Sunday, February 17, 2013

New York State wants you to have your health records easily and confidentially accessible on the internet, so its building a special online portal for the purpose

The obvious first question that comes to mind, is Will all this largesse of information be truly for all citizens or will it be another class-specific boondoggle from which the really poor are excluded because they can't afford personal computers and the monthly service chargers that Internet Providers charge? It woud be wonderful if the health-system in the state of New York realized that it coudn't really go universal in this hi-tech way with patients medical and health information, unless it had its mandate expanded to information generally that woud include provision of free personal computers and online identity security to all New York residents or citizens. That shoud bring many new incoming residents to the state, becawz the poor in many places in America and abroad woud be delited to get free internet access for all sorts of jolly things, including free health info to boot. (8-)

— Albert Gedraitis

InformationWeek HealthCare (Feb198,2k13)

New York Challenges Developers To Create Patient Portal

Michelle McNickle

Associate Editor of InformationWeek Healthcare

Portal to let New Yorkers access their health data is "tip of the iceberg" for future state-wide consumer health applications, says contest sponsor New York eHealth Collaborative.

Michelle McNickle | January 18, 2013 12:38 PM

10 Mobile Health Apps From Uncle Sam

(click image for larger view and for slideshow)

Designers and developers are invited to create a new patient portal to give New York residents access to their health information online. The portal is important -- a way for New Yorkers to access their health information online -- but it's just the "tip of the iceberg" for letting developers build applications that use New York's statewide network of e-health data, said David Whitlinger, executive director of New York eHealth Collaborative, in an interview with InformationWeek Healthcare.

NYeC, a non-profit organization, manages the State Health Information Network for New York (SHIN-NY). The network has now pulled enough data from regional health information organizations that NYeC, in partnership with health IT catalyst Health 2.0, is opening it up to the design of a patient portal and the future possibility of additional apps.

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"Part of the way we've established the network is we've built it as a platform, so it allows us to create a programmatic environment, and we can build an ecosystem of applications," said Whitlinger. "….[W]e're launching this challenge, and the opportunity is large, but we think this is going to spur many applications for the consumer, the patient, the New Yorker."

[ For another point of view on PHRs, see Why Personal Health Records Have Flopped. ]

Designers and developers have until April 11 to submit mockups for the challenge, and they already can access a "sandbox" where designers and developers can get dummy patient data. The sandbox has all the programming attributes of building an application against it, and Whitlinger said NYeC is looking for mockups that express how users can interact with their health records in an engaging and interactive way. Mockups must let patients log on with a user name and password, view a full layout of their health record, and access a list of medical professionals. The portal also will provide an overview of patient privacy rights.

"So today, we're able to reach out to the developer and creative community and say 'Okay, we now have a platform that's built up enough records and is programmatically available -- come with your best and brightest," he said. "We want those mockups to be really innovative with the user interface and the user experience -- so how to not represent data in a dull and static way so it doesn't have value beyond the folks who crave that utility, but an engaging application or set of applications."

After the April 11 deadline, New Yorkers can vote on the mockups online and in a series of webinars, Whitlinger said. NYeC might also open up voting in a larger, in-person forum to hear opinions directly. Since NYeC was formed, Whitlinger added, the collaborative has received numerous phone calls from state residents asking for access to records.

"Anyone with a disease and who has the less-than-desirable need to carry around their paper records … they can't wait for this functionality," he said. "We're really anxious to be able to tap into that pent-up demand and say, 'Okay, here are 20 great ideas from the design community. Tell us what you like, don't like, mix and match: give us your thoughts and become part of one of the largest user focus groups ever launched."

Once winners are determined, the challenge will award $25,000 in prizes to first, second and third place. NYeC also will work with a vendor to build the portal and run it on behalf of the state via its health information exchange network.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)

Doctors have all sorts of excuses for poo-poohing users' ratings online because they want to silence patients

