April 2nd, 2009 by Medgadget in Better Health Network, News
Tags: Accident, Cardiology, Defibrillator, Electircal Shock, ICD, Medgadget, NEJM, Washing Machine
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An interesting case of electrical interference has been reported by Danish physicians in the New England Journal of Medicine. A patient with an implanted cardiac defibrillator was taking a shower when he got zapped twice for no apparent reason. The physicians, speculating on the cause of the events, sent an electrician to the man’s house to see if some type of electromagnetic interference could have been at fault. Turns out that a self-installed washing machine didn’t have its ground cable connected, turning house wiring into the washing machine’s private radio station.
More about the story at Discover Health News…
Article extract in NEJM: Inappropriate ICD Shocks Caused by External Electrical Noise
**This blog post was originally published at Medgadget.com**
April 1st, 2009 by DrRich in Better Health Network
Tags: Drugs, Finance, Government, Pharmaceuticals, Price, Saving Money On, Walmart
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Recently, DrRich offered for your consideration a brilliant proposal that would assure at least some continued advances in pharmaceutical therapy, while at the same time providing for drug price controls.
DrRich was gratified to find that the majority of comments and e-mails he received regarding this proposal were quite complimentary. Sure, there were the obligatory cavils that the drug companies deserve what they’re getting (the essential evil nature of drug companies was, of course, a point that DrRich cheerfully conceded from the outset), and that certain interest groups (breast cancer, AIDS, etc.) even with government price controls would continue funding research aimed at treating certain specific illnesses (a prospect which ignores that translating the kind of basic research done by, say, the NIH into actual useful products requires specific companies to risk hundreds of millions of dollars in product development; see here), but on average the response to DrRich’s proposal was most favorable.
That proposal can be summarized as follows. Each American would formally elect to participate or not in a voluntary plan of price controls. Those who elected to participate would be entitled to receive any legal prescription drug at low prices set by a sympathetic government board, as long as the drug had been on the market for some fixed amount of time. (DrRich arbitrarily suggested five years, but that number could just as easily be set at 10 years, or any other value.) Those who choose not to participate in the price control plan would have to pay whatever the drug companies wished to charge them for all their prescription drugs – but they would be eligible to receive new prescription drugs immediately upon FDA approval (that is, the five- or 10-year waiting period would not apply to them). Finally, individuals would be able to change their status (from participant to non-participant, and vice-versa) only every two years.
Just as is the case with the drug price controls currently under consideration by the Obama administration, DrRich’s plan would achieve low drug prices for anyone who elected to participate. But DrRich’s plan offers, in addition and in distinction, a mechanism by which pharmaceutical progress could continue, albeit at a slower pace than we see today. That is, it provides a population of individuals willing to pay full price for new drugs, thanks to whom the drug companies will be induced to continue spending on drug development.
As a result, even those who choose to participate in DrRich’s price control plan would be able to count on a pipeline of new drugs, which would become available to them at very low prices after the mandated five- or 10-year delay. This is a very useful feature that would not be available under Mr. Obama’s price controls. Indeed, participants in DrRich’s plan would be placing themselves in a situation reminiscent of that experienced by Canadians today. (Canadians, of course, can rely on a steady stream of new, cheap drugs which come to them, with some delay, thanks to a population of individuals south of their border who are paying full freight for those same drugs.)
All we need now is to launch a grassroots movement to convince our legislators that this proposal offers all the benefits of the drug price controls now under consideration by the Obama administration, without its major drawback (i.e., a complete stifling of pharmaceutical progress). Then, having done that, we will simply need to set up the federal bureaucracy to establish and administer the participation status of every American, and a government board that will set the official prices of all prescription drugs. With the kind of streamlining in federal processes and procedures promised by the Obama administration, we should be able to implement DrRich’s plan in a matter of just a few years.
The Punch Line
There is, of course, a punch line.
Now that you have had ample time to digest the favorable implications of DrRich’s proposal, and can plainly see the wisdom behind it, you will be delighted to know that you don’t actually have to wait for federal legislation and the establishment of a vast new price-control bureaucracy in order to participate. You can participate today, right now, with nobody’s acquiescence but your own.
Here’s how. Simply declare to yourself that DrRich’s system is already in place, and that you are a participant, and that the only drugs available to you are the ones that have already been on the market five or 10 years or longer. (You can choose your own personal waiting period.) When you see your doctor, insist – demand – that he/she prescribe only older drugs. The price of most of these drugs will be set not by a government panel, but by WalMart (which for many common generic drugs has set a co-pay of $4). By declaring yourself as boycotting the brand new drugs that are being sold (unfairly, of course) at the highest premium, your personal drug costs will be remarkably reduced – just as if federal price controls were really in place.
