human resources consultant Towers Watson.

 

Another plus from an employer perspective: keeping workers at the office. "Some employers want to provide Main Street USA, keeping employees on site and providing them with the services they'd otherwise be leaving the office for," says Ed McNamara, vice president of sales and marketing for CHS Health Services, which operates 115 health centers in 32 states.

Making necessary drugs available on the job removes one more barrier that may stop people from sticking to their drug regimen. Lack of adherence with doctors' prescriptions adds an estimated $100 billion to health care spending annually by some estimates. Some employers also eliminate copayments for some common drugs at the on-site dispensaries.

Don't expect the full range of medicines offered at the local drugstore. Although some big companies have full pharmacies, it's more common for companies to stock 50 or so common drugs in prepackaged containers, "so they don't need a pharmacist on site," says Bruce Hochstadt, with benefits consultant Mercer. Others make arrangements with a local pharmacy to deliver drugs to the company a few times a day.

Onsite pharmacies are more appealing to many employers than some other services they might offer, like X-rays. "The convenience is there for the employee, but there's less of an investment up front," says Ha Tu, a senior researcher at the Center for Studying Health System Change.

3.1 million young people covered after health care law

WASHINGTON�More than 3.1 million Americans ages 19 through 25 are covered by their parents' medical insurance policies because of a provision in the 2010 health care law, the Department of Health and Human Services is expected to announce today.

That's up from 2.5 million in December. About 75% of people in that age group now have insurance, up from 64% in 2010, records show.

"This policy doesn't just give young adults and their families peace of mind, it also gives them freedom," said HHS Secretary Kathleen Sebelius, hitting upon a note often struck by Democrats making the case that the law allows young people to pursue entrepreneurial careers that may not give them health benefits. "They will be free to make choices based on what they want to do, not on where they can get health insurance."

The provision has become so popular � both for security reasons for consumers and financial reasons for insurers � that several health companies and employers say they intend to keep it even if the Supreme Court were to strike down the law, or portions of it, this month.

It also adds healthy people to the insurance pool should the court strike down just the part of the law that requires people to buy health insurance, said Ron Pollack, founding executive director of Families USA, which supports the law.

Three large insurers � Humana, Aetna and UnitedHealth Group� have said they intend to leave the provision in place because the policy provides "peace of mind" and stability.

"It's good for consumers," said Robert Zirkelbach, spokesman for America's Health Insurance Plans, adding that there has been no data yet on whether the provision brings down health costs. "The goal is to try to get as many people covered as possible."

Adding young people, who tend not to use health services as much as older people, should bring down everyone's costs, said Sandy Praeger, Kansas insurance commissioner and former president of the National Association of Insurance Commissioners.

"I think it's a good business decision," she said. "If it was causing premiums to go up, companies would think long and hard about going back to the old ways."

.

Gains in coverage were highest for young men � from 58% to 72%, the new data show. Men ages 19 through 25 are the least likely of any group to have insurance, which probably played into the large increase, according to HHS. The total percentage of young adults who were uninsured fell from 34% in 2010 to 28% in 2011.

"It is striking and very heartening to know that 3 million young adults have gained financial and health security," said Richard Kronick, deputy assistant secretary for health policy for the U.S. Department of Health and Human Services. "I'm not sure I've ever seen a result quite so striking in such a short period of time."

Though he has called for the law to be "repealed and replaced," Republican presidential candidate Mitt Romney has not said whether he would try to keep this portion of the law.

Replacement options are plentiful for lost 'loveys'

When Catharine Blake told her daughter Francesca, 3, not to bury her prized Gumby figure in the sand on a beach in Well, Maine, two summers ago, Francesca didn't listen. An hour later, Gumby was gone.

"I panicked and started digging up hole after hole and tried to figure out the general area it was in," recalls Blake, 39. "I probably spent 45 minutes doing this while Francesca was crying and upset. I must have looked like a loon."

Blake, a psychotherapist in Andover, Mass., says she stopped the search when "the reasonable part" of her brain kicked in. Her stepfather recalled seeing a Gumby in a nearby store, so Blake texted her mother, who was out shopping.

When the beachgoers returned home, a familiar green plastic figure was on the porch.

Francesca was overjoyed. "I promise I'll never lose you again," she told Gumby. Two years later, she still talks about Gumby's return � though he now lives at the bottom of her toy box, Blake says.

Tips to avoid potential problems

Buy duplicates of a beloved item as soon as you realize your child has a favorite; switch them regularly so the child doesn�t realize there�s more than one.

Set limits on where the lovey goes, such as never leaving the house, or having a certain item for car rides but another for use inside the house or crib. If that doesn�t work, keep a close eye on the toy when traveling. �Do not leave it in the hotel bed tangled up in the sheets,� said Lisa Oliver, founder of LostMyLovey.com. �Many moms have told me the sad story of leaving lovey in the bed, and hotel maids scooping it up in the wash, never to be seen again.�

Take photos of the item before it goes missing, so you�ll have an image of the item you are searching for, says Rosemary Bouchet of Plush Memories. Photos are handy if you need to search online lost-and-found boards or make �Missing� signs to post in the neighborhood.

Young kids often get attached to a particular object or toy for comfort; these items are sometimes known as loveys or transitional or comfort objects. When they go missing, parents often are as distressed as their child.