This news report by Ken Terry points us to a cluster of problems on how patients get to be part of the patient-doctor dialogue in a way that is not overwhelmed by thechnologistic newspeak — "patient engagement" and "physician-patient communications" where the patient is to be "engaged" by the doctor (which still leaves a lot of room for manipulation and bullying by doctors) and where the physician comes first, not the patient, while the problem is the physician's need to communicate with the hapless patient, who in turns needs to be patient, and not an active iformative party to a dialogue in which both sides communicate. Real communication of the explicitly patient-doctor dialogue kind begins with the patient and the opening, if necessary, by the doctor for the patient to lead the way (even where shy or intimated) in the conversation. The patient has valuable info which only she or he can give the doctor, under what shoud be normal circumstances. The doctor in the beginning of the relationship shoud be a listener, thinker, and learner. Most important of all perhaps is the patient's development of the narrative of her illness, not the doctor's imposition of a narrative out of his genomic studies in the case of cancer patients, or blood-suger samples and stats in the case of diabetes patients.
See our earlier ruminations on the report of Dr Marco Annoni et al, in the work of the Medical Humanities approach to medicine even in the case oncology/hematology which had been quite dismissive of the patients' narrativization of their illness, and the imposition of the doctors' narrative on the basis genetics/genomics studies that disappeared the patients' narratives, erasing the patient along with her/his narrative and imposing the purely scientistic narrative developed with hi-technology according to the philosophy of medicine of the doctor alone. I am currently in that position, once again, in relation to the diabetes element in my illness. Questions like my life-horizons, philosophy and ethics of my own longevity, and my right to die with dignity at the time and in the place of my own choosing has been set at nawt by know-it-all naturalistic scientistic medicine that pretends omnisience and ends up a function of the nanny-state, not an aid to my own flourishing for perhaps a few more years before I go willing and with joy to meet my Maker. Medicine today needs its own inner reformation.

— Albert Gedraitis

InformationWeek HealthCare (Feb18,2k13)

Doctors Take Dim View

Of Users' Online Ratings

Doctors question small sample sizes and what ratings measure, but many peek at their own report cards anyway.

Ken Terry

Physician leaders are wary of online physician ratings but are interested in what patients have said about them, according to a recent survey by the American College of Physician Executives (ACPE). Moreover, most of the respondents agreed that ratings will become more important in the era of value-based reimbursement.

Only 12% of the physician leaders said that consumer rating websites were helpful and should be made more available. Twenty-six percent said they were a nuisance and provided no benefit, and 29% said that the sites were not used very much by patients and didn't really affect their organizations.

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About 55% of the physicians believed 25% or less of their patients had used an online physician rating site, and 35% of respondents estimated that between 25% and 50% of patients visited those sites.

According to a recent Pew Internet survey, only 20% of Internet users -- a subset of all consumers and, therefore, of patients -- had consulted online reviews of particular drugs or medical treatments, doctors, hospitals or other providers. Just 3 % to 4% of Internet users had posted reviews of healthcare services or providers.

[ Doctors interact with patients online more than ever. Read HealthTap, Avvo Marriage Gives Consumers More Online Docs. ]

The small sample size is one reason why physicians distrust online consumer ratings, said Seth Glickman, MD, assistant professor of medicine at the University of North Carolina in Chapel Hill, in an interview with InformationWeek Healthcare. Glickman, an expert on patient experience surveys, pointed out that physicians also are concerned about the possibility that competitors might plant negative reviews. And there are concerns, he said, about whether the sites are measuring what makes patients happy or what represents good clinical care.

"For example, giving a patient an antibiotic prescription for a cold is not good medicine, but there's some evidence showing that when patients receive that prescription, they feel they've received better care," said Glickman.

Some of these issues carry over to external physician ratings that are more scientifically valid, such as those from Press Ganey, the National Committee on Quality Assurance, the Joint Commission and some health plans. The ACPE survey found that only 29% of respondents viewed these ratings as useful, while 14% regarded them as a nuisance and a time waster. Forty-one percent had a neutral opinion about these report cards.

In contrast, 75% of the respondents said their organizations rated physician quality internally, and 71% of the physician leaders said these ratings were valuable and that they supported their use.

Despite the overwhelming rejection of online consumer ratings of physicians, two-thirds of the respondents said they had viewed their own ratings on websites such as Healthgrades, Vitals and Angie's List. Of those who had looked at their report cards, 39% agreed with them and 42% partially agreed with them. Only 19% said the reviews were completely wrong.

This did not surprise Glickman. "Many of us are aware of the things we do well and the areas we need to improve on," he said. "When you have a well-designed survey instrument and you amass feedback from a critical mass of patients, you can see those themes emerge. It's a good sign that physicians are at least open to the possibility of what that information can provide and use it as a platform to figure out a way to improve the care they deliver."

As more consumers write and read reviews of physicians on these websites, he added, doctors will start to take them more seriously. "The more information that's available in the public domain, the more likely physicians are to review the information and to believe that it's valid, based on larger samples."

