Tuesday, April 23, 2013

Healthcare IT Implications of Healthcare Reform

I'm regularly asked how Healthcare Reform will affect IT arranging and usage throughout the following few years.

Initially, some foundation.  The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872)  were gone to address a few issues with health awareness in the US.  We're using 17% of our Gross Domestic Product on social insurance, yet we have more awful populace wellbeing conclusions than numerous other industrialized social orders using half as much.  Healthcare expenses are climbing speedier than expansion.  We have huge variety in practice designs that is not clarified by patient co-morbidities nor supported by relative viability confirmation.  We need to extend access to wellbeing protection to 95% of the populace, bring down our using development rate, and incentivize conveyance framework change.

By what means will we do this?

Wellbeing protection change grows scope, makes gimmicks and expenses of arrangements transparent, and evacuates the boundaries to selection made by prior condition contemplations.

Installment change changes the Medicare installment frameworks from expense for-administration to Value Based Payment - paying for great conclusions instead of amount of consideration.  Pilot undertakings will test new installment routines and conveyance models.  Successful advancements will be generally executed.

We should take a gander at the installment change subtle elements that will prompt conveyance framework change.

Medicare Initiatives incorporate

*medicare imparted funds system including Accountable Care Organizations (Acos)

*national experimental run program on installment packaging

*independence at home show program

*hospital readmissions decrease program

*community-Based Care Transitions Program

*extension of Gainsharing Demonstration

Medicaid Initiatives incorporate

*health Homes for the Chronically Ill

*medicaid Community First Choice Option

*home and Community Based Services State Plan Option

*hospital Care Integration

*global Capitation Payment for Safety Net Hospitals

*pediatric Acos

I accept that Accountable Care Organizations will be the perfect spot to have a few of these developments including packaged installments, the restorative home, and an expanded concentrate on health.

The greater part of this requires imaginative IT help.

Here are my main 10 IT ramifications of medicinal services change

1.  Certified EHR engineering needs to be actualized in all practices and healing facilities which meet up to structure Accountable Care Organizations.  Ehrs are foundational to the catch of clinical and regulatory information electronically so information might be changed into data, learning and shrewdness.

2.  Health Information Exchange among the Pcps, Specialists, and Hospitals is important to facilitate mind.  Data offering will begin to the "pushed" trade of patient rundowns in 2011 and advance to in the nick of time "pulls" of information from numerous sources by 2015.

3.  Health Information Exchange to Public Health registries is important to  measure populace wellbeing over the group.

4.  Quality information warehousing of key clinical markers over the ACO is important to measure results.  2011 will be about measuring practice and healing facility level quality, 2013 will be about measuring quality all through the responsible consideration association, and 2015 will be about measuring patient-driven quality paying little mind to the site of forethought.

5.  Decision help that happens progressively is required to guarantee the right proof based forethought is conveyed to the right patient at the correct time - not excessively little or an excess of consideration, yet simply the perfect measure of consideration to keep up health.

6.  Alerts and Reminders are discriminating to raise the mind-boggling measure of information around a patient to activity that a parental figure (or the patient) can take to keep up wellbeing.

7.  Home mind is required to anticipate clinic readmissions, give mind that is predictable with patient inclination, and to enroll families as a feature of the forethought group.  Novel IT results range from associated purchaser wellbeing gadgets (circulatory strain sleeves, glucometers, scales) to remote telemetry illuminating clinicians about agreeability with medication.

8.  Online access to therapeutic records, secure correspondence with guardians and modified patient instructive materials are required to improve workflow, enhance coordination, and captivate patients.

9.  Outcomes are trying to measures and we'll require new inventive wellsprings of information, for example, a patient reports of wellbeing, activity, and side effects.

10. Income Cycle frameworks will need to be essentially altered as we move from charge for administration models to esteem based installment and gainsharing when Acos convey higher quality look after less cost.

So there you have it - find the Pcps, Specialists and Hospitals you need to structure an ACO then completely execute Ehrs, Phrs, Quality Data Warehouses, Health Information Exchange, Decision Support Systems with cautions and updates, homecare help including shopper social insurance gadget interfaces, and new income cycle frameworks.  Luckily this is decently adjusted to Meaningful Use Stages 1,2, and 3, so you'll be doing it at any rate.

Good Living Life

My daughter was admitted early decision to Tufts University, so the anxiety of the college application process is passed.  One of her essays asked her to describe the environment in which she was raised and how it influenced the person she is today. It's worth sharing her observations on what constitute living the good life:

"At this moment, from a room of windows, I can see tall pine trees framing a beautiful, soft green yard. A little vegetable garden lies to my right, with lettuce enduring the brisk autumn wind. Above it stands a lone maple gradually turning brilliant shades of fire. A heavenly light illuminates the clouds passing overhead in the vast baby blue sky. The wisteria climbs the windows to my left, waiting for a warm spring to show its beautiful lavender flowers. The wind passes through the wooden chimes hanging from our crabapple tree, initiating a clonking chorus. Bamboo lines the white rock river with a little wooden bridge. A stone bench rests near the fence, where my father sits and plays his Shakuhachi (traditional Japanese flute). Cardinals, sparrows, and grackles fly overhead, seeking food, warmth, and family. As I open a window, a rush of sweet, crisp autumn cold fills my senses, making me shiver. These wonders surrounding me in such a welcoming, beautiful, and inspiring home and community fostered an appreciation for the subtle things in life. I learned to openly embrace the world around me, understanding and loving its everlasting beauty. Nature is a teacher and a gift, one never to be overlooked. I’ve grown as a student, an observer, an appreciator, and a believer in the magic and beauty of the world."

