Health Information Technology and the Stimulus Package: Information and Changes for the Public and Employment Opportunities

November 16, 2009 by

Health information technology (HIT) is a broad term used to describe the digital storage, management, and secure exchange of health information between patients, providers, government, and insurers.  The information being exchange primarily refers to but is not limited to Electronic Health Records (EHRs are sometimes called electronic medical records (EMRs)).

Earlier this year, Obama’s American Recovery and Reinvestment Act of 2009 (the Stimulus Bill) was signed into law.  One part of the Stimulus Bill; the Health Information Technology for Economic and Clinical Health (HITECH) Act, aims to increase the use of an EHR by doctors and hospitals by:

  • “Requiring the government to take a leadership role to develop standards by 2010 that allow for the nationwide electronic exchange and use of health information to improve quality and coordination of care.”
  • “Investing $20 billion in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health information.”
  • “Saving the government $10 billion, and generating additional savings throughout the health sector, through improvements in the quality of care and care coordination, and reductions in medical errors and duplicative care.”
  • “Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT.”

Information and Changes for the Public:
Health information technology and electronic health records will not only improve patient care but also change the way we experience health care.   Even the best doctors can make mistakes or unintentionally overlook important details; an EHR will reduce the risk of these errors.   EHRs negate mistakes made due to sloppy handwritten notes.  They have automatic drug-drug/ drug-food interaction and allergy checks, and since they are online, standard drug dosage information and educational patient information can also be accessed.  Built- in alerts remind doctors of preventive care timelines, and can track referrals and test results.

Another major advantage of EHRs is they are maintained digitally and once they progress to their full potential, they can be accessed from anywhere.  Because it is simple to back-up this data to another location, EHRs also guarantee information will never be lost or damaged as a result of a natural disaster.  In the event of an emergency hospital visit or sickness while away from home, a doctor will immediately be able to pull up a patient’s chart and access information potentially crucial in diagnosing and treatment.  Referral doctors will be able to see any treatment a patient is undergoing by other doctors and make decisions that will not interfere with that treatment.

Though there are many benefits, HIT is not without its drawbacks.  Advocacy groups like the ACLU are wary of HIT and question how secure confidential medical records will really be if they are kept digitally online.  The potential for online medical records to be hacked is real and very serious; electronic databases and servers regularly experience hack attempts and an EHR would be no different. 

It is easy to placate the fear of EHRs being hacked and find comfort in the idea that “if someone really wanted my medical file they could just as easily break into my doctor’s office.”  This leads to the conclusion that “nobody would break into my doctor’s office to steal my records, because I am simply not that important.”  However, hacking into an EHR system is not the same as breaking into your doctors.  The threat of your EHR being attacked is not only about your personal health information; hacking into an EHR means gaining access to everyone’s valuable health information.  Hackers could sell the information found in the nation’s family histories, mental health history, test results, current medication, etc… or use it to bribe and blackmail people in countless ways for countless amounts of money.  Even worse, they could change the EHR causing unimaginable damage.

However, the benefits of an EHR far surpass the risks.  The government is working hard to minimize the threat of hacking.  Part of the HITECH is to strengthen “Federal privacy and security law to protect identifiable health information for misuse as the health care sector increases use of Health IT.”

Information and Changes for Employment:
Employment for medical records and health information technicians is very good and is expected to grow faster than the average professional field.  The projected employment for 2016 is 200,000.  That is 30,000 more than 2006 or an 18% increase.  Physicians’ offices, home health care services, outpatient care centers, and nursing and residential care facilities will have the most job growth and creation of new jobs.  Job growth in hospitals will not be as great but new jobs will still be created.

The growth of HIT and increased use of EHR will benefit everyone and is not something to be scared of.

Questions: Does anyone work in a facility that has already implemented an EHR?  Have you experienced or do you foresee any other problems or risks with an EHR other than hacking?

About the Author: Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearManagementMatters.com blog. 

References:
Bureau of Labor Statistics.  Occupational Outlook Handbook, 2008-2009 Edition.  Medical Records and Health Information Technicians. http://www.bls.gov/oco/ocoS103.htm

Title IV- Health Information Technology for Economic and Clinical Health Act.  January 16, 2009.  http://waysandmeans.house.gov/media/pdf/110/hit2.pdf

Why Consumers Need to Demand More From Drug Companies

November 9, 2009 by

A recent article in the New England Journal of Medicine, Lost in Transmission- FDA Drug Information That Never Reaches Clinicians reported that key information is missing from prescription drug labels.  Authors Dr. Lisa M. Schwartz and Dr. Steven Woloshin wrote, “Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.”  They go on to explain, “FDA approval does not mean that a drug works well; it means only that the agency deemed its benefits to outweigh its harms” and “drug labels are written by drug companies, then negotiated and approved by the FDA.” GetAttachment2

Schwartz and Woloshin profile three drugs, Zometa, Lunesta, and Rozerem as examples of how drug labels are missing information.  All three drug labels were indeed missing information.  In their review of Lunesta and Rozerem however something stands out, both Lunesta and Rozerem had intense direct- to- consumer advertising campaigns.  Lunesta is reported have spent more than $750,000 a day in its 2007 advertising campaign and to have sales reaching almost $800 million last year.  Rozerem is described as being “aggressively promoted to consumers.”  This information could easily be omitted from the article without detracting from the issue of drug information not reaching clinicians; the inclusion of this information is interesting.

