Integrating IT into the Fastest Growing Sector of the US Economy - Healthcare

Representative Bart Gordon (D-TN), Chairman of the US House Committee on Science and Technology, has introduced a bill (H.R.2406) authorizing the National Institute of Standards and Technology (NIST) to develop guidelines for promoting fully integrated health information technology. The healthcare industry is only investing about 2% of its revenue in IT (financial services invests 10%), a topic I touched upon in an earlier blog, Hospital Errors: Who Pays? The Centers of Excellence who are investing revenue in IT are reaping benefits in terms of reduced errors an improved outcomes.

The debacle of chaos in the aftermath of Hurricane Katrina brought home to many of us the urgency of adoption of electronic health records (EHR) so that health professionals can have ready access to patient medical histories in times of crisis. Poor communication has been found to be responsible for 80% of medical errors. It is estimated that savings of $ 77 billion (5% of annual US healthcare budget) could be realized in savings once a fully functional health IT network was established.

Dissenters are concerned that patient privacy rights will be completely eroded with big government, insurance and corporations funding and developing IT networks. Patient Privacy Rights is an organization founded by psychiatrist Deborah Peel, MD. She knows from first hand experience that people will forego medical treatment if they think others will have access to their medical records. Think about it. You think your child may be bipolar. How bad does it get before you actually consult a psychiatrist? Do you really want that label stuck on your child for the rest of his/her life? Is the label going to effect their ability to get insurance, a job or anything as an adult? We don't know. We don't really know how many people have access to all the bloody, sordid details of our lives in our medical records. So those of us smart enough to figure it out, don't trust our doctors and don't reveal any more than we have to get what we need out of an office visit. We take care of ourselves and each other and try to avoid hospitals and doctors offices as much as we can. We think those HIPAA papers we sign guarantee our privacy, but they actually grant access to our medical records to our employers and their associates.

IT implementation, like electronic voting, is a great idea as long as we take great pains to assure that patients own their own records and no one has access to them, without their express permission.

Thank you Knee Deep Photography for use of most excellent photo, White Noise.

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CDC Health Advisory: Serious Eye Infection due to Contact Lens Solution

A Health Advisory was released by the Centers for Disease Control (CDC) in conjunction with the Food and Drug Administration (FDA) May 25, 2007 identifying an outbreak of an amoebic eye infection associated with use of Advanced Medical Optics (AMO) Complete R Moisture Plus solution. Based on the findings, recommendations are that soft contact lens wearers who use the solution:

• Stop using the solution immediately
• Stop using your current contact lens storage container and replace it with a clean new one
• Discard your current pair of soft contact lens and replace them
• See a health care provider for an eye examination

Acanthamoeba Infection is caused by an amoeba that occurs every where in nature. Symptoms include:

• eye redness
• eye pain
• blurred vision
• sensitivity to light
• excessive tearing

If you have these symptoms, stop wearing contact lens immediately and begin wearing eyeglasses. Make an appointment with your doctor immediately. Complications of the infection are permanent visual impairment and blindness.

AMO, for its part, has announced a voluntary recall and is asking anyone with problematic reactions to report this to 1-800-347-5005.

Thank you nadaquehablar for the use of photo.

Labels: eyes, product safety, recall

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Thank you Colin Son for Grand Rounds 3.36!

Colin Son is a former Cinematic Arts student, now studying medicine and blogging in Texas. He is a talented writer of From Medskool The Journey to and Through, he included my post Hospital Errors: Who Pays? in this week's Grand Rounds. It is one of the best Grand Rounds ever, & makes for great, entertaining, informative reading. Check out Healthline's own Joshua Swimmer's post The Encyclopedia of Life and E.O. Wilson, or Stories of Guns, if you want insight into the life of a South African surgeon.