The psychology behind lost loveys

Why are certain toys and stuffed animals so important to young children? They represent secure relationships with caregivers, says Stephanie Pratola, a psychologist in Salem, Va. She says loveys can help kids feel more secure in new situations and help them separate from parents or other caregivers.

When loveys get lost, kids pick up on a parent's reaction, she adds. "Frantically searching for a lost toy or speeding back to the place it was lost probably will create additional anxiety for the child. Parents might sometimes inadvertently overly encourage the attachment to a particular object."

Ultimately, whether or not a lost item ever surfaces, most kids move on. "Most leave them behind when they're ready, without difficulty," Pratola says.

But sometimes, seeking a lost item can become a sweet childhood experience.

Kathleen Reilly, 42, a freelance writer and book author in Raleigh, N.C., fondly recalls how her parents helped her replace a plastic snake prize she lost at age 8 on a bumper car ride. She and her mother rode the ride again in an attempt to find it, but never did. Her father spoke to a kind carnival worker, who let her win another snake.

Reilly, who didn't learn the real story until years later, says the experience thrilled her, and helped her see how other people could help "make a little magic happen for your kid."

Replacing the beloved item

A number of replacement options are now available :

eBay. Look through existing listings or post a note in the "Want It Now" section.

LostMyLovey LLC. Web designer Lisa Oliver, 43, of Austin, Texas, created the site in 2009 after searching for her daughter's favorite purple bunny one too many times. The lost-and-found site also sells ID tags for toys and acts as a middleman for those who don't want to put phone numbers or other identifying information on tags. Today, the site has about 1,000 members and "we have helped many, many people find replacement or backup loveys," she says. "I've seen several situations where someone was desperate for a particular toy and a nice mom said 'Gee, I have this in my toy box and my child doesn't even care about it. I'll mail it to you!' It's a feel-good kind of thing."

Plush Memories, founded by Rosemary and Fred Bouchet of Vincent, Ala. The retired couple started the site in 2005 as a free service for people seeking lost stuffed animals, in tandem with an online plush animal store and an offshoot of their vintage collectible online store. "We consider this to be our Christian ministry," says Rosemary Bouchet, 68. They are assisted by a group they call their "Fabulous Finders," usually toy sellers who check in to see if anyone is seeking toys they have in stock. There are now 161 Fabulous Finders worldwide, and the site has helped 504 people locate lost loveys since 2010, when the Bouchets began keeping track.

Tips for winning the IT 'talent war'

The U.S. labor market may be soft, but health IT is booming, with many hospitals locked in pitched competition to hire skilled technology professionals. At the HIMSS Virtual Conference & Expo on Thursday, one recruiter laid out a battle plan for finding – and keeping – good employees.

In her presentation, "Winning the Healthcare IT Talent War," Tiffany Crenshaw, president and CEO of Greensboro, N.C.-based Intellect Resources, showed how a dearth of talented and motivated employees can have an adverse impact on hospitals' organizational goals – and ultimately slow the nationwide push to digitize healthcare.

With meaningful use and ICD-10 and accountable care all adding to the healthcare workload, Crenshaw's core message was that organizations "need to have a good strategy" to recruit and retain good talent. 

"Our candidate pool is very lean right now in health IT," she said. "There is extreme demand for resources."

She showed how, when it comes to IT professionals with in-demand skill sets the "turnover rate is starting to increase dramatically" at hospitals nationwide.

Moreover, the quality of that scarce talent is improving – which Crenshaw chalked up to a "hangover from the recession," when many skilled workers lost their jobs.

At the same time, "structural issues are starting to come to the forefront" at many healthcare organizations that show that they're badly lacking when it comes to attracting, on-boarding, and keeping these crucially valuable employees.

The Department of Labor projects the need for some 50,000 workers in health IT in the coming years, Crenshaw pointed out. Meeting that need will strain many providers' resources as they try to offer higher salaries and better benefits in an extremely competitive market.

Those that can't attract top talent will also suffer: Understaffing will impact their organizational goals, their ability to meet deadlines, their team morale, their ability to retain staff and more.

Crenshaw highlighted what she called a "scary statistic": Without sustained structural improvements in acquisition and on-boarding, she said, turnover could reach 28 percent by 2013.

With a "booming go-live market" and "more emphasis on training than ever before," that's not a recipe for any sort of sustained success. So she laid out a strategy for winning, starting with the need to "size up the enemy."

Every part of your organization should be under the microscope, said Crenshaw. What is your company culture like? Your salary/benefits/relocation package? How aggressively are you recruiting? Have you framed your approach with a strategy and process, or is it haphazard? Do you make use of recruiting technology, to track resumes? Do you laud your employees with awards and recognition? Do you offer professional development opportunities? How is your employees' work/life balance?

It's important to develop well-written job descriptions, and to update them when appropriate, she said. Hiring managers, HR and stakeholders should all be on the same page. Once an offer is made, it's important to "reach out" and keep the lines of communication open between the initial offer and the starting day.

Once that day comes, it's important to "roll out the red carpet," and keep these new employees busy with challenging work – any downtime in the early-going will cause many skilled workers to start having second thoughts, said Crenshaw.

