Archive for June, 2009
by Caitlin
Last week, Obesity published a study finding that people classified as ‘overweight’ according to their Body Mass Index (BMI) (25-29.9) may live longer than people with a ‘normal’ reading (18.5-24.9). It is theorized that the extra weight actually protects the body during the stress of aging. At first I thought this was further proof that thin is not in, and that a healthy person should have a few extra pounds; however, perhaps the study is just another indication that the BMI calculation is misleading, and it is not the best way to measure one’s physical fitness.
I’ve been skeptical of the BMI since high school when during our annual Fitness Test the most athletic girl in the grade (made of sheer muscle yet standing only 5’1) was deemed ‘overweight’ due to the ratio of her weight to height. Since muscle weighs more than fat, serious athletes can have a higher BMI simply because they weigh more. Perhaps some of the ‘overweight’ participants in the Obesity study had a high BMI but longer lifespan because they had a high muscle content, not because they were overweight and out of shape. By the same token, it’s also possible that a participant with a ‘normal’ BMI was simply ‘thin’ but not physically fit.
Lenny Bernstein of the Washington Post, and a critic of the BMI, recently visited the University of Maryland’s Department of Kinesiology to try various fitness tests, including the VO2 max test, to see if they are better indicators of health and fitness than the dubious BMI. In the end, Mr. Bernstein argued that the VO2 max test and other simple tests that can be done in your doctor’s office, such as measuring pulse and blood pressure, are in fact effective ways to measure how in shape you are.
So perhaps Mr. Bernstein has it right in the end – while it’s clear that a one-size-fits-all test to measure health and fitness may not be accurate (otherwise my high school colleague would have been named the most physically fit student), it’s measuring fitness, not weight, that is the key. While the BMI may help people reach a healthy weight for their height, it’s your level of physical fitness that reigns supreme.
June 30th, 2009
By Anna Gueldenhaupt, Europe
It’s amazing what can be achieved with a mobile phone, but have you ever wondered what such a device can do beyond making calls, sending text messages, taking pictures and accessing the internet?
A relatively recent development is the emergence of mHealth or mobile health: defined by Wikipedia as the term for medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, PDAs and other wireless devices.
mHealth technology is mainly being taken up in developing countries that have to bypass the physical infrastructure costs associated with fixed-line technology to jump straight to mobile technology as isolated populations in developing countries need access to suitable communications technology including vital healthcare provisions.
Driven by companies like ARM, the cost of smart components for mobile technology continues to decrease. The ever-developing functionality of mobile phones now allows for SmartPhone-capabilities in relatively inexpensive devices. However, it is important to remember that the capabilities of such devices in developing countries have not yet reached the sophistication of those in other parts of the world. Yet, the basic SMS text functions and the real-time communication capacity can still offer a number of potential uses to healthcare professionals and patients.
Replacing the Physician?
The potential of mobile technology to revolutionise healthcare is clear, but what is also clear is that it will not completely replace the physician, the nurse or the healthcare professional. Its purpose, however, can be manifold and can offer a multitude of solutions to:
• Raise awareness and educate the public on specific disease and conditions
• Data mining and collection for public health purposes and clinical trials
• Remote monitoring of for example diabetes, HIV, weight and smoking cessation
• Communication for and training of healthcare workers
• Disease surveillance and the tracking of epidemic outbreaks such as Malaria, TB and Avian Flu.*
This kind of mobile technology has incredible potential to promote healthy lifestyles and enhance the quality of healthcare by making it easier to access medical and health information. The prospect of advancing public health and clinical care through encouraging communication and facilitating health practice can then improve the health of isolated populations.
The Potential Exists
The range of opportunities for mHealth includes the ability for users to store their personal health information safely and securely on their phone and enable them to share it with the suitable healthcare professional when needed. It can also enable easy communication between healthcare providers, patients, and others, providing medication reminders, appointment scheduling and emergency calling. Furthermore, it can serve as a platform for wellness-related, weight-related and disease management programmes.
Additionally, it can also offer quick access to health information and provide efficient tools for medical research and surveys that can garner important information from isolated populations that isn’t readily available.
