Collaborative Family Healthcare Association

Most Adults Go Online for Health Information

By Cole Petrochko, Staff Writer, MedPage Today

Just over half of U.S. adults under 65 used the Internet to look up health information over the course of a year, according to the first National Health Interview Survey to collect data on health information technology.

Although Americans are still concerned about security of medical information, the survey showed that 5% of consumers had used e-mail to contact healthcare providers directly.

The survey of 7,192 participants measured consumers' use of health information technology. Specifically, CDC researchers asked when participants had used a computer to store, retrieve, share, or use healthcare information to make decisions and communicate, to conduct research, and to communicate with healthcare and prescription providers and engage in other forms of Internet dialog.

The study found 51% of adults 18 to 64 used the Internet to look up health information at some point over a 12-month period. Previous research had shown that over 60% of all adults in the U.S. had, at some point, used the Internet to search for health or medical information.

Not surprisingly, 18- to 49-year-olds were more likely than older adults to use health information technology.

Women were more likely than men to use the Internet for health information in all surveyed categories, including:

Chatting online about health topics (2.5% of men versus 4.1% of women)
Researching health information (43.4% versus 58%)
Communicating with healthcare providers (4.2% versus 5.6%) or scheduling an appointment (1.8% versus 3.5%) by e-mail
Refilling prescriptions online (5.3% versus 6.6%)

The survey was conducted by the CDC and the National Center for Health Statistics.

Integration and Current Healthcare Trends

How Healthcare Reform Could End the Stepchild Status of Primary and Behavioral Healthcare: A Talk with AAFP Board Chair Dr. Ted Epperly

BHC

Ted Epperly, M.D., FAAFP, a family physician in Boise, Idaho, who follows a patient-centered medical home model of care that incorporates behavioral health, is board chair of the American Academy of Family Physicians. In recent months, he has spoken with President Obama on several occasions about his concern related to the shortage in primary care and the incentives (or lack of incentives) our country offers medical students to consider primary care. He says that primary care and behavioral healthcare providers have been considered 'stepchildren' in the past, but that he’s confident healthcare reform efforts in Congress could provide some remedy.

Dr. Epperly wrote in an AAFP statement earlier this year, “If America is to right the ship of health care and turn it toward a system of higher quality, improved efficiency, better outcomes, less cost, and decreased geographic and ethnic disparity, it must increase the number of primary care physicians. We cannot meet that goal without dramatically changing the policies that affect our medical education system, graduate medical education and the incentives that draw students to careers in primary care. This decline has nothing to do with the value of primary care and everything to do with a system that claims to support primary care but fails to actually act on its pronouncements.”

Dr. Epperly speaks with BHC today about these important issues facing primary care and behavioral healthcare providers.

Continuing to Try

GOP and Democrats Agree Health Overhaul Not Dead

WSJ

WASHINGTON — Democrats and Republicans agreed on Sunday that President Barack Obama’s health overhaul wasn’t dead. They disagreed over whether that was a good thing.

Democrats portrayed the health-care effort as a valiant crusade that had suffered a setback but could return to life. “We’re still inside the five-yard line,” White House spokesman Robert Gibbs said Sunday on CNN’s “State of the Union.” “We’re one vote away in the House of Representatives from making health-care reform a reality.”

He added, “The president is ready, willing and able to sit down and listen to Republican ideas for how we improve the health-care bill.”

House Minority Leader John Boehner (R., Ohio) made the overhaul sound more like a corpse that refused to die.

“We’ve seen all week Speaker [Nancy] Pelosi, Majority Leader [Harry] Reid continuing to scheme and plot, trying to find some way to get their big-government takeover of health care enacted,” Boehner said on NBC’s “Meet the Press.” “I do think they are having problems, but I think Republicans are going to continue to be vigilant.”

Republicans insisted they want change — “No one in Washington thinks our health-care system is perfect, and certainly not Republicans,” Boehner said — while Democrats said parts of the legislation would have to be changed.

Top Ten Predictions for Healthcare IT in 2010

via Chilmark Research
by John

Source Article

Plenty of top ten predictions on any number of topics, but it is rare to find one focusing on healthcare IT, Chilmark Research’s bailiwick. And while we may be just a little late in getting this out there onto the streets, it is mid-January after all, our quick search on the net did not turn up any other posts with such a finely tuned agenda so here goes…

1) HITECH Act Suffers Birthing Pains: Despite the hard work of many to create clear guidelines (meaningful use & certification of EHRs), roll-out extension centers, and establish Health Information Exchanges (HIEs), we have only just begun. The devil is in the details (implementation/execution) and 2010 will be marked by a number of stumbles and most likely a significant amount of wasted tax dollars.