In 1997 the FDA issued new regulations governing television advertising of prescription drugs; following this change direct- to- consumer drug advertising soared.  Prescription drugs became commercialized; direct- to- consumer advertising repackaged drugs into a shiny product to be sold to the public.  In this light, is it surprising that drug companies would over exaggerate the benefits of their drug and down play the risks?   The purpose of advertising is to make consumers think they need a product and make them want to buy it; drug companies are no different.  Consumers have learned to be skeptical of the dubious claims made by advertisements but direct- to- consumer drug advertising is new.  Consumers have more faith in the claims made by drug companies because the idea that drug companies might manipulate information at the risk of the consumer is so unsettling.

By including information on the direct- to- consumer advertising campaigns of Lunesta and Rozerem, Schwartz and Woloshim provide further insight into the motivations (money) behind excluding certain information from drug labels.  It also highlights how for years the public has accepted and believed the claims of drug companies without question despite numerous incidents of drug companies being exposed as less than forthright.  You can be angry with the drug companies for omitting information or mad at the FDA for not making it easier to access the information.  But isn’t it time we as consumers start to demand more from drug companies?

Questions: Do you agree with the above statement that as consumers, it is time to start demanding more from drug companies?  Have you experienced any type of negative side effects to your medication that was not listed on the label?

About the Author:  Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearNursingMatters.com blog. 

References:

Lost in Transmission- FDA Drug Information That Never Reaches Clinicians
http://healthcarereform.nejm.org/?p=2126&query=home

Milwaukee Area Health Care Costs Remain Higher than Midwest Average

November 5, 2009 by

According to a study released on Tuesday, healthcare costs in southeastern Wisconsin are declining greatly.  While they are still above the Midwest average, the most recent study commissioned by the Greater Milwaukee Business Foundation on Health Inc., shows a great improvement.  In 2003, the area’s costs were 39% above the Midwest average and in 2000 they were 55% higher.  Currently, they are only 9% above the Midwest average. health_costs

“This is a vast improvement,” said Ron Dix, the foundation’s executive director.

Gains in efficiency of the region’s health care systems played a huge contributing factor to the improvement. 

Bruce Kruger, executive vice president of the Medical Society of Milwaukee County, says “What’s occurring in Milwaukee is physicians and hospitals are doing a better job of all working under one payment system and offering more integrated care”. 

“As well, members have been given more financial responsibility while employers generally have made their plans ‘less rich’”, says Dianne Kiehl, executive director of the Business Health Care Group, an employer coalition created to help bring health care costs in southeastern Wisconsin in line with other cities in the Midwest.   

While changes are trying to be made, payments to physicians are still 24% higher than the Midwest average. 

There are currently larger physician practices in Milwaukee compared to other areas of the Midwest, says Kiehl.  Compared to if there were many smaller practices, larger physician practices make it more difficult to negotiate rates.    

The Wisconsin Health Information Data Mart has information provided by all the large health plan administrators that will help drill down into where the highest costs are. 

The Greater Milwaukee Business Foundation on Health is planning to commission another similar study to analyze 2009 health care costs.  It hopes to make the results available by early 2011, Dix said.   

To read the full article visit http://www.jsonline.com/business/68879872.html 

Questions: Have you experienced high health care costs in the Milwaukee area?  Do you think the employers should continue to make their plans “less rich”?

About the Author: Joan Speelich is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearNursingMatters.com blog. 

HIPAA and Its Implications

November 2, 2009 by

From its birth in the U.S. Congress in 1996, HIPAA has played both normative and authoritative roles with respect to patient privacy as well as health insurance security.  The Health Insurance Portability and Accountability Act (HIPAA) is composed of two separate Titles, each pertaining to issues of health insurance proteHIPAAction for employees and their families during a change or loss of occupation, and medical record privacy.  This article will consider Title II of the Act and some of the ways in which it affects both health care workers and patients.

Title II, Administrative Simplification (AS) provisions, calls for and prescribes the establishment of nationally cohesive standards for all health care transactions, or rather, the use and dissemination of health care information.  Its primary intention is to help protect and retain the privacy of such health care information.  (I.e.: medical records, payment history, etc.)  The AS is comprised of five sets of rules, two of which are relevant to our purposes.  The Privacy Rule pertains to both paper and electronic health care files, and prescribes regulatory measures for both the use and disclosure of protected health information (PHI), being “any information held be a covered entity which concerns health status, providers of health care, or payment for health care that can be linked to an individual”.  This particular rule also requires the training of all individuals working within a medical establishment with regard to the proper procedures concerning both PHI and HIPAA.