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Health Court? Senate Ponders Bill S1337

The Senate Health, Education, Labor and Pensions Committee is considering a bill, the Fair and Reliable Justice Act, that proposes a different model for medical malpractice dispute resolution. The model that is attracting the most attention is the special health court model, in which judges with health care expertise, rather than juries, would adjudicate medical malpractice claims. Critics claim that the current system isn't working for patients or providers. Expert witnesses would be paid by the court rather than attorneys for the parties involved, as under the current system. Decisions made by the health court would set new standards of care. If providers meet that standard of care, they would not be subject to financial penalties, regardless of patient outcome. Pain and suffering awards would be granted according to a schedule that would be apply to all patients. The goal of the system would be to make justice more reliable, as well as improve medical practice.

Common Good, a bipartisan group whose moniker is "Restoring Common Sense to America", is a nonpartisan coalition dedicated to restoring common sense to the law. Their site lists many groups like the AARP and the American Academy of Family Physicians, who back this bill for patient safety. Proponents of health courts claim that the current system has created incentives to hide errors. The Agency for Healthcare Research and Quality (AHRQ) reports that medical errors are one of the nations leading causes of death and injury. Almost 100,000 people die each year in US hospitals as the result of medical errors. That is more deaths than from AIDS, breast cancer, or motor vehicle accidents. Hospitals are bad for your health. The statistics prove it. To err is human. To not learn from our mistakes is diabolic.

Thank you hummana for use of Friday night in Sevilla photo.

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Hospital Errors: Who Pays?

The Indianapolis Star reports that Medicare, the largest single payer of medical bills in the US, is scrutinizing conditions caused by medical error and considering not paying for them. This ought to shake up the health care industry, because where Medicare goes, commercial insurance providers like Blue Cross/Blue Shield and United HealthCare tend to follow. Medicare is considering not paying for these hospital acquired problems:

• air embolism
• objects left in the body after surgery
• bed sores
• falls
• wrong surgery
• catheter associated infections (either urinary or vascular)
• transfusion reactions from being given the wrong blood type
• hospital acquired infections

Basically, Medicare may stop paying for complications that occur from hospital care if those complications did not exist before the person was hospitalized. This comes at a time when US hospital errors have continued to rise by 3%. Healthday News reported the HealthGrades Patient Safety in American Hospital Study findings that there were 1.16 million "patient safety incidents" among the 40 million Medicare hospitalization records studied 2003-2005.

• Those involved in the above had a 25% chance of dying. Almost 250,000 preventable deaths were reported
• Excess costs of these "incidents"? $8.6 billion (Medicare patients 2003-2005)
• Greatest increases? Post-op sepsis, post-op respiratory failure, bed sores

Researchers report a "chasm in quality" between the nation's top tier and bottom tier hospitals. McLeod Health in Florence South Carolina is one of those top tier medical centers, largely because over the past decade they have invested resources in process improvement, including IT. They are ranked #1 in South Carolina and the top 10% in the country for cardiac interventions. McLeod Health has automated drug dispensing, medication reconciliation, physician order entry and while the cost was high, the outcome has been worth it. They participate in the National Voluntary Hospital Reporting Initiative to help "raise the bar for Health Care Performance".

Be an informed health care consumer. Find out the HealthGrade of your facility and doctor. Ask questions. Be informed. It's your body. It's your life.

Thank you homernoh for use of photo, Hospital sunset (Phoenix AZ).

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Thank you Ian Miller, for Grand Rounds 3.35!

Ian Miller is an Emergency Department nurse with 20 years experience and a blogger at impactEDnurse.com. He hosted Grand Rounds, a round up of the best medical writing in the blogosphere, and issued a challenge for us to submit a post we were particularly proud of. He was kind enough to include my post AJ Hits the Skids: Men & Depression along with many other posts you will want to read. The photos in Unbounded Medicine's post Limb to Crotch are astounding. Worth your time to read these posts.

Thanks Aussie V for setting me straight...

