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Latest Posts

Newt Gingrich’s Take On Facebook Saving A Woman’s Life

I’ve seen at least half a dozen links to the op-ed coauthored by Newt Gingrich and neurosurgeon Kamal Thapar about how the doctor used information on Facebook to save a woman’s life. (It was published by AOL News. Really.)

In brief, a woman who had been to see a number of different health care providers without getting a clear diagnosis showed up in an emergency room, went into a coma and nearly died. She was saved by a doctor’s review of the detailed notes she kept about her symptoms, etc., which she posted on Facebook. The story is vague on the details, but apparently her son facilitated getting the doc access to her Facebook page, and the details posted there allowed him to diagnose and treat her condition. She recovered fully.

Newt and Dr. Thapar wax rhapsodic about how Facebook saved a life, and sing the praises of social media’s role in modern medicine. (I’m not sure how this really fits in with Newt’s stance on health reform, within his 12-step program to achieve the total replacement of the Left…but, hey, nobody has the patience these days for so many details anyway.)

Regular readers of HealthBlawg know that I would perhaps be the last to challenge the proposition that social media has a role to play in health care. However, I think Newt got it wrong here. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Medical Apps: To Come From A Hospital, Not An App Store?

research2guidance.jpgIn the future your medical apps might come from your hospital, not your app store. So says a recently published report by Research2Guidance, a mobile technology research company based in Germany. In their report, titled “Health Market Report 2010-2015″ the market researchers came to the conclusion that the dominant mode of application distribution in the future will be from doctors, hospitals and other care providers.

The report also painted a bullish picture of healthcare app adoption, estimating that the number of users of mHealth apps on smartphone phones will reach 500m by 2015. However, the revenue from this sector will still be driven mostly by device sales and through provision of services, rather than by paid downloads.

The report preview shows it to be organized into three “dimensions”: a) The smartphone market, b) The current state of the mHealth market & c) mHealth outlook to 2015. One would imagine that the last portion will be the most avidly read read as the numerous stockholders in mHealth — telecoms, device makers, insurance and pharmaceutical companies, hospitals and entrepreneurs jockey to position themselves in this rapidly-evolving land grab. Read more »

*This blog post was originally published at iMedicalApps*

Health Information: Who’s Using A Cell Phone To Find It?

What do cell phones and health-information seeking have in common? Very little, at least among the chronically ill (e.g., the folks who are driving healthcare use and cost). An American Medical News article about the latest Pew Research Center’s Internet & American Life Project study on mobile phone use caught my eye. The introduction to the article reads:

Despite the proliferation of cell phones in the United States, the number of people using them to access health information is low. But experts believe the sheer number of people using mobile phones and wireless devices means that health information eventually will get more mobile as well.

According to the study, 85 percent of Americans use mobile phones, but only 17 percent of cell phone owners have used them to look up health information. Nine percent of Americans have downloaded a health-related app on their cell phone.

Get this: The highest use of cell phone health-information seeking and downloading cell phone health apps was among 18- to 29-year olds at 29 percent and 15 percent respectively. With the exception of accidents, 18- to 29-year-old adults are generally among the most healthy demographic. Read more »

*This blog post was originally published at Mind The Gap*

Notes From The Connected Health Symposium 2010

I [recently] attended the Connected Health Symposium in Boston. I enjoyed many of the sessions (sometimes wished I could have attended two simultaneously, though the livetweeting — #chs10 — helped on that front), and as usual enjoyed the hallway and exhibit floor conversations too. As is often the case at conferences these days, I had the opportunity to meet several online connections in real life for the first time. 

(I will not attempt to give a comprehensive report of the symposium here. Please see the livetweeting archive and other reports to get a sense of the rest of the event.)

This year’s exhibit floor included a diverse mix of distance health tools. Most striking from my perspective was the fact that most of these tools do one of two things: Enable patient-clinician videoconferencing, or upload data from in-home monitoring devices. The best of the second category also trigger alerts resulting in emails or PHR/EHR alerts to clinicians if vital signs are out of whack, or phone calls to consumers or their caregivers if, for example, meds aren’t taken on time (one company had a pill bottle with a transmitter in the cap that signals when it’s opened; another had a Pyxis-like auto-dispenser, that looked like you’d need an engineer — or a teenager — to program it). One tool — Intel’s — seemed to combine most of these functions, and more, into one platform, but it’s barely in beta, with only about 1,000 units out in the real world.

The speakers this year seemed to return again and again to several major themes: (1) Is any particular connected health solution scalable? (2) Who will pay for connected health, or mobile health (mHealth)? and (3) Does it work? Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Mobile Health: Joy Or Dismay?

Last month, PricewaterhouseCoopers (PwC) issued a report, Healthcare Unwired, examining the market for mobile health monitoring devices, reminder services, etc. among both healthcare providers and the general public. One of the big take-away points seems to be that 40% of the general public would be willing to pay for mobile health (or “mHealth”) devices or services ranging from reminders to data uploads — and the reaction by insiders is either joy (40% is good) or dismay (40% is not enough).

PwC estimated the mHealth market to be worth somewhere between $7.7 billion and $43 billion per year, based on consumers’ expressed willingness to pay. Deloitte recently issued a report on mPHRs, as well — and there is tremendous interest in this space, as discussed in John Moore’s recent post over at Chilmark Research. I agree with John’s wariness with respect to the mHealth hype — there is certainly something happening out there, but significant questions remain: What exactly is going on? Is there reason to be interested in this stuff or is it just something shiny and new? Can mHealth improve healthcare status and/or healthcare quality and/or reduce healthcare costs? Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Latest Interviews

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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