Another relevant aspect of HIPAA, with respect to privacy, is a subsection of the Security Rule, a rule that is concerned only with electronic data, known as the Physical Safeguards. This facet of the Act itself attends to the control of physical access in order to protect against any inappropriate entrance into classified data.

HIPAA violations are far from uncommon.  Many are reported, but few are actually prosecuted.  This was not the case, however, in a recent incident involving a nurse in a midsize regional medical establishment.  This individual, Ms. A (whose actual name shall not be disclosed), had been employed by her respective clinic for 5 years and, as of late, was married to a man who had been involved in a car accident for which he was being sued.  She came upon the file of her husband’s plaintiff at her office during the course of the lawsuit, took some notes that had been kept in the plaintiff’s medical file, and brought them home to her husband.  In turn, Mr. A contacted the plaintiff urging him to drop the lawsuit given certain facts regarding what had surfaced in his medical record.  The plaintiff immediately contacted the clinic as well as his attorney.  Ms. A was subsequently and instantaneously fired from her job.  The couple were indicted a month later and charged with violating HIPAA, with “conspiracy to wrongfully disclose individual health information for personal gain with maliciously harmful intent in a personal dispute”, and with witness tampering (which was charged to her husband exclusively).  The charge against Mr. A was dropped after negotiations.  However, Ms. A still faces up to 10 years in prison and up to $250,000 in fines.  Not only this, but the nursing board in her respective state is attempting to have her nursing license revoked.  For the full story, visit http://www.renalandurologynews.com/Staff-Nurse-Faces-Jail-Time-for-HIPAA-Violations/article/119854/

This case is a blatant and highly perceptible situation in which a health care employee violated the boundaries of normative ethical privacy practices in the pursuit of personal gain.  However, no malicious intent need be present in order to carry out such violations.

Though HIPAA has undoubtedly protected innumerable individuals’ health care privacy, it has also raised certain complications as well as costs.  Training with respect to HIPAA has proved to be insufficient and toilsome as a staggering majority of health care workers report being uncertain of its scope and needless to say, its more specific mandates.  Not only this, but costs for medical institutions have significantly increased in tandem with the increase in paperwork required by the Act.  Due to the deducible detriments that have, and may very well continue to occur as a result of such confusion and costs, it is imperative that these matters are resolved by both legislators and by those who manage health care institutions.  

Questions: Do you think Mrs. A and Mr. A faced a fair punishment?  Should Ms. A be subject to high fines and 10 years in prison for her actions?

About the Author: Patricia Heise is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearNursingMatters.com blog. 

References:

“Staff Nurse Faces Jail Time for HIPAA Violations.” Ann W. Latner, JD. October 1, 2008. http://www.renalandurologynews.com/Staff-Nurse-Faces-Jail-Time-for-HIPAA-Violations/article/119854/

“Health Insurance Portability and Accountability Act of 1996.” 104th Congress. August 21, 1996. http://aspe.hhs.gov/admnsimp/pl104191.htm

“Health Insurance Portability and Accountability Act.” http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act

Experiences with Health Care in South Korea

October 26, 2009 by

 One of our writers for Clear Medical Solutions is currently residing in Seoul, South Korea and wanted to share her experiences with the health care system.  Below is an interesting article on her experience and point of view of the South Korean health care system and how it differs from health care in the U.S.

 I teach English in Korea and have lived here for little over a year.  During my stay, I have had several encounters and experiences with the health care system.  Korea has a National Health Insurance Corporation (NHIC), which guarantees health insurance for all Korean Citizens.  Foreigners are also covered by the National Health Insurance (NHI) provided they meet the necessary requirements.  My status as a registered, employed alien, with a proper visa (E2 for me) grants me access to the same NHI benefits as those for Korean nationals.

I am by no means an expert on the NHI; most of my knowledge about the NHI and health care in Korea comes from experience.  However, I do know the basics of how it works, the benefits, and what is coverP1030335ed.  Only properly documented and employed foreigners are eligible for NHI.  A monthly contribution is deducted from each pay check.  The contribution is determined by the monthly wage multiplied by the contribution rate (currently 5.08%).  The employee pays half of the contribution and the employer is responsible for the other half. 

The NHI has a co-pay system; patients pay 10- 20% of the total cost for inpatient care. Outpatient co-pay varies between 30- 50%.  General hospitals require 50% co-pay, while hospitals require 40%.  The co- pay for clinics and pharmacies is 30%.   There is mandatory minimum payment of 3,000 Won for visits when the charges do not exceed 15,000W. 

Currently 1 USD equals about 1,164W or .85 USD equals about 1,000W.  It may be easier to think 1 USD equals 1,000W, since I will be quoting all prices in Won; just remember the actual cost in U.S. dollars will be slightly less.

In my experience, the quality of health care in Korea is equal to the U.S.  The major difference is NHI makes the healthcare vastly more affordable and accessible.  The costs for doctor visits and prescriptions are literally pocket change.  Appointments are unnecessary for small clinics.  Hospitals and dental offices usually require (or strongly recommend) making an appointment, but there is rarely more than a two day wait for an appointment.