2) Hospitals and Large Practices Bite the Bullet, EMR Vendors Cheer, Small Practices Look on with Jaundiced Eye: With a clear signal from Washington on what will be required to get HITECH funding/reimbursement for EMR purchases/upgrades to meet meaningful use, hospitals and large practices will begin seriously evaluating and buying EMR solutions (HIMSS will be hopping this year). That’s the good news. Bad news, most small practices where estimates of 80% of all patient-physician interaction occur, will still be behind the eight ball on EMR adoption and struggle to meet HHS-efined time-lines for reimbursement.

3) Consolidation will Accelerate: Large HIT vendors will acquire smaller firms to either meet meaningful use guidelines (e.g. acquire PHR company to meet 2013 requirements) and move into adjacent downstream markets. Don’t be surprised if a large IT vendor from outside the industry makes a buy to move into this now lucrative market.

4) Regulatory Crackdown Increases: Not a tough prediction as the new administration has signaled that it will enforce laws on the books that the previous administration simply ignored. With more stringent HIPAA guidelines now in play expect to see some significant fines such as the one levied against CVS for $2.25M in 2009. IT security (software & services) will be another hot market in the healthcare sector in 2010.

5) Second Gen mHealth Apps Enter Market – Melding of Smartphones and Devices Remains Nascent: With literally thousands of mHealth apps now available, most of them crappy one dimensional apps, we will begin seeing more sophisticated mHealth apps enter the market. These apps will also command a price, but their value will easily justify the purchase for many consumers. In 2009 there was also a lot of buzz around the melding of med devices and smartphones, (remember the iPhone 3GS intro with J&J on stage demo’ing Lifescan). That buzz faded rapidly when FDA showed up to inquire about compliance. FDA approval requirements/process (and aforementioned strengthening of enforcement by this administration) will limit introduction and thus proliferation of new innovative devices hinged to a smartphone.

6) CMS Still Twittles its Thumbs Regarding Remote Monitoring, Payers and Large IDNs Step-up: For some ungodly reason, CMS just can’t seem to get his mind around the concept of remote monitoring/telehealth and will not open its purse to reimburse for such services. That leaves the elderly out of the equation but increasingly, large IDNs will adopt such care modalities to improve care after discharge and capitalize on payer pay for performance incentives. A much small market will be services/systems that baby boomers purchase to assist them in caring for their elderly parents.

7) Baby Boomers Struggle Caring for Their Parents – Seek Solutions: In the last week in casual conversation the topic of caring for elderly parents among my baby boomer peers has come up on several occasions. This is quickly becoming a very big problem for many of us as we struggle to insure our parents are healthy, or at least being well taken care of, while we reside in the next city, state or maybe even country. There are no easy ways that I or my peers (some of those I have spoken to are senior leaders in the HIT market) know of to address this issue. We are seeking solutions, we want system changes (e.g., proxy sign-offs, Social Security Admin releases, etc.) that will simplify our ability to care for our parents.

8.) HealthVault Continues to Put Distance Between Itself and Other Personal Health Platforms (PHP): While Dossia struggles to get its founding members to on-ramp to the Dossia platform (still only Wal-Mart today though have been told 2-3 others should go live in Q1), and Google messes around with Android and Chrome while virtually ignoring Google Health, Microsoft’s HealthVault continues to push ahead becoming the defacto PHP in the market much like Apple’s iPhone is the defacto smartphone today.

9) Telecom Companies Struggle to Define Their Role in the Healthcare Sector: Virtually all of the major telecom providers in the US have a healthcare strategy, but to date, they have little to show for it. While we expect that they will become more vocal (i.e., more press releases) these PRs will be more show than substance and telecoms will continue to flounder in this market.

10) I will “Podium” at the Northeast Spring Classic Cycling Roadrace – Tour of Battenkill: This is a real stretch goal for me for two reasons: First, I have never raced this race before and reports are, its a tough one at 62 miles, mix of paved and dirt roads with some serious climbs. Second, it has been awhile since I’ve done some serious racing – a lot of training ahead. I do have one thing going for me though, I am a “climber” and this is a climber’s race. Hmm, maybe this warrants a trip back out to San Diego for some good climbing workouts with my friend’s club, Slow Step.

Useful Twitter advice for doctors

via KevinMD.com

Original Article

Thanks to Medscape for including my take in their recent article, “Is Twitter a “must” for doctors?”