Meanwhile, he said, physicians should bear in mind that there are areas of health care, such as patient engagement and physician-patient communication, where consumer ratings can be insightful. "There's some good evidence that when we do better in those areas, we can deliver higher quality care at lower cost. Patients can provide valuable feedback in those areas, which can lead to higher quality care," he said. Of the 730 physician leaders who participated in the ACPE poll, 31% worked for health systems, 24% for hospitals, 20% for group practices, and 9% for academic health centers. Twelve percent were in private practice.

Why doctors get entangled in the affairs of the medical world so deeply they don't speak out for patients

I remember when a doctor I knew did speak out. He was a missionary doctor in Kenya, at home in New Jersey USA on furlough. He went to visit a philosophy student of mine in hospital. The doctor took one look at the patient, knowing a bit of the background story from my student's wife (she a student also). He ordered the student transferred to another hospital and there the staff re-opened the previous surgery to find, it turned out, a set of surgical scissors sewed into the operating wound and left there to fester. The deeply implanted scissors were literally killing my student. It was a happy-ending story. But what if the missionary doctor hadn't arrived at David's bedside from Kenya?

— Albert Gedraitis

New York Times (Feb17,2k13)

NEWS ANALYSIS

Doctors who don’t speak out

By BARRY MEIER

Published: February 15, 2013

THE note sent by a doctor to several executives at Johnson & Johnson was blunt: an artificial hip sold by the company was so poorly designed that the company should slow its marketing until it understood why patients were getting hurt.

Enlarge This Image

Andrew Testa for The New York Times

A faulty hip replacement a doctor removed from a patient.

The doctor, who also worked as a consultant to Johnson & Johnson, wrote the note nearly two years before the company recalled the device in 2010. And it was far from the only early warning those executives got from doctors who were paid consultants. Still, the company’s DePuy orthopedic unit plowed ahead, and those consultants never sounded a public alarm to other doctors, who kept implanting the device.

The memos have recently emerged during the trial of the first of more than 10,000 patient lawsuits brought against Johnson & Johnson over the hip implant device, the Articular Surface Replacement, or A.S.R. The company has insisted that it acted responsibly in determining when to halt its sale. But plaintiffs’ lawyers have offered a portrait of executives who put profits ahead of patients, even scuttling a plan to fix the implant because it cost too much.

It might not be surprising to find that executives acted to protect a company’s bottom line. Still, the Johnson & Johnson episode is also illuminating a broader medical issue: while experts say that doctors have an ethical obligation to warn their peers about bad drugs or medical devices, they often do not do so.

“Questioning the status quo in medicine is not easy,” said Dr. Harlan Krumholz, a professor at Yale School of Medicine.

Physicians may remain silent for a variety of reasons, he and other experts said. They may fear that speaking out could get them sued or believe that a product problem was an anomaly or their fault.

Doctors also have an aversion to reporting. For instance, while the Food and Drug Administration relies on physicians to help monitor product safety by alerting the agency to adverse patient reactions, doctors usually do not make such filings, saying they are too busy for the paperwork.

“The standard in the medical community is not to report,” said Dr. Robert Hauser, a cardiologist who, along with a colleague, warned other doctors in 2005 about a defective heart implant.

There is another reason doctors may choose to remain silent, experts say: their financial ties to a drug or device maker.

For years, such consulting payments have raised concerns about the impact of money on a doctor’s decision about which drugs to prescribe or how to interpret research findings. Money can also shift a physician’s sense of loyalty, said George Loewenstein, a professor at Carnegie Mellon University who has studied medical conflict-of-interest policies. “If someone has been paying you or employing you, it is very difficult to blow the whistle,” said Professor Loewenstein, who teaches economics and psychology. “It offends our sense of loyalty.”

Dr. Krumholz said he also believed that such loyalties were between a doctor and a company’s executives, rather than with a company or its brand. Over time, a physician may come to see his relationships with those officials in terms of friendship, while companies see an influential doctor as an asset who helps develop products and boost sales.

For a consultant, breaking those ties can carry a cost. For example, when Dr. Lawrence D. Dorr, an orthopedic specialist, warned fellow surgeons in an open letter in 2008 that a hip implant made by Zimmer Holdings was flawed, he became the subject of a whisper campaign that questioned his skills as a surgeon.

“The first thing that a company does is to put out a campaign that a surgeon does not know how to operate,” said Dr. Dorr, who was a consultant to Zimmer when he wrote the letter. “It hurt my practice for a year.”