Success Already Visible
mHealth is well positioned to benefit from best practices and available technology that has been seen in already existing projects. For example the TeleDoc project in India. TeleDoc provides mobile devices to village health workers in India, which enables them to communicate with doctors who use web applications to help diagnose and prescribe for patients. The project was originally launched as a pilot project in 15 villages in April 2003 and has already proved quite successful.
Another example is the Nacer project in Peru, which is a phone and web-based information and communication system that has enabled health professionals in remote locations to communicate and exchange critical health information between themselves, medical experts and regional hospitals. The project is geared particularly at women during pregnancy and childbirth and aims to lower maternal death rates in the Ucayali region of Peru, by enabling the exchange of rapid, real-time information between all healthcare professionals.
The number of similar projects continues to grow offering opportunities to patients and healthcare professionals alike, not only in developing countries, but globally.
*Vital Wave Consulting (February 2009). mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World. United Nations Foundation, Vodafone Foundation. pp. 9. http://www.vitalwaveconsulting.com/pdf/mHealth.pdf.
June 24th, 2009
by Caitlin
There are no set rules for how a visit to the doctor’s office should go, but there’s a general understanding that 1) the patient will tell the doctor what’s wrong, 2) the doctor will examine the patient and conduct tests to 3) diagnose and ultimately treat the problem. If these steps aren’t properly fulfilled, there’s a big chance the patient will be misdiagnosed and then mistreated. This we know. That’s why it’s so surprising to hear that according to a study conducted by Dr. Lawrence P. Casalino of Weill Cornell Medical College, “7 percent of clinically significant findings [are] never reported to the patient.”
Large hospitals and practices and hospitals using a combination of paper and electronic record keeping methods were the worst offenders. As an ardent organizer, this sounds like perhaps the classic issue of “too many hands in the pot.” To this point, it turns out that small practices, classified as those with eight or fewer physicians, had the smallest number of infractions.
One might argue that this is the perfect evidence in support of electronic record keeping. In this way, a doctor can obtain test results, make a diagnosis, immediately enter the diagnosis into the patient’s records, and even notify the patient. But maybe it’s an even better argument for getting back to the basics of a doctor’s office visit: conduct an examination, make a diagnosis, order treatment. With the small practices performing better than the large practices, one has to wonder if red tape combined with doctors and hospital staffs spread too thin is the primary contributor to this problem.
Fortunately, Dr. Casalino offers some sage advice that brings hospitals back to the roots of the doctor’s visit: deliver test results to the appropriate doctor for sign off, notify the patient of the results and document the patient received the test results, and instruct the patient to call the office if the practice staff fails to deliver the test results within a certain time period.
June 23rd, 2009
By Shannon
In corporate America, we’re always hearing about the importance of work/life balance. Studies have been done and companies have acted on the results, designing new programs, benefits and organizational initiatives that help employees get home sooner and gain added flexibility in their schedules so they can maintain their out of the office personas. But, reading this New York Times article by Pauline W. Chen, M.D., it struck me that one profession where the concept of work/life balance might be taken for granted is in the medical community.
Dr. Chen provides an interesting perspective, her own, on the pressures doctor’s feel from training all the way through to practice as they strive to always be there for the patient. She makes some very compelling points that support the need for physicians to find the right work/life balance early on in their careers. It may seem easier said than done for a group of clearly driven and dedicated individuals, but the benefits will surely translate into their patient care.
From the perspective of patients, we often assume that our doctors and nurses are (or should be) available to us 24/7. Looking at it holistically, I, for one, can say that I hope all physicians take the advice outline by Chen. Finding time for themselves and carving out an identity outside of their practices will surely provide them with a fresher perspective as their practice medicine.
And, hey, no matter what your profession, we can all benefit from summer Friday’s, right?
June 19th, 2009
By Cheri
During Dr. Don Wright’s update on the HHS Action Plan to reduce the rates of hospital-acquired infections (HAIs) in the country at APIC 2009, he noted that before the problem can be fixed there were vast gaps in HAI knowledge. Some of the problems he brought up were:
- Patient Tracking: Many patients leave the hospital to reside in long term care or proceed with out patient treatments. If an infection develops as a result of a procedure/medical device that is implanted for these on going therapies, it is never tracked back to the hospital to be included in their HAI rates.