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Case in Point: United HealthCare & Michael Moore's "Sicko"

Filmmaker Michael Moore is at it again, this time armed with a documentary about a topic we all love to hate - the US healthcare system. Sicko, his film, is being aired in Cannes for the film festival, and draws attention to the 47 million uninsured Americans. Moore compares the US system to that of Canada, Britain and France in the film. The World Health Organization (WHO) ranks the US system 37th in the world while France is ranked the best healthcare system.

As if fate wanted to drive home the director's point, the State of Nebraska Department of Insurance announced a $650,000 settlement with United HealthCare. The insurer, which covers 250 million Nebraska residents, broke Nebraska laws 800 times. Failures cited were: decision delays, bad decisions, and bad information given to consumers. Poor UHC - the nation's second largest health insurer was involved in the October 2006 shake-down down due to stock option backdating. Like many other companies, they got caught issuing the stock on one day, but pricing them as if they had been issued at an earlier date. Joe Paduda writes the informative blog, Managed Care Matters and he can't get too mad at UHC for trying to streamline their lab practices, consolidating with one preferred partner, LabCorp. Besides cost-savings, the rationale is that enhanced data mining and analytics could improve UHC's disease management strategies. I used to work in insurance myself. Until we come up with a better system, nationwide, you have to believe they aren't all bad. Smart, caring people work there. Yes, they want to make money, but they want to help, too.

Moore's film, which opens in the US June 29, focuses on the shabby healthcare treatment of the heroes of 9/11. Mt. Sinai Medical Center released a study last year connecting inhaled dust at ground zero with the numerous health problems suffered by thousands of workers. Studies indicate that 70% of Ground Zero workers have respiratory problems and many lack health insurance. The report states that 40 % either never had health insurance or lost their insurance after they became too sick to work.

Sicko: The Movie

Thank you slagheap for use of your WTC 9/11 photo.

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Tony Takes a Trip - With a Little Help from a Cactus

You didn't think I would let a week go by without commenting on Tony Soprano's peyote trip in Las Vegas, the latest twist in The Sopranos, did you? Peyote is a naturally occurring hallucinogenic plant material derived from a cactus native to the US southwest and Mexico. Indigenous people have been using it on this country for centuries in elaborate prayer and vision quest ceremonies. Use of it under these controlled circumstances was legalized in the US in 1995. Possession of hallucinogenic psilocybin mushrooms is also legal in the US, but selling them is not.

To prepare for a vision quest, peyeteros submit to ritual confession and purification ceremonies. The cactus button is eaten as a medico-religious sacrament. Healing is prayed for and tutelary visions and teachings are anticipated. Clearly, recreational use of hallucinogens is a popular past time. Ecstasy (MDMA) is a synthetic and popular club drug. Fans of the TV show know that Soprano is a lucky guy. He had a good trip and an epiphany at sunrise, despite the fact that his preparatory rituals involved a questionable "mercy" killing of his own nephew and intimate play dates with a beautiful girl his son's age, "stripping her way through college."

Our society is really conflicted about drug use. I was working on a project here at Healthline and had to come up with a definition for Cannabis intoxication. The definition is something like the effects include mild euphoria, relaxation and sleepiness. That doesn't sound so bad, in fact, it sounds like a billion dollar pharmaceutical industry for medications like anti-anxiety drugs. In fact, marijuana has been used for thousands of years by humans to treat pain and a variety of other ailments. It is illegal in most of the US, except Oakland, CA. Medical marijuana is used today to treat cancer patients and Harvard researcher John Halpern, MD has been studying the health benefits of psychedelics.

Dr. Halpern has received FDA permission to give Ecstasy to end-stage cancer patients. Dr. Andrew Sewell is exploring the use of LSD as a treatment for cluster headaches. Clinical trials are being planned to explore using hallucinogens to treat anxiety and alcoholism. Respected researcher Richard Doblin warns that personality deterioration occurs with repeated ingestion (greater than 50 episodes). Nevertheless, Dr. Charles Grob has secured approval to study the effects of psilocybin mushrooms in the terminally ill.