Recently, I severely burned my feet in a few places.  I tried treating them myself at first but was unsuccessful.  On my way home one night, I sought the advice of a pharmacist.  I showed the pharmacist my burned feet and he sold me a box of Band-Aids and a tube of Silmazin Cream (1% silver sulfadiazine cream; the Korean equivalent to Silvadene or Flamazine).  The total cost of the cream and Band- Aids came out to be around 6,000W.  The next morning I went downstairs to my regular pharmacist and bought gauze and medical tape; 3,000W.  A few hours later, I noticed one of the burns was developing a red circle around it, was warm to the touch, and was increasingly uncomfortable.  I headed back downstairs to the pharmacist hoping she could help me and she sent me to the doctor on the second floor.  The doctor examined the burns, cleaned them, put an ointment on them, dressed them and wrote me a prescription for antibiotics; 4,000W.  Back downstairs at the pharmacy, I filled the prescription, a 2-week course of antibiotics; 7,000W.  The total expenditure for treating my 2nd degree burns was 20,000W; I did not have to make any appointments nor sit idly in the waiting room of a doctor’s office. 

All foreign teachers must undergo a yearly physical.  These are usually performed at bigger hospitals opposed to clinics.  The physical includes but is not limited to a chest x-ray, vision and hearing test, urine test, CBC, and HIV/ AIDS STD test.  You change into a hospital gown/top and you are pushed from one room to the next for each test to be performed. The most jarring aspect of the physical for me was the urine test.  The nurse handed me a Dixie cup, which I thanked her for and used to get a cup of water before proceeding with the test.  As I turned back from the water cooler and saw her face, I realized the Dixie cup was meant to collect my urine, not for me to drink out of.  I do not think it matters how many times you do it, walking out of a bathroom holding a Dixie cup of your own urine and placing it on a tray next to other cups urine always feels wrong.  Dixie cups aside, the physicals are easy to get and it usually does not take more than 30 min from when you walk in the door to when you walk out.  I paid 60,000W for my physical this year, but the cost can vary from 55,000- 70,000W depending on where you go.

Dental work also costs much less in Korea than in the U.S.  Friends of mine have had root canals, cavities filled, and crowns made (all things covered by NHI);they all rave about the price and how the quality of care was the same (some said better) as what they were used to back home.  I have not had dental work of that nature done.  However, I am currently undergoing Invisalign treatment for cosmetic purposes, which is not covered by NHI.  Even without the benefit of NHI, I am saving a great deal of money by having it done here rather than in the U.S.   Invisalign performed in the U.S. by an American doctor costs on average $5,000.   My Korean dentist received her degree from Tufts University, is an ADA member and is licensed to practice in several East coast states. I am paying 3,500,000W for my treatment (note: at the time of payment the exchange rate was different so 3,500,000W was about $2,800USD).   And my experience with Invisalign in Korea far surpasses the one I had with braces in the U.S.

The health care system in Korea also has some differences which are cultural.  Confidentiality, which is paramount and a cornerstone in health care in the U.S. is pretty much non-existent here.  I read warnings about this before I came here so I was prepared for it to be a little lax, but I was beyond shocked when my co-teacher showed the parking attendant the results of my physical in order to get her parking validated.  When I recovered from my shock and asked her about it, she did not see anything wrong, strange, or inappropriate with sharing the test results with a stranger whose job it was to monitor a parking lot.  As it turns out, it is not uncommon for doctors or nurses to discuss one patient in front of other patients or for the pharmacist to talk to other people about what medication you are taking.

Koreans typically do not play an active role in their health care.  For the most part, they believe in their doctors, trust them completely and never question them.  As a result they are often less informed about their treatment.  Experience has taught me not to question a Korean on the specifics of any treatment they are receiving because the answers alternate between “Because the doctor told me to” or “I don’t know.” 

I on the other hand like to know about my treatment.  I want to know what’s wrong with me.  I want to know what medication I am being given and why and I want to know the possible side-effects of this medication.  All this proved to be too much for one doctor.  My questioning of him during the examination and then disagreeing with his initial diagnosis that I had an STD (an unfortunate assumption sometimes made about foreigners, which is why a test is included in our physical) did not go over well.  I think I pushed him too far when I asked him for a translated version of the prescription he was writing so I could know what I was taking (or could at least Google it).  He was taken back by this request and stunned for a moment before he ordered one of his nurses to do it and shut the door on me.  The other doctor I have seen did not have a problem with this request and in addition to writing the English name of the drug he also wrote its purpose.

The physical manner in which prescriptions are filled is another difference between health care in Korea and the U.S.  Instead of the nice little orange bottles, clearly labeled with a patients name, drug dosage, and instructions; prescriptions in Korea come in rows of sealed little bags.  Each bag represents one dose.  P1030293When I filled my prescription for two weeks of antibiotics, the pharmacist handed me 14 little rows with three bags to each row (take 3 times a day for 2 weeks).  My qualm with the bag system is the loss of control I feel by not being able to control my own medication and again not knowing what I am taking.  However, I see how this system might have its merits for older patients taking multiple pills a day and how it could help prevent them from missing a dose or taking the wrong medication.