TRADITIONALLY, doctors have brought problems to the attention of colleagues by conducting research and publishing their findings in a medical journal. The advantage of that system helps ensure the credibility of study data and protects a researcher from random attack, said Dr. David Blumenthal, the president of the Commonwealth Fund, a group that studies health policy issues.

But getting a study published can take a year or two; some Johnson & Johnson consultants did publish studies about the hip’s flaws, but they largely appeared after it had been recalled.

Dr. Blumenthal said there was probably a need for more immediate ways for doctors to share their concerns, like forums supported by professional medical organizations. Another approach would be to have companies hire doctors as consultants whose sole concern was product safety, Professor Loewenstein said.

The results of not speaking out are playing out in a Los Angeles courtroom, where the first Johnson & Johnson hip case is unfolding. In the years before the implant’s recall, a British physician, Dr. Antoni Nargol, and a colleague were among those who tried to alert surgeons to the problem.

But the silence of other doctors apparently gave company executives the upper hand; in meetings with Dr. Nargol, they said that he seemed to be the only doctor having trouble.

He said recently, “They told me there were no other problems.”

Barry Meier is a reporter who covers business and medicine for The New York Times.

Friday, February 15, 2013

French slawterghouse cawt selling horsemeat as beef ...

A business in France is shedding crocodile tears because the govt shutdown of its operations will put 300 butchers out of work.

-- Albert Gedraitis

Christian Science Monitor (Feb15,2k13)

French firm suspended after horsemeat scandal

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The winter blues — Seasonal Affective Disorder (SAD)

Of all places, I found this item on depression caused in large part by the weather in Northern countries, found it in the newsletter of a small political party here in Ontario, Canada. It is cawzed by reduced light in relation to eating habits and physical activity. It's called Seasonal Affective Disorder (SAD).
I am depressed, but I'm not lonely, but am having severe problems with the health service I need.

— Albert Gedraitis

Family Coalition Party (Feb15,2k13)

Winter:

an elder's worst nightmare

Friday, February 15, 2013 - 09:14:38 AM
by Pete Aarssen, CFP, CLU, CH.F.C., EPC

It’s 5:30 p.m. and the sun is already set. Yes, the lights
go out early in our long, cold Canadian winters. Hunkering
down in our homes for much of our day can make even the
sturdiest folks a little stir-crazy but for elders, the long
winter months bring increased isolation, boredom and
depression. Some head south for the winter but for those who
remain, life can start to appear less satisfying.

There is a scientific connection to the effect of reduced
light on our moods, eating habits and physical activity: it
is called Seasonal Affective Disorder, known also by the
appropriate acronym S.A.D. The likelihood of developing
S.A.D. increases during winter months. Elder’s face
increased isolation and loneliness as a normal part of the
aging process.

Later in life, they see a narrowing of their social network
brought on by the deaths or institutionalization of their
peers and extended family members. With fewer and more
globe-trotting children, elders also experience the physical
and sociological distancing of themselves from their
children. With decreases in physical mobility as they age,
elders grow more dependent on others but have fewer to which
to turn. In some cases, their gloom turns to depression.

Depression is four times more likely to strike people over
age 65 than any younger age group. It is readily treated but
few get the help they need. It is difficult for anyone
supporting an elder- a child, a sibling, or a caregiver- to
imagine ramping up the attention they already pay to their
loved ones. However, it is more important than ever to stay
in touch with elders during the winter season, to increase
visits or make excuses to call them. (I hope my mother is
not reading this column!)

It isn’t easy. We all have busy, demanding lives. But if we
can stop for a minute to consider that more than 90% of
elders live alone or with one dependant, we will also
realize that it doesn’t take much to brighten their day.
Make personal contact by picking up the phone, stopping in
for tea, popping up on Skype, or even sending a text message
if you’re really on the go!

Health professionals assert that psychological well being is
interconnected with physical and social health. It’s true!
My siblings and I can almost pin point when my mother’s
existing chronic health ailments are going to be at their
worst: usually when there has been a prolonged gap in people
having visited.

As we age, our time perspective changes. I can think to
myself ‘I just saw my mother a week ago’ but to her, that
can seem too long. We don’t have to do all the socializing
ourselves and it doesn’t have to be complicated.

There are also some great community social programs
available. Some include home visits. Sadly, they are less
familiar to elders so time spent investigating them would be
wise. There are services that can be purchased as well.
These range from home care to snow removal to meal and
cleaning services. Even if hiring a service is not entirely
needed, you will be adding another socializing experience to
their week. And high school students can earn their
community service hours by visiting elders too!