I discuss some common sense tips doctors should follow while using Twitter:

1. Patient privacy is paramount. Do not discuss individual cases or provide patient advice via Twitter.
2. Use Twitter to point your patients to trustworthy online health information sources.
3. Use Twitter as a tool to promote your practice’s brand. More and more patients are using Twitter; those who do are likely to feel positive about their physicians using it as well. More than just a fad, Pho says that Twitter is here to stay and offers tremendous potential.
4. Remind your patients using Twitter: Be careful whom you follow. Anyone can sign up for Twitter claiming to be a physician.

I cannot emphasize the first point enough. When using Twitter and Facebook (versus, say, a blog), it’s easier than ever to hit the enter key and broadcast content to the world. It’s essentially an instant message to the masses.

With that in mind, any medical professional using these sites better be more careful than ever to protect patient privacy.

Health IT Roundup: Sharing Data, Tracking Medical Errors And Revealing Costs

via Kaiser Health News

Posted: January 21, 2010

The Wall Street Journal: The Journal's Informed Patient column reports that the "non-profit Institute for Safe Medication Practices, which is certified by the federal government to collect error reports and other information about quality breaches, and the American Society of Health-System Pharmacists are launching a new National Alert Network for Serious Medication Errors." The network will spread the word of dangerous medical errors in hopes that doctors and nurses will learn from mistakes and prevent future blunders (Landro, 1/19).

Fort Collins Coloradoan: A Colorado state lawmaker is expected to introduce legislation to create "an online portal allowing Colorado residents to research the cost of specific medical procedures at hospitals statewide." The database would include information collected from insurers and hospitals, in an effort to encourage state residents to seek greater value in health care services (Magill, 1/19).

ComputerWorld/San Francisco Chronicle: "The e-health revolution got a shot in the arm earlier this month when health care network giant Kaiser Permanente and the U.S. Department of Veterans Affairs declared a months-long pilot program of sharing patient electronic health records (EHR) a success. … Such EHR efforts are likely to become far more widespread as the $17 billion designated for incentive payments for e-health record projects in the American Recovery and Reinvestment Act becomes available" (Mearian, 1/18).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Motivating Young IT Talent

via advance for HEALTH INFORMATION EXECUTIVES

By Steve Huffman

Original Article

When I was young, my mother would tell me to appreciate the differences in others, rather than just point out those differences.

Well, there have been hundreds of books and articles written on the differences and unique traits of Generation Y, the age group born anywhere between the late 1970s and late 1980s. Of all the age cohorts -- Gen X, baby boomers and Gen Y -- comprising the bulk of today's workforce, the most interesting and challenging in terms of talent motivation is Gen Y.

When you hire Gen Y talent, it doesn't take long to see the fundamental differences in their approach to corporate culture and work. For example, I've found that they prefer to be connected to a bigger picture, desire growth -- but not at the traditional corporate culture pace -- and crave an unprecedented level of autonomy in comparison to other age cohorts. For many IT managers, learning to appreciate the differences and figuring out how to engage these talented employees may require a new approach.

The fundamentals

I can't talk about motivation without first covering a fundamental principle of trust related to young IT talent. Have you ever looked at a Gen Y professional's FaceBook page? A Gen Y will say most anything and expect to read about what is going on with almost everyone. As CIO at Memorial Health System (South Bend, Ind.), I have found that it is imperative to communicate in ways and with a frequency that baffle some of my colleagues. I have a FaceBook page, a Twitter account and send out a frequent blog-style e-mail to my entire department that includes what is going on within the organization and also what I am personally working on. The "what I'm working on" section includes both professional and personal information. This is the way younger generations communicate on a daily basis; they connect well with this type of organizational communication.

You and your management team also need to recognize that a rigid communication structure that forces team members to make the majority of their communication through layers of management does not sit well with this generation. You have to be comfortable with "stopping by" to talk about the business, family and personal interests. Your management team has to be comfortable that their team members can also feel free to stop by and chat with the CIO anytime about anything. This leads to interesting communication challenges, but those are easily overcome as long as you follow up on issues that arise.

What's the bigger picture?

Wouldn't we all want to know how our day-to-day work links to where our businesses is going and truly believe that we are making a difference? The IT talent from Gen Y, from my experience, almost requires this connection. As a CIO, just writing a strategic plan to cover 12 to 18 months isn't good enough. You have to be able to communicate how each workgroup and each person connects through the plan and why it is important to the business.