Korean pharmacies bare little resemblance to the big corporate owned pharmacies like Walgreens and CVS found the in the U.S.  The wide florescent lit aisles with rows upon rows of cold, flu, headache, stomachache, heartburn, etc., medicine are replaced with surprisingly small shops, stocked floor to ceiling with foreign medication, most of it behind a counter and controlled by the pharmacist.  P1030341When you have a cold (or any other ailment) in Korea you go talk to the pharmacist and s/he supplies you with the proper medication (in baggies) based on your symptoms; opposed to going to the drugstore in the U.S. and matching your symptoms to a box of cold medication.  I prefer the U.S. system and so do most foreign teachers, which is why there is a cabinet stocked full of Advil, DayQuil, NyQuil, Imodium AD, etc., in most of our apartments.  The benefit of the Korean system is that more drugs are available over the counter than in the U.S.  The Silmazin I bought for my burns would have required a prescription in the U.S.  More significantly, birth control does not require a doctor’s prescription and can be obtained from a pharmacist.

Health care in Korea has its pros and cons; it has been an adventure for me to experience and has given me numerous stories to tell.  In the end, what has surprised me the most about health care in Korea is how even as a foreigner who does not speak the language; I have never had a problem accessing the health care.  Come January 1, 2010 I will no longer be covered under my mother’s health insurance (which was very good insurance).  With that date looming I have actually started to think about health insurance and health care for the first time in my life.  I know the high quality health care the U.S. is capable of providing because I am used to receiving it; however, as of January 1st I am not sure how to access that care.  I am dismayed by this fact; the fact that accessing healthcare in a foreign country where I am temporarily residing may be easier than accessing healthcare in my home county where I am a citizen. 

Questions: Based on the above story, how do you feel about the health care system offered in South Korea? Patient confidentiality is a huge focus point for health care in the U.S.; would you be willing to give up patient confidentiality for more available and affordable health care?

About the Author: Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearNursingMatters.com blog. 

References:

NHIC- National Health Insurance Corporation

http://www.nhic.or.kr/eng/

 

Invisalign Payment Options and Treatment Costs http://www.invisalign.com/WillFit/Pages/PaymentOptions.aspx

Some Alternative Ideas During Breast Cancer Awareness Month

October 17, 2009 by

For the last 25 years, Breast Cancer Awareness Month has been an international campaign aimed at sharing information about the disease as well as raising funds in order to find better treatment and hopefully a cure.  It appears as though this effort is finally beginning to prove successful, as evidenced by a plateau in incidence rates that has now occurimagesred after decades of steady increases.  

In what promises to be a turning point in the battle against Breast Cancer, new cases of Breast Cancer actually experienced a decline from 1999 to 2005.   This drop in new cases has led to quite a bit of speculation, and some have even gone so far to say that this drop may be due to a sudden accompanying drop in the use of mammography or post-menopausal hormone replacement therapy.  This idea (and other similar ideas), if proven true, would fly in the face of conventional cancer treatment, and is worthy of discussion. 

In one such case, a Norwegian study that appeared in the Journal of American Medical Association’s Archives of Internal Medicine in 2008 revealed that there was a sudden 22% increase in breast cancer occurrences in women who began regularly receiving mammography screening (i.e. every two years).  Though there are a number of possible reasons for this increase (such as radiation and trauma to breast tissue), it seems to be the case that the increase in cases is not, at least purely, a result of heightened awareness linked to more frequent testing.    

Some researchers speculate that the procedures that follow positive mammographic results may actually be the culprits in the progression of cancer.  Typically, after one becomes aware of a cancerous growth in one’s body, discovering whether or not the growth is malignant is the subsequent step.  However, the way some practitioners go about this task has become the target of new research to learn more about the progression of the relevant cancerous activity.  

Traditionally, biopsy is the main method utilized in discovering the nature of the cancer.  This procedure is one in which a sample is removed from the growth for the purpose of observing its behavior on a cellular level.  Though the biopsy does achieve its objective, some researchers wonder if it may lead to a greater problem.  

When a person is experiencing a cancerous growth within their body, sometimes the body itself responds in such a way as to create a barrier around the growth in order to contain it.  When this barrier is broken, particularly in the case of biopsy, metastasis (the spread of cancer) may occur more rapidly than it would otherwise.

One alternative form of screening that does not involve radiation is known as thermography.  This method utilizes a medical screening device that emits infrared detectors, which produces little to no harm to the bodily tissue.  Obviously much more research is needed on the subject, and is just one more reason why we need to raise more money for research.  

In addition to alternative treatments out there, there are also some alternative prevention ideas out there as well.  It appears that some in the community believe that vitamin D may be a tremendously effective route towards the avoidance of developing a variety of cancers.  