It just may be that in the next decade or so we will all find, like Tony, that taking a trip and a change of scenery may be good for our mental health.

Thank you nashnazzy for use of photo Peyote in Paradise.

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Omega-3 Fatty Acids: Can't Hurt, and They Might Help - with a lot of things...

Some reports released by the National Institutes of Health (NIH) in the past few weeks indicate that adding omega-3 fatty acids may be a good way to protect yourself and your loved ones against many nasty conditions you probably don't want to get. Vital for human life, omega-3 fatty acids are found naturally in fish oils, but since most of us don't eat enough fish regularly to provide the beneficial omega-3 fatty acids we need, supplements are recommended.

• The American Heart Association (AHA) has endorsed taking omega-3 fatty acids to increase HDL (good cholesterol) while decreasing LDL (bad cholesterol)
• Omega-3 fatty acids decrease risk of blood clots, heart attack and high blood pressure
• Omega-3 fatty acids help control inflammatory processes and decrease the need for pain medicines in people with rheumatoid arthritis
• Omega-3 fatty acids have been found to decrease problems associated with diabetes, inflammatory bowel disease, asthma, Berger's Disease and Raynaud's Disease
• Omega-3 fatty acids may lower the risk of Alzheimer's disease
• Omega-3 fatty acids help decrease some complications of AIDS
• A diet rich in omega-3 fatty acids strengthens the immune system and helps prevent cancer
  

Some of the most exciting uses of the natural supplement are in mental illness and dementia:

• The NIH is recruiting volunteers for a nation-wide study to determine if omega-3 fatty acids slow the progression of Alzheimer's Disease.
• A diet rich in omega-3 fatty acids helps stabilize moods and decrease depression
• Studies show that omega-3 fatty acids may help ADHD, bipolar spectrum disorder, anxiety and schizophrenia

Omega-3 fatty acids are found in walnuts and flaxseed oil. If you have one of the above conditions, it is recommended you discuss the adding the supplements to your medical regimen with your health care provider. Flaxseed source is felt to be the safest. Omega-3 fatty acid supplements do thin the blood, so it is important to discuss their use with your doctor if you are taking aspirin and any blood thinners.

Thank you cenz for the use of the gorgeous photo, Mackerel Fishing at Brixham Lighthouse.

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Thank you Daniel Goldberg @ Medical Humanities Blog, for Grand Rounds 3.34

Another fascinating compilation of medical writing is available for your perusal at Medical Humanities Blog, and my post, Unraveling the Mysteries of Neurodegenerative Diseases, was included this week. Check it out just to see the beautiful wood block print De Corporis fabrica (1543). I'm kind of a nut for medical history anyway. Lots of great reading; enjoy!

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Global Healthbeat: Getting a Handle on Cancer in Developing Countries

The Global Health International Council convenes in Washington D.C. May 29 - June 1, and one topic experts will be discussing is that of cancer in the developing world. In the past year or so, researchers and organizations like WHO, and INCTR have sounded the alarm on the major disease burden of cancer in developing countries. Cancer rates are rising sharply in developing countries, and the Global Health Council reports that 70% of the world's 7.6 million cancer deaths in 2005 were in those countries. Citing a study in the Annals of Oncology, Global Health Council reports that 12.5% of all deaths in developing countries are caused by cancer; more than the total of all deaths caused by AIDS, tuberculosis and malaria combined.

Some researchers speculate that as people adopt the habits of wealthier nations - smoking, poor diet and carcinogens in the workplace - cancer incidence has increased. Stomach, liver and cervical are infection-related cancers which have higher incidence in these countries. Epidemiologists suggest that weak public health systems in these nations cannot control infective agents and contaminants. Other cancers (lung, breast and colorectal) may reflect the longer life expectancies developing nations are enjoying as family size is limited.