As an example, one of our strategic positions for 2009 was to become "easy to work with." This required some significant changes in our help desk strategy and our desktop support structure. Each of our managers was able to communicate why these changes in everyday work linked to the 2009 strategy, and why that strategy --being easy to work with -- ultimately could help our hospital with its strategic position. There was an inextricable link to what managers were doing and how it was going to impact the business of the health system.

Original Article

Reflections On The State Of Online Healthcare

via eDocAmerica

Article source

As 2009 draws to a close, the US health care system is ailing and quasi-reform proposals are frantically being debated and voted on. Although some type of reform is likely in 2010, we will have only scratched the surface of what still needs to be changed.

One particular aspect relates to the ease with which patients can use the internet to improve their health care. At eDocAmerica, we’ve been using the internet to improve the health of our users for over a decade. Ten years ago, I predicted that patients would routinely use internet messaging to interact with the health care industry by now, but I was wrong. Although, increasingly, web 2.0 approaches are providing innovative communication and health management tools for patients, the growth of interaction between patients and doctors has been much slower than I predicted it would be. And the future still remains cloudy. The issues are nothing new and include:

1. Many patients still lack ready, reliable internet access. This is especially true for those who need it most: sick, elderly, and financially disabled persons.

2. Most insurance companies do not recognize e visits as reimbursible under health insurance plans. This provides a powerful disincentive for physicians to spend significant amounts of time answering e mail questions from their patients, since they are reluctant to bill patients directly for this type of service.

3. Professional liability issues have not been well worked out, leaving physicians and malpractice insurers feeling squeamish about supporting this approach.

4. Licensure issues remain the domain of individual states, are not consistent from state to state, and maintain unachievable standards in their definition of “doctor patient relationships”. This requires a physician who wants to provide “on line care” to have a license in every state for which they provide this care (edoc provides medical information, not on line practice). Moreover, they define the minimum requirements for establishing a doctor patient relationship as an “in office” history and physical examination performed by that individual.

5. Physicians and health care providers who are interested in providing online care are dissuaded from getting involved lest they be tarred by the brush of thousands of online health care supplement companies, bogus care recommendations from quacks, and illegal drug distributions sites.

So, how will we deal with this, and in what direction will we go in the future? Hopefully, my predictions for the next few years will be more accurate than my last ones:

1. Online care will continue to grow, in spite of the obstacles mentioned above, because the internet an incredibly powerful and efficient resource for patients. The growing demand will eventually overwhelm the remaining barriers.

2. Patient and peer groups will become increasingly sophisticated, with or without the cooperation of health care providers, and will increasingly rely on each other, rather than sole reliance on trained professionals.

3. Grudgingly, more payers will begin to support online care as the patients/employee groups realize the benefit and demand it of their employers and insurers.

4. Access to online services will continue to grow, including adaptation on cell phone applications, which will lower the bar for patient groups that are currently left out of the action.

The ability to communicate with a physician via secure e mail has tremendous benefits, including saving unnecessary office visits, allowing patients to optimize the timing of their visits to physicians, and increasing patients’ confidence to act on issues and questions. Moreover, it allows physicians and patients to emphasize and more efficiently monitor preventive practices such as healthy diet, exercise programs, weight loss programs, smoking cessation and others.

Health care reform may increase the number of patients who have some type of insurance, but thus far, has not included proposals to reform the online environment to encourage or stimulate more communication between doctors and patients.

Article source

Primary Care & The Advantage Of Continuous Communication

via better health

by Alan Dappen, MD

Original article

A Case Report: Even a Doctor Needs to Talk to His Doctor

I love the following battery of questions I hear from doctors and patients alike regarding telemedicine: “Don’t you think it might be dangerous to answer a patient’s medical questions by phone or email?” and “Shouldn’t you handle all issues in the office with a face-to-face visits like most other primary care physicians (PCPs)?” and then “Isn’t medical care by phone or email impersonal, shoddy, and second rate?

I however argue that everyone with these assumptions is wrong, Wrong, WRONG!

To challenge this notion, I invite you to consider your own routine health care problems, and to count how many issues really have required a physical exam to determine the proper way to treat them. If you’re like most people, I bet you’ll say that more than half of the times you didn’t need a face-to-face visit.

Let’s take my own personal health as a case report. It’s been a year since my own heart attack and stent placement, which I blogged about this when I got home from the hospital last Christmas.