Furthermore, since currently there really aren’t federally-mandated price controls, drug companies are not yet constrained from investing in new drugs. As long as this situation continues, there will be a steady stream of new drugs exiting that magic five- or 10-year boycott period you have set for yourself, and thus becoming available to you under your personal, voluntary price control plan.
And best of all, if you were suddenly to develop a medical condition that clearly calls for one of the brand new drugs, one that wouldn’t be available to you, either temporarily under DrRich’s Voluntary Price Control System, or ever under a government-mandated price control system (because under the government plan the drug never would have been developed in the first place), you won’t need to wait five or 10 years (or forever) to get that drug. Since you are really only “pretending” there are drug price controls, the moment you decide that a system of price controls is no longer accruing to your own personal benefit, you can simply ask your doctor to write you a prescription.
So: those clamoring for government price controls on drugs can have them today – this very afternoon. They can experience every aspect of price controls (both low prices and the unavailability of new drugs) in a way that places them in no worse a position (indeed, in a far better position) than if government price controls were actually in place, and without reducing the options for everyone else.
Indeed, considering the above, the only way it would make sense to continue demanding mandatory price controls would be if something other than reducing drug prices were the chief motivating aim.
DrRich leaves it as an exercise for his regular readers to determine what that motivating aim could possibly be.
**This blog post was originally published at Dr. Rich’s Covert Rationing Blog.**
March 31st, 2009 by DrRob in Better Health Network
Tags: Case Study, Dr. Rob Lamberts, Electronic Medical Records, EMR, Health IT, IT, Patient Participation, PHR
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Our office has been on Electronic Medical Records (EMR) for nearly thirteen years. We see a high volume of patients, keep our overhead down, and are able to be quite successful financially. All of the “EMR is impossible” and “EMR makes things worse” stuff you read around the web are disproved quickly with a step into our office. We implemented EMR successfully in a private practice setting without help from an economic stimulus, a hospital system, or a magic wand.
Not that it was easy; we went through many years of struggle to get to where we are today. We struggled mainly because we were exploring unknown territory. We had very few other successful EMR implementations to learn from. We used slow computers and programming developed in the pre-Internet era. We made huge mistakes and struggled at times to make our monthly budget.
But we did it, and practices implementing now can learn from my and others’ success. Probably the main lesson we learned is to put office function ahead of implementation. Since we are a business, we must stay profitable while implementing. Since we are practicing medicine, we must never compromise quality in the process. This meant that we implemented over time, focusing on parts that would either improve our process or at least not bring us down.
Now we are at the position I thought might never come: survival is no longer in question, so we can dream. We don’t have to act defensively, we can push the envelope. We can afford to ask the question: “How can we build the best medical experience for our patients?” We can imagine a destination and actually attempt to get there.
The ideal destination is one in which our patients’ care is improved by maximizing efficiency on our end. Obviously I don’t want to make things harder for our practice, I want to make things easier. But the goal of care is ultimately centered on the patient, not us. So is there a way to accomplish both goals? I think there is, and I think that our EMR is the tool that makes it possible.
Here are our goals in the process:
- Simplify how things are done
- Always have the right information available
- Make communication clear and easy
- Achieve the highest quality possible
I’m sure some think this is just idealism and can’t happen in reality. I agree and disagree. No system can be perfect, but the current healthcare system is so inefficient and ineffective that huge gains can be made. The best way to show that is to get down to specifics. Here is where our practice is heading:
Simplify
The thing that takes the most time away from actual patient care is documentation. Doctors are paid by the volume of documentation, not its quality. Still, the main purpose of a record is to accurately know what is going on with the person facing you in the exam room. Unfortunately, the patient is continually changing, so some information is only accurate for a short time. Has the patient seen a specialist or been in the hospital? Have the medications been changed, or just not taken? Have they changed jobs, quit smoking, or gotten married? Did their sister just get diagnosed with cancer? The task of keeping this information up to date is extremely difficult.