"Structure and follow-through" – when it comes to on-boarding, orientation, review and beyond – are key, she said.

As one example of original thinking with regard to the hiring process, Crenshaw pointed to Baton Rouge, La.-based Ochsner Health Systems, which earlier this year launched Big Break, a one-day "American Idol type event" – complete with a "big marketing splash" – where scores of applicants "auditioned" for IT jobs.

That's the sort of bold approach to staffing that will be necessary in the crucial coming years, said Crenshaw: "It's time for you to get very serious about your recruiting, your retention and your on-boarding"

It would not be the end of health reform, just a chance to get it right

If President Obama is now confiding to Democratic donors that he may have to “revisit” health care in a second term if the Supreme Court throws out his first attempt, as Bloomberg News reported June 1, maybe this time we can get it right.

Instead of trying to dress up our broken private insurance-based system, or resuscitating elements of a convoluted plan the court may overturn, it’s time to try something different.

Fortunately, we have a well established, uniquely American model in place, one that meets the legal test. A program that already takes care of the 40 million Americans over 65. That has the added benefits of being universal in coverage and far more cost efficient than our present system.

Nurses rally for Medicare for all and a tax on Wall Street to help pay for it in Chicago May 18

It’s called Medicare. And it’s been working well for nearly 50 years, and remains wildly popular, even among those hate “Obamacare.”

How do we fix our health care system? Easy, and we don’t need 2,700 pages either. Just open up Medicare to cover everyone, regardless of age.

It’s a step we should take, no matter how the court rules.

Even if the law is upheld, some 27 million Americans would remain uninsured by 2016, according to the Congressional Budget Office, families will continue to struggle with rising out-of-pocket health costs and un-payable medical bills and more employers will drop coverage or shift more costs to employees.

Can our nation stand another fight over health care reform? The better question is, can we afford not to?

Over the past year, nurses have seen an alarming nexus between the economic decline and broad erosions in health status, such as stress-induced heart ailments, anxiety and “gut” disorders, health woes associated with poor nutrition, and illnesses traditionally seen in adults increasingly found in children. Nurses now routinely see patients skipping or delaying not just routine medical visits, but even cancer treatment and other life-saving or life prolonging care due to cost.

A library of surveys and studies document these worrisome trends.

A Centers for Disease Control analysis found a quarter of children age 17 and under were in families struggling to pay medical bills.

In 2010, 30 million Americans were contacted by debt collection companies chasing them to pay medical bills, a jump of 5 million people in just half a decade, the Commonwealth Fund reported. Unpaid bills as small as $250 were ruining credit records for many. Medical bills account for 62 percent of personal bankruptcies, and nearly 80 percent who went broke from health care had insurance.

Fifty million Americans still have no health coverage. Another 29 million are under insured with massive holes in their health plans, an increase of 80 percent since 2003, according to the journal Health Affairs.

What do they do for care? They suffer in silence, until it hurts so bad they go to where it is most expensive, the emergency room. AFebruary report by the Pew Center on the States recorded a 16 percent in the number of people going to the ER for dental care.

A Kaiser Family Foundation survey last December found a majority of those uninsured or with poor coverage delaying needed care, and 75 percent of the unemployed or under employed skipping dental checkups or recommended medical treatment or tests or not filling prescriptions.

Those boasts about how we have the best medical system in the world need a re-write, the best perhaps based on ability to pay. As a nation, we spend twice per person as much as many countries for health care, but get far less. We’re falling farther behind other countries in life expectancy, infant mortality, waits for care, costs for doctor visits, surgeries, and prescription drugs, and health care well-being for our children.

If you want to stew over just one sobering statistic, consider this: According to the World Health Organization, the U.S. ranks behind more than 40 other countries in death rates for child-bearing women.

What distinguishes us is that virtually all those other countries havesome form of coordinated national health care system, like our Medicare. We have private insurance companies whose prime directive is earning profits for their investors, not guaranteeing patients get the care they need when they need it.

Let’s take that mulligan on health care reform and do a make over. Just as we fought to provide retirement security, including health care for everyone over 65, we can make the same effort for the rest of our nation. There’s no time to lose.

Aveksa helps hospitals govern inside access

WALTHAM, Mass. – While hospitals and healthcare providers are on a constant lookout for cyber-based attacks from without, the threat from within is just as real.

For instance, John Halamka, chief information officer for the Boston-based CareGroup Health System, says his network fires two to three people a year who illegally gain access to medical records.

To determine who within a healthcare organization gets to look at what records, hospitals are deploying access governance solutions. Among the vendors providing such services is Waltham, Mass.-based Aveksa, Inc., which recently launched Aveksa Access Request and Change Manager.

According to Brian Cleary, Aveksa's vice president of marketing and products, the company's enterprise access governance platform creates a database of parameters for every employee or position in the healthcare organization. The idea, he said, is to create a set of rules that can be referenced for every single foray into the provider's database.

"We ensure that compliance can be streamlined and repeatable," he said. "We're really a process and policy administration technology."

Analysts say the access management field is complicated, but vital.

"Understanding the relationship of people to responsibilities (and) responsibilities to roles and how entitlements satisfy the responsibilities that roles signify is a significant challenge. Without this understanding, however, it is difficult to resolve an organization's access-related security and policy vulnerabilities," said Kevin Kampman, senior analyst at Burton Group.