When the body produces vitamin D, organs such as the kidneys and liver activate a hormone.  This hormone causes a phenomenon called cellular differentiation, which is an effect that in many ways seems opposite to that of cancer.  In fact, human cancer cells have been shown to have specific receptor sites for vitamin D.  As exhibited in lab animals, vitamin D3 also inhibits a process known as angiogenesis, or the growth of new blood vessels that permit the spread of cancer.

In conclusion, we have a long way to go towards minimizing the effect of Breast Cancer on our loved ones, and it is always helpful to have an understanding of varying ideas on treatment and prevention.  This month, donate money to research and continue to urge your loved ones to be aware of their bodies and the very real potential for Breast Cancer.  Together we can help make a difference.

(Clear Medical Solutions and Clear Medical Agency do not actively engage in cancer research and this article is not a position paper supporting any particular school of thought on treatment or prevention of Breast Cancer.  This article is for information purposes only and is only meant to stimulate discussion and awareness about this very serious topic.  We are thankful for all the men and woman that work day and night to make a difference in this fight and we believe that preventing the deaths of thousands of loved ones around the world is a noble cause worth investing in.  We support all research and ideas that may lead to a safer world where the fear of Breast Cancer can someday be history.)

Question: What do you think about the Norwegian study done in 2008?

About the Author: Ashley Montore is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearManagementMatters.com blog.            

References:

“Breast Cancer Rates Soar after Mammograms and Some Cancers May Heal Naturally.” Sherry Baker. November 24, 2008. http://www.naturalnews.com/024901.html

“The Risks Associated with Biopsies.” Jo Hartley. December 24, 2008. http://naturalnews.com/025159_cancer_biopsy_Prostate.html

“Vitamin D is Nutritional Key for Prevention of Breast Cancer.” Mike Adams. October 13, 2009. http://www.naturalnews.com/027230_cancer_Vitamin_D_brst.html

(Clear Medical Solutions and Clear Medical Agency do not actively engage in cancer research and this article is not a position paper supporting any particular school of thought on treatment or prevention of Breast Cancer.  This article is for information purposes only and is only meant to stimulate discussion and awareness about this very serious topic.  We are thankful for all the men and woman that work day and night to make a difference in this fight and we believe that preventing the deaths of thousands of loved ones around the world is a noble cause worth investing in.  We support all research and ideas that may lead to a safer world where the fear of Breast Cancer can someday be history.)

The Fate of Medical Transcriptionists and the Advancements of Voice Recognition Technology

September 29, 2009 by

GetAttachmentMedical transcription is a lesser-known profession to the general public in spite of the fact that medical transcriptionists (MTs) are a part of everyone’s health care.  Medical transcriptionists transcribe the dictated recordings made by doctors or health care professionals into reports, correspondence, and other administrative documents.  An example, familiar to anyone who has watched one of the highly popular crime dramas on television is when a medical examiner is seen saying the findings of an autopsy out loud; it is a MT who turns that recording into a written report.  In addition to autopsy reports, MTs are also responsible for referral letters, discharge summaries, diagnostic imaging studies, medical histories, physical examination reports, operative reports, and consultation reports.  The completed transcript is returned to the professional who dictated it for review, signature, and movement into the patients file.

The future and security of MT’s jobs has begun to be questioned as voice recognition (VR) technology becomes increasingly refined.  VR converts spoken words into text, potentially eliminating the need for MTs.  Proponents for VR advertise how VR will save medical professionals thousands of dollars over employing MTs.  However, the reality is VR is nowhere near refined enough to replace MTs. 

VR technology would need to be able to “understand” different accents, separate background noise from what is being dictated, and convert any abbreviations used into their full form.  In addition, context plays a large role in understanding spoken language.  VR needs to “understand” context to differentiate between: urine vs. you’re in, cauterize vs. caught her eyes, align vs. a line, dilate vs. die late, and so on before it can replace MTs.

Currently, VR for the purpose of medical transcription is being used in two ways, front-end VR and back-end or deferred VR.  Front-end VR creates a report that rarely goes through an MT but is more time consuming for the medical professional.  Medical professionals using front-end VR dictate into a recognition system and the words are displayed on a monitor as they are spoken; the dictator is responsible for catching mistakes, editing, and completing the document for sign off.  The question for professionals using front-end VR is; is editing reports a better use of their time than seeing additional patients?

Back-end VR is when a recording of what is being dictated is played and a draft document is created.  Both the draft document and voice recording are sent to an MT who listens to the recording, edits the draft, and finalizes the report for sign off.  Back-end VR is the most common form of VR being used in medical transcription.  Back-end VR has made medical transcription more efficient and helps MTs generate more reports in less time.

VR will not make MTs obsolete. The duties and responsibilities of MTs may change due to advancements in VR technology but the day when VR completely eliminates the need for MTs is not in the foreseeable future.  According to the Bureau of Labor Statistics, the outlook for job opportunities for MTs is good. The aging baby boomer population will increase the demand for MTs.  Employment opportunities for MTs are projected to grow faster than the average.  A 14 percent growth is expected between 2006- 2016; in 2006 98,000 MTs were employed, by 2016 112,000 MTs are expected to be employed.  MTs jobs are secure and they should view VR as a tool to aid them in their job, not as threat.