- Measurement: Hospitals report on infections in different ways. Catheter related blood stream infections, for example, can be reported on by the number of infections that occur over the number of days (infections/catheter days) or by the number of infections per catheters inserted (infections/catheters inserted). This makes it difficult to compare rates across hospitals.
- Infrastructure: The way the infrastructure is currently set up, information reported or plugged into one government system, cannot be easily formatted/extrapolated for another report.
There are certainly steps that need to be taken to help reduce rates of HAIs but it sounds like HHS has developed a comprehensive plan, taking into account the current system’s short comings, to find a solution.
June 10th, 2009
As a new generation of users come on the scene and popularity continues to spike, can we coax the healthcare industry into diving deeper with social media practices and leading the conversation?
By Dana
Last week, DiagnosisPR attended the Healthcare and Social Media Panel hosted by the Mass Technology Leadership Council (check out #MassTLC’s blog post recapping the event). Experts from all different walks of healthcare came together to provide tips for leveraging social media to positively impact patient and physician groups—a difficult endeavor, considering not only the compliance, transparency and ethics issues at stake, but also the broad array of constituents (and associated special interests) that need influencing in order to spur significant societal shifts.
The panelists pointed out that as we’re seeing across most next generation media channels, people are less concerned with having access to tomes of content, and rather seek out interaction and resources online. It makes sense, really: one-way communication and tightly packaged messages are fast becoming a thing of the past, especially in a field where consumers have a vested interest in cutting through any marketing haze to decipher what’s real versus what’s hype. In the realm of social media, Content is no longer king – Conversation is. Patients and physicians alike are becoming increasingly focused on making responsible diagnoses and healthcare choices, and the most direct avenue for achieving this is access to other human beings.
We’ve seen companies across the healthcare industry balk against adopting social media strategies for some time now, most recently in the form of drug companies reluctant to join the Twittersphere. What’s more, famous cases like that of the notorious Dr. Flea and the HIPAA crackdown could make some physicians skittish when it comes to joining the conversation. This broad-brush caution is reasonable, but risky at the same time: we learned from panel moderator Lynne Dunbrack that 60 million adults in the US are currently using social networking in some capacity. A marked spike in social media consumption among the middle-aged cohort is a promising sign for all those in the healthcare industry…Health 2.0 has a new face, and one that is itching for information and participation. In order for healthcare to positively impact this population and precipitate change, it is more vital than ever before to join these discussions and increase accessibility.
Check out some great strategies for leveraging social media for healthcare in this slideshow. Do you have any suggested strategies you’d like to share?
June 9th, 2009
One of the themes being discussed at the APIC Annual Conference has been customization. Obviously, there isn’t a turn-key solution to prevent infections and I’ve heard many conversations about customizations that may be available from vendors. Of particular interest was a PICC procedural tray that can come with different checklists, as each institution has different checklist protocols for insertion of PICC lines. Obviously the more a vendor learns about customer needs the better they can effectively partner with them to lower infection rates.
What has your experience been with customization? Do you work with vendors that offer this?
June 8th, 2009
By Cheri
DiagnosisPR has made the trek to sweltering Fort Lauderdale to report on the latest trends in the broad field of infection control from the Association of Professionals in Infection Control and Epidemiology (APIC) Annual Conference. This year’s show was kicked-off by an inspiring keynote presentation from Benjamin S. Carson, MD of Johns Hopkins Medical Institutions about turning challenges into triumphs. The audience walked away with new strategies for succesful infection prevention and control programs. With guidelines in place from the Centers for Medicare and Medicaid where some hospital-acquired conditions are deemed non-reimbursable, infection control is top of mind for infection control specialists and the C-suite alike. Stay tuned for more coverage from APIC!
June 8th, 2009
By Erica
Last week, we had the opportunity to interview Barbara Duck, a healthcare industry veteran who reports and comments on a variety of healthcare news through her blog, The Medical Quack. Barbara shared with us her thoughts on EMR, Twitter and the future of healthcare with the Obama administration.
Here’s what she had to say…
We know your blog, The Medical Quack, has a loyal following and your posts have been featured in outlets such as the Wall Street Journal and Reuters. Could you tell us more about the blog and how you got started?