"Leveraging automated solutions that are designed to identify and maintain these policies and relationships helps to mitigate vulnerabilities," Burton said. "The organization can reduce the risk associated with inappropriate access privileges and institute the discipline needed to limit or prevent their recurrence. The organization also benefits by clearly articulating relationships, a perspective that contributes to business transparency and effectiveness."
 

Mobile telehealth solution helps UK patients monitor chronic illness

In July 2011, NHS Bristol awarded a £1.4 million contract to Safe Patient Systems to provide telehealth monitoring to patients with chronic conditions. The contract has since enabled patients with chronic obstructive pulmonary disease (COPD) and congestive heart disease to benefit from daily remote clinical monitoring using mobile phones, officials say.

The Safe Mobile Care system uses mobile phones programmed with personalized care plans created from the system’s Web-base application software. Patients receive daily prompts to complete clinically validated questionnaires and capture relevant vital signs using wirelessly connected monitoring devices.

Responses are automatically sent to Safe Mobile Care Triage Management software. If a response indicates that a patient’s condition may be worsening, an alert is generated automatically and sent to a nurse or doctor. They then advise the patient on the next course of action.

Safe Mobile requires no broadband installation or complex technical support, officials say. A nurse or clinician can also install the system’s devices and guide the patient through any of the processes in using the system.

“This technology will play a key part in delivering the self-care agenda in Bristol, supporting patients to understand the link between symptoms and related treatments and behaviors," said Sian Jones, program manager, long-term conditions at NHS Bristol. "Having started with COPD and congestive heart failure patients, there is an interest in rolling this out to include other long term conditions, to maximize the benefits for people in Bristol."

The Reward for Donating a Kidney: No Insurance

From the New York Times –

When Erika Royer�s lupus led to kidney failure four years ago, her father, Radburn, was able to give her an extraordinary gift: a kidney.

Ms. Royer, now 31, regained her kidney function, no longer needs dialysis and has been able to return to work. But because of his donation, her father, a physically active 53-year-old, has been unable to obtain private health insurance.

Like most other kidney donors, Mr. Royer, a retired teacher in Eveleth, Minn., was carefully screened and is in good health. But Blue Cross and Blue Shield of Minnesota rejected his application for coverage last year, as well as his appeals, on the grounds that he has chronic kidney disease, even though many people live with one kidney and his nephrologist testified that his kidney is healthy. Mr. Royer was also unable to purchase life insurance.

Officials with Blue Cross and Blue Shield of Minnesota refused to discuss Mr. Royer�s case because of privacy laws, but said in a statement that Minnesota residents who are rejected by private insurers can buy coverage through the Minnesota Comprehensive Health Association high-risk pool, which is what Mr. Royer said he did, though he is paying more for less comprehensive insurance.

The officials refused several requests for an interview, saying in an e-mailed statement that �healthy individuals who happen to have one kidney can and do receive coverage� through Blue Cross and Blue Shield as long as their test results are within medically accepted normal ranges.

Mr. Royer said he is baffled by the denial. �From my perspective, I�d be a good risk,� he said. �I�d just be putting in premiums and helping balance the system out.�

There is little data on how often kidney donors have trouble obtaining insurance, but advocates say the fear of being uninsurable may be a powerful deterrent to donation. A 2006 study done by an advocacy organization for transplant professionals found that 39 percent of transplant centers reported that they had had eligible donors who declined to donate because they feared having future insurance problems.

The health of living donors is seldom at issue: Though some research suggests that kidney donors may be slightly more prone to develop high blood pressure as they age, long-term studies have found donors live as long as other healthy people. One study reported that donors live even longer.

Most insurers maintain that prior kidney donation does not affect coverage decisions or premiums, but while transplant cases like Mr. Royer�s are rare, advocates and social workers who work closely with donors say the problem may be more common than is recognized. A review study published in 2007 by Canadian researchers found that as many as 11 percent of them have encountered problems with life and health insurance coverage.

It�s a problem with implications for thousands of people. In 2008, the last year for which figures were available from the National Institute of Diabetes and Digestive and Kidney Diseases, 17,413 kidney transplants were performed, most of them (11,382) from cadavers. But there were 87,820 people awaiting a kidney transplant as of February 2011, and another 2,249 waiting for both a kidney and a pancreas.

Continue reading…

Top CEOs offer checklist for better healthcare

WASHINGTON – Some of the nation's top healthcare CEOs have issued a 10-item checklist for spurring high-value healthcare that includes health IT best practices.

The checklist is part of a discussion paper the CEOs authored that bears the emblem of the Institutes of Medicine. However, it also carries a disclaimer that the views expressed in the discussion paper are not necessarily those of the authors’ organizations nor of the IOM.

[See also: IOM to release new report on health IT and patient safety]

"The Checklist’s 10 items reflect the strategies that, in our experiences and those of others, have proven effective and essential to improving quality and reducing costs," the authors write.

On the topic of IT, they state: “Reliable information systems are critical not just to ensure care quality, but also to improve efficiency in administrative and other process measures.”

In keeping with their precept of “continuous improvement,” the CEOs ask themselves and their senior leaders these questions about IT:How well is our IT system used to help providers streamline administrative tasks and improve the care experience and patient outcomes?How well is our EHR aligned with meaningful use requirements?