Patients are the ones who know these things best, but they are only passive participants in the process. To keep the record accurate, I must ask them all the right questions on a regular basis. This cuts into time that should be devoted to care. So why can’t the patients be allowed to maintain this part of the record? Why shouldn’t they have access to parts of their record and the ability to correct errors? Here is how we see this happening:
- Certain parts of the record should be available for patients to review online. Basic demographics, medications and allergies, family history, and lifestyle information is a good start. If something new has happened, the patient can either update this information directly (like marital or smoking status) or notify the office of changes (like medication lists).
- If the patient doesn’t update it online, then they can do so when they come into the office (while sitting in the waiting room). Some people will undoubtedly not want to do this, but a significant percent will, decreasing the workload on the office while maximizing the quality of information.
- Patients should be able to communicate important information to the office online. If they go to the ER or see a specialist, if their blood pressure or sugars are high, they should be able to send that information directly to the physician.
Another area of potential gain is the gathering of information for a visit. When a person comes to the office, they have to answer a series of questions related to the visit:
- what are the symptoms the are having?
- Are there any other symptoms?
- How have they been since the last visit?
Gathering this information is essential, but it is one of the main causes of delays. Here is how we want to employ technology to improve this process:
- Put kiosks in our waiting room where patients can provide information, such as:
- History of their present illness. If they are sick, then what are the symptoms and how long have they gone on?
- Review of systems. What other things are going on in their health?
- Medication and demographic review (if not done already online).
- If patients fill out information online before coming to the office, the staff will bring them to see the doctor immediately (or at least as soon as possible).
Even 50% participation by patients in this process will have a huge impact on our office workflow. The end result is a win-win: the patient is seen sooner, the information is more accurate, and the workload of the staff is reduced. Will there be problems? There always are; but the advent of ATM machines, airport kiosks, and online shopping are a few examples of process automation that have greatly improved the customer experience. Why should medicine be different?
I am going to stop here, as I don’t want to lose you (if you haven’t already whacked the keyboard with your forehead). Hopefully you can see that the use of technology applied smartly can help patients and medical offices at the same time.
And this is just the start.
**This post was published originally at Musings of a Distractible Mind blog.**
March 30th, 2009 by Emergiblog in Announcements, Better Health Network
Tags: Blog World Expo, Johnson & Johnson, Kim McAllister, Las Vegas, Medblogger Conference, MedPage Today, New Media Expo, October
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The Medbloggers are now a part of BlogWorld/New Media Expo 09!
Thanks to sponsorship from Johnson & Johnson and MedPage Today, the “Medlblogger Meet-Up” is now a reality.
But it is so much more than “just” a meet-up.
A full day of topics, voted on by the medical bloggers themselves, will be presented, with plenty of time to mix and mingle with our blogging colleagues.
Blog World/New Media Expo 09 will take place at the Las Vegas Convention Center the weekend of October 15-17.
New blogger, established blogger, podcaster or internet broadcaster, there is a place for you in Las Vegas!
Interested in just the Medblogger topics?
You’ll want to join us on October 15th, when the Medbloggers will take their place in the premier blogging conference by holding a full day of sessions and meetings devoted specifically to medblogging.
Want to get deep into the heart of blogging as a lifestyle? Ready to take your blog to the next level?
Then you’ll want to attend the entire BlogWorld/New Media Expo conference where you will learn from the very best of the blogosphere. If you’ve heard of them, they will be at the BlogWorld/New Media Expo 09.
There is a price range for every budget.
The option is yours.
The pleasure is ours.
Please join us!
Check out the BlogWorld/New Media Expo site for details (link above). Registration begins soon!
**This blog post was first published at Kim McAllister’s Emergiblog.**
March 30th, 2009 by KevinMD in Better Health Network
Tags: Closing Departments, India, Job Loss, KevinMD, Outsourcing, Radiology, Small Hospitals, Wage Crisis
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More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.
It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.
Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term job security because their core value proposition can now be outsourced.”
This trend was entirely foreseeable. Cash-strapped hospitals are finding it cheaper to outsource x-ray readings, and furthermore, it seems that both nighthawks and dayhawks provide better service and more timely interpretations. This adds up to a declining need for an in-house radiology staff.
That’s bad news for some. Radiology departments at smaller hospitals may close, and eventually general radiologist salaries will come under pressure.
The answer? Like everything else in medicine, radiology sub-specialists will increasingly be in demand. Expect procedure-based, interventional radiology to grow, since what they do cannot be outsourced. Health care costs will correspondingly rise.
So, like primary care, don’t be surprised if the days of general radiology are numbered.
**This post was originally published at Dr. Kevin Pho’s blog, KevinMD.**