I have not spent my entire career in healthcare; rather I spent over 20 years in outside sales with Fortune 500 companies before making the jump. I began programming and writing code which eventually led to me writing a medical records program. That was my first introduction into the healthcare space. I began a dialogue with physicians at EMR Update and they really encouraged me to start my blog.
The Medical Quack is somewhat of a “kitchen sink” meaning I cover just about anything that I feel holds interest. I try to keep everything at a level where all my readers can understand. I enjoy covering recent trends in the news, novel medical devices and speaking with a range of interesting, healthcare professionals. I am pleased that the site seems to resonate with so many and I look forward to continuing this journey!
Around 11 years ago, you worked with a local family physician to create an electronic medical records (EMR) system. In your opinion, how far have we come with EMRs since then? How far do we have to go?
That was back when things in software were much more primitive and simple. It was not a simple job, though as it started out with one module and one back end and grew to 4 front ends and 2 back ends for the entire process. I learned that what looks good to the programmer is not always good for the end user – the physician. We have certainly come a long way with EMRs – no longer is one person writing, developing, selling and maintaining systems for physicians. Now there are entire teams of developers to do what one person may have done a decade ago. We still have a ways to go in terms of adoption of EMRs, but it is a work in progress and the value of EMRs continues to be a hot topic in the media.
I wrote a post recently that explores the possibility of security loopholes in EMRs. Given my background, I think this is a very important issue and I believe that thorough testing of medical software is vital and that rushing EMRs – or any kind of software – will not be useful in the long run.
What do you make of the strong emphasis on healthcare IT and reform by the Obama administration? As healthcare is a field that is known to be slow to adopt technology, how do you see the industry overcoming this obstacle?
As I am a true “techie,” I think the focus on healthcare IT is incredibly exciting. From an early stage, I realized how important organizing information was, and I was a very early user of the PDA. I knew the benefit of saving time by not having to look through paper files was ultimately going to help me succeed. I think this same idea can be applied to healthcare. The more organized we can become as a nation, meaning everyone from hospitals to small practices, the more effective our system will be. I think Obama’s emphasis on this task is wonderful and should prove to be very fruitful.
The healthcare industry has a reputation of being quite slow to adopt technology, but I think the best way to overcome that obstacle is for those who believe in the power of technology to be persistent and keep showing exactly how it is able to make the industry better as a whole. The financial commitment from the Obama administration is certainly an enormous step and should contribute to the continued adoption of technology by healthcare professionals.
We see you have an active presence on Twitter. What type of impact do you foresee Twitter and other social networking sites having on the medical community? Do you think these sites can help in pushing adoption of other health IT tools?
I think Twitter is a fantastic resource and I am especially excited to see the impact it will have on the medical community, as it has already had a big effect on the way consumers gather and disseminate information in general. I have nearly 1,500 followers, which goes to show that the average patient is taking an active role in the exchange of information and is interested in healthcare.
I absolutely believe social networking sites are having a positive impact on the adoption of health IT tools – it is simply another way to push information out to people. As they say, knowledge is power and the more patients and healthcare professionals understand about what healthcare IT can do for them, the more likely they are to adopt the tools.
During the history of your blog, what has been your most memorable interview or post?
In every one of my memorable interviews, the fascinating part was being able to speak to individuals who had so much knowledge and information to offer, perhaps outside of the normal items and technology my readers see in the news, which is what I try to do: offer educational healthcare information that perhaps is not noticed or otherwise missed.
Regenerative medicine is also something I discuss quite a bit as most people are not even aware of what it does or that it exists. One memorable interview was with Mark Bleyer, President of Cook Biotech and Mike Hiles, Ph.D., VP of Research and Lead Research Scientist at Cook Biotech. They helped me share with my readers some exciting healthcare information that is available and adds to the quality of life in so many instances.
http://ducknetweb.blogspot.com/2009/03/regenerative-medicine-and-how-it-works.html
Another memorable interview was with Michael Naimoli, Industry Solutions Director for Microsoft’s U.S. Health & Life Sciences Group and a former biopharmaceutical scientist. Life Sciences is a difficult and hard to understand topic for many, but hopefully I was able to explain some of what is done there in layman’s terms to where each reader came away with some knowledge.
http://ducknetweb.blogspot.com/2009/05/deep-dive-into-microsoft-life-sciences.html
June 8th, 2009
