MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'healthcare solutions'. Sat, 03 Sep 2011 02:51:12 +0100 http://www.medworm.com/index.php?rid=5159864&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fepic-as-a-victim-of-its-own-success.html Katherine Rourke, who blogs over at Hospital EMR and EHR picked up on one of my recent notes about Epic (see: The Feasibility of Using the Epic EMR as a "Platform" to Extend Its Functionality) and posted the following note: Could Epic End Up The Victim Of Its Own EMR Success? Here is a copy of her commentary with a few minor edits. Boldface emphasis is mine: In essence, the [recent Lab Soft News] post makes three key points: Epic is implemented, or soon will be, in virtually every large U.S. hospital Epic keeps very close control of how its system is implemented and developed in an effort to control performance Given this desire for control, Epic isn’t likely to let other vendors create software to interoperate with its EMR If the Lab Soft News author has his facts right, Epi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5159864 Tue, 23 Aug 2011 12:46:33 +0100 5159864 http://www.medworm.com/index.php?rid=5159865&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fsix-major-disruptions-still-to-come-in-halthcare.html Predictions about strategic shifts in healthcare intrigue me. There is always the question in one's mind about whether you agree with the list. A recent article was labeled as a list of healthcare "disruptions" but otherwise caught my attention (see: 6 Major Disruptions Still To Come In Healthcare). Here's the list stripped of the accompanying brief explanations: Conversion of physicians to electronic health records. Removing the responsibility of records-sharing from the patient. The rise of the genomic signature as part of the medical record. Moving the responsibility [for] care and outcomes from the provider location to the consumer location. The rise of health avatars. The change in physician compensation from fee-for-service to fee-for-outcomes. What interested me... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5159865 Mon, 22 Aug 2011 12:15:33 +0100 5159865 http://www.medworm.com/index.php?rid=5140318&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fcan-hospitals-become-more-health-outcome-oriented.html I have previously discussed some of the problems associated with fee-for-service and the need for hospitals and physicians to be more oriented to health outcomes (see, for example: Performing Procedures Can Be Lucrative for Physicians). I think that most people understand that the pursuit of outcomes is superior to fee-for-service but the challenge is revamping our reimbursement system to favor the former approach. A recent note by written by Dave Chase, the CEO of Avado.com, a health technology company, made this same point very eloquently (see: Making Newspaper Industry Mistakes).  Below is an excerpt from it: Now consider healthcare in the U.S.: There’s a clear understanding that the industry must shift its focus towards outcomes from “do more, bill more” orientation....Prev... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5140318 Tue, 16 Aug 2011 13:41:41 +0100 5140318 http://www.medworm.com/index.php?rid=5131063&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fdeclining-autopsy-rates.html Discussion About Reinventing the Autopsy; Reinventing the Autopsy: CT Imaging as a Routine Part of the Procedure; NYT Highlights the "Virtopsy" Used for All Military Autopsies). The virtopsy would undoubtedly be more accurate than the classic autopsy. It also could be performed less expensively and more quickly. You can refer back to my previous notes for more details about its advantages. It is currently the norm for the U.S. military and also widely adopted in countries such as Switzerland. As noted in the excerpt above, one of the major reasons for the decline in the autopsy rate is that it's time-consuming and thus expensive. It's also an uncompensated hospital service. Needless to say, family members are also often reluctant to allow the procedure on relatives withou... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5131063 Mon, 15 Aug 2011 17:40:33 +0100 5131063 http://www.medworm.com/index.php?rid=5119007&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fethical-questions-posed-by-office-emr-by-epocrates.html Epocrates is a very successful smartphone app for physicians. The company recently announced the availability of an electronic health record (EHR) (see: Epocrates electronic health record raises new possibilities and ethical questions). Below is an excerpt from an article about this new product that may raise some ethical concerns: ...Targeted to small and solo physician practices, the [Epocrates EHR product] is a web-based software-as-a-service platform which will be offered on a monthly-subscription basis. At launch , it includes a native iPhone app that appears to include access to patient records as well as e-prescribing functionality, with iPad support reportedly in the works. Epocrates EHR will also include support for billing/coding, data analysis and reporting, and an interesting t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5119007 Wed, 10 Aug 2011 12:00:00 +0100 5119007 http://www.medworm.com/index.php?rid=5097117&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fhospitalists-add-to-the-cost-of-healthcare-according-to-recent-study.html This study should come as no surprise to anyone. Here's what I think may be occurring: Hospitalists work for health system CEOs who place a high value on a shorter length-of-stay (LOS) for patients. The will thus tend to discharge patients as soon as possible. CEOs have been conditioned over the past many years to relish shorter LOSs because the measure has attained the status of a quality indicator and also because shorter LOS patients are more profitable. I also assume that hospitalists tend to favor discharge of patients to rehabilitation or nursing facilities rather than to home because they do not know them well and also to ensure a speedier, medically supervised recovery. Almost everyone agrees about the solution to this problem. It is stated clearly in the excerpt above: &quot... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5097117 Thu, 04 Aug 2011 14:35:03 +0100 5097117 http://www.medworm.com/index.php?rid=5097119&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F08%2Fsome-interesting-insights-into-the-use-of-generic-drugs.html We are obviously in an era in which most drug prescriptions will default to a generic product when available. A recent article discussed how drug prices are about to plummet on the basis of expiring pharmaceutical company patents. Most, if not all, of these patent-protected drugs will be replaced by generic equivalents (see: Drug prices to plummet in wave of expiring patents). Included in the article were some fascinating facts about generic drugs. Below is an excerpt from it: The cost of prescription medicines used by millions of people every day is about to plummet. The next 14 months will bring generic versions of seven of the world's 20 best-selling drugs, including the top two: cholesterol fighter Lipitor and blood thinner Plavix....Between now and 2016, blockbusters with about $2... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5097119 Wed, 03 Aug 2011 00:31:50 +0100 5097119 http://www.medworm.com/index.php?rid=5078059&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fcancer-survivorship-and-the-role-of-pcps.html I have posted a number of previous notes about cancer survivorship (see: Cancer Survivorship, an Emerging Subdiscipline in Oncology; "Chemo Brain" Can Persist for Three to Five Years; Exercise Can Help Reverse; New Research Casts Spotlight on "Chemo Brain"). However, I have not given much thought to exactly which physicians would administer long-term care to cancer survivors. A recent article addressed this topic (see: Study: Doctors differ in how best to care for America's 12 million cancer survivors). Below is an excerpt from it: There are major differences between oncologists and primary care physicians regarding knowledge, attitudes, and practices required to care for American's 12 million cancer survivors. That is the key finding of the first national... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5078059 Thu, 28 Jul 2011 19:00:12 +0100 5078059 http://www.medworm.com/index.php?rid=5029240&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fcerner-fights-back-in-the-emr-market-network-of-services-for-a-community-of-care.html In my opinion, Cerner is facing a formidable competitor, Epic, in the high-end, larger hospital EMR space (see: Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion; Is Cerner Modifying Its EMR Business Model?). John Moore who blogs over at Chilmark Research recently posted a long piece suggesting that Cerner is crafting a new strategy in order to compete more effectively with Epic. He suggests, first, that It emphasizes support for "communities of care" (i.e, city, region, state, employer). Cerner also intends to provide a "PHR with an ecosystem of third party apps." This will serve as a replacement for the now departed Google Health product (see: Google Health Calls It Quits; Lessons Learned about PHRs or Not). Here is a link to John's note (see: Steppin... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5029240 Thu, 14 Jul 2011 14:02:53 +0100 5029240 http://www.medworm.com/index.php?rid=5008681&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fthe-epic-emr-as-a-platform-extending-its-functionality-with-other-products.html For a number of reasons, Epic has achieved a near monopoly of the EMRs installed in the largest U.S. hospitals (see: ShandsHealth Goes Live with Epic; Company Penetration of the Hospital Market; Why Does Epic Keep Hammering Cerner? Mr. HIStalk's Opinion). In my opinion, this trend poses a significant challenge for healthcare in general. Here's a quote from the first of these two notes describing the nature of this challenge: Epic...has a reputation of closely controlling the installation and development of its EMR software products. This is the basis for its record of successful system installations and part of the appeal of the product to hospital CEOs and CIOs. Furthermore, the evolution of clinical hospital systems (e.g., EMRs, LISs, RISs, etc.) is a critical element in the over... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5008681 Fri, 08 Jul 2011 13:31:58 +0100 5008681 http://www.medworm.com/index.php?rid=5008682&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fshould-diagnostic-test-scheduling-be-personalized.html I have posted previous notes about the need for periodic mammograms including the frequency of routine screening based on age (see: Shift to Digital Mammography Results in Increased Patient Recalls; Confusion Caused by Conflating "False Positive" and "Overdiagnosis" in Breast Cancer). Now comes news of research suggesting that mammogram screening should be personalized (see: Mammogram scheduling should be personalized, not based on age alone: study). The article caught my attention because of the use of the term personalized. Here is an excerpt from the article: Mammograms should not be done on a one-size fits all basis, but instead should be personalized based on a woman’s age, the density of her breasts, her family history of breast cancer and other factors includin... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5008682 Thu, 07 Jul 2011 16:12:55 +0100 5008682 http://www.medworm.com/index.php?rid=5008684&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F07%2Fa-very-bad-idea-health-insurer-to-purchase-troubled-health-system.html We are rapidly transitioning to an era of Big Medicine characterized by most significant decisions being made in concert by Big Payers (insurance companies and the federal government), Big Insurance Companies, and Big Pharma (see: Physician Private Practice Declines; the Last Barrier to Emergence of "Big Medicine"). This trend is accelerating due to the fact that more than half of young doctors are taking salaried positions with health systems (see: Hospitals Use Their Medical Schools, Residencies for Later Physician Recruitment). Small private physician practices will no longer be part of this mix. Now comes the news that, at least in the Pittsburgh area, there are plans for an insurance company to purchase a large health system (see: Health care in the balance: Highmark to buy ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=5008684 Tue, 05 Jul 2011 15:42:33 +0100 5008684 http://www.medworm.com/index.php?rid=4976215&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fevidence-based-order-sets.html I am generally unenthusiastic about the term "evidence-based-medicine" (EBM) because it's often used synonymously with high-quality care. For the most part, however, I do see value for what are called "evidence-based order sets." The University of Kansas Hospital has recently gone live with 240 such order sets developed by Zynx Health’s clinical decision support unit. Here is an excerpt from the press release (see: The University of Kansas Hospital Goes Live with ZynxOrder and ZynxCare Integrated into EHR): ...The University of Kansas Hospital has gone live with 240 evidence-based order sets deployed via computerized provider order entry (CPOE)....The implementation of evidence-based order sets and plans of care within an EHR will enable The University of Kansas H... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4976215 Tue, 28 Jun 2011 13:12:07 +0100 4976215 http://www.medworm.com/index.php?rid=4911611&cid=t_156985_113_f&fid=34625&url=http%3A%2F%2Ftraffic.libsyn.com%2Fnversel%2FRick_Kneipper_-_Anthelio.mp3 Why are physicians still resisting EMRs? Maybe it’s because systems aren’t easy to use and lack interoperability. That’s the hypothesis of Rick Kneipper, co-founder and chief strategy officer of Anthelio Healthcare Solutions, a Dallas-based business process services firm that until February was known as PHNS. In my latest podcast, Kneipper joins me to discuss the shortcomings of current EMRs and current EMR policy, and offers his remedies for the problems. Give it a listen, then share your thoughts, too. Podcast details: Interview with Rick Kneipper, co-founder and chief strategy officer, Anthelio. MP3, mono, 64 mbps, 12.7 MB. Running time 27:50 1:05 Why he thinks current EHRs aren’t meeting their promise of improving safety, quality and efficiency of healthcare 2:00 Mo... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4911611 Tue, 07 Jun 2011 20:28:20 +0100 4911611 http://www.medworm.com/index.php?rid=4902700&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F06%2Fweb-vido-chats-as-an-important-component-of-patient-care.html This article instead emphasizes the need for a "more equal dialogue between patient and clinician and improve the nature of the relationship."  Some patients tend to get overwhelmed in a formal medical setting and may not address all of their problems with  the physician. They may also think that "the doctor is too busy to bother with my petty complaints." With video chat, the patient remains on his or her home turf and hence the discussion may be conducted on a more equal footing. (Source: Lab Soft News) Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4902700 Mon, 06 Jun 2011 18:47:23 +0100 4902700 http://www.medworm.com/index.php?rid=4872495&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fincidentalomas-revisited-revisited.html I recently posted a note about so-called incidentalomas, lesions often "accidentally" discovered during CT scans that have been ordered on the basis of other diagnostic concerns. You may want to refer to it to refresh your memory about the topic (see: How to Avoid the Risks of a CT Incidentaloma). Dr. Mark Pool who blogs over at The Daily Sign Out has posted a a well-thought-out note that extends this discussion in some interesting ways (see: Incidentalomas revisited). Below is an excerpt from it: Dr. Bruce Friedman posted a thoughtful blog on Lab Soft News recently concerning "incidentalomas" ....This post happened to coincide with a new working committee at my hospital commissioned with developing a virtual clinic for following patients who have incidental lung nodule... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4872495 Thu, 26 May 2011 23:24:39 +0100 4872495 http://www.medworm.com/index.php?rid=4829329&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fmanage-raw-data.html A recent article I came across examines how the mining and analysis of "raw data" in various industries will provide an opportunity for innovation (see: New Ways to Exploit Raw Data May Bring Surge of Innovation, a Study Says). Below is an excerpt from it: Math majors, rejoice. Businesses are going to need tens of thousands of you in the coming years as companies grapple with a growing mountain of data. Data is a vital raw material of the information economy, much as coal and iron ore were in the Industrial Revolution. But the business world is just beginning to learn how to process it all. The current data surge is coming from sophisticated computer tracking of shipments, sales, suppliers and customers, as well as e-mail, Web traffic and social network comments. The quantity of ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4829329 Mon, 16 May 2011 13:54:52 +0100 4829329 http://www.medworm.com/index.php?rid=4821174&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F05%2Fwgeneral-internal-medicine-does-not-pay-off-for-recent-graduates.html We are undergoing major changes in the choices being made by young physicians in terms of how they practice medicine after their completion of training. The most striking change has been the large percentage that are accepting salaried positions with large health systems, many as hospitalists. A recent article provides evidence of the continuing trend away from general internal medicine (see: Young doctors find general internal medicine doesn't pay), Below is an excerpt from it: Many young physicians continue to steer away from general internal medicine, despite increased exposure to the field during medical school and a more favorable view of the specialty among medical students. The decline is contributing to a growing shortage of primary care physicians when demand for such services... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4821174 Thu, 12 May 2011 12:53:12 +0100 4821174 http://www.medworm.com/index.php?rid=4747908&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fradiology-job-market-trends-downward-blame-technology-and-reimbursement.html Here are summaries of three conversations that I have had recently: A newly graduated physician tells me that her colleagues widely understand that the radiology job market is lousy with the exception of interventional radiology (IR), for which there are plenty of openings. A mid-career, highly specialized  academic radiologist tells me that there would be few, suitable positions available for him if we were to change positions. A very senior radiologist in a large, midwest hospital tells me that he is working twice as hard to simply maintain his expected income; he cites digital pathology and PACS as the enabling technologies that allow him to ramp-up his personal efficiency and effectiveness. All of this caused me to search the web for some further discussion of the current radio... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4747908 Mon, 25 Apr 2011 12:12:55 +0100 4747908 http://www.medworm.com/index.php?rid=4734681&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fexactly-who-are-served-by-medical-professional-societies.html As a result of the political flap around Dr. Lazar Greenfield and the American College of Surgeons (ACS), he has resigned as the incoming president of the society. Here's an excerpt from the latest article (see: Head of Surgeons Group Resigns Over Article Viewed as Offensive to Women): The president-elect of the American College of Surgeons resigned his position Sunday after weeks of controversy surrounding a Valentine’s Day editorial he wrote touting the mood-enhancing effects of semen on women during unprotected sex....Dr. Greenfield, 78, was the editor in chief of Surgery News when the editorial was published but resigned that position in the wake of the controversy; the entire issue of the newspaper was withdrawn. He is an emeritus professor of surgery at the University of Michig... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4734681 Wed, 20 Apr 2011 12:54:48 +0100 4734681 http://www.medworm.com/index.php?rid=4724275&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Fthe-value-of-self-management-for-many-chronic-diseases.html Participatory healthcare is one of the so-called "Four P's" of modern medicine -- the other three are preventive, predictive, and personalized (see: The Future of Healthcare and the Four P's: Preventive, Predictive, Personalized, Participatory). This approach to healthcare was covered in a recent article that referred to it as self-management of chronic diseases (see: Moving to Self-Management for Arthritis — and Other Chronic Diseases). The reason that patient participation in chronic diseases is so appealing is that it reduces costs and, more importantly, requires patient buy-in to the process. This inevitably results in more effective care. Here's an excerpt from the article: With obesity, sports injuries and the aging of the baby boomers all driving an increase ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4724275 Mon, 18 Apr 2011 11:39:28 +0100 4724275 http://www.medworm.com/index.php?rid=4704967&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F04%2Ftighter-integration-of-cvs-minuteclinic-with-chicagos-advocate-health-care.html There has always been some challenges associated with the business model for walk-in clinics located in retail pharmacy chain stores. Commonly staffed by nurses, they were only prepared to deal with minor health problems and routine procedures. This approach often did not generate enough business. Therefore, some began to place physicians in these clinics who were then able to treat more significant health problems. Once some of these clinics started in this direction, it made sense to contract with local hospital systems to both provide physicians and also to integrate the clinic records with those of the health system. This provided a referral network for the more seriously ill patients who were being turned away from the nurse-staffed clinics. The Cleveland Clinic was an early participa... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4704967 Tue, 12 Apr 2011 14:08:34 +0100 4704967 http://www.medworm.com/index.php?rid=4643005&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Ffwhy-and-how-hospitals-should-market-themselves.html For the most part and in my opinion, hospitals don't don't do a very job of marketing themselves. This is not surprising given that most of them are non-profit and most such organizations do not seem to be proficient in this area. However, the use of social media for marketing is free of cost and relatively simple to engage for this purpose. According to a recent study, even here most hospitals don't always get their message out (see: Study: Hospitals' Facebook use is poor). Below is an excerpt from the article: U.S. hospitals are not taking advantage of the opportunities Facebook creates to better engage patients, build healthcare communities or develop their hospital brands, according to a new study....According to the study, only a few hospitals across the the country ar... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4643005 Mon, 28 Mar 2011 13:04:31 +0100 4643005 http://www.medworm.com/index.php?rid=4600803&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Foffice-based-specialists-abandon-hospital-call-responsibilities.html The inexorable transition toward more salaried, hospital-based physicians, hospitalists, is accelerating. Many physicians favor these positions because they can avoid the burden of managing an office practice. They are also seeking a more tolerable, and predictable, work-week. Hospital executives like to hire hospitalists because this allows them to exercise more control over the physicians on the hospital staff (see: The Emergence of the Surgicalist). One of the consequences of this shift is that many office-based physicians are losing their ability to perform various medical procedures. This void is being filled by proceduralists in hospitals (see: The Emergence of the Proceduralist in Hospitals; Two Definitions for the Physician Proceduralist). All of these changes are resulting in a ma... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4600803 Wed, 16 Mar 2011 11:53:08 +0100 4600803 http://www.medworm.com/index.php?rid=4532579&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F03%2Fsee-drugmakers-create-mobile-phone-apps-to-track-diabetes-cancer-drugmakers-led-by-novartis-ag-and-merck-co-boosted-in.html This article highlights three major reasons why Big Pharma is starting to invest in smartphone apps. If patients are non-compliant, the various drugs that are being prescribed for them may be judged to be non-efficacious in retrospective, post-market studies. This non-compliance problem has arisen in response to pressure from government-run health plans. The article provides two more reasons for companies to invest in the development of smartphone apps. The FDA is breathing down their necks about direct-to-consumer (DTC) ads on television (see: It's Time for the FDA to Prohibit Direct-to-Consumer Advertising by Pharmaceutical Companies). If and when such ads are banned, the companies will have another trick up their sleeves -- drug marketing via smartphone apps. However, there is a dow... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4532579 Tue, 01 Mar 2011 14:45:25 +0100 4532579 http://www.medworm.com/index.php?rid=4436948&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Fbehavioral-economics-and-the-clinical-labs.html Financial incentives for the pursuit of wellness or adherence to medical regimens can occur in various forms (see: Paying Patients to Stay Healthy; Discrimination Against the Poor?; A Lottery to Improve Patient Adherence to Warfarin Therapy). One type of such incentive is for employers to offer two kinds of health insurance: a "regular" type and a second that requires qualification on the basis of certain health parameters or goals such as BMI, blood pressure, cholesterol level, and periodic physical exams. A recent note in Dark Daily referred to such programs as being based on behavioral economics, a new perspective for me (see: Behavioral Economics Likely to Push Up Utilization of Clinical Pathology Laboratory Tests). Below is an excerpt from it: Pathologists and clinical labor... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4436948 Fri, 04 Feb 2011 15:24:10 +0100 4436948 http://www.medworm.com/index.php?rid=4424487&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F02%2Ftelerehab-after-total-knee-replacement.html One of the challenges of telemedicine for the past several decades has been the tendency for its supporters to align it with some health services without a natural fit. This is to say, those requiring one-on-one, live physician and nurse interactions. I have now come across one type of service, post-operative physical therapy, that seems to be a natural for telemedicine. A recent article discusses an example of a successful telerehab program (see: Telerehab Works After Knee Surgery) In a noninferiority trial, telerehabilitation fared at least as well as conventional therapy on all study outcomes after six weeks, including the primary outcome...according [a reesearcher in the field]. In fact, telerehabilitation resulted in greater improvement on the WOMAC stiffness subscale and the Patient-... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4424487 Tue, 01 Feb 2011 13:26:30 +0100 4424487 http://www.medworm.com/index.php?rid=4411721&cid=t_156985_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2Fmx56MBMU3R4%2F The behind-the-scenes world of pharma data and related healthcare info can often appear as inside baseball but, as we know, knowledge is power and metrics is king. So it should not come as a surprise that the value and volume of mergers and acquisitions in the pharma and overall healthcare info tech world is on the rise, at least according to a new report from an investment bank. To wit, the total deal value rose 81 percent in 2010, was estimated to be $11.6 billion from $6.4 billion the year before. The total number of deals also jumped - by 13 percent to 224 last year from 199 in 2009, according to Berkery Noyes, which noted there were 53 financially sponsored transactions in 2010, with an aggregate value of $2.8 billion. By comparison, there were 171 strategic deals. The largest transa... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4411721 Fri, 28 Jan 2011 13:45:58 +0100 4411721 http://www.medworm.com/index.php?rid=4382956&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2011%2F01%2Fhow-healthy-is-e-health.html Here's a definition for e-health from Canada: {A]n overarching term used to describe the application of information and communications technologies in the health sector. It encompasses a range of purposes from purely administrative through to health care delivery. This definition seems to me to provide a good start but, in my opinion, is insufficient. It doesn't touch on the notion of health information acquisition by consumers via the web, which is one of the most far-reaching aspects of e-health. This pursuit of knowledge by healthcare consumers is critical because it it allows them to educate themselves and prepares them to take more responsibility for their own health. Keeping all of this in mind, I now want to turn to a recent article that raises the issue of the "health&... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4382956 Fri, 21 Jan 2011 14:43:39 +0100 4382956 http://www.medworm.com/index.php?rid=4266287&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F12%2Fwmajor-shifts-in-use-medical-imaging-in-emergency-departments.html It will come as a no surprise to readers of this blog that the practice of medicine is changing radically, particularly the use of CT scans and other diagnostic studies. Part of the shift is due to the fact that younger physicians are losing their ability to diagnose at the bedside. Part is due to the increasing sophistication of imaging technology itself. Certainly part is due to the pressure to practice defensive medicine. A recent article puts some real numbers to this shift in the use of CT scans in hospital emergency departments (see: Use of CT Scans in Emergency Departments 'Skyrocketing'). Below is an excerpt from the article: The use of computed tomography (CT) scans in emergency departments (EDs) throughout the United States has increased dramatically in recent years, and ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4266287 Wed, 15 Dec 2010 15:10:55 +0100 4266287 http://www.medworm.com/index.php?rid=4098477&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fonocology-concession-under-attack-by-health-insurance-companies.html The oncology concession is the percentage of the cost of chemotherapy (i.e., the drug markup) that is retained by the oncology group for prescribing the drug (see: Academic Oncology and the "Chemotherapy Concession"). These are a number of problems associated with such a payment not the least of which are the following: (1) there is an incentive for an oncologist to treat the patient with advanced disease with little hope of significant amelioration of it; and (2) there is an incentive to treat the patient with newer, non-standard biotech drugs that are frequently more expensive. Health insurers are now evaluating new oncology payment systems in order to remove these perverse incentives (see: Insurers Test New Cancer Pay Systems). Below is an excerpt from the article: The insurer... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4098477 Fri, 22 Oct 2010 16:40:50 +0100 4098477 http://www.medworm.com/index.php?rid=4031513&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F10%2Fmin-search-of-an-accountable-care-organization.html Mr. HIStalk, in his Monday Morning Update 10/4/10, highlights a YouTube animated video entitled In Search of an Accountable Care Organization. As most of you will know by now, an ACO or Accountable Care Organization is a key requirement in the recent healthcare reform legislation. Hospital executives are searching for the secret sauce about how to transform their organizations into one. Information technology, and particularly EMRs, are critical elements in the recipe. Watch this short video -- very enlightening and uncomfortably funny. KevinMD, a well-known and highly respected blogger about health issues, has this to say about ACOs: Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government....Mu... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4031513 Mon, 04 Oct 2010 12:31:47 +0100 4031513 http://www.medworm.com/index.php?rid=4013589&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Fhealth-insurance-companies-try-financial-incentives-with-insured-patients.html The idea that health insurance companies should pay or reward their customers to lead healthier lives poses a set of moral conundrums. Those opposed to such a policy correctly state that a health insurance company should not need to pay individuals to improve their own health. Are not such benefits so appealing in and of themselves that no additional incentives are required? Supporters of such plans will often respond in the following way: Use whatever means that work because the end justifies the means in terms of cost savings and the pursuit of wellness. Here is an excerpt from an article on this topic as it relates to medication compliance (see: Insurers Try Incentives to Improve Medication Adherence): The poor compliance not only affects quality—nonadherent patients have higher hospi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=4013589 Wed, 29 Sep 2010 14:51:26 +0100 4013589 http://www.medworm.com/index.php?rid=3969191&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F09%2Facademic-medicine-and-the-oncology-concession-1.html I recently came across an article discussing the difficulty in recruiting academic oncologists that brings to light some issues that are not commonly discussed in the literature (see: Why Academic Divisions of Hematology/Oncology Are in Trouble and Some Suggestions for Resolution). Below are two excerpts from it:Academic divisions of hematology/oncology seem to have difficulty recruiting and retaining excellent productive clinicians. A major reason for this is that salaries do not compete with the private sector for similar work....The academic salaries are approximately one third of practice because the chemotherapy concession has been given to the academic hospital. In addition, there may be substantial problems in under-billing, lack of attention to detail in billing, and poor collect... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3969191 Tue, 14 Sep 2010 12:48:11 +0100 3969191 http://www.medworm.com/index.php?rid=3687370&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Fretirements-of-lab-professionals-will-pose-challenge.html One of the many challenges we are facing in the clinical lab industry is a shortage of medical technologists as well as an aging of this group (see: Comments on the Medical Technologist Shortage). This aging phenomenon is not restricted to med techs but also applies to baby-boomer doctors and nurses as well, according to a recent article (see: Retirements by baby-boomer doctors, nurses could strain overhaul). Below is an excerpt from the articleSince the passage of the health-care law in March, much has been said about the coming swarm of millions of retiring baby boomers and the strain they will put on the nation's health-care system. That's only half the problem. Overlooked in the conversation is a particular group of boomers: doctors and nurses who are itching to call it quits. ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3687370 Tue, 22 Jun 2010 12:26:59 +0100 3687370 http://www.medworm.com/index.php?rid=3683903&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Fpatient-navigators.html I have been developing a list of of new types of healthcare professionals who interact directly with patients. Here's how it currently stands: coach, counselor, telephone booster, and nurse-information-triage(ist) (see: The Emerging and Expanding Role of Counselors in Healthcare; Telephone Calls and Emails as Key Components of Primary Care). To this list, we can now add patient navigator (see: Patient Navigators: A Different Viewpoint), Quoted below is an opinion piece by an oncologist, Dr. Barbara McAneny, who reacts to a previous article in the Journal of Oncology Practice that advocated the use of patient navigators in physician office settings:The authors suggested that patient navigators would be a valuable addition to any practice and described their use in several settings. If w... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3683903 Fri, 18 Jun 2010 12:49:12 +0100 3683903 http://www.medworm.com/index.php?rid=3676905&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Fpatient-navigators.html I have been developing a list of of new types of healthcare professionals who interact directly with patients. Here's how it currently stands: coach, counselor, telephone booster, and nurse-information-triage(ist) (see: The Emerging and Expanding Role of Counselors in Healthcare; Telephone Calls and Emails as Key Components of Primary Care). To this list, we can now add patient navigator (see: Patient Navigators: A Different Viewpoint), Quoted below is an opinion piece by an oncologist, Dr. Barbara McAneny, who reacts to a previous article in the Journal of Oncology Practice that advocated the use of patient navigators in physician office settings:The authors suggested that patient navigators would be a valuable addition to any practice and described their use in several settings. If w... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3676905 Fri, 18 Jun 2010 12:49:12 +0100 3676905 http://www.medworm.com/index.php?rid=3672066&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Fpreventive-medicine-number-of-deaths.html We need to place greater emphasis on wellness and preventive medicine in our lives and healthcare system (see: Wellness, Preventive Medicine, and the Classic Disease Model). The goal of such an approach is to prevent diseases before they strike and thus both improve the quality of life of Americans and also reduce our healthcare costs. Luckily, the recent healthcare reform legislation funds various preventive medicine initiatives (see: Some Encouraging News About New Federal Funding for Preventive Medicine Initiatives).It is commonly stated that we are in the midst of a chronic disease epidemic (see: Seeking Solutions to the Chronic Disease Epidemic) with increasing incidence of obesity (see: Obesity as a Cause of Death Recorded on Death Certificates) and diabetes (see: The Staggering Cost... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3672066 Thu, 17 Jun 2010 11:57:35 +0100 3672066 http://www.medworm.com/index.php?rid=3636038&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Femerging-role-of-in-healthcare-counselors-in-healthcare.html A recent article listing and describing the fastest growing jobs in healthcare caught my eye (see: Fastest Growing Jobs in Health Care). Below is the list from it that I have edited for the sake of brevity: Physician assistants Medical secretaries Physicians and surgeons Registered nurses Counselors Licensed practical and licensed vocational nurses Billing and posting clerks and machine operators Social workers Receptionists and information clerks Clinical laboratory technologists and technicians Pharmacists I was pleased to see that clinical laboratory technologists and technicians made the list. but just barely. However, the  category that I found to be the most interesting, and that I have placed in boldface, is counselor. Here's how the job is described in the arti... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3636038 Mon, 07 Jun 2010 12:16:50 +0100 3636038 http://www.medworm.com/index.php?rid=3621970&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Fuse-of-a-telephone-booster-to-promote-enhanced-public-health-outcomes.html Patients or healthcare consumers with chronic diseases such as diabetes or conditions like obesity frequently need ongoing personal or network support and encouragement. Such support can be provided in the form of a health coach (see: "Cancer Coaches" Start to Play Significant Role in Cancer Care). Also proved effective have been city-by-city "biggest loser" wight loss competitions (see: Richfield, Minn. 'Biggest Loser' contestants pay it forward). The common element here is mentorship, group support, and personal interactions in the pursuit of successful outcomes in disease/condition management. I did not have a good label for the telephone support process for health goals until I came across a report of an article in the Journal of Telemedicine and Telecare (s... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3621970 Wed, 02 Jun 2010 12:17:25 +0100 3621970 http://www.medworm.com/index.php?rid=3618104&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F06%2Fit-as-a-critical-component-of-participatory-medicine.html Participatory medicine is defined in the following way:  a model of medical care in which the active role of the patient is emphasized. The term participatory medicine has been used...to mean one or more of four interrelated ideas: A group of people who suffer from a chronic disease form a community (often an online community, a support group) to share information and mutually support each other. Members of a patient community (or members of a community disproportionately affected by a disease) play important roles in community health decision-making. Patients [are required to] play a role as part of collaborative "treatment teams" addressing their diseases. A patient is "mindfully" involved in treatment, by making behavioral changes, meditating, or similar acts. ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3618104 Tue, 01 Jun 2010 12:08:30 +0100 3618104 http://www.medworm.com/index.php?rid=3577655&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F05%2Ftelephone-calls-and-emails-critical-component-of-primary-care.html This news will come as no surprise to readers of this blog. KevinMD reports that telephone calls and e-mails occupy a large component of the time of a primary care physician according to a recent paper in the NEJM (see: Calls and e-mails to patients is a big part of primary care). Below is an excerpt from his note:There’s been a lot of commentary on a recent article from the New England Journal of Medicine, detailing the undocumented tasks that a typical primary care physician performs. For those who haven’t read the piece, entitled, What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice....To summarize, primary care doctors are responsible for much more than seeing patients in the exam room. In the cited practice, which has a fairly typical makeup, physicians w... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3577655 Wed, 19 May 2010 11:51:42 +0100 3577655 http://www.medworm.com/index.php?rid=3505148&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F04%2Fwwcancer-survivorship-a-growing-subdiscipline-within-oncology.html The special challenges of caring for cancer survivors is spawning a new subdiscipline in oncology, survivorship. There are various resources now available focusing on aspects of this new field. One of them is a site providing links to 14 articles presented at the Fourth Biennial Cancer Survivorship Research Conference in Atlanta, Georgia, in June 2008 (Cancer Survivorship Research: Mapping the New Challenges Supplement). Here is a brief summary of some of the general topics covered in these articles: Health-related outcomes and care Beliefs and survival Quality of life Patterns of adaption to the disease Protective buffering of cancer survivors by family and friends Partner-assisted emotional disclosure Impact of cancer on spousal labor earnings Time costs of informal care-giving It sho... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3505148 Mon, 26 Apr 2010 12:00:00 +0100 3505148 http://www.medworm.com/index.php?rid=3354592&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F03%2Fdrone-technology-causes-upheaval-in-the-air-force.html Although we are not always acutely aware that such changes are occurring, technology innovations can have a profound effect on various aspects of our lives such as the nature of our work or business models. One example of such an innovation is digital radiology which set the stage for Nighthawk Radiology Services and the emergence of global teleradiology networks. A recent article discussed the conundrum for U.S. Air Force generals about how to manage and reward drone pilots who have never stepped into a combat jet (see: Combat Generation: Drone operators climb on winds of change in the Air Force). Below is an excerpt from it:The Air Force's identity crisis is one of many ways that a decade of intense and unrelenting combat is reshaping the U.S. military and redefining the American way... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3354592 Thu, 11 Mar 2010 13:03:49 +0100 3354592 http://www.medworm.com/index.php?rid=3262919&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F02%2Fpublic-policy-as-a-key-driver-for-preventive-medicine.html I have come to the unwelcome conclusion, for me, that the majority of Americans will not spontaneously turn to a healthier lifestyle merely to prolong their own lives and reduce health costs in the process. For many, it's also necessary to create a local environment and set of resources more conducive to healthy behaviors such as taking daily walks and eating better. Here is where public policy comes into play. It was therefore with some interest that I read about what is going on in Albert Lea, Minnesota (see: The Minnesota Miracle). Here's an excerpt from the article: Amid a pep-rally-like atmosphere in a high-school auditorium [in May, 2009], the 18,000-resident community [of Albert Lea, Minnesota] kicked off the AARP/Blue Zones Vitality Project, sponsored by the United Health F... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3262919 Thu, 11 Feb 2010 13:23:47 +0100 3262919 http://www.medworm.com/index.php?rid=3194037&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2010%2F01%2Fthhealthcare-reform-next-chapter.html I have posted a number of of notes about healthcare reform but not lately (see: The Link Between Healthcare Reform and Post-Graduate Medical Training). For my money, the current draft of the legislation is primarily about health insurance reform and pork than anything else. My current malaise about this topic relates more to my chagrin aboout the political logrolling and lobbying rather than a lack of interest in reform (see: Health Insurers Emerge as Major Foes of Healthcare Reform; American Attitude toward Reform Through the Eyes of David Brooks). We are proceeding to the next "political" chapter because of the recent senatorial upset in Massachusetts with the election of a Republican to the slot and the new political calculations (see: After Massachusetts Senate defeat, Obama ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3194037 Thu, 21 Jan 2010 13:07:31 +0100 3194037 http://www.medworm.com/index.php?rid=3124710&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F12%2Fsaving-lives-with-webbased-patient-registries.html Certainly the idea of creating patient registries is not a new one. Tumor registries have been in existence for many decades. However, it seems that moving such registries to the web and moving their locus of control to foundations has given them new life and purpose. Details of this evolution were provided in a recent article in the New York Times (see: Tool in Cystic Fibrosis Fight: A Registry), Below is an excerpt from the article:In the 1950s, children with cystic fibrosis usually died before they reached kindergarten age, their airways choked with mucus by a genetic disorder that disrupts their ability to clear infections from their lungs. Today, many people with the disorder are living well into their 30s and beyond....These patients owe their lives, at least in part, to a carefully ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3124710 Mon, 28 Dec 2009 13:21:05 +0100 3124710 http://www.medworm.com/index.php?rid=3115306&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F12%2Fphysican-staffing-company-and-the-changing-healthcare-culture.html One of the major recent changes in the healthcare culture has been the emergence of hospitalists. I have documented various types of these hospital-based physicians including intensivists, surgicalists, proceduralists, and laborists. Now, it seems, that this concept is being pushed further by a hospital staffing company that supplies them, as well as nurses, to hospitals when and where they are needed (see: Blackstone’s Health-Care IPO and the Changing Culture of Medicine). Below is an excerpt from the article:Team Health, a hospital staffing company that’s mostly owned by the big private-equity shop Blackstone, is selling shares this week in an IPO that could bring in $300 million..... Hospitals pay the company to provide doctors and nurses; Team Health makes most of its money from hi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3115306 Wed, 23 Dec 2009 15:04:32 +0100 3115306 http://www.medworm.com/index.php?rid=3101078&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F12%2Ffneurointerventionologist-busts-up-cerebral-embolus-with-a-catheter.html You may have heard about interventional radiologists. They are adept at guiding catheters to various organ sites via arteries and veins and then repairing damage or delivering doses of drugs locally. You can review the list of common IR procedures in the Wikipedia description of the field. One of the challenges for interventional radiologists is that some of them may lack the broad clinical training necessary to treat acutely ill patients. I have always assumed that some of these  procedures would shift to clinicians who receive special training in catheter work. I recently uncovered an article about a neurointerventionologist (neurointerventionist?) who is well known for extracting cerebral emboli in acutely ill stroke patients (see: Neurologist performs catheter procedure on stroke... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3101078 Fri, 18 Dec 2009 13:32:36 +0100 3101078 http://www.medworm.com/index.php?rid=3092958&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F12%2Fhow-the-drug-industry-spends-20b-a-year-on-marketing.html The large pharmaceutical companies are in the midst of what I view as a major transformation of their business models. I have documented some of these changes here. One has been the outsourcing of new drug development to contract research organizations, referred to as CROs (see, for example: CROs Continue to Prosper; Benefits of Big Pharma Outsourcing). Another manifestation of this change has been a series of ethical lapses including large payments to academic physicians and the publication of ghost-written medical journal articles (see: Details Emerge About Ghost-Written Medical Articles for Wyeth; Medical Schools Share Some Blame in Scandals Involving Pharma Payments to Faculty). More evidence of this change has been the company emphasis on direct-to-consumer (DTC) advertising, which I ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3092958 Wed, 16 Dec 2009 12:59:25 +0100 3092958 http://www.medworm.com/index.php?rid=3063487&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F12%2Fradiiology-groups-create-their-own-inhouse-versions-of-nighthawk.html Nighthawk Radiology Services has filled an important niche for hospital-based radiology groups in the past. As the name implies, the company offers the services of its own radiologists to interpret studies performed at night. Some of these personnel are located in countries with different time zones than the U.S. such as Australia to facilitate this process. This was viewed as a desirable alternative to having the associates of the local hospital-based radiology groups perform this night work. I have posted a number of notes about various aspect of the "Nighthawk" business model. Unfortunately for the radiology groups involved, some hospital administrators have asked the following question: If we use the Nighthawk services during off-hours, why not "disassociate" from o... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3063487 Mon, 07 Dec 2009 13:47:54 +0100 3063487 http://www.medworm.com/index.php?rid=3045041&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F12%2Fshopping-around-for-the-best-prices-for-healthcare-services.html One of the most innovative features of walk-in retail clinics, located in chain pharmacy and big-box stores, is that they frequently post their price lists for the services they provide. This is rare for providers of healthcare services but may mark the beginning of a trend. A recent article in the New York Times provided guidance for consumers who are price-sensitive or believe that healthcare services should be exposed to market competitive forces. Below is an excerpt from this article (see: (see: Seeking the Best Medical Care Prices):Health care consumers are encouraged to comparison-shop on things like doctor’s fees and heart surgery rates. But unfortunately, most of us have little clear or useful information to go shopping with....An estimated 15 percent of adults younger than 65 no... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3045041 Tue, 01 Dec 2009 13:32:46 +0100 3045041 http://www.medworm.com/index.php?rid=3026918&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F11%2Famerican-college-of-physicians-defends-evidencebased-medicine.html In a previous blog note about the recent flap relating to mammography recommendations for women in their 40"s (see: Science-Driven Medicine Bumps Up Against Perception of Risk with Mammography), I made the following statement:So the question for health and lab professionals is whether this is a general vote in favor of early screening and against EBM and comparative effectiveness as tools and analytic methods for the future. I think that the answer to this question is probably no because of some of the unique aspects of mammography in particular and women's breast health in particular. Breast screening in so ingrained in our culture through long-standing practice that it will be nearly impossible to alter in any substantial fashion. However, any health panel recommendations in the... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=3026918 Wed, 25 Nov 2009 13:44:59 +0100 3026918 http://www.medworm.com/index.php?rid=2963349&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F11%2Ffdeveloping-incentives-for-consumer-to-become-engaged-in-preventive-medicine.html I have posted a number of previous notes about preventive medicine and also commented about how most physicians tend to focus on the treatment of disease (disease model) rather than health promotion and preventive medicine. Below is an excerpt from an article which suggests that healthcare personnel should place more emphasis on "health" (see: Making health care about health):As a young cardiologist, Steve Devries noticed a disturbing pattern: His patched-up heart patients kept returning for repairs. It happened so often that Devries decided there must be another way to advance patients' health. Today, his thriving Chicago practice focuses exclusively on preventing disease, and Devries is far more likely to counsel patients about diet, sleep habits and exercise than to prescr... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2963349 Thu, 05 Nov 2009 16:10:56 +0100 2963349 http://www.medworm.com/index.php?rid=2886753&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F10%2Freaction-to-note-on-flaws-in-the-canadian-healthcare-delivery-system.html In a recent note, I discussed some flaws in the Canadian healthcare delivery system and how it possibly could be reformed (see: The Fundamental Flaws in the Canadian Healthcare Delivery System), quoting the work of Nadeem Esmail, an economist from the Fraser Institute. The piece has stimulated two Canadian physician readers to submit comments, which I now elevate to the level of this note: (Dr. EM) [Nadeem Esmail] removed data from some OECD slides to enhance his point: the country with the largest %GDP health spending is the USA -- by far. In 2003, USA= 16%GDP, Canada= 10%. Other than that, the overall message is correct. In particular, Canadian doctors are truly more pessimistic than other doctors, as shown here. His solution is good, rational and should be well accepted by hospital admi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2886753 Tue, 13 Oct 2009 13:22:17 +0100 2886753 http://www.medworm.com/index.php?rid=2876375&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F10%2Fthe-fundamental-flaw-in-the-canadian-healthcare-delivery-system.html I recently attended the Executive Edge conference in Toronto that focused on various aspects of clinical lab management in Canada. For me, one of the most impressive lectures was delivered by Nadeem Esmail, Director of Health System Performance Studies at The Fraser Institute (see: Demographics, New Technologies, and Health Care). He presented a critique of the Canadian healthcare delivery system from the perspective of an economist and healthcare analyst. Given that the U.S. is now enmeshed in a prolonged debate about how to improve our own system, I thought that it would be useful to present the key points of his analysis of a system admired by many in the U.S.: Canada lags behind most other countries with similar universal healthcare systems in terms of capital expenditures for expensiv... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2876375 Fri, 09 Oct 2009 12:36:10 +0100 2876375 http://www.medworm.com/index.php?rid=2804251&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F09%2Fdecisionaids-for-helping-consumers-make-informed-medical-decisions.html Who is the best person to advise you on important medical decisions? Nearly everyone would respond to this question by citing their family physician. It turns out that this ain't necessarily so according to a recent article (see: Weighty Choices, in Patients’ Hands). Here are some of the details:For patients [with serious diseases], the current health-policy debate comes down to a very personal issue: how to make ever-more-complex decisions when faced with multiple options, each with no clear advantage and with risks and harms that patients may value differently. Preliminary data from the National Survey of Medical Decisions, conducted by researchers at the University of Michigan, showed that doctors are more likely to discuss the advantages of treatments while giving short shrift to... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2804251 Thu, 17 Sep 2009 13:51:33 +0100 2804251 http://www.medworm.com/index.php?rid=2762166&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F09%2Finoffice-histopathology-labs-as-an-example-of-the-integration-of-diagnostics-into-clinical-care.html Integrated diagnostics can be defined as the integration of the diagnostic activities of specialties such as pathology, lab medicine, and pathology into related healthcare processes such as therapeutics (see for example: Siemens' Pursuit of an Integrated Diagnostics Portfolio; The Evolution of Integrated Diagnostics into Integrated Diagnostic Centers). This goal is pursued in order to get beyond the "diagnostic silos" that are the norm today. By this latter term, I mean that the various diagnostic professionals work independently to generate their reports but, of course, frequently refer to the previously published reports of the other groups. The development of an integrated diagnostic center is one way to solve the silo problem (see for example: Can Existing Breast Clinics ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2762166 Thu, 03 Sep 2009 11:57:07 +0100 2762166 http://www.medworm.com/index.php?rid=2688942&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F08%2Fexpenditure-on-complementary-and-alternative-medicine.html I illustrated in a previous note that there is broad overlap between wellness, pre-disease, and complementary and alternative medicine (CAM) (see: Wellness, Preventive Medicine, and the Classic Disease Model). Complementary medicine can be defined in the following way:...[C]omplementary medicine is used by conventional medical practitioners to refer to non-invasive, non-pharmaceutical techniques which are used in conjunction with medical treatments such as drugs and surgery. The term implies that conventional medicine is used as a primary tool and the non-invasive, non-pharmaceutical techniques are used as a supplement when needed.I fully understand that CAM is a broad term and incorporates a number of therapies that may provide few objective health gains such as aromatherapy. However, man... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2688942 Mon, 10 Aug 2009 13:07:15 +0100 2688942 http://www.medworm.com/index.php?rid=2671121&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F08%2Fmmsome-interesting-statistics-about-ambulatory-surgery.html I have concerns about the continuing migration of various diagnostic and surgical procedures to office, clinic, and ambulatory settings. My concerns are based on the fact that the majority of pathologists, and the clinical labs that they manage, are hospital-based. A large percentage of the small biopsy surgical pathology work is migrating to in-office histopathology labs where it is diagnosed by pathologists working for large clinical groups (see: Corrected Definition for a Pod Lab and a Look at In-Office Labs, More on Integrated Diagnostic Centers; Trend or Lukewarm Idea?). Ambulatory surgery centers (ASCs) are also widely proliferating, many of them physician-owned (see: Outpatient Surgery Now Dominates the Inpatient Variety in the U.S.). A recent article in the Wall Street Journal prov... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2671121 Wed, 05 Aug 2009 12:06:38 +0100 2671121 http://www.medworm.com/index.php?rid=2667756&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F08%2Fdeloitte-dbriefs-webcast-on-comparative-effectiveness.html The term comparative effectiveness is much in the news these days, often in connection with discussions about healthcare reform. I have posted previous notes about it in addition to an allied concept, treatment efficacy. Comparative effectiveness, in my mind, is also a first cousin to evidence-based medicine (EBM). All of these concepts are associated with the need to treat patients in the most effective manner. They also relate to the important goal of compensating physicians for treatments that are likely to improve the health status of patients rather than on a fee-for-service basis. A recent webinar by consultants from Deloitte on comparative effectiveness provided a very comprehensive view of the topic. Following the presentation, the firm provided a link to their PowerPoint presentat... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2667756 Tue, 04 Aug 2009 12:19:44 +0100 2667756 http://www.medworm.com/index.php?rid=2660968&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F07%2Ftutueliminating-administrative-red-tape-in-healthcare.html Everyone seems to be in agreement that the administrative costs in healthcare are a major burden and contribute to the rapidly increasing cost of services. A recent article on this topic concluded with a call for physician practices, hospitals, insurance payers, benefits managers and others to adopt a coordinated approach for the reduction of red tape (see: Cutting healthcare red tape could save billions, says coalition). Below is an excerpt from the article with The nation could save billions of dollars each year in the healthcare system by addressing certain areas of administrative complexity, according to a new report from the Healthcare Administrative Simplification Coalition. HASC is a public/private partnership of organizations committed to reducing the administrative costs and compl... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2660968 Fri, 31 Jul 2009 13:54:40 +0100 2660968 http://www.medworm.com/index.php?rid=2649313&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F07%2Fmayo-clinic-to-open-wellness-center-in-mall-with-diagnostic-screening.html Walk-in clinics that are located in malls, big-box stores, and retail drug stores have provided a new model for healthcare delivery at the basic level. They are frequently staffed by nurse clinicians and provide only a limited array of services. Patients with serious or acute problems are referred to other facilities. Generally speaking, these clinics have not offered lab testing in keeping with the type of low-level problems being treated. Although most of these clinics have been launched by for-profit companies, other health systems such as the Cleveland Clinic have opted to participate in the new model (see: Cleveland Clinic Partners with Minute Clinic in Retail Health Services). A recent article discussed how Mayo was planning to open a clinic in the Mall of America with a somewhat dif... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2649313 Wed, 29 Jul 2009 12:00:00 +0100 2649313 http://www.medworm.com/index.php?rid=2641525&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F07%2Fcan-the-cleveland-clinic-model-be-replicated-in-other-hospitals.html I am enthused about the quality of healthcare that can be delivered by multidisciplinary teams (MDTs) such as the ones that staff the U.K. one-stop breast clinics and, more broadly, most cancer centers (see: The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.). The Wall Street Journal, in a recent article covering the Barack Obama visit to the Cleveland Clinic, had this to say about the healthcare delivery model utilized by this hospital (see: Replicating Cleveland Clinic's Success Poses Major Challenges):The key to the Cleveland Clinic's success, many policy makers say, is its integrated approach. Like other so-called multispecialty clinics, the Cleveland Clinic employs its own physicians, creating teams of specialists that collaborate in treating each pa... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2641525 Mon, 27 Jul 2009 12:00:00 +0100 2641525 http://www.medworm.com/index.php?rid=2634686&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F07%2Fkey-trends-that-are-now-occurring-in-pathology-the-clinical-labs-and-healthcare.html I am in Chicago to attend the 2009 AACC annual meeting which includes the largest clinical lab exposition in the world. I was invited to deliver a lecture at the parallel meeting of the Diagnostic Marketing Association (DxMA), which builds diagnostic industry leadership by providing industry knowledge, professional development and a venue for the exchange of ideas. Here is the title and link to that presentation: Ten Hot Trends in Healthcare, Lab Medicine, and Pathology Informatics.Although many of the trends have genereal applicability to healthcare delivery, all of them were chosen because of their particular relevance and importance for the future of pathology and lab medicine, frequently using an informatics lens to assess them. See what you think. I am going to rework this lecture sho... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2634686 Thu, 23 Jul 2009 13:17:55 +0100 2634686 http://www.medworm.com/index.php?rid=2606249&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F07%2Frepurposing-obsolete-hospitals-as-integrated-diagnostic-centers.html I have been an advocate of the merger of pathology and radiology into what could be described as the new medical specialty of diagnostic medicine. This merged specialty can also referred to as integrated diagnostics. The integration of pathology and radiology is related to the idea of the development of Integrated Diagnostic Centers (IDCs). These are clinics staffed by multidisciplinary teams and focused on the goal of diagnosing disease faster, better, and less expensively than the norm today. Most such centers today specialize n the diagnosis of breast masses. In the U.K, they are referred to as one-stop breast cancer clinics (see: The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.). What is the basis for the claim that IDCs can arrive at diagnoses faster, bett... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2606249 Thu, 16 Jul 2009 10:57:52 +0100 2606249 http://www.medworm.com/index.php?rid=2594655&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F07%2Fff-selfmanagement-of-heart-disease-an-emerging-approach.html The idea of persuading or empowering consumers to take more responsibility for their own health is broadly taking root (see: "Participatory Medicine" and Its Relationship to Clinical Lab Testing). The well-established previous name for this movement is Health 2.0, which emphasizes the role of the web in providing broad access to information about health and disease. A recent article on the web discussed the role of patients in helping to manage their own heart disease (see: Tackling Heart Disease Together or Alone: The Behavioural Science of Self-Management). Below is an excerpt from it with boldface emphasis mine:Heart disease is the leading killer in the U.S. and throughout most of Europe. People’s behaviour can protect and reduce risk of heart disease, and interventions to h... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2594655 Mon, 13 Jul 2009 11:24:42 +0100 2594655 http://www.medworm.com/index.php?rid=2561638&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F07%2Fmm-the-phr-as-a-tool-to-enable-consumers-to-take-responsibility-for-their-health.html Healthcare consumers need to take more responsibility for their own health, particularly to avoid or ameliorate chronic diseases such as obesity, diabetes, and heart disease. They also need access to the proper tools to achieve this goal. Tethered personal health records (PHRs) enable the transfer of critical health data from hospital and office EMRs to consumer-controlled records. With the exception of some health systems like Kaiser Permanente and the Cleveland Clinic, most providers have not been quick to endorse tethered PHRs. John Moore, who blog over at Chilmark Research, suggests that Microsoft is pursuing an international strategy for its PHR, HealthVault (see: HealthVault’s International Strategy). This will presumably enable consumers to self-manage, to some degree, their chron... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2561638 Wed, 01 Jul 2009 11:18:14 +0100 2561638 http://www.medworm.com/index.php?rid=2553258&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F06%2Finclusion-of-molecular-diagnostic-testing-in-comparative-effectiveness-studies.html I have made the point in previous notes that clinical lab testing, particularly molecular diagnostics, will comprise a key component of most comparative effectiveness research (CER). See, for example, the following: Comparative Effectiveness, Healthcare Cost Reduction, and Virtual Decision Trees; A Look at Deloitte's Healthcare Reform Pyramid: A Strategy for Reducing Costs; Moving Resources from the Therapeutic to the Diagnostic Silo; Biomarkers Used to Assess Treatment Efficacy. I suspect that most lab professionals assume that this same conclusion will be reached quickly by most comparative effectiveness researchers. Nevertheless, I was encouraged that the Association for Molecular Pathology (AMP) took advantage of the surge in CER funds to submit a letter to the Federal Coordinating... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2553258 Mon, 29 Jun 2009 12:17:50 +0100 2553258 http://www.medworm.com/index.php?rid=2515310&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F06%2Fvalue-of-onestop-breast-clinics-proven-in-the-uk.html I have posted previous notes about integrated diagnostics, the merger of pathology and radiology, and integrated diagnostic centers (IDCs).The latter are multidisciplinary, integrated clinics where patients can be referred for rapid and efficient diagnosis. It turns out that IDCs are called "one-stop" breast clinics in the UK and that they have achieved an admirable record of success there (see: Missed cancer diagnoses rare at ‘one-stop’ breast clinics). Below is an excerpt from an article about these facilities with boldface emphasis mine:Missed breast cancer diagnoses are very rare among UK women discharged from one-stop symptomatic breast clinics, indicate reassuring findings published in the British Journal of Cancer. Patients with breast concerns may attend clinics with ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2515310 Thu, 25 Jun 2009 10:59:27 +0100 2515310 http://www.medworm.com/index.php?rid=2463306&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F06%2Fa-proposed-new-model-for-general-medicine-practices.html I have posted a number of previous notes about hospitalists and all of the variations on this same theme including intensivists, surgicalists, proceduralists, and laborists. All such physicians work for hospitals on a salaried basis and assume responsibility for patients admitted to the hospital. A physician blogger, KevinMD, reproduces a piece by Dr. Steven Weinberger (ACP: A practice model for increasing the appeal of General Internal Medicine), which is the first in a series of web articles about modes of practice published by the American College of Physicians. I reproduce an excerpt from it below:The silos of ambulatory general internists and hospitalists have emerged in part to be time-efficient, so that the physician’s day is not fragmented by the need to round on inpatients while... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2463306 Mon, 08 Jun 2009 12:59:40 +0100 2463306 http://www.medworm.com/index.php?rid=2448204&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F06%2Fassessing-the-cost-of-undiagnosed-disease.html I have posted a number of previous notes about the cost of care for various chronic disease (see: Seeking Solutions to the Chronic Disease Epidemic, Cost Savings Associated with Home-Based Physiologic Monitoring) with a special focus on diabetes (see: The Staggering Cost of Treating Diabetes, Mandatory Pre-employment Lab Testing for Acute or Chronic Disease). Now comes an article discussing the cost of undiagnosed cases of diabetes (see: Costs Are High From Undiagnosed Diabetes). This new idea poses a number of interesting issues and challenges. Below is an excerpt from the article with boldface emphasis mine:Scientists used data from more than 3 million people included in the National Health and Nutrition Examination Survey to estimate costs and numbers of people in the U.S. with undiagno... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2448204 Mon, 01 Jun 2009 12:09:54 +0100 2448204 http://www.medworm.com/index.php?rid=2442887&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F05%2Fcchit-certification-and-meaningful-use-of-emrs.html Meaningful use is a concept that has emerged as basis for determining whether federal funds can be used to subsidize the purchase of certified EMRs by hospitals. CCHIT has established a presence as the key certifying organization. I must confess that I have not been following CCHIT very closely but my instincts tell me to be very suspicious of any organization that is closely linked to HIMSS. In a previous note, I discussed the role of HIMSS as a trade association (see: HIMSS Describes Itself as a "Trade Association" in a Press Release). HIT blogger Dana Blankenhorn holds the same suspicions regarding CCHIT as he opines in a recent note (see: Will meaningful use go down CCHIT rabbit hole?). Below is an excerpt from his opinion piece with boldface emphasis mine:CCHIT, a creature o... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2442887 Mon, 25 May 2009 13:28:04 +0100 2442887 http://www.medworm.com/index.php?rid=2417168&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F05%2Fcomparative-effectivenss-healthcare-cost-reductions-and-virtual-decision-trees.html I have posted a number of previous notes discussing how to assess comparative effectiveness and efficacy of various medical treatments (see: A Look at Deloitte's Healthcare Reform Pyramid: A Strategy for Reducing Costs, Is My Chemo Working? -- FLT PET Scans May Provide the Answer, Using Diagnostics to Monitor the Effectiveness of Treatment). The topic of comparative effectiveness is important for lab professionals because lab tests will necessarily be a key element in any such program. Dana Blankenhorn, who frequently blogs about the health industry, discussed this topic and its relationship to cost-containment in a recent note (see: Industry commits to comparative effectiveness). Below is an excerpt from the note with boldface emphasis mine:$2 trillion. Insurers, drug companies and ot... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2417168 Tue, 19 May 2009 12:00:00 +0100 2417168 http://www.medworm.com/index.php?rid=2408722&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F05%2Fsteve-ballmer-on-the-future-of-computing-three-screens-and-the-cloud.html I believe in cloud computing and think that this model will soon be embraced by most industries, with the probable exception of healthcare, and will also rapidly become the norm for personal computing. I have posted a number of notes about this topic. I have also posted a number of notes about smart phones, viewing them as types of mini-computers, and emphasizing their role in e-health and m-health, with the latter "m" standing for mobile (see: Making e-Health Information Accessible with Smart Phones, The Mobile Web and the Future of eHealth). Nearly all of my own daily computing work takes place in the cloud and I have never worked more efficiently in my life. All of these ideas coalesced in my mind when I heard Steve Ballmer, CEO of Microsoft, utter a simple statement in a podc... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2408722 Fri, 15 May 2009 11:40:57 +0100 2408722 http://www.medworm.com/index.php?rid=2342002&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F04%2Fpreventive-and-predictive-medicine-as-part-of-the-healthcare-continuum.html In a recent note, I began to explore the medical disciplines of preventive and predictive medicine and, briefly, the role of clinical lab testing within them (see: The Relationship Between Predictive and Preventive Medicine). Dr. Brian Jackson of ARUP Labs posted a very perceptive comment after reading the post and I copy it below in its entirety:When most people think about preventive care, they picture "healthy" individuals. But the benefits of preventive care, including screening and other "wellness" tests, are much higher in individuals who are at high risk. This particularly includes those with chronic diseases. e.g. LDL monitoring is much more important in a diabetic than in someone with no risk factors for CAD. This suggests an even stronger relationship between... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2342002 Mon, 13 Apr 2009 12:00:00 +0100 2342002 http://www.medworm.com/index.php?rid=2302482&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F03%2Fthe-demise-of-the-general-surgical-pathologist-and-radiologist.html I have posted a number of previous notes about Nighthawk Radiology and the manner in which Nighthawk Radiology plus radiology networks, originally designed for off-hours support, have paved the way for auctions of the professional services of radiologists. KevinMD recently posted an interesting note about "dayhawk" radiology and the the possible decline in the number of general radiologists (see: Nighthawks, dayhawks, and the demise of the American radiologist). Below is the note with boldface emphasis mine: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... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2302482 Tue, 31 Mar 2009 11:37:03 +0100 2302482 http://www.medworm.com/index.php?rid=2281097&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F03%2Fall-media-is-one-relevance-for-medical-knowledge.html Jeff Jarvis in his blog Buzz Machine informs us, at least from the perspective of the CUNY Graduate School of Journalism and its curriculum, that media is becoming singular, which is to say that all media are converging (see: What’s a medium?). The bigger point is that media is becoming singular. Especially as newspapers die and more people watch what we used to call TV online or on mobile, it will be absurd to separate the forms. In my day (picture me blogging that from a rocking chair), we had to pick our medium once for a career. Now, every time a journalist goes out to cover news, she must be equipped and prepared to gather and share it in any and all media. That’s what we mean when we say convergence.He's right of course. However, allow me to to extend his point to the converg... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2281097 Fri, 20 Mar 2009 12:52:34 +0100 2281097 http://www.medworm.com/index.php?rid=2281099&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F03%2Fupcoding-can-result-in-greater-healthcare-costs-post-emr-adoption.html We are now beginning to consider the question of whether the federal stimulus funds being allocated to hospitals and physician offices in support of the accelerated deployment of information technology will be beneficial. I have always been a strong advocate for the use of healthcare information technology but I want to interject a note of caution here. The deployment of outdated or poorly designed technology in various healthcare settings can also be harmful. It's also useful to keep in mind the various incentives that are in play when discussing IT deployment in healthcare. In a previous note (see: Why the Prices Charged by Hospital for Inpatient Care Are Irrelevant), I quoted Steve Lipstein, CEO of the BJC HealthCare System in St. Louis who made the following point in a podcast: the... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2281099 Thu, 19 Mar 2009 14:34:48 +0100 2281099 http://www.medworm.com/index.php?rid=2269255&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F03%2Freducing-admissions-from-the-emergency-department-to-improve-hospital-financials.html There are various ways in which a hospital can improve its overall financial picture in these challenging economic times. For those facilities with a high percentage of Medicaid inpatients, one approach is to reduce the number of inpatient beds allocated to the hospital emergency department, the origin of most hospital admissions of uninsured patients of limited means. This topic aligns closely with previous notes that I have posted on the non-profit status of hospitals. Below is a story about a policy decision regarding "emergency patient beds" at the prestigious University of Chicago Medical Center from the Wall Street Journal with boldface emphasis mine (see: Chicago Hospital Doctors Protest Planned Bed Cuts):More than 190 doctors at the University of Chicago Medical Center si... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2269255 Mon, 16 Mar 2009 12:00:00 +0100 2269255 http://www.medworm.com/index.php?rid=2261629&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F03%2Fcvs-shifts-some-of-its-retail-clinic-operations-to-seasonal-schedule.html I have been very enthusiastic about the concept of walk-in retail clinics in big-box stores. It now appears that this new mode of healthcare delivery may yet be another victim of our failing economy or perhaps of the CVS business model and overcapacity (see: CVS Shutters 90 Retail Clinics for the Season). Below is the story with boldface emphasis mine:In what may be an ominous sign for retail clinics, CVS Caremark has closed about 90 of some 550 MinuteClinic locations until the next flu season or other “seasonal” needs demand their services, This is the first time CVS has put any of its clinics on a “seasonal” schedule: spring is typically a slower season for the clinics. The company told Dow Jones the move was meant to “align with consumer demand,” and that it hasn’t exited ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2261629 Tue, 10 Mar 2009 14:59:23 +0100 2261629 http://www.medworm.com/index.php?rid=2240649&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F03%2Flaborists-another-category-of-hospitalbased-physician.html The growth of hospital-based, hospital-employed medical specialists continues unabated. We  have encountered hospitalists, proceduralists, intensivists, surgicalists. Now add laborists to the list (see: Laborists, and how rising malpractice premiums and the physician payment system are fueling the rise of hospital-only obstetricians). I have posted previous blog notes about this topic. Here are KevinMD's views on the laborist:Meet the obstetric version of hospitalists, known as laborists. Faced with rising malpractice premiums, and the increasing financial pressure to see more patients in the office, more obstetrician/gynecologists are ceasing to deliver babies. In fact, according to Massachusetts' largest malpractice carrier, more than half of the OB/GYN's they cover hav... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2240649 Fri, 06 Mar 2009 12:50:33 +0100 2240649 http://www.medworm.com/index.php?rid=2194785&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F02%2Fthe-famous-received-better-and-worse-healthcare-than-the-rest-of-us.html In a recent note (see: Carcinoma of the Pancreas in the News; Some Additional Information), I discussed cancer of the pancreas and mentioned the fact that Supreme Court Justice Ruth Bader Ginsburg was being treated for the lesion. Now come news that her lesion was benign but that another smaller malignant lesion was discovered at the time of the operation (see: Justice Ginsburg’s Cancer Treatment Takes Unusual Turn). Below is an excerpt from the article with boldface emphasis mine:U.S. Supreme Court Justice Ruth Bader Ginsburg was released from Memorial Sloan-Kettering Cancer Center today after she underwent surgery last week to remove a tumor in her pancreas. New details that have emerged about her health aren’t so easy to interpret. First off, the small tumor that was removed, which ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2194785 Wed, 18 Feb 2009 14:12:27 +0100 2194785 http://www.medworm.com/index.php?rid=2194786&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F02%2Fdoes-banning-pharmaceutical-gifts-to-physicians-hurt-the-economy.html KevinMD, the author of a very successful health blog, posted a recent note posing the controversial question of whether the fact that pharmaceutical companies are now generally banned from providing gifts to physicians is hurting the economy (see: How banning pharmaceutical gifts to doctors may hurt the economy). Below is his note in its entirely with boldface emphasis mine:Massachusetts is considering implementing some of the toughest laws in the country regulating the pharmaceutical industry from giving gifts of any kind to doctors, and restricting drug company funding. MedPage Today ...reports that one unexpected consequence is that many major physician conferences are pulling out of the city. For instance, the American Academy of Allergy, Asthma & Immunology pulled its 2015 convent... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2194786 Tue, 17 Feb 2009 16:05:29 +0100 2194786 http://www.medworm.com/index.php?rid=2190484&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F02%2Fnote-to-philanthropists-pay-people-to-change-their-behaviors.html If you have any extra cash lying around and you want to devote it to a good cause, you might consider using some of it as an incentive to cause individuals in your community to change their unhealthy behaviors. The positive effect of such philanthropy was spelled out in a recent article in the Wall Street Journal (see: More Smokers Quit if Paid, Study Shows).  Below is an excerpt from the article with boldface emphasis mine:Smokers who are paid to quit succeed far more often than those who get no cash reward, according to a new study that provides some of the strongest evidence yet that financial incentives can help change such behavior....The study, one of the largest of its kind, comes at a time when more employers, schools and other institutions are paying people to do everything ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2190484 Mon, 16 Feb 2009 15:07:48 +0100 2190484 http://www.medworm.com/index.php?rid=2172813&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F02%2Fnew-twist-on-hospital-morbiditymortality-rankings-by-procedure.html I have always held the belief that one of the shortcomings of hospital rankings by the mortality of  procedures performed there had an inherent bias against academic medical centers that often care for the sicker patients. A recent note in the Wall Street Journal Health Blog raises an interesting point in this regard. Below is an excerpt from it with boldface emphasis mine (see: Two Hospitals See High Death Rates from Heart Procedure):Two Massachusetts hospitals are trying to explain why their cardiac catheterization programs had unusually high death rates a couple of years ago. The state public health department has requested an explanation of why [the prestigious] Massachusetts General Hospital’s and Saint Vincent Hospital’s death rates among patients who underwent the procedur... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2172813 Tue, 10 Feb 2009 11:28:57 +0100 2172813 http://www.medworm.com/index.php?rid=2163525&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F02%2Fdisruptive-innovation-and-healthcare.html In a number of previous notes, I have suggested that our healthcare system is broken and needs radical reform. In one of them, I pointed out some of the absurdities of hospital pricing (see: Why the Prices Charged by Hospital for Inpatient Care Are Irrelevant). I have also discussed in previous notes the idea of disruptive innovation that was originated by Clayton Christensen and colleagues. Dr. Jason Hwang, a co-author with Christensen of "The Innovator's Prescription: A Disruptive Solution for Health Care" will be lecturing about this same topic at the upcoming Lab InfoTech Summit on March 16, 2009, at the Venetian Hotel in Las Vegas. Many people are in agreement that we badly need a new healthcare business model and disruptive innovation can provide a lens through which we... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2163525 Thu, 05 Feb 2009 12:35:42 +0100 2163525 http://www.medworm.com/index.php?rid=2156356&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F02%2Foutpatient-surgery-now-the-norm-in-the-us.html This article is filled with interesting statistics. I can easily understand the the growth of the number of endoscopies of the large intestine described, given the increased emphasis on this procedure for diagnostic purposes. I was mildly surprised by the number of endoscopies of the small intestine over the period of the study-- 3.5 million. I was also not surprised by the greater number of surgeries and visits by women compared to men. I have dealt with the higher utilization of healthcare services by women than men in previous notes (see, for example: Just Relax; Spousal Nagging Has a Beneficial Effect on Your Prostate Health).I believe that this trend toward outpatient services is inexorable, not only in surgery but in all areas of healthcare delivery. Outpatient care is obviously less... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2156356 Tue, 03 Feb 2009 13:12:46 +0100 2156356 http://www.medworm.com/index.php?rid=2137493&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Fin-search-of-a-good-doctor.html The New York Times provide a wealth of good information in a recent article about how to select a good physician and hospital (see: In Search of a Good Doctor) I can't do it justice in this short note so read the whole thing, if you are interested. It lists a number of key web sites that can be utilized for information. Listed below are a few of the recommendation that I have distilled from the article about how to seek top quality medical care: You can use Hospital Compare, a service of HHS, to evaluate the quality of hospitals in your neighborhood. I have discussed this web site in a previous note (see: Reduced Cost of Offshore Surgical Procedures Puts Pressure on U.S. Hospitals to Compete). Browse the web to gain knowledge about various diseases and current methods of treatment in o... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2137493 Tue, 27 Jan 2009 13:59:10 +0100 2137493 http://www.medworm.com/index.php?rid=2128823&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Fdeloitte-offers-what-is-calls-the-healthcare-reform-pyramid-as-a-graphic-representation-of-how-to-pursue-reform-in-our-outmod.html Paul Keckley and Howard Underwood of the Deloitte Center for Health Solutions present what they call the Healthcare Reform Pyramid in a recent article. It's a graphic representation of the goals we need to pursue in order to reform our outmoded healthcare delivery system while reducing costs (see: Reducing Costs While Improving the U.S. Health Care System: The Health Care Reform Pyramid). Their illlustration is worth some attention. As one might expect, the base layer is healthcare information technology (HIT). This will not come as a surprise to any reader of this blog. The second layer toward the top is labeled comparative effectiveness/ evidence-based medicine. The third is coordination of care with a special focus on the Primary Care 2.0 Model, also called the Medical Home. The p... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2128823 Fri, 23 Jan 2009 13:24:33 +0100 2128823 http://www.medworm.com/index.php?rid=2125242&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Fusual-customary-and-reasonable-charges.html In a recent note, I reported the story of how UnitedHealth was penalized for the action of Ingenix, its subsidiary, that developed the reference databases used to establish usual, customary, and reasonable (UCR) rates. UCRs are used by health insurance companies to bill consumers who venture "out of network" for their healthcare (see: UnitedHealth Settles Suit with New York Attorney General Cuomo). UnitedHealth has been forced to divest itself of Ingenix and pay a fine for its alleged misdeeds. Dave Williams, who blogs over at Health Business Blog, has raised some interesting questions about this Ingenix story (see: Is the Ingenix settlement usual, customary and reasonable?). Below is an excerpt from his note: UCR [usual, customary, and reasonable charges] is a squishy concept an... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2125242 Thu, 22 Jan 2009 14:20:42 +0100 2125242 http://www.medworm.com/index.php?rid=2115515&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Fdestination-programs-at-academic-health-centers.html So-called destination programs are cropping up at various large medical centers as evidence of further specialization of healthcare delivery at the hospital level and also of an in-country variant of medical tourism. I have posted a number of previous notes about medical tourism. I performed a Google search on the terms "destination program" and "hospital and got 554 hits. The basic idea behind these programs is the hospitals market themselves as being particularly skilled at treating certain conditions. Unlike medical tourism abroad, such programs are quality-driven rather than cost-driven. Below is an excerpt from an email that I received on January 16, 2009, from the University of Michigan Health System (UMHS) describing a new step in their offering:Today, we’re pleased... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2115515 Mon, 19 Jan 2009 13:27:44 +0100 2115515 http://www.medworm.com/index.php?rid=2107650&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Ffree-exercise-and-nutrition-in-parks-in-brazil.html In a previous post, I discussed the very high cost to our healthcare system of many largely preventable chronic diseases and the need for a preventive medicine infrastructure to promote health habits (see: The Need for a Preventive Medicine Infrastructure in the U.S.). I was intrigued to come across an article discussing a successful free exercise and nutrition program that has been launched in Brazil (see: Free exercise and nutrition program in Brazil could serve as model in United States). Below is an excerpt from the article with boldface emphasis mine:What if free exercise classes were offered in public spaces such as parks, beaches and recreation centers? When a city government in Brazil tried such a program, it greatly increased physical activity among community members. A group of h... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2107650 Thu, 15 Jan 2009 12:44:34 +0100 2107650 http://www.medworm.com/index.php?rid=2097811&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2F-need-for-a-preventive-medicine-infrastructure-in-the-us.html This article got me thinking. Why do we spend so many billions of dollars on disease treatment and so little on disease prevention? The answer, I think, is that there are so few advocates for healthy living in our communities and little infrastructure to encourage and support preventive medicine. Moreover, our physicians are reimbursed for treating disease and provided noting for helping their patients change their bad habits. I am purposely avoiding a discussion of the fact that most physicians have little or no training in preventive medicine. Who do we expect will be lobbying our politicians at the state and federal levels for the funding of health programs such as exercise, smoking cessation, and weight reduction. Compare this with the number of lobbyists who will be advocating new hos... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2097811 Mon, 12 Jan 2009 13:16:32 +0100 2097811 http://www.medworm.com/index.php?rid=2089894&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Fphysician-bloggers-effective-communication-with-healthcare-consumers.html Through my recent participation in Twitter (more about microblogging and Lab Soft News in a later note), I have been electronically introduced to Dr. Minas Chrysopoulo whose username in Twitter is mchrysopoulo. If you sign up as one of his followers on Twitter, you can read his periodic 140-character-long Tweets relating to breast cancer and surgical reconstruction. He also blogs about reconstructive surgery at Breast Cancer Reconstruction Blog. Note the developing link between blogging and microblogging.As I have commented in previous notes, professional blogging is a component of the total blogosphere (see: Professional Blogs as Meta Information Resources). I define professional bloggers as those individuals who write notes within their professional sphere and expertise as opposed to tho... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2089894 Thu, 08 Jan 2009 12:16:30 +0100 2089894 http://www.medworm.com/index.php?rid=2083930&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Fwipro-launches-payperuse-his-lite-software.html I have posted a number of blog notes about Software-as-a-Service (SaaS). My own belief is that "renting" software and the necessary associated data storage on the web eliminates many of the problems associated with PC-based applications such as PC failure, data backup, and the necessary periodic software upgrades. I interact with web-based applications for more than 80% of my daily computing activities including the writing and publishing of this blog as well as my email and business-related applications using Gmail and Google Apps.I fully understand that a hospital executives or hospital-based lab professionals might be nervous about deploying a "pay per use" model for an EMR or LIS. Nevertheless, there seems to be progress in this category of software, as demonstrated... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2083930 Tue, 06 Jan 2009 13:16:11 +0100 2083930 http://www.medworm.com/index.php?rid=2073846&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2009%2F01%2Fdecline-in-general-surgeons-impact-on-rural-healthcare.html I posted a previous note about how general surgery is becoming a less attractive specialty for new medical school graduates (see: General Surgeons as the Primary Care Docs of the Operating Room). The article quoted drew a parallel between general surgeons and primary care physicians. The reason that general surgery is becoming less attractive is that these specialists often shoulder a heavy burden of the call schedule in hospitals and also end up referring many of the interesting cases to the surgical subspecialists. In that note, I addressed the on-call issue in the following way:For me, the on-call issue is a distraction that can be solved relatively easily. The hospitals can hire their own surgicalists about which I have previously blogged (see: The Emergence of the Surgicalist) and tak... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2073846 Fri, 02 Jan 2009 13:30:41 +0100 2073846 http://www.medworm.com/index.php?rid=2065205&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F12%2Ftwo-defintions-for-physicial-proceduralist.html In previous notes, I have discussed the preceduralist, by which is meant a hospital-based physician who specializes in performing various invasive, skilled procedures such as fluoroscopy, conscious sedation, upper airway endoscopy, and percutaneous tracheostomy (see: The Emergence of the Proceduralist in Hospitals, Cedars-Sinai Medical Center - Hospital innovators 2007). This development is part of the growing specialization of physicians and also the growth of "-ists" such as hospitalist and surgicalist. The latter are hospital employees who assume the previous role of private physicians who admitted their patients to hospitals and provided oversight for their care during the hospital stay (see: The Emergence of the Surgicalist). I have just become aware of another definition fo... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2065205 Wed, 24 Dec 2008 14:32:56 +0100 2065205 http://www.medworm.com/index.php?rid=2039849&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F12%2Fcontinuing-differentiation-of-the-radiology-network-ecosystems.html Ole Eichhorn has performed a very valuable service in his Daily Scan blog by publishing a long set of perceptive observations about the RSNA (Radiological Society of North America) conference in Chicago (Visiting RSNA). RSNA is one of the largest conferences in the world and attracts about 60,000 registrants annually. His blog note is a gem and I will return to it again because of the many valuable insights it contains. Below is only one of them -- short but powerful. There were a number of “Nighthawk-like” companies, providing outsourced Radiology reading services. Either at night, or offshore, or with some kind of subspecialty. With Radiology being digital, it is clear that Radiology reading can be done remotely, and a whole ecosystem is forming around this. You can imagine the same ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2039849 Tue, 16 Dec 2008 13:16:53 +0100 2039849 http://www.medworm.com/index.php?rid=2005589&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F12%2Fhimss-describes-itself-as-a-trade-association-in-press-release.html Mr. HIStalk comes up with an interesting tidbit about HIMSS in the following post:HIMSS "applauds" ...Tom Daschle’s appointment as HHS secretary, apparently joining every other industry in hoping for some Uncle Sam handouts. HIMSS says it’s looking forward to "working closely" with Daschle, Obama, and every citizen of Washington, DC and its suburbs to make sure the feds help pay for technology that supposedly already pays for itself. HIMSS calls itself both a membership society and a vendor trade association in its press release, which is the first time I recall hearing anyone there publicly admit the latter. Does that mean we all belong to a vendor trade association? Here's the exact language from the HIMSS press release to which Mr. HIStalk refers:The Healthca... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=2005589 Mon, 01 Dec 2008 15:35:00 +0100 2005589 http://www.medworm.com/index.php?rid=1990575&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F11%2Fmedical-students-picket-for-disclosure-of-facultypharma-financial-ties.html In general, I believe that medical students should spend their time hitting the books rather than engaging in various forms of social protest. However, I have just discovered a situation where it seems to be that a medical student "action" would be warranted (see: Harvard Med Students Might Want to Look Up Charles Grassley). Below is an excerpt from the note from the WSJ Health Blog:Medical students, unite! It’s time to fight for your right to know your profs’ drug-industry ties! That’s what’s happening over at Harvard, where some 40 students rallied recently on the steps of Harvard Medical School’s Gordon Hall. Along with some folks from Tufts and Boston University, they were waving signs and pushing for tighter conflict-of-interest policies vis-a-vis Harvard docs and ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1990575 Wed, 26 Nov 2008 12:24:04 +0100 1990575 http://www.medworm.com/index.php?rid=1960525&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F11%2Fupmc-expands-its-business-relationship-with-ge-medical.html I have posted a number of previous notes about the University of Pittsburgh Medical Center (UPMC) including the most recent about its joint-venture with GE Healthcare, Omnyx, in the area of digital pathology (see: GE Medical Partners with UPMC in Pathology Imaging Venture). Now comes more news that UPMC is expanding its relationship with GE by the establishment of 25 oncology centers starting in Germany, Turkey, Greece and South Korea over the next decade (see: U. of Pittsburgh Medical Center, Working With a G.E. Unit, Plans Big Expansion Abroad). The story was also covered by the Wall Street Journal (see: GE Sets Deal for Clinics With Partner). Below is an excerpt from the article with boldface emphasis mine:As the dominant hospital system in western Pennsylvania, the University of Pittsb... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1960525 Fri, 14 Nov 2008 13:22:07 +0100 1960525 http://www.medworm.com/index.php?rid=1911303&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F10%2Fon-line-auction.html You could see this one coming from a mile away. As soon as you unlink radiologists from their group practices, hospitals, and the capital investments in equipment and physical facilities, you open the door for a more competitive salary environment. Recall that radiologist play little role in digital image acquisition with the occasional exception of ultrasonography. Their common professional role is to sit in dark rooms and interpret images. This can be done anywhere in the world.The success of teleradiology (see my previous notes on Nighthawk) has now made it possible for hospital executives to place radiologist services up for bid and contract with the lowest bidder in any city. A recent note comments on this new business model (see: Let the commoditization of medicine begin).  Bel... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1911303 Mon, 27 Oct 2008 12:11:35 +0100 1911303 http://www.medworm.com/index.php?rid=1855971&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F10%2Fge-healthcare-s.html The success and status of GE Healthcare has been of interest to clinical laboratory professionals lately because the company, in parallel with Siemens Healthcare Diagnostics, has begun to blend in-vitro diagnostics with medical imaging to form the new specialty of diagnostic medicine. Also of interest has been the company's pursuit of what it refers to as the early health model as both a marketing slogan and a new approach to healthcare delivery. A recent article about GE Healthcare in the Wall Street Journal (see:  Curing What Ails GE's Health Unit) suggests that the company is entering some rough waters which may hinder its future ambitions. Below is an excerpt from the article with boldface emphasis mine: GE Healthcare sells machines that discover why people are sick. The ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1855971 Tue, 07 Oct 2008 11:17:55 +0100 1855971 http://www.medworm.com/index.php?rid=1850921&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F10%2Frecommendations.html I have published a number of previous notes about personal health records (PHRs) including a recent one about Health Vault with a reference to Google Health (see: Some Clues About the Microsoft Healthcare IT Strategy). I have come to the conclusion that there is very little future for the so-called untethered PHRs, which is to say web-based stand-alone PHRs. The only ones that will thrive are those with links to hospital EMRs such that some of the medical information contained in the hospital electronic records can be replicated to the tethered PHRs. It is impractical to suggest families will assume the onerous task of hand-entering even a small portion of their health records to a web-based system. John Moore, who blogs over at the Chilmark Research, recently discussed the relationship be... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1850921 Fri, 03 Oct 2008 12:38:07 +0100 1850921 http://www.medworm.com/index.php?rid=1840897&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F10%2Fdeveloping-coun.html In recent post (see: Promoting Health in Developing Countries with New Delivery Model), I discussed how a new healthcare delivery model being developed in Bangladesh may serve as a model in some aspects for the U.S. When writing the note, my tongue was only partly inserted into my cheek. Dr. Ajit Singh, formerly president of the Siemens Oncology Care Systems Group and now CEO of BioImagene, makes a similar point during a video interview on YouTube.The short interview was taped at TiECon 2007 and focused on Dr. Singh's opinion about the current status of healthcare IT in developed countries. At the beginning of the interview, he describes it as primitive. When asked to elaborate on this idea, he indicates that the healthcare industry is both fragmented and burdened by legacy systems. He a... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1840897 Wed, 01 Oct 2008 11:05:33 +0100 1840897 http://www.medworm.com/index.php?rid=1837063&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F09%2Fwhat-can-google.html I recently received a comment from a healthcare blogger, Dr. Peter Kim, in response to my note about Microsoft's EMR product, Amalga (see: Amalga Makes Inroads in the EMR World). It raises some interesting points so I reproduce it below. You may want to take a look at Dr. Kim's blog (see: The EMR/EHR Show). He has also blogged specifically about Google's role in EMR development (see: Is Google The Answer To EMR?). ...I have strong doubts that either company [Google and Microsoft] will successfully make it into the EMR/EHR market as we know it. By that, I mean, with local interfacing with the myriad of very specific, idiosyncratic systems. EMR's today exist at the hub of each office/implementation's world, including interfaces with hospital systems, local lab services, radiology groups, spe... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1837063 Tue, 30 Sep 2008 11:31:54 +0100 1837063 http://www.medworm.com/index.php?rid=1837064&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F09%2Fmedical-tourism.html Community hospitals and large health systems in the U.S. are insulated from market forces, when compared to other businesses, because of their non-profit status, the reimbursement system, and the lack of competition from other hospitals in many communities. One of the reasons that I personally favor medical tourism is that it can introduce an element of competition with respect to some common surgical procedures such as hip and knee replacement. A recent health blog note in the Wall Street Journal underscored this point about competition and suggested that some hospital systems are beginning to get the message (see: Medical Tourism Starts at Home). Below is an excerpt from the it: More than 20 years ago researchers at Dartmouth found huge variations in the intensity and cost of heal... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1837064 Mon, 29 Sep 2008 11:38:11 +0100 1837064 http://www.medworm.com/index.php?rid=1825440&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F09%2Fpromoting-healt.html An article just published discusses a project by some heavy hitters to develop a new sustainable healthcare model for Bangladesh, one of the poorest countries in the world (see: Grameen Health to Establish Independent Collaborations with Pfizer, GE Healthcare, and Mayo Clinic to Create Sustainable Healthcare Delivery Models for the Developing World). Below is an excerpt from it with boldface emphasis mine.Grameen Health...will establish independent partnerships with Pfizer Inc., GE Healthcare, and Mayo Clinic to create sustainable models for healthcare delivery in the developing world....These multiple, independent collaborations will focus on social business models in which the businesses are self-supporting and any profits are re-invested into the system in order to reach more of the poo... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1825440 Thu, 25 Sep 2008 11:57:37 +0100 1825440 http://www.medworm.com/index.php?rid=1825441&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F09%2Famalga-makes-ma.html I have published previous notes about Microsoft's EMR venture, Amalga (see: Microsoft Renames and "Integrates" Its Healthcare Software Line; Developing an Electronic Medical Record Ecosystem (Network)). I have also posted previous notes about both the Microsoft and Google PHR products, HealthVault and Google Health.I was very interested to learn in a recent article (see: El Camino Opts to Aggregate Data) that the Amalga product is now being deployed at El Camino Hospital. Below is an excerpt from the it with boldface emphasis mine:El Camino Hospital of Mountain View, Calif. has selected Amalga from Microsoft...as its data platform. El Camino plans to use the product to aggregate its clinical, financial and administrative information, which currently resides in disparate, transact... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1825441 Wed, 24 Sep 2008 12:09:09 +0100 1825441 http://www.medworm.com/index.php?rid=1815205&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F09%2Feven-more-on-th.html I have posted a number of previous notes about Epic Systems with particular emphasis on it's corporate culture (see: Epic Systems and Its Corporate Culture; More on the Epic Culture: Is This a Cult or a Company?; Epic Flexes Its Political Muscle in Wisconsin with Boycott). These notes have drawn considerable attention, particularly from IP addresses inside the company. The CEO and founder of the company, Judith Faulkner, shapes the company's culture but she rarely speaks to the press. I was therefore interested to discover an article from December, 2002, describing her own views about the Epic corporate culture (see: Epic's Founder Judy Faulkner Speaks on Culture, Business Beliefs, and Recruiting). Below is an excerpt from it:All potential employees go through a rigorous screening process.... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1815205 Tue, 23 Sep 2008 11:36:09 +0100 1815205 http://www.medworm.com/index.php?rid=1798036&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F09%2Fwhich-patients.html I have posted a number of previous notes about walk-in retail clinics because I believe that this is a new model for healthcare delivery based, in part, on price transparency. I also believe that, in time, this type of clinic will become a significant venue for lab testing, although this is not the case today. I came across a note recently in the New York Times health blog with some new and interesting information about the type of patients who are using these clinics (see: Which Patients Are Going to Retail Clinics?). Below is an excerpt from it: In a new study  [of walk-in clinics; Retail Clinics, Primary Care Physicians, And Emergency Departments: A Comparison Of Patients’ Visits] that helps fill [the information] gap, researchers pooled data from 1.35 million visits to more... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1798036 Tue, 16 Sep 2008 12:31:56 +0100 1798036 http://www.medworm.com/index.php?rid=1738970&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F08%2Fvendor-credenti.html Mr. HIStalk alerts us to a new vendor "purchasing, credentialing, and compliance" web site for hospitals:Reader comment: "Re: Sisters of Mercy Health System, St. Louis. They are requiring vendors to register at vendormate.com and pay an annual fee to do business with them." Mr. HIStalk Response: I hadn’t heard of Vendormate, which offers vendor credentialing and compliance solutions. It’s an ingenious business model run by mostly Georgia boys. Worth a look. Here's how Vendormate summarizes its services on its web site:Vendormate VISION provides a standardized process and directory through which organizations can better manage compliance and purchasing tasks associated with their suppliers. It will revolutionize how you qualify and choose your vendors and will be a... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1738970 Wed, 27 Aug 2008 11:14:30 +0100 1738970 http://www.medworm.com/index.php?rid=1717088&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F08%2Fdifferentiating.html I have posted a number of previous notes about RHIOs. If you review these notes, you will discover that I have never been enthusiastic about RHIOs and their business models because I never thought that they offered sufficient incentives for hospitals to participate. John Moore, who blogs over at Chilmark Research, distinguishes between RHIOs and HIEs and predicts in a recent note, accurately in my opinion, why the latter organizations will have a greater chance of success (Why HIEs Succeed and RHIOs Languish). Below is an excerpt from his note with boldface emphasis mine:Back at the beginning of the year, I did a Top Ten Predictions post where one of the predictions was the continued struggles of Regional Health Information Organizations (RHIOs) and the steady rise of Health Information Ex... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1717088 Tue, 19 Aug 2008 12:00:00 +0100 1717088 http://www.medworm.com/index.php?rid=1704651&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F08%2Fmaking-e-health.html Many healthcare professionals are very computer literate. Among the younger members of the group, I am sure that the percentage approaches 100%. However, when we define computer literacy, we tend to ignore the "computers" that the majority of U.S. citizens carry around in their pockets -- cell phones and particularly smart phones. In other words, we tend to make a distinction between a computer and a cell phone although the two platforms are rapidly converging. More people have ready access to a cell phone or smart phone than to a a computer. This fact was brought vividly to my mind in a recent healthcare blog note (see: Internet expert fields questions on participatory medicine). Below is an excerpt from it:  Q. What are your thoughts on the potential for mobile smart phon... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1704651 Wed, 13 Aug 2008 13:09:10 +0100 1704651 http://www.medworm.com/index.php?rid=1602936&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F07%2Fradiofrequency.html I came across a recent article that discusses a non-surgical means for ablating malignant lesions of the lung for patients who cannot tolerate surgery or other therapeutic approaches (see: Non-Surgical Approach Can Treat Lung Cancers). It's called radiofrequency ablation (RFA), Below is an excerpt from the article with boldface emphasis mine: A minimally invasive procedure normally used to treat liver cancer also holds promise for lung cancer patients, according to a new study. In the study..., 88 percent of lung cancer patients responded well to treatment with percutaneous image-guided radiofrequency ablation (RFA). RFA is performed in less than an hour and is a non-surgical procedure that targets large tumors with no harm to surrounding healthy tissue. After one year, 70 percent of pati... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1602936 Wed, 09 Jul 2008 12:00:00 +0100 1602936 http://www.medworm.com/index.php?rid=1551253&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Flong-detailed-a.html Anyone deeply involved in lab computing needs to understand the companies supplying  LISs and EMRs to this market. Part of this understanding involves the "culture" of these companies. The term corporate culture is complex and incorporates a number of variables. As one measure of the complexity of the term, a Google search for it yields 4,450,000 hits. As only one example, some HIT companies are technology-driven whereas others are more marketing-driven. Probably no company is as interesting culture-wise as Epic Systems, currently the market leader in the EMR market. A recent article (see: Behind the Curtain) discusses the company in great detail. For me, the most interesting part of the article was the list of the differences between Epic and its competitors. Below is that ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1551253 Fri, 27 Jun 2008 13:00:00 +0100 1551253 http://www.medworm.com/index.php?rid=1546573&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Fsome-new-insigh.html The cognitive and behavioral aspects of bypass brain are now in the news as a result of the presidential political campaign and Bill Clinton's behavior. Read more about this in a recent blog note (see: 'Bypass Brain': How Surgery May Affect Mental Acuity). Below is an excerpt from the story with boldface emphasis mine: Aides to Bill Clinton last week vehemently denied speculation that the former president's intemperate remarks on the campaign trail were due to mild cognitive damage from his quadruple-bypass surgery in 2004....But the condition dubbed "pump head" or "bypass brain" has long been recognized by doctors, even if they seldom warn patients about it....Symptoms include short-term memory loss, slowed responses, trouble concentrating and emotional ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1546573 Thu, 26 Jun 2008 12:00:00 +0100 1546573 http://www.medworm.com/index.php?rid=1543012&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Fsometimes-consu.html Reports from healthcare consultants can sometimes be warmed-over pap or merely external validation of decisions already made by hospital executives. On occasion, however, reports from consultants can surprise you. This was obviously the situation described in the following article with boldface emphasis mine (see: WVU dumps its consultant):West Virginia University officials fired a $75,000-a-month consulting firm Friday, saying the consultants' scathing report about WVU's health science division and affiliated hospitals was full of errors and misunderstandings. The nine-page report, by R&V Associates of Pittsburgh, alleged that "serious," "intolerable" and "alarming" problems at WVU hospitals put patients' lives at risk.  The consultants cited the une... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1543012 Tue, 24 Jun 2008 13:00:00 +0100 1543012 http://www.medworm.com/index.php?rid=1537847&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Fwho-owns-pacs-r.html Veteran readers of this blog will probably know that I am a strong proponent of having laboratory professionals "manage" their own LISs. Lab tests results are a strategic asset in hospitals, underlying about 70% of hospital diagnoses and constituting about 70% of the data contained in electronic medical records. How does one determine who manages (i.e., owns) the LIS? Easy! Who makes the decisions regarding access to lab information? Who formats that information? Who has the final word on policy issues regarding that information. Who has both de jure and de facto control (i.e., stewardship) over it? If you need to pull out an org chart to answer these questions, you are in trouble. Needless to say, I was interested in a recent article (see: Who owns PACS -- Radiology or IT?) abou... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1537847 Mon, 23 Jun 2008 11:24:23 +0100 1537847 http://www.medworm.com/index.php?rid=1531086&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Fbudget-allocati.html John Moore at the Chillmark Research blog introduced one of his recent blog notes (see: Tradition Grapples with Insatiable Demand) in the following way:Dan Nigrin, the CIO from Children’s Hospital Boston ...is struggling with the insatiable demand for HIT among care providers ...at Children’s while concurrently dealing with an industry that is so bound by tradition. On one hand he must prioritize spending across any number of categories that he characterized as infinitely long (healthcare still spends a woefully low 1-3% of revenue on IT, as a comparison, manufacturing is spending between 4-6% and financial institutions spend even more). Yet on the other-hand, he needs to find new ways to more effectively leverage this spend to insure effective adoption occurs. Not an easy task in this... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1531086 Fri, 20 Jun 2008 12:26:41 +0100 1531086 http://www.medworm.com/index.php?rid=1512067&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Fi-will-be-deliv.html I will be delivering a lecture to the 42nd annual Congress of the Brazilian Society of Clinical Pathology (Sociedade Brasileira de Patologia Clínica; SBPC) on July 3, 2008, in Sao Paulo, Brazil. The lecture is entitled "Integrated Diagnostics Emerges as a Key Element in Healthcare." The lecture will address the development of integrated diagnostic centers (IDCs) which I believe will play an important role in the future of healthcare delivery. Below is a summary of this presentation that I was asked to write for the SBPC web site.The general field of diagnostics, with molecular diagnostics and medical imaging at its core, is undergoing an explosion of knowledge providing the potential to diagnose disease in its pre-clinical pre-symptomatic stage before any physical manifestations... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1512067 Thu, 12 Jun 2008 11:57:23 +0100 1512067 http://www.medworm.com/index.php?rid=1502467&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Fshould-the-hosp.html Mr. HIStalk recently commented on the topic of whether a hospital experiences better financial performance if the CIO reports to the CFO rather than to the CEO. Below is his note in its entirety (boldface emphasis mine): A study says that hospitals in which IT reports to the CFO have better financial performance. Actually, I’m reading between the lines since reading the actual lines themselves would set me back $7.95 and I don’t really buy the premise (and therefore the article). I recognize some Florida State University names among the authors, I think. I would think it’s hard to prove that IT reporting influences the hospital bottom line vs. happens to correlate to it in some way. There’s also the question of value and quality, of course.Here's the "money" quote from th... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1502467 Mon, 09 Jun 2008 11:54:15 +0100 1502467 http://www.medworm.com/index.php?rid=1494237&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F06%2Fthe-big-three-i.html A recent announcement by GE Healthcare about an upcoming conference in Dubai (see: GE Healthcare to focus on emerging healthcare trends at second annual Middle East Media Summit ) reinforced in my mind what I believe are now, and will continue to be, the three dominant fields in healthcare: cardiology, oncology, and IT. Below is an excerpt from the article with boldface emphasis mine:The aim of this year's Middle East Media Summit is to further assist in promoting healthcare knowledge across the region....Today, the region faces a number of significant and serious healthcare challenges: life expectancy lags behind developed countries, the population is both increasing and ageing, and its citizens suffer some of the highest rates of obesity and diabetes in the world....This is the company's... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1494237 Thu, 05 Jun 2008 12:07:32 +0100 1494237 http://www.medworm.com/index.php?rid=1477809&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fadvances-in-por.html I have posted a number of previous notes about portable ultrasound devices. The technology has been widely and rapidly adopted in emergency medicine (see: World's Smallest Ultrasound Device Unveiled) because it increases the speed and quality of diagnoses and also generates additional revenue. It's a good example of how technology is causing "leakage" of imaging procedures to specialties other than radiology. I came across another article about this same topic with special emphasis on the increasing sophistication of chip technology (see: Chip Advances Lift Ultrasound Market, Help Save Lives). Below is an excerpt from it with boldface emphasis mine: Two hours after the patient had a heart attack...doctors at St. Luke's-Roosevelt Hospital Center in New York discovered his heart w... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1477809 Fri, 30 May 2008 12:00:00 +0100 1477809 http://www.medworm.com/index.php?rid=1472378&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fgrowth-of-walk.html I have posted as number of previous notes about walk-in clinics. I had latched onto the idea that such clinics would serve as a new model for healthcare delivery, offering reasonable prices and convenient locations. It now appears that there was probably too much hype associated with this new form of service and there has been a noticeable decline in the opening of new facilities. A recent Wall Street Journal article provides the details (see: Health Clinics Inside Store Likely to Slow Their Growth). Below is an excerpt from the article with boldface emphasis mine: The boom in walk-in health clinics located inside pharmacies, supermarkets and big-box retailers is showing signs of slowing.[See the chart at the left illustrating the largest walk-in clinic operators in t... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1472378 Wed, 28 May 2008 12:00:00 +0100 1472378 http://www.medworm.com/index.php?rid=1469563&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fsearch-engine-f.html Search engines have been a critical factor in making the web so useful. I am personally partial to Google. I also find Google Scholar useful when researching complex medical topics. I often tend to use it even before PubMed. In fact, Google Scholar can be used as a portal to search medical article archived in PubMed. Here is a brief description of PubMed:PubMed is a service of the U.S. National Library of Medicine that includes over 17 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources. Now comes news about some recent refinements of a search engine designed specifically for healthcare professionals but also available to healthcare consumers (see: SearchMedica Off... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1469563 Tue, 27 May 2008 12:00:00 +0100 1469563 http://www.medworm.com/index.php?rid=1432335&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fcompleting-heal.html Scott Shreeve in his Crossover Health blog raises the interesting issue of the need to complete healthcare transactions at the point-of-service (see: Millenial Patients: Care Delivery for the Next Generation of Patients). This goes to the question of how to modify healthcare transactions so that they more closely resemble the level of service offered in most other more consumer-oriented businesses. Here's an excerpt from his blog note with boldface emphasis mine: In addition to getting comfortable discussing pricing, providers will need to be able to complete healthcare transactions at the point of service. As more consumers pay a higher percentage of their own healthcare costs (consumer payments are about $50 billion today), healthcare providers will need to adopt new technology and busi... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1432335 Fri, 09 May 2008 11:18:42 +0100 1432335 http://www.medworm.com/index.php?rid=1428928&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fan-update-on-th.html Veteran readers of Lab Soft News may remember a flurry of activity in the November-December, 2006, time period regarding the Kaiser HealthConnect project (see: Kaiser & Epic Respond to Justen Deal's E-Criticism; Is Kaiser Hijacking the Blogosphere?). Much of the controversy related to a young Kaiser employee name Justen Deal who surfaced as an IT whistle-blower and blogged about the total cost of the HealthConnect project, the periodic unplanned and prolonged computer downs, and the rather slow roll-out of the inpatient Epic software to hospitals in the Kaiser chain. Mr. HIStalk provides us with the following update on the HealthConnect project:Kaiser says its HealthConnect outpatient rollout is finished, with all 8.7 million enrollees having access, but inpatient is installed in only... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1428928 Thu, 08 May 2008 12:21:29 +0100 1428928 http://www.medworm.com/index.php?rid=1423047&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fmajor-discovery.html The Wall Street Journal has just run an excellent piece (see: Medical Specialties Hit by a Growing Pay Gap) about how some highly trained medical specialists like neuro-ophthalmologists end up at the lower end of the pay scale because they don't perform procedures. Here's the "money" quote from the article about why procedures tend to be reimbursed by payors at a high level as compared to, say, physician time and expertise. Blame it on Medicare and the federal government (boldface emphasis mine):But in the early 1990s, Medicare implemented a new system to set standard fees for physicians' services and procedures. The system's aims were to clamp down on prices and, ironically, narrow the disparity between the bread-and-butter office visit and more-expensive specialty procedures. O... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1423047 Tue, 06 May 2008 11:19:30 +0100 1423047 http://www.medworm.com/index.php?rid=1416174&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fvirtual-on-line.html I have published a number of previous notes about the efficiency of physician emails to patients, also referred to as on-line consultations and e-consultations. Here is one example: Doctors Slow to Adopt Email with Patients. Here's another note about the relevance of e-consultations for PCPs: More on Redefining the Role of the PCP. It turns out that a new term is also being used to describe physician interactions with patients: virtual on-line visits (VOVs). A recent article discussed this type of consultation (see: US doctors offer online consultations) and highlighted a web site, RelayHealth, that can be used to enable them. Below is an excerpt from the article with boldface emphasis mine:When Dr Michelle Eads makes a house call, she no longer has to spend time in her car sitting in traf... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1416174 Fri, 02 May 2008 11:30:36 +0100 1416174 http://www.medworm.com/index.php?rid=1413391&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F05%2Fcondom-manufact.html You can't make this stuff up. The Trojan Company, a major manufacturer of condoms, has gone on the road with a bus tour to promote safe sex (see: Rubber Hits the Road as Trojan Campaigns for Sexual Health in America). The press release announcing the tour makes interesting reading. Below is an excerpt from it with boldface emphasis mine: ...[T]he Trojan Evolve tour will travel across the U.S. raising awareness regarding the poor state of sexual health in America and urging Americans to petition for change. The fact is, this is not a sexually healthy nation, and the Evolve tour is designed to address this head on by inspiring a positive sexual health movement and empowering Americans to change behaviors and opinions about carrying and using condoms. With primetime network television re... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1413391 Thu, 01 May 2008 12:00:00 +0100 1413391 http://www.medworm.com/index.php?rid=1406883&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F04%2Fthe-musculo-ske.html The New York Times on April 22, 2008, featured a full page advertisement for the Hospital for Special Surgery. The motto for the hospital, as seen in this ad, is "Specialists in Mobility." Also, according to the ad, the Hospital for Special Surgery is a "world leader in musculoskeletal research, linking laboratory science to state of the art clinical procedures." This caught my attention and caused me to think about the topic of specialized hospitals (see: Cardiology Morphs into Cardiovascular Medicine). It's commonplace for various organ systems or patient categories to form the basis of a specialty practice in medicine. Think cardiovascular medicine, gastroenterology, pediatrics, and obstetrics/gynecology. Also increasingly common, as in the case of cardiovascular m... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1406883 Tue, 29 Apr 2008 12:19:21 +0100 1406883 http://www.medworm.com/index.php?rid=1403998&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F04%2Fhimss-president.html According to an interview in the WSJ Health Blog, Steve Leiber, the chief executive of HIMSS, is nervous about personal health records (PHRs) (see: How Personal Health Records Could Make Care Less Efficient). Here is an excerpt from the note (boldface emphasis mine):...Steve Leiber — who runs Healthcare Information and Management Systems Society, the trade group for health IT — pointed out a potential downside to the patient-centric records. “Physicians aren’t going to trust it,” he said. That could be trouble if patients opt for the personal records and try (because of privacy concerns, say) to keep their medical information off of a doctor or hospital’s electronic medical record. John of the Chillmark Research blog places this remark from Leiber into the appropriate conte... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1403998 Mon, 28 Apr 2008 12:07:47 +0100 1403998 http://www.medworm.com/index.php?rid=1390957&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F04%2Fbroader-user-of.html A recent article about the opening of PETNET's first molecular imaging biomarker production facility in Chennai, India, caught my attention for a couple of reasons (see: Siemens to launch PETNET services in India). Below is an excerpt from the article with boldface emphasis mine:Siemens...announced the launch of its project to set up [PETNET's] first molecular imaging biomarker production facility in Chennai. The new facility will enable the healthcare providers in and around Chennai to access the PET.CT technology for diagnosis of patients with life-threatening diseases ...PETNET Solutions, a fully owned subsidiary of Siemens Medical solutions, operates the largest PET radiopharmacy network [comprised of] over 44 radiopharmacies and distribution centers at multiple locations that produce ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1390957 Tue, 22 Apr 2008 11:32:22 +0100 1390957 http://www.medworm.com/index.php?rid=1379324&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F04%2Fmore-on-redefin.html In my note yesterday (see: Have PCPs Become Obsolete?), I discussed what I perceive as the need to redefine the role and skill set of PCPs. The Health Care Blog has a long and thoughtful note (see: The Changing of the Guard) about the consequences of the graying and impending mass retirement of baby-boomer physicians. Much of this note focuses on the changing relationship between hospitals in a community and the physicians practicing in that community. It's well worth reading. One paragraph caught my attention and I reproduce it below, with boldface emphasis mine, because of its relevance to the management of a PCP's office practice: Regardless of what Washington policymakers do about reforming payment, primary care practitioners must also develop a new operational model, which hospitals c... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1379324 Thu, 17 Apr 2008 11:47:20 +0100 1379324 http://www.medworm.com/index.php?rid=1376642&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F04%2Fmany-pcps-are-b.html Having covered various topics such as the growth of Wal-Mart and retail pharmacy walk-in clinics and the proliferation of hospitalists of various stripes (intensivist, surgicalist, preceduralist), I have personally come to the conclusion that the days of the primary care physician (PCP) are numbered and that this group of physicians needs to redefine themselves and upgrade their skills. This same idea has occurred to Scott Shreeve (see: Gatekeepers vs. Quarterbacks: Primary Care Gets Back in the Game). Below is an excerpt from his recent blog note with boldfaces emphasis mine:...I have become very interested in redefining health care financing to align incentives in order to obtain better health care outcomes. I believe that primary care needs to be paid in a way that recognizes the value ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1376642 Wed, 16 Apr 2008 11:14:30 +0100 1376642 http://www.medworm.com/index.php?rid=1347283&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F04%2Fphillips-picks.html I have posted a number of previous blog notes about Philips Healthcare, a major multinational player in the medical imaging field as well as many other areas. Now comes the news that Philips will acquire Tomcat Systems, a Northern Ireland-based supplier of cardiovascular information systems (see: Philips Buys Tomcat Systems). Philips has been keeping to the sidelines while rivals GE Healthcare and Siemens Diagnostics have acquired companies in the healthcare IT sector. However, Philips has now made its move into what is being referred to by John at the Chillmark Research blog as a specialty-specific "CVIS" software company (see: Philips Picks Up Niche CVIS Software Company). The Chillmark blog focuses on healthcare IT issues and is well worth reading. Below is an excerpt from the... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1347283 Thu, 03 Apr 2008 11:32:06 +0100 1347283 http://www.medworm.com/index.php?rid=1340495&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F04%2Fpresident-of-ec.html I have been following the progress of eClinicalWorks (eCW) for some time, posting a number of notes about the company (see as an example: More on eClinicalWorks: A Successful PMS for Office Practices). eCW has developed and sells one of the leading  office EMRs that can also be called an ambulatory EMR or EMR/PMS. The president of the company, Girish Kumar Navani, is refreshingly candid and always has interesting insights about his company and the larger HIT industry. A recent interview of him by Mr. HIStalk is no exception to this rule (see: HIStalk Interviews Girish Kumar Navani, President of eClinicalWorks). Below is an excerpt from the interview in Q and A format with boldface emphasis mine. The portion selected focuses on patient portals and personal health records (PHRs). Q: You... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1340495 Tue, 01 Apr 2008 11:41:24 +0100 1340495 http://www.medworm.com/index.php?rid=1324965&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Fcerners-winona.html I have posted notes in the past about Cerner's Winona Health Project (see: The Winona Project: Is This a RHIO Success Story?). The project received very laudatory coverage on the PBS New Hour last night (see: PBS News Hour to feature Winona's Health Information Technology). Cerner is certainly to be commended for having launched this community-wide demonstration project five year ago and sticking with it over the years to achieve a successful result. The town, hospital, and medical practitioners were hand-picked because of their willingness to serve as a guinea pig for this experiment, but this detracts little from the successful outcome that can be seen today. It's a pity that more communities have not emulated the electronic medical record success experienced in this small Minnesota town... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1324965 Tue, 25 Mar 2008 12:00:03 +0100 1324965 http://www.medworm.com/index.php?rid=1319276&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Fmore-on-reinven.html In a recent post (see: Reinventing the Autopsy: CT Imaging as a Routine Part of the Procedure), I suggested that this may be the right time to begin to reinvent the autopsy. In particular, I believe that a whole-body CT scan should be a mandatory first step in all such procedures. At the beginning of this note, I cited Dr. Jared Schwartz as the individual who had stimulated my interest in integrating imaging techniques such as the CT scan into the standard autopsy. He has posted a comment to this note which I copy below with boldface emphasis mine:Bruce you are correct I have been preaching to pathologists, pathology educators and hospital leaders of the potential value of reinvigorating the autopsy using modern technologic tools. Imaging combined with fine needle aspiration and the promis... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1319276 Fri, 21 Mar 2008 12:28:51 +0100 1319276 http://www.medworm.com/index.php?rid=1303154&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Flower-mortality.html Conclusions: In-hospital mortality is reduced for patients undergoing lung cancer resections at teaching hospitals, with results prominent at all but the highest volume institutions. Lower mortality rates persisted at GSTH [general surgery teaching hospitals] and TSTH [thoracic surgery teaching hospitals]. Understanding and disseminating the processes of care associated with these settings may improve quality of care for lung cancer patients, and decrease patient bias against teaching hospitals.The only thing that surprised me in this article was the assumption of the authors, contained in the last paragraph, that there is a "patient bias against teaching hospitals." I do understand that patients tend to rebel against becoming "guinea pigs" in teaching hospitals. H... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1303154 Fri, 14 Mar 2008 12:21:23 +0100 1303154 http://www.medworm.com/index.php?rid=1300240&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Fdiabetes-epidem.html I have posted a number of previous notes about the costs associated with the care of patients with chronic diseases, particularly diabetes mellitus. I must now confess to a  naiveté about the epidemiology of diabetes since I have been assuming that it was most prevalent in the western developed countries. In these countries, obesity is common (see my previous notes about the metabolic syndrome), exercise is often avoided, and high caloric diets are the norm. I have now discovered in an article published in 2007 that the Middle East is the hub of the diabetes epidemic (see: Middle East Remains Hub Of Diabetes Epidemic). Here is a quote from it: The number of adults with diabetes in the Middle East & North Africa (MENA) is expected to nearly double over the next two decades from ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1300240 Thu, 13 Mar 2008 12:00:37 +0100 1300240 http://www.medworm.com/index.php?rid=1294287&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Fsome-dark-cloud.html It has been suggested that one of the reasons that Siemens and GE have acquired a number of IVD companies lately, thereby extending their reach in diagnostic medicine, is that demand for medical imaging equipment is softening. Their hedge has been prompted, in part, because insurance companies and Medicare are taking a harder look at the rising cost of imaging procedures. A recent article (see: Cranking Up the Volume) addressed this issue. Below is an excerpt from it with boldface emphasis mine:  One reason medical costs are getting way out of control: GE employs too many good salesmen....But a year ago Medicare cut the price it pays for imaging, so [one radiologist] gets paid 15% to 50% less for each order, depending on the type of scan....[The radiologist] was forced to take a 2... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1294287 Tue, 11 Mar 2008 12:35:31 +0100 1294287 http://www.medworm.com/index.php?rid=1290946&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Frecipe-for-avoi.html Everyone involved in healthcare information technology (HIT) is familiar with the history of frequent failure or inadequate performance of EMRs. Just to get a rough handle on the breadth of this problem, I searched Google using the following search terms: failure OR problem EMR OR EHR. Here is the resulting search that shows 2,670,000 hits. Not a perfect measure of the depth of the problem but a good way to launch this discussion. With this background information in mind, it would seem reasonable to assume that some HIT professionals would be wringing their hands. After all, hospital CIOs and CMIOs are changed with the purchase and deployment of EMRs. Mr. HIStalk opines below about how to avoid EMR failures in response to a query from a blog reader:From Greg Tourniquet: "Re: CIS fai... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1290946 Mon, 10 Mar 2008 12:10:16 +0100 1290946 http://www.medworm.com/index.php?rid=1280672&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Fpersonal-health.html I have posted a number of previous notes about personal health records (PHRs) and predicted that they will not be used by a large swath of healthcare consumers. The reasons for this are, first, that most people are healthy and lack strong incentives to maintain such records. Secondly, the lion's share of the most important clinical information is locked up in hospital and office EMRs. Hospitals and physicians lack both the technology and financial incentives to replicate "their" information to consumer-controlled PHRs. Lastly, many consumers lack the technical facility and time to maintain their own PHRs on a continuing basis. I recently listened to a podcast interview of HIMSS CEO Steve Lieber (see: Neil Versel's Healthcare IT Blog; Podcast with HIMSS CEO Steve L... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1280672 Wed, 05 Mar 2008 12:57:01 +0100 1280672 http://www.medworm.com/index.php?rid=1277767&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F03%2Fnew-york-eclini.html I have posted a number of previous notes about office EMRs and a successful vendor of one such product, eClinicalWorks. There are many advantages to integrating and linking the office EMRs in a community to each other and to regional hospitals. The path is clear when the medical practices are owned by a health system. The office EMR chosen in such cases will be the office version of the EMR installed in the flagship hospital of the health system. In other words, a hospital e-strategy is assumed. One example of an office EMR is the Centricity EMR, referred to the GE web site as "an ambulatory care medical record that also integrates with GE Healthcare's practice management solutions for a practically paperless office." eClinicalWorks represents a contrasting e-strategy that ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1277767 Tue, 04 Mar 2008 13:22:38 +0100 1277767 http://www.medworm.com/index.php?rid=1268323&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F02%2Fhealth-insuranc.html It now appears that some health insurance companies have decided to reimburse physicians for the delivery of online professional services, which is to say for virtual office visits (see: Online house calls click with doctors). Below is an excerpt from the article: Since the dawn of e-mail, patients have been pleading for more doctors to offer medical advice online....There was always one major roadblock: Most health insurers wouldn't pay for it....In recent weeks, Aetna Inc., the nation's largest insurer, and Cigna Corp. have agreed to reimburse doctors for online visits. Other large insurers are expected to follow, experts say. These new online services, which typically cost the same as a regular office visit, are aimed primarily at those who already have a doctor. The virtual visits are... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1268323 Fri, 29 Feb 2008 13:13:01 +0100 1268323 http://www.medworm.com/index.php?rid=1261581&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F02%2Fcancer-coaches.html Cancer patients need all of the help that they can get, particularly from empathetic and knowledgeable guides who are familiar with the ups and downs of the treatment process. But the kind of "help" that I am discussing here is not necessarily a shoulder to cry on -- it's assistance in making informed decisions when and where they count most. I did not have a suitable name for this type of person until now -- I have discovered that they are now referred to as cancer coaches or patient navigators and below is an excerpt from an article (see: Cancer 'coaches' sway treatment choices) that describes the role in detail (boldface emphasis mine): Bad advice, or just too much of it, can compound the trauma and damage done by the disease itself, cancer patients often find. Friends and ... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1261581 Wed, 27 Feb 2008 12:58:35 +0100 1261581 http://www.medworm.com/index.php?rid=1225169&cid=t_156985_155_f&fid=34629&url=http%3A%2F%2Flabsoftnews.typepad.com%2Flab_soft_news%2F2008%2F02%2Fge-healthcare-d.html I have posted a number of previous notes about GE Medical's interest in, and publicity about, the early health model (EHM). I have speculated in these notes about the significance of this new approach to healthcare delivery and its tight links to molecular medicine. My first impression about the EHM was that it would be both a marketing slogan and business strategy that would be pursued primarily in countries with sophisticated healthcare delivery systems. This turns out not to be the case as illustrated in a recent article about GE's participation in the development of turn-key hospitals in the Middle East and Africa (see: GE Healthcare Signs Mou With Saudi German Hospitals Group). Below is an excerpt from the article (boldface emphasis mine):In response to the strong demand for affordabl... Lab Soft News blogs http://www.medworm.com/rss/comments.php?id=1225169 Tue, 12 Feb 2008 12:53:22 +0100 1225169