About the Author: Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearNursingMatters.com blog. 

References:

Bureau of Labor Statistics “Occupational Outlook Handbook, 2008-09 Edition.”

http://www.bls.gov/oco/ocos271.htm

 MedGenMed “Voice Recognition and Medical Transcription” August 27, 2004.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1435648

Fight or Flight, No Longer a Viable Option: How to Manage Stress in the Modern World

September 21, 2009 by

 Fight or flight is our bodies’ primitive and automatic response to stress.  In prehistoric times this response essentially saved mankind from extinction.  Imagine the primitive man walking back to his cave after a hard day of hunting and foraging when all of a sudden he is confronted by a saber- toothed tiger.  His stress level immediately rises; he realizes the only way to relieve his stress is to remove the stressor.  He has two options run (flight) or fight the beast.  Either way, the stressor will be removed and he can continue on his way to his cave; hopefully he is victorious in his fight but even if the saber- toothed tiger wins, the caveman’s stress will be relieved.Stress-ZebraStripes

 Unfortunately primitive man’s way of managing his stress is no longer applicable in the modern world.  You can not punch your boss in the face nor can you run out of a board meeting in tears and hide under your covers, at least not if you want to keep your job.  Today it is much harder, in some cases near impossible, to escape the stressors in your life.  Therefore, it is important to find methods of managing and coping with stress.

A simple search online produces many methods for managing or relieving stress.   Some of these methods are not practical for all people, such as; taking a break to nap, enrolling in an online course, going on vacation, and practicing yoga or meditation for one to two hours a day.  However, there are ways to relieve stress that anyone can do:

1) Learn to Ask for Help: Asking for help is not a weakness, but a strength.  It is a sign of someone who is aware of his or her weaknesses and wants to improve, it promotes better communication in the workplace, and it demonstrates a willingness to learn.

2) Learn to Say NO: Saying no to colleagues or friends may be difficult but it is essential to minimizing stress.  If you are already overwhelmed, adding more to your workload will only increase stress.  You should also consider whether or not the person asking for a favor would reciprocate a favor when you request one.

3) Practice Breathing Exercises: Breathing exercises can help clam you down and focus clearly at the task on hand.  One method is to close your eyes, inhale through your nose for the count of three, hold for 1, and exhale through your mouth for the count of five.  The second one simply increases the time, inhale for the count of five, hold for one, and exhale for eight.  Repeat this exercise a few times or until you feel your stress decreasing.  It can be surprising how much this simple exercise can help.

4) Exercise: If you have time, exercising is a great way to relieve and manage stress.  Exercise has been proven to improve ones mood.  It also provides a distraction from problems and is an outlet for frustration.

5) Create a Schedule: Creating and maintaining a schedule helps keep you on track and focused.  A schedule can aid you in seeing what you have time for and what you don’t have time for.  It prevents you from over booking activities and making commitments you cannot keep.

6) Me Time: “Me Time” is time devoted exclusively to you and is vital in managing stress.  “Me Time” provides an escape to do anything you want.  During this time you no longer have to worry about the stress of work, family, financial problems, etc…  You are freed from the stressors in your life.

 Managing stress can be difficult and affect the quality of you life, which why it is crucial to find a way that best suits you.  Proper management of stress leads to a happier and more fulfilling life. 

Do you have any stress management techniques to add? Have you used any of the aforementioned techniques before and have they helped?

About The Author:

Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the ClearHIMMatters.com blog. 

Regional Health Information Organizations have a Long Ways to Go

September 1, 2009 by

In reading about Regional Health Information Organizations (RHIO), it is interesting to note how colossal and incredibly complex some possible solutions seem.  Health information exchange (HIE) is the goal of these organizations along with facilitating improvements in healthcare.  Unfortunately, many of the proposals being ping-ponged about today lose track of this goal due to financing, collaboration, and planning issues.  Currently, this movement and the technology are still largely in the visualization and troubleshooting phase.  There never has been a one-size fits all solution that could cure the health care system, and yet that is how many innovations including Electronic Medical Records, Computerized Physician Order Entry (CPOE), and RHIOs are presented.  It is important that development and application do not interfere with the health care process.  As a distant goal, HIE is an excellent idea that has the potential to facilitate a lot of positive developments, but perhaps on a smaller scale.  As a more immediate endeavor, it is presenting with mixed results and stumbling on issues like implementation, usability, and lack of collaboration.   pnetwork1m2

While each individual HIE endeavor and its successes and failures are unique, collaboration is an element that should be included in business plans more and more.  Many health care professionals continue to maintain that patients, consumers, physicians, IT professionals, and accountants should all be a part of discussion, development, and usage of RHIO and HIE.  In his article, “Health Improvement Technology,” Dennis Schmuland, M.D., writes, “The fixation of the industry and health information technology community on digitizing and exchanging health data and information has caused the industry to undervalue the breakthrough possibilities of collaboration technologies.”  Technology provides a means to achieve, but health information exchange cannot occur without participation from all parties involved.  Here in Milwaukee County, a major part of the Emergency Department Linking Project was an agreement and collaboration between the “CEOs of all the major health systems in the Milwaukee metropolitan area to commit to the project” (Hagland 1). 