[See also: IOM finds healthcare data for children lacking]

They also present examples of how IT best practices resulted in better care and millions in savings at their organizations.

At Geisinger Health System, for example, IT helped lower costs over the past five years, saving $1.7 million from reduced chart pulls; more than $600,000 from reduced printing and faxing; more than $500,000 per year from reduced nursing staff time through ePrescribing; and more than $1 million from reduced transcription.

The checklist and a list of the authors and their affiliations are on the next page.

ACPE launches new online journal for emerging physician leaders

TAMPA, FL – The American College of Physician Executives (ACPE) announced Tuesday the launch of LeadDoc, a new online journal aimed specifically at medical students, residents and young physicians interested in the management and leadership aspects of healthcare.

According to ACPE, the free bimonthly journal offers short feature stories and videos on topics the business side of healthcare. LeadDoc also provides profiles of successful physicians who share their tips and offer insight on how to create a unique career path.

"Our goal is to inform and guide young physicians as they launch their careers in health care – regardless of where their professional paths may eventually lead," said Peter Angood, CEO of ACPE. "In essence, every physician is a leader at some level. The key to being successful is embracing not only how to become an expert on the clinical side of medicine, but also in proactively developing the leadership and management skills that will truly help set them apart from others."

[See also: Need for speed will send doctors to the cloud, experts say.] 

The first issue features a profile of Pakhi Chaudhuri, a young Colorado pediatrician who opened her own clinic in an area where many children are at-risk for abuse and neglect. It also features a personal essay by ACPE member Joseph Kim, a physician and developer of several technology-related blogs, on how he was able to turn his passion for technology into a career in social media. In addition, an executive recruiter gives her top ten hints for mastering a video interview.

Future issues will include tips on successful resume writing, a guide to negotiating contracts, solutions on how to counteract burnout and a story about the challenges faced by young physician leaders who are managing physicians older than them, ACPE officials said.

ACPE said LeadDoc welcomes articles or short videos on topics relevant to young physicians. All submissions should be submitted as an attached file to an email, and should include an abstract describing the piece. The recommended length for an article is between 500 and 1,000 words. A video submission should not be more than five minutes long. Articles can be emailed to cjohnson@acpe.org or rapple@acpe.org. Only original work will be considered. However, an article that expands on issues raised in other articles, books or speeches is acceptable. Graphs, charts, photographs and other illustrations are encouraged. 

Health IT spending flying high, survey says

CLEARWATER, FL – Healthcare IT spending hasn’t shown signs of slowing down anytime soon. In fact, a Black Book HIE survey released today projects that industry spending will triple by 2014.

Despite these projections, the majority of U.S. hospitals (80 percent) and physicians (97 percent) remain disconnected from HIE technology. The survey’s numbers suggest, however, that the tides are indeed changing. Although only one in 15 provider organizations indicated they are developing strategies to advance them towards HIEs, industry tech executives sang a different tune, with 84 percent saying they are actively taking measures to move towards HIE adoption. 

 [See also: HIE on the upswing.]

“The current driving forces of HIE adoption are clearly apparent: accountable care implementations, meaningful use implementations, the need for care coordination, outcomes-based reimbursement challenges, available funding and opportunities for regional stakeholder participation,” says Black Book’s senior partner, Doug Brown. 

The survey, included in Black Book’s 2012 State of the Health Information Exchange Industry report, consists of 4,000 healthcare delivery and insurance organizations and provides an aggregated insight into the conditions and priorities of the enterprise HIE marketplace. It also includes validated client experience and satisfaction ratings on private HIE developers with functionally comparative products. 

The report also includes ranking of the top enterprise HIE firms based on the responses of HIE early adopters and users, in addition to currently implementing customers. Vendors were evaluated on 18 key performance indicators including stakeholder alignment, accountable care support, sustainability, interoperability, analytics, accessibility, configuration, interfaces and implementations, clinical workflow, data integrity and security. 

 [See also: Black Book Rankings names top EMR vendors for 2011.]

 The report notes the following other key findings:

28 percent of respondents are cautiously increasing HIE spending before the end of 2012, but eight of 10 providers expect organizational HIE budgets to significantly increase by 2014.85 percent of hospital executives assert that their expedited HIE adoption implementations are mainly inspired by pressures to prepare for ACOs and changing reimbursement models.83 percent of hospitals and 17 percent of all providers either already have or plan to participate in an HIE solution currently. 95 percent of all providers expect to be included in at least one HIE interface by July 2013.98 percent of those providers with HIE strategies in place will focus entirely on community or regional exchanges for the foreseeable future, rather than national health record exchange initiatives.41 percent of healthcare technology executives say interoperability is one of their top three priorities for 2012, while 92 percent of CIOs expect it will be a top three 2013-2014 focus area for their organizations.

More than half of all hospitals and payers agree that the HIE return on investment will be discovered in the collaboration on accountable care organizations and patient centered medical homes.

Face-chewing victim will have long road to recovery

MIAMI(AP)�A homeless man whose face was mostly chewed off in a bizarre, vicious attack faces a bigger threat from infection than from the injuries themselves, according to experts on facial reconstruction. He will require months of treatment to rebuild his features and be permanently disfigured.