As a parent, I want my daughter to feel good about herself.     In her essay, she highlighted the simple things that bring richness to her life  - a vegetable garden, autumn colors, and a supportive community of family and friends.

I can understand her point of view.

As I write this, I'm sitting in an old Morris chair, sipping Gyokuro green tea, breathing in wisps of smoke from Blue kungyokudo incense. Breakfast will be a bowl of steel cut oatmeal with a few drops of Vermont maple, and soy milk.  

The ability to sit quietly and think, enjoy wholesome foods, and enjoy the warmth and comfort of a small home while the weather outside is cold and blustery gives me an overwhelming sense of well being.

I hope my daughter continues to appreciate that the good life comes from the basics of food/clothing/shelter/family/self-worth.

Tufts University is a great fit for her and I'm confident the next four years will polish and amplify the foundation she's already built.    As she creates her own version of the good life, we'll always be available for advice and support, but as of next Summer, she's a fledgling, exploring the world on her own.

Monday, April 22, 2013

Health Care and Swimmer's Ear

During the warmer months of the year, the popular activity with many people is to go swimming. In addition to being a fun way to relax, you can get lots of exercise and great physical stamina from participating in this great water sport. But sometimes, you can experience problems with a common infection in the ear, especially during the summer, called Swimmer’s Ear—an inflammation, irritation, or infection of the outer ear and ear canal. The medical term for swimmer's ear is otitis externa.

Occurring commonly in the outer ear canal, which runs from your eardrum to the outside of your head, swimmer’s ear is often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth, according to the Mayo Clinic. Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer's ear by damaging the thin layer of skin lining your ear canal.

Swimmer's ear symptoms are usually mild at first, but they may get worse if your infection isn't treated or spreads, according to the Mayo Clinic, at this site: http://www.mayoclinic.com/health/swimmers-ear/DS00473 . Doctors often classify swimmer's ear according to mild, moderate, and advanced stages of progression.

1. Mild signs and symptoms:

• Itching in your ear canal
• Slight redness inside your ear
• Mild discomfort that's made worse by pulling on your outer ear (pinna, or auricle) or pushing on the little "bump" (tragus) in front of your ear
• Some drainage of clear, odorless fluid

2. Moderate progression:

• More intense itching
• Increasing pain
• More extensive redness in your ear
• Excessive fluid drainage
• Discharge of pus
• Feeling of fullness inside your ear and partial blockage of your ear canal by swelling, fluid and debris
• Decreased or muffled hearing

3. Advanced progression :

• Severe pain that may radiate to your face, neck or side of your head
• Complete blockage of your ear canal
• Redness or swelling of your outer ear
• Swelling in the lymph nodes in your neck
• Fever

According to the National Institutes for Health (NIH), ear drops containing antibiotics are usually given, usually for 10 to 14 days. If the ear canal is very swollen, a wick may be applied in the ear to allow the drops to travel to the end of the canal. Your doctor or nurse can show you how to do this. Other treatments may include:

• Antibiotics taken by mouth if you have a middle ear infection or infection that spreads beyond the ear
• Corticosteroids to reduce itching and inflammation
• Pain medication, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
• Vinegar (acetic acid) ear drops

People with chronic swimmer's ear may need long-term or repeated treatments to avoid complications. Placing something warm against the ears may reduce pain. More details can be found at this website: http://www.nlm.nih.gov/medlineplus/ency/article/000622.htm .

According to the American Academy of Otolaryngology, other factors that may contribute to swimmer’s ear include:

• Contact with excessive bacteria that may be present in hot tubs or polluted water
• Excessive cleaning of the ear canal with cotton swabs or anything else
• Contact with certain chemicals such as hair spray or hair dye (Avoid this by placing cotton balls in your ears when using these products.)
• Damage to the skin of the ear canal following water irrigation to remove wax
• A cut in the skin of the ear canal
• Other skin conditions affecting the ear canal, such as eczema or seborrhea

If left untreated, complications resulting from swimmer’s ear may include:

--Hearing loss. When the infection clears up, hearing usually returns to normal.
--Recurring ear infections (chronic otitis externa). Without treatment, infection can continue.
--Bone and cartilage damage (malignant otitis externa). Ear infections when not treated can spread to the base of your skull, brain, or cranial nerves. Diabetics and older adults are at higher risk for such dangerous complications. To evaluate you for swimmer’s ear, your doctor will look for redness and swelling in your ear canal. Your doctor also may take a sample of any abnormal fluid or discharge in your ear to test for the presence of bacteria or fungus (ear culture) if you have recurrent or severe infections. More info can be found at their site: http://www.entnet.org/HealthInformation/swimmersEar.cfm .