Per the ED Linking Project Information Paper, “The primary goal of the ED Linking project is to provide patient health information where currently there often is none or very little available to help ED and Community Health Center clinicians in Milwaukee County provide patients quality, safe, and cost-effective health care” (Webb 1).  Initially, the project focused on sharing information on patients and visits to the emergency department.  Laboratory results, medication data, and insurance information will eventually be exchanged as well, if they are not already a part of this project.  Perhaps what hurts health information development most is extremely aggressive deadlines which make agreeable growth and collaboration between vendors, IT professionals, doctors, health care providers, and patients.  The incremental approach Milwaukee’s ED Linking project has taken allows for adjustment, adaptation, and room for growth.  According to Dr. Mark Friesse, Professor of Biomedical Informatics at Vanderbilt, “Every state is doing great things.  Everyone is teaching us a different part of the answer” (Blair 6).  In some ways, this may broaden perspectives and help piece together a model RHIO or HIE to build off.  Undoubtedly, some will chalk this up to progress being made, but real progress might more clearly be made via collaboration and real health information exchange. 

Unfortunately, there is no shortage of obstacles to tackle and issues to understand surrounding RHIO and HIE foundation.  If everyone was equally motivated, eager to learn, and up to date with the state of health care, modernization might be much to easier achieve.  Kind of like a science fair, this phase will undoubtedly have more successes and flops.  Establishing more meetings to initiate these exchanges is a good way to enable health information exchanges.  There are groups that focus solely on idea sharing, learning experiences, and problem solving dialogue for these reasons.  Listed below are some examples:

  1. North Carolina Healthcare Information and Communications Alliance Inc.   http://www.nchica.org/
  2. HIE Seamless Exchange Solutions  http://www.hielix.com/

What do you think about the progress of RHIO’s so far?  Is it beneficial for all to collaborate and work together? Please, don’t hesitate to chime in and share your thoughts. 

About The Author:

Mario Raspanti is a Staff Writer with the Clear Medical Solutions Communication Team.  His work is regularly shared on the Clear Medical Agency newsletter and the ClearManagementMatters.com blog.  

Bibliography:
Blair, Robin.  “RHIO Nation.”  Health Management Technology:  The Source for Information Systems Solutions.  February 2006.   http://www.providersedge.com/ehdocs/ehr_articles/RHIO_Nation.pdf

 Hagland, Mark.  “From Struggles to Success:  Part technology, part cooperation and part good old fashioned trial and error are what it takes to build or break a RHIO.”  Healthcare Informatics.  

http://www.healthcare-informatics.com/ME2/Sites/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=AE404FB40DFE434B91B79D9C2AD6BF50&SiteID=Main%20Si_e

 Schmuland, Dennis.  “Health Improvement Technology.”  Health Management Technology:  The Source for Information Systems Solutions.  May 2009.  http://www.healthmgttech.com/features/2009_may/0509_health.aspx

Webb, Denise.  “Emergency Department Linking Project Information Paper.”    <http://ehealthboard.dhfs.wisconsin.gov/materials/materials/EDLinkingProjectInformationPaper06102008update.pdf&gt;

Hospital Gambling on EHR

August 4, 2009 by

I caught this story on the news and was surprised at first, but then on second thought I realized it’s not that surprising given the state of our rural hospitals in many areas.  I’m sure many hospitals might have to make tough decisions just like Sac-Osage Hospital in Missouri. 

A few details about Sac-Osage Hospital:

  • 47 bed hospital
  • Spending $1 million to move to an Electronic Health Record (EHR)
  • Operating on a $370,000 deficit
  • Hoping the Obama Stimulus Package will help make this change profitable in 2011
  • E.R. and ambulance services facing closure of services depending on whether or not local voters approve property tax

Sac-Osage has an average census of 5 inpatients per day, so obviously they will have difficulty raising revenuSac-Osage Hospitale to cover this large of an expense.  However, they are looking into the future, hoping that they will meet the criteria of “meaningful use” of the EHR as stated in the Obama stimulus package, and then receive some unknown amount of the stimulus money that will help offset the costs.

Some might say it is risky, but if they don’t do it now, they will not have enough time to prepare for the stimulus package and starting 2015, healthcare providers who haven’t made the switch may face financial penalties.  Whether Sac-Osage Hospital decided to take action or continue as is, the future of their facility is unforeseeable at this time.    

If you are interested in the full story, click here: http://m.apnews.com/ap/db_16052/contentdetail.htm;jsessionid=93CF354D45905A0D57914503C657E091?full=true&contentguid=LUV8siO4&detailindex=#display

What do you think about this?

If you were a small rural hospital in the same situation, would you bite the bullet and take the chance on an EHR in hopes it will be worth it in the end, or would you continue operating the same way and plan to make the change to an EHR later on down the road when/if you can afford it?

Please, feel free to share your thoughts!


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