Though gruesome, such severe facial injuries are generally not life threatening. The most serious risk to Ronald Poppo as he remained hospitalized Wednesday were germs that may have been introduced by the bites of the naked man who attacked him. One of the 65-year-old's eyes was also gouged out.

"The human mouth is basically filthy," said Dr. Seth Thaller, the chief of plastic and reconstructive surgery at the University of Miami's Miller School of Medicine.

It's not clear why Poppo was attacked Saturday afternoon by 31-year-old Rudy Eugene alongside a busy highway. Police have released few details, but surveillance video from a nearby building shows Eugene pulling Poppo from the shade, stripping and pummeling him before appearing to hunch over and then lie on top of him.

A witness described Eugene ripping at Poppo's face with his mouth and growling at a Miami police officer who ordered him to get off the homeless man. The officer shot and killed Eugene.

Eugene's younger brother said he was a sweet person who didn't drink much or use hard drugs.

"I wish they didn't kill him so he could tell us exactly what happened. This is very uncharacteristic of him," said the brother, who asked for anonymity to protect his family from harassment.

Police union officials representing the officer said the scene on the MacArthur Causeway was one of the goriest they had ever seen.

"He had his face eaten down to his goatee. The forehead was just bone. No nose, no mouth," said Sgt. Armando Aguilar, president of the Miami Fraternal Order of Police.

Poppo has been in critical condition in recent days, but police didn't give an update on his condition Wednesday.

Thaller, who is not treating Poppo, and other plastic surgeons said the rebuilding of Poppo's face would happen in stages after doctors try to keep his wounds clean, salvage viable tissue and determine a plan for skin grafts. Protecting his remaining eye and maintaining an airway are priorities.

To keep the wounds clean, doctors use grafts of the patient's skin, cadaver skin or synthetic skin to cover the exposed bone or cartilage, said Dr. Blane Shatkin, a plastic surgeon and director of the wound healing center at Memorial Hospital Pembroke in South Florida. The coverage would act like a dressing, protecting the wound as it heals.

Poppo's lifestyle and health before the attack could determine how doctors proceed and whether they eventually consider a facial transplant, plastic surgeons said. Poppo had been homeless for more than 30 years, previously survived a gunshot wound and faced multiple charges of public intoxication, among other arrests.

"You would not just take this guy to the OR for a face transplant � you really have to go in a staged fashion. You save what you can and use what you have available first, don't burn any bridges and move forward slowly," Shatkin said. "And you have to see what he wants."

Psychological care is important to the recovery, and patients need to participate in the decision-making process, said Dr. Bohdan Pomahac, a surgeon at Brigham and Women's Hospital in Boston. He performed a facial transplant on a Connecticut woman who was mauled by a friend's pet chimpanzee in 2009.

"I think the patient has to be able to cope with the injury and the trauma and needs to figure out what has happened. It often takes them weeks to understand what has happened," Pomahac said.

The chairman of the Miami-Dade County Homeless Trust, Ron Book, said the last time Poppo sought help from the agency finding someplace to sleep was in 2004. However, on Thursday the Jungle Island zoo on the MacArthur Causeway called for an outreach team to deal with Poppo, who had been living on the roof of the attraction's parking garage.

Poppo was belligerent and aggressive, but he was not arrested, Book said.

A report from the group says that Poppo had been homeless before arriving in Florida. He first came to one of the group's shelters in Miami on Dec. 27, 1999, and he stayed for 141 days. Since then he stayed at another shelter in 2003 for 10 days and several other shelters for one night each.

The attack was captured by security cameras at The Miami Herald's headquarters. The newspaper posted the uncensored video online late Tuesday (http://hrld.us/N9GlGB).

It shows a naked Eugene walking west on the sidewalk alongside an off-ramp of the causeway. A bicyclist speeds past Eugene just as he turns to something in the shade, in an area obscured by palm trees.

After a couple minutes, Eugene rolls Poppo's body into the sun and begins stripping off his pants and pummeling him. Later, the footage shows Eugene pull Poppo farther up the sidewalk. Though the view is partially obstructed by the mass transit rail above, Eugene appears to hunch over and lie on top of Poppo.

The footage shows a bicyclist slowly pedaling past the men about halfway through the attack, followed by a car slowly driving on the shoulder of the ramp. Cars regularly pass by the scene from the beginning of the attack, but their view was likely obstructed by a waist-high concrete barrier.

Two more bicyclists cross the scene before a police car arrives nearly 18 minutes into the attack.

An officer gets out of the car and appears to do a double-take at the scene before pulling out his gun. He fatally shot Eugene, apparently within a minute of arriving, but the shooting is obscured from view by the tracks.

Miami police have not released 911 calls. The medical examiner declined to discuss Eugene's autopsy, and results of toxicology tests could take weeks.

Eugene left his girlfriend in Fort Lauderdale around 5 a.m. Saturday, then stopped at a friend's. He said he was on his way to Urban Beach Week, a series of outdoor concerts and parties on Miami Beach, according to his brother. No one knows what led to him walking naked on the causeway.

"Where's the car, where are his clothes? We don't know where his stuff is," the brother said. "How did he get there naked in the middle of the daytime and nobody saw him?"