Suggested strategies are:

• Immunization against or treatment of infectious agents associated with cancers (e.g HPV vaccine and Hepatitis B vaccine)
• Tobacco and alcohol control programs
• Promotion of healthy diet of fruits and vegetables with fewer fats and processed foods

Experts will be brainstorming on ways to get cancer prevention and treatment in developing nations on the global health agenda. We applaud them for bringing our awareness to this important issue.

Thank you night_eulen for use of the photo of health workers in Samarkand, Uzbekistan.

Labels: cancer, developing world, WHO

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Que Significa ser Padres? Parenting Advice en Espanol

Just in time for Dia de los Madres, the National Institutes of Health (NIH) is offering a free publication with Evidence-Based Parenting Guidelines. The English version, Adventures in Parenting, is also available. Call 1-800-370-2943. Llama este numero para este librito de 70 paginas para tener exito con la crianza de los ninos desde recien nacidos hasta 14 anos de edad.

One thing that is certain not to be recommended is leaving your toddlers at home alone while you go out to dinner. Parenting is a verb, and when your kids are frustrating you and you are pulling your hair out wondering what to do next, think about how tough the world is for them. Follow the advice of the basketball coach who works a second job as crew on my commuter ferry , " Love them some more."

Thank you torres21 for use of photo rioBapt 035.

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Bipolar Spectrum Disorder Updates

While depression is the leading cause of disability in the world, new studies coming out of the National Institute of Mental Health (NIMH) suggest that we need to readjust our thinking about bipolar disorder. As a multi-dimensional problem, they suggest it should be considered a spectrum disorder (like Autism). Reporting the results of a study published in the Archives of General Psychiatry, NIMH reports that up to 97% of the 9,282 adults participating in the study had co-morbidities of anxiety, depression, or substance abuse disorders and were in treatment for those problems rather than the bipolar disorder.

Researchers reported that many participants were receiving the wrong treatment for the illness: only 40% were receiving a mood stabilizer, anticonvulsant or antipsychotic. NIMH researcher, Kathleen Merikangas, Ph.D., stated that such a "...high rate of inappropriate medication use among people with bipolar spectrum disorder is....potentially dangerous because use of an antidepressant without the benefit of a mood stabilizer may actually..." make things worse. Dr. Merikangas and her colleagues fear that bipolar spectrum disorder is masquerading as other illnesses in clinics around the world and clinicians are missing opportunities to treat people appropriately.

Even with underreporting and lack of recognition, NIMH estimates that 5.7 million US citizens suffer from bipolar disorder. While all of us suffer mood swings, the changes in personality, behavior and energy are disabling in people with the disorder, especially children. Not everyone responds to the medications described above. Researchers are hoping that new findings from the first Genome-Wide study of the illness will yield promise for individualizing treatment options. Researchers involved in the NIMH Genetics Initiative Project report that "...the likelihood of developing bipolar disorder depends...on combined effects of many different genes in the brain..." Researchers are focusing on the DGKH gene that is active in the pathway where lithium works its magic in the brain. Advances in genetic technology are allowing researchers to scan thousands of genes at one time to detect variations. The variations influence the likelihood of a person getting an illness. Genetic researchers can compare test subject variations against healthy subject variations and against another gene pool of similar ancestry in a different part of the world to test the validity of their findings.

Finally, five famous bipolar people to think about today:

1. Hugo Chavez, Presidente of Venezuela
2. Kurt Cobain, suicide (maybe) musician
3. Florence Nightingale, nurse and health reformer
4. Jimi Hendrix, (Seattle has a high suicide rate)
5. Vivien Leigh, actress

Thank you otfrom, for use of the photo, Mad Multi Manic Camera Toss.