Swimmer’s ear is treatable. Other than being irritating and problematic in its initial stages, it can be properly diagnosed by your doctor and easily resolved. Just don’t delay taking action on any infection of any kind. Remember, your hearing is a vitally important function of life. Don’t abuse it.

Until next time.

Monday, April 15, 2013

You Wouldn't Think This Would Be So Hard

This recommendation on tamoxifen followup from the ob/gyn council confuses me. Basically it says to watch postmenopausal women on the drug carefully but to ignore premenopausal women who also take it.

Premenopausal women don't have problems with it, they say. Or they might say that endometrial overgrowth is expected and not to worry about it. Honestly, I'm not sure.

But either one of those readings doesn't bring me any comfort. I'm a premenopausal woman who had ovarian cysts--simple and complex--and an extremely thickened endometrium throughout my four years on tamoxifen.

Now, almost two years past stopping the drug a year early because of these problems, I still have them.

What does it mean? There is little to no information to help me understand this, it seems.

After burning through ob/gyns whose answer is to take hormones to regulate the cycle, I'm finally self-referring myself to my town's only gynecological oncologist to see if that doctor can shed any more light on what might be going on and what is the best course of action.

Taking hormones when my breast cancer responds to hormones is not the answer for me.

So we need another course of action, because all the research I can find says it's not a good thing to walk around with a constantly-building-up endometrium. If that doesn't indicate cancer today, it's at least a breeding ground for cancer to grow. Not to mention it has to be a sign of whacked-out hormones that I assume have to be affecting me on a daily basis in terms of mood and general functioning ability. And the fact that any period I ever do end up having is a tsunami that makes me immediately anemic.

This isn't a good way to live my life. So here you go, ob/gyns, this can happen in premenopausal women who take tamoxifen. I honestly cannot believe it is such a rare thing. But I guess if no one is watching us closely, we'll never know that. It will continue to be chalked up as "being near menopause" (all my bloodwork says I'm nowhere near that) or "a lingering effect of chemo," etc.

I'm looking for something better than that and a way to really deal with this.  

Friday, April 12, 2013

An Easy One

Have you noticed all the articles debating if you should take social security at 62 or wait until your "full retirement age?"

There are a lot of them. And the most interesting reading always comes from the reader comments that follow the article.

Folks are outspoken about taking the money the moment they can, before they die early or it all disappears because of government mismanagement.

Other folks are equally outspoken about waiting and getting an 8 percent return on their investment for each year of doing so.

Then there are those who trot out mathematical equations and probability tables to show that people might have to live to 80 to break even if they do wait over taking the money right away. And others who use the tools to show that if you've made it to 65, you'll likely live into and possibly past your 80s, so you'll want a bigger check to last the long haul.

It's clearly a big deal for a lot of people, and something more and more people are thinking about.

As someone who has had breast cancer, I feel that I get to avoid complicated analysis on this one, for which I am relieved.

Should I be lucky enough to make it to 62, I will take it the first day I can. And I'll be happy for every month's check I get to cash.

Not such a hard decision. I wish others were so easy.

Saturday, April 6, 2013

Out of the Reference Range

My oncologist's office doesn't include a reference range with bloodwork results. This means patients can see their complete blood count results but will have nothing to compare them to. If a result is flagged as high or low, there is no way to know how high or low it might be.

Useless, no?

Apparently the front office people at this office think it makes perfect sense and told me so. That's the way they do it, they said, and if I want the range, I can go over to the hospital and request it from medical records.

What? A range is not protected information. It is vital information, however. And it is information I need right alongside my bloodwork. I'm not going anywhere else for that information. It needs to come from my oncologist's office at the time I'm presented with the results.

Even doctors and nurses wouldn't know what to do without the range.

But I was laughed at for insisting that they give me the range and for asking them to pass along my suggestion that they provide this information for every patient--that bloodwork never go out without it.

After I didn't leave, they finally checked with a nurse. Apparently, nurses can print a version of the results that also lists the range. Just like I, and any other person in the world, would or should want.

What this tells me is that most oncology patients, maybe most patients, don't actually ask to see a printed copy of their blood results--or any test results. Most of us, I guess, are happy to wait until that postcard either arrives or doesn't arrive in the mail to tell us we're good enough.

Sorry folks, I'm here to tell you that doctors don't always follow up. Sometimes they forget you and your test completely. So to assume it's okay because you haven't heard is dangerous. And to think that a postcard tells the whole story is misguided as well.

I've had too many tests that matter too much to leave this in anyone else's hands but my own. I always want all the results, and I'd suggest others think about it, too.

Along those lines, I have a call in to the office manager to make sure that everyone who does take an active role in their health has the correct tools for the job.