Police said that his car was towed from a Miami Beach street sometime Saturday. It was parked illegally and was one of dozens towed during the weekend festivities.

Eugene had a job detailing cars at a dealership and had been arrested a handful of times on marijuana-related charges, his brother said.

"I don't understand any of this," the brother said. "I know my brother, and anybody else who knows him knows he was a genuinely sweet person."

Sick in America: Hispanics Grapple With Cost And Quality Of Care

In our recent poll on what it means to be sick in America, one ethnic group stands out as having special problems � Hispanic Americans.

iStockphoto.com

The national survey, conducted by NPR with the Robert Wood Johnson Foundation and the Harvard School of Public Health, sheds new light on Hispanics' health issues. It runs counter to the widespread impression that African-Americans are worst-off when it comes to the cost and quality of health care.

Take the pocketbook issue. When we asked about the burden of out-of-pocket costs � the medical bills not covered by insurance or any government program � 42 percent of Hispanics say this is a "very serious" problem for them.

That's more than twice the proportion of non-Hispanic whites with recent illness who say so, and 8 percentage points higher than African-Americans.

 

Robert Blendon of Harvard, who helped design the poll, says Hispanics "are more likely to be uninsured or have insurance with big holes in it than African-Americans."

That may be, he says, because Hispanics are more likely to live in rural areas or in cities where fewer supports are available for uninsured or poorly insured people. "A lot of Hispanics work for small businesses with terrible insurance or none at all," Blendon notes.

The National Alliance for Hispanic Health says that Hispanics are more likely to lack health insurance than any other group � 31 percent are uninsured, compared to 21 percent of non-Hispanic blacks and 12 percent of non-Hispanic whites.

Other recent data show that nearly half of all Hispanics are on Medicaid or income-eligible for the program, a safety net for the poor and near-poor. That's higher than any other U.S. racial or ethnic group. (Hispanics are also highest in being eligible for Medicaid but not enrolled.)

Elderly Hispanics are also less likely than other groups to be on Medicare.

That all fits with another finding from the Sick in America poll. Among Hispanics who've been seriously ill within the past year, one in four say they weren't treated as well because of their health insurance situation. That's almost twice as many as recently sick whites.

Hispanics report more problems with the quality of their care too.

An unusual feature of the Sick in America poll is that it compared the experience and opinions of Americans who have been hospitalized within the past year or had serious illness requiring "a lot of medical care" with those without major illness.

Most polls don't separate out the sick and the well, so the problems of those with recent experience of the U.S. health care system can be masked.

It turns out thatnearlytwice as many Hispanics with recent illness (42 percent) say their care was poorly managed than sick whites (23 percent).

Hispanics are far more likely to say they had to wait for test results (32 percent) compared to whites (19 percent) or blacks (15 percent).

And Hispanics are much more likely to say they didn't get access to the latest technology (29 percent) than whites (12 percent) or blacks (13 percent).

Blendon says there's no evidence that Hispanics have higher expectations of health care than other groups, which could explain these perceptions. "My gut feeling is that they would have lower expectations," he says.

The Harvard researcher, an expert on public opinion and health care, predicts that these previously uncovered perceptions about health care among Hispanics are likely to become more visible.

"Hispanics are becoming a greater proportion of the US population and are having more influence in politics and policy," Blendon says. "So their concerns about health care are likely to be heard more widely in the future."

Subrogration software a hit

SALT LAKE CITY, UT – SelectHealth brought in house the follow-up reimbursement area of its subrogation processes nearly a year ago.

Since then, the health plan has been able to quickly identify subrogation opportunities and has seen “very big financial improvement over and above” its previous process, said Marc Rueckert, SelectHealth’s senior operations review manager.

Though it varies by state, the industry standard of recovery through subrogation is between 1/2 percent and 1 percent of total claims paid. Prior to using its new process, SelectHealth’s results were lower than the standard, but have since improved 2-3 times over its previous rate, Rueckert said.

Just as important, bringing all subrogation processes in house versus outsourcing has created a stronger ownership of results, better communication and access to all its systems, he said.

SelectHealth implemented SCIOinspire’s technology originally to cover high-dollar case management cases but soon expanded its functionality to identify subrogation opportunities.

Health plans need a good case management platform and an efficient management process, said Krishna Kottapalli, chief sales and marketing officer for SCIOinspire. The more proactive health plans are at tracking and managing, the higher the percentage of capture and recovery, he said.

Control is also important, said Nick Fioravanti, director of client services for SCIOinspire. Having a good grasp of a health plan’s business and member make-up and being able to closely interface with other departments are some of the benefits of having subrogation processes in house.

Although the industry has not done any benchmarking studies, subrogation results in billion-dollar recovery for big insurance carriers, said Michael Carr, executive director of the National Association of Subrogation Professionals.

Carr pointed out that subrogation investment costs one-third less than premium investments. “A small percentage of the claims you pay out are subrogatable if you are good at identifying it,” he said.
 

White House Overwhelmed with Requests for Obama to Meet with “Mad as Hell Doctors” about Single Payer

The “Mad As Hell Doctors” from Oregon are making themselves heard at the Obama Administration with an email campaign that threatened to shut down the White House inbox.