Labels: bipolar, genes, genetic research, mood stabilizer

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Thank you Dr. Tam, for Grand Rounds 3.33: The Blogger that is Eating Manhattan

TB Tam put together this week's serving of medical writing at The Blog That Ate Manhattan. He had kind words about my post The Barbarian Invasions & National Cancer Control Month, musings about a beautiful film, my father's death from prostate cancer, pain control, dysfunctional families and time spent on Lake Champlain. Dr. Tam features some posts with gross photos (Dr. CG George) that you might want to check out. I found the post Radiation Risk of CT Scanning most interesting and the story of Barbados Butterfly cause for consternation. Thanks for your kind words, TB.

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AJ Hits the Skids: Men & Depression

The Sopranos is not just my favorite TV show, it is my favorite medical TV show, and last night's episode, Walk Like A Man, featured the Soprano's son AJ lying on the sofa, in the throes of Major Depression. The World Health Organization (WHO) reports that depression is the leading cause of disability...in the world. Depression is the 4th leading contributor to the global burden of disease and occurs in people of all genders, ages and ethnicities, yet less than 25% have access to effective treatments. For the longest time, we heard that depression was more common in women than in men, but that just doesn't jibe with the fact that suicide is much more common in males than females. Major depressive disorder is the single biggest risk factor for suicide. It used to be said that black men didn't get depressed or commit suicide as often as white men, but that, sadly, has changed. The suicide rate for black males doubled after 1980 and is now the third leading cause of death in black men 15-24.

In my personal and professional experience, men and women manifest depressive symptoms differently. Young males, like AJ, are the most at-risk population for suicide in the US. They stop eating, they sleep a lot, they stop going to work. Their family and friends don't know what to do. The men are adults, they are usually rational, productive members of society. Loved ones don't know how to react to this person who does not seem sad or blue. Often, when men are depressed, they just seem really angry and shout "Leave me alone!" So people do, leave them alone. And the depression gets worse. Or depressed males drink alcohol as a way to "self-medicate" and relieve the pain of feeling no pleasure.

It is really tough for concerned family, friends, coworkers or neighbors to know when to step in and take action when a guy has locked himself in his house or his room and is yelling to leave him alone. Do you call the cops? For the cops to come, you have to be certain he is a danger to himself. That is, he is not eating, he is stating he wants to die and that he is going to kill himself. It is a pretty ugly scene for everyone involved, when the police come in black gloves and escort an angry person against his will to the hospital for an involuntary commitment. Families feel certain their son or husband or brother will hate them forever or never speak to them again. A psychiatrist evaluates the person to determine the necessity for involuntary commitment. The determination of the psychiatrist is sent to the Court. Within 24 hours, another evaluation is done to determine the need for further inpatient treatment, outpatient treatment or release. If held for treatment, a person can usually only be held involuntarily for ten days. Each step is agony and pits the civil rights of the depressed person against the needs of the people who love him to see him well and happy.

For a mob family, Carmella and Tony were pretty savvy and did the right thing by their son. They got him in to see a competent psychiatrist who asked the right questions and started him on the medication Lexapro. As with most antidepressants, it takes a few weeks for the mood to lift, and people do have to be aware that they may experience an increase in suicidal ideation for the first week or two. AJ consumed alcohol along with his Lexapro. Not a good idea as it can increase some of the side effects. Tony felt guilty that he passed this "gift" of depression, a genetic tendency to see the bleak side of life, on to his son. Studies from the National Institutes of Mental Health (NIMH) suggest that people with a depression-linked gene variant have an anxious temperament and weaker connections in the mood-regulating circuit. These studies show promise for future treatment options.

Thank you unclejerry for use of the photo.

Labels: depression, Sopranos, suicide

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Thank You, My Three Shrinks, for Grand Rounds!

It was with temerity that I submitted my post The Human Brain as a Deadly Weapon: Privacy Laws vs. Protecting the Publicto Grand Rounds 3.32 at Shrink Rap: BYOB (Bring Your Own Brain). The three shrinks (Dinah, Roy and Clinkshrink) write a blog "by psychiatrists for psychiatrists" - that's heady stuff. Please click on the link just to enjoy the brain graphic alone and if you are really interested, you can hook up to their Podcast!

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