So remember, before you curl up in front of the fire with a
cup of hot chocolate with your family tonight, think of who
would appreciate a visit or a phone call from you the most.
I’ll bet an elder comes to mind.

Reprinted by permission.

Pete Aarssen is a Certified Financial Planner and Elder
Planning Counselor, currently working as a Regional Director
with Freedom 55 Financial Division. His work as the Elder's
Spokesman has made him an in-demand speaker on elder issues
in Canada.

He and his wife Shelley live on a hobby farm with their four
children outside of Sarnia, Ontario.

WHO pinpoints origin of new SARS-like virus transmitted person-to-person

There have been deaths already from the newly-discovered virus rampant, the point of origin, or the point of emergence into public knowledge of the SARS-like virus has been the work of the World Health Organization (WHO), for which all Christians shoud thank the Lord. The new virus seems to require person-to-person transmissionl. But as Kate Kelland's article below tells us, we can't be sure what is in store for in the world population as such viruses mutate and produce new strains very rapidly.

— Albert Gedraitis (yes, I'm still suffering from depression)

SunSentinel (Feb15,2k13)

New SARS-like virus shows

person-to-person transmission

by Kate KellandReuters

2:41 p.m. EST, February 13, 2013

LONDON (Reuters) - A third patient in Britain has contracted a new SARS-like virus, becoming the second confirmed British case in a week and showing the deadly infection is being spread from person to person, health officials said on Wednesday.

The latest case, in a man from the same family as another patient, brings the worldwide number of confirmed infections with the new virus - known as novel coronavirus, or NCoV - to 11.

Of those, five have died. Most of the infected lived or had recently been in the Middle East. Three have been diagnosed in Britain.

NCoV was identified when the World Health Organisation (WHO) issued an international alert in September 2012 saying a virus previously unknown in humans had infected a Qatari man who had recently been in Saudi Arabia.

The virus belongs to the same family as SARS, or Severe Acute Respiratory Syndrome - a coronavirus that emerged in China in 2002 and killed about a tenth of the 8,000 people it infected worldwide. Symptoms common to both viruses include severe respiratory illness, fever, coughing and breathing difficulties.

Britain's Health Protection Agency (HPA) said the latest patient, who is a UK resident and does not have any recent travel history, is in intensive care at a hospital in central England.

"Confirmed novel coronavirus infection in a person without travel history to the Middle East suggests that person-to-person transmission has occurred, and that it occurred in the UK," said John Watson, the HPA's head of respiratory diseases.
He said the new case was a family member in close contact with another British case confirmed on Monday and who may have been at greater risk because of underlying health conditions.

The WHO said although this latest case shows evidence of person-to-person transmission, it still believes "the risk of sustained person-to-person transmission appears to be very low".

RISK VERY LOW, BUT VIRUSES CAN MUTATE

Coronaviruses are typically spread like other respiratory infections such as flu, travelling in airborne droplets when an infected person coughs or sneezes.

Yet since NCoV was identified in September, evidence of person-to-person transmission has been limited.

Watson said the fact it probably had taken place in the latest two cases in Britain gave no reason for increased alarm.

"If novel coronavirus were more infectious, we would have expected to have seen a larger number of cases than we have seen since the first case was reported three months ago.

Tom Wilkinson, a senior lecturer in respiratory medicine at Britain's University of Southampton, said that if NCoV turned out to be like the previous SARS outbreak, it may prove quite slow to spread from one human to another.

"But it's early days to make any definite statements because viruses can change and mutate very rapidly, so what is right today may be wrong tomorrow," he told Reuters.

Based on the current situation, the WHO said all member states should continue surveillance for severe acute respiratory infections and investigate any unusual patterns.

"Testing for the new coronavirus should be considered in patients with unexplained pneumonias, or in patients with unexplained severe, progressive or complicated respiratory illness not responding to treatment," it said in a statement.

The WHO said on Monday that the confirmation of a new British case did not alter its risk assessment but "does indicate that the virus is persistent".

The British patient confirmed on Monday had recently travelled to Saudi Arabia and Pakistan, and is in intensive care in a separate British hospital, the HPA said.

Among the 11 laboratory confirmed cases to date, five are in Saudi Arabia, with three deaths; two are in Jordan, where both patients died; three are in Britain, where all three are receiving treatment; and one was in Germany in a patient from Qatar who had since been discharged from medical care.

The WHO said at this stage there is no need for travel or trade restrictions, or for special screening at border points.

(Reporting by Kate Kelland; Editing by Michael Roddy)