Since my heart attack, I’m exercising regularly (although admittedly not as often as I’d like), have maintained a constant weight (although fit the classic 95% failure to lose weight that plagues almost everyone), have had no further chest pain, and continue on all the meds I was started on when I left the hospital. All of my home blood pressure readings have been normal over the past year and my last cholesterol readings are close to ideal. My body mass index (BMI) is 27 … so, yes, I know I should lose 12 pounds. I’ve been aware of this since before the heart attack and little, including a face-to-face visit with my doctor, magically will make this horse lose 12 pounds.

The cardiologist said she wanted to “see me” within a year after I passed my Thallium stress test. So here are the issues she wanted to cover during the physical exam:

1. Should I continue to stay on Plavix? I’ve been taking the drug for a year, and it’s expensive. Is there an advantage to my continuing to use it at this point instead of taking plain old inexpensive Aspirin? Since I have a high deductible health plan, I, like many Americans, worry about the cost of the medicine and would like to stop contributing to Pharmaceuticals’ profit margins.

2. Is there a different cholesterol regimen I should be following? My LDL cholesterol is 75 while my HDL is only 45 on maximum strength simvastatin (Zocor). I know more aerobic exercise and weight loss would help and I’m going to repeat to the cardiologist the same excuse everyone gives me: “I’m busy working and trying to keep a semblance of a family life, so I do forego exercise from time to time.” Can seeing my doctor face-to-face help me prioritize, improve my exercise pattern, lose weight, or improve my cholesterol numbers?

3. Should I repeat a Thallium stress test? I’m on high deductible health insurance and this test costs me $1200. If a third party payer wants to pick up the tab, then no questions asked. Otherwise what information will a new test provide that my weekly ice hockey game isn’t already doing to inform me about my cardiovascular system … I had exercise induced chest pain before my heart attack announced itself so assuming I’m not in denial again, is a thallium stress test really going to help guide any clinical changes?

4. What do my labs show (cholesterol, blood sugar, chemistry panel, liver function tests etc.)?

5. What is my random blood pressure and pulse and weight? Are my heart sounds any different?

Out of this entire list, the heart exam (which takes 10 seconds to do) is the only thing that a face-to-face visit with the cardiologist might need. Assuming most people don’t have a stethoscope and aren’t trained to understand what they are listening to, the next question is: What are the value, yield and likelihood of the heart exam helping the cardiologist with any of the questions above in my case example?

The answer: nothing. This entire visit should be conducted by telephone or videoconference. What the cardiologist needs is a progress report and what I need is to tap into her knowledge and expertise so that I can make the best informed decisions for me. I don’t need her listening to my heart or checking an EKG. These will provide no relevant data regarding my care. Instead the face-to-face visit with a 10 second heart exam satisfies a single objective. It justifies a billable service to the insurance company. No heart exam, no billable service.

Instead what I need is a DocTalker cardiologist. Let me pay for 15 minutes of her time to answer the questions relevant to my care and keep me at work so I can get done in time to exercise. Speaking of which, it just snowed and it’s time to catch up on some cross-country skiing. I’ll carry my cell phone with me so in case one of my patients needs to reach me I’ll have an excuse to ski slowly.

Happy and safe holidays and may you too be able to talk with your doctor by phone or videoconferencing whenever want and from wherever you are in the following year. That truly might make all our health care a lot better quality and affordable.

Until next week, I remain yours in primary care,

Alan Dappen, MD

Original article

Patients using internet health information without physician guidance

via KevinMD.com

he advent of the internet, combined with social media, has made everyone experts and has increased the disdain for authority.

No where is that more apparent than the firestorm that surrounds vaccines and its detractors.

The Los Angeles Times’ James Rainey writes a column on the phenomenon, observing the backlash against a well-written, nuanced piece debunking the link between vaccines and autism.

But as we know, those who already believe there is a connection are unlikely to be swayed. And on the web, it’s easy to find data and studies that fits an already established mindset.

Mr. Rainey notes a danger to this growing phenomenon:

Citizens armed with information are sure they know better. Readers who brush up against expertise believe they have become experts. The common man rebels against the notion that anyone — not professionals, not the government and certainly not the media — speaks with special authority.

Where it stops, nobody knows. But already we see a wave of amateurs convinced they can write a pithier movie review, arrange a catchier song, even assess our planet’s shifting weather conditions, better than the professionals trained to do the job.

Of course, we are seeing this in medicine as well. 60+ percent of patients consult the internet for health information, and a small but growing minority feel they can act on what they find on the web without physician guidance.

To be sure, doctors and other health professionals don’t get everything right. But anyone can find information on the web, which can be of dubious accuracy.

Knowing what to do with that data can only come with experience and training.