The road-tripping, physician-activists from Oregon known as the “Mad As Hell Doctors” received a pressing call from the White House this week to demand they remove a letter on their website requesting a meeting with President Obama to discuss “the moral, social and fiscal imperative” of a single payer health care system. The reason for the call: too many emails from supporters have overwhelmed the White House inbox.

Adam Klugman, National Creative Director for the Mad As Hell Doctors campaign and the person who received the call, puts it this way. “Chris Whitty from the White House Office of Scheduling called me and said that he has been ‘besieged with emails’ from within the millions of single payer supporters in this country who feel that Congress and the President have completely turned their back on them. It told him that it’s not our campaign that’s applying pressure. It’s the people. I also told him that we’d be glad to take the letter down, just as soon as the President agrees to meet with us.”

When Dr. Paul Hochfeld, an E.R. physician from Corvallis, Oregon and a fellow Mad As Hell Doctor, heard about the call he was encouraged. “Getting a phone call like this from the White House means it’s working. They hear us. They know we’re here. And now they know that we speak for much of the Single Payer Nation who absolutely deserve to be heard on this issue. The only question is, will the White House listen?”

“We have to keep putting pressure on the White House,” says Klugman. “We’re getting through to the people who make the decisions. That means it is critical that all of us intensify the letter writing campaign. Single payer supporters need to log on to our website, go the ‘Letter to Obama’ page and fill out the support letter today. It’s obviously working but we’ve got to step it up.”

Supporters can log on at www.MadAsHellDoctors.com to find out more.

Nine More Go to Jail for Single Payer

Following a pattern of civil resistance in Washington D.C. and around the country, citizens in Des Moines Iowa on Monday risked arrest to press for the creation of single-payer healthcare, the establishment of healthcare as a human right, and an end to the deadly practices of Iowa’s largest health insurance company, Wellmark Blue Cross Blue Shield.

Dr. Margaret Flowers, who has herself gone to jail for single-payer in our nation’s capital, was on hand to speak in Des Moines. She called me with this report. Nearly a month earlier, on June 19, 2009, Des Moines Catholic Workers had delivered a letter (PDF) to Wellmark addressed to its CEO John Forsyth requesting disclosure of Wellmark’s profits, salaries, benefits, denials and restrictions on care. The letter had not been acknowledged by Monday, and the Catholic Workers and their allies decided to take action again.

Thirty people arrived in the Wellmark lobby in Des Moines and asked to see Forsyth or any of the members of the board of directors or the operating officers. They were told that none were available, and instead the police arrived. Nine of the 30 refused to leave and were arrested. Flowers did not yet know what the charges will be but suspected trespassing. The nine latest supporters of single-payer to go to jail for justice are:

Mona Shaw, Renee Espeland, Frankie Hughes (age 11), and Frank Cordaro, all from Des Moines Catholic Workers; Leonard Simmons from Massachusetts; Robert Cook; Eddie Blomer from Des Moines; Kirk Brown from Des Moines; and Chris Gaunt from Grinnell, Iowa.

These nine and others like them around the country represent, I think, the incredible potential to energize the American public on behalf of a struggle for the basic human right of healthcare, a potential being blocked by the work of activist organizations that reach out from Washington to tell the public that single-payer is not possible, rather than reaching into Washington from outside to tell our public servants what we demand.

Here’s a blog from Digby acknowledging the reduction of the public option from where it started to next-to-nothing. It’s not clear whether Digby thinks it would have been smarter to start with single-payer, in order to end up with a better compromise than what you get by initially proposing the weakest plan you’ll settle for. But Digby argues that proposing single-payer from the start would not have given single-payer itself any chance of succeeding, and this is proven — Digby says — from the fact that the public option is having such a hard time succeeding.

I can’t prove this is wrong. Everything Digby writes is smart and to the point. But this does omit an important factor or two. Namely: single-payer turns an obscure wonkish policy mush into a clear and comprehensible civil rights issue. Even with it blacked out and shunned by the White House and astroturfing activist groups, single-payer still has people sacrificing and going to jail for it. Nobody goes to jail for a public option.* Nobody even knows what it is. Nobody will even know whether they got it if a bill is passed until experts debate the point for them — at which point it’s too late. Making healthcare a right rather than a legislative policy energizes people, and that potential has hardly been tapped and should not be written out of consideration.

John Nichols understands this, as does Glen Ford from Black Agenda Report.

Even defenders of a public option depict it as a step toward single-payer, while missing the potential of single-payer activism in the short term to improve the public option. So, all agree that in the long run a movement for single-payer is needed. It can begin with phone calls this week in support of these measures and with a massive presence on July 30 in Washington, D.C.

Obese teen had to be cut from home in U.K.

LONDON(AP)�Emergency workers who needed to take an obese teenager from her home to a hospital in Wales had to break through a wall of the residence to get her out and into an ambulance, officials said Friday.

The rescue on the second floor of the small house on Thursday used scaffolding as a ramp to lower the woman to the ground level, the local Rhondda Cynon Taf council said.

The unidentified 19-year-old remained hospitalized Friday and her medical condition was not released.

Neighbors said her weight had risen as high as 380 kilos (835 pounds).

The U.K. has one of Europe's fattest populations: more than 60% of adults and one third of children aged 10-11 are overweight or obese, roughly similar to U.S. statistics.