Saturday, January 31, 2009

Healthcare IT Stimulus and EHRs

The 20 billion dollar Health IT stimulus could potentially force doctors to choose "between VHS or Betamax at a time when we see Blue Ray on the horizon".
I fear that any large scale government spending on health care IT, especially in the area of EHRs (Electronic Health Records), will end up being corporate welfare for the large, established IT vendors. There are a lot of smart people developing the next generation of health care computing, but unfortunately they may be shutout from the market if this spending plan comes to fruition.

I've seen over the past several years how federal and state dollars have been wasted in creating RHIOs. Many of these RHIOs found that after the initial grant money dried up, there really wasn't a compelling business value that would lead to sustainability. The grant funds just made these entities chase some misguided business plan/vision which really did not address true needs in the community for which providers would be willing to pay for.

If EHRs are truly vital to the efficient and safe delivery of health care, and actually help physicians and other providers do their job well, then these end users should pay for the technology themselves. The argument made from the other side is that the cost of EHRs is more than physicians can afford. I think then, the real issue is, perhaps the current crop of EHRs is based on old, clunky, expensive technology. Unfortunately, we may not get to see the future technology for EHRs if the government dumps billions into forcing physicians to buy current systems.

Saturday, January 24, 2009

Telemedicine in 1924?

The Concept of Telemedicine existed in 1924!
The only problem, the technology did not exist at that time. This magazine cover is quite remarkable in that it demonstrates the current concept of telemedicine, complete with videoconferencing, remote stethoscope and even an printer! Perhaps this young patient is receiving a prescription.
Also see this interesting article.

Sunday, January 18, 2009

Bail out Money, how far does it go?

The folks at Powerline blog posted some interesting facts about the nearly trillion dollars in bail out funds:

A Dozen Fun Facts About the House Democrats' Massive Spending Bill

1. The House Democrats' bill will cost each and every household $6,700 additional debt, paid for by our children and grandchildren.

2. The total cost of this one piece of legislation is almost as much as the annual discretionary budget for the entire federal government.

3. President-elect Obama has said that his proposed stimulus legislation will create or save three million jobs. This means that this legislation will spend about $275,000 per job. The average household income in the U.S. is $50,000 a year.

4. The House Democrats' bill provides enough spending - $825 billion - to give every man, woman, and child in America $2,700.

5. $825 billion is enough to give every person living in poverty in the U.S. $22,000.

6. $825 billion is enough to give every person in Ohio $72,000.

7. Although the House Democrats' proposal has been billed as a transportation and infrastructure investment package, in actuality only $30 billion of the bill - or three percent - is for road and highway spending. A recent study from the Congressional Budget Office said that only 25 percent of infrastructure dollars can be spent in the first year, making the one year total less than $7 billion for infrastructure.

8. Much of the funding within the House Democrats' proposal will go to programs that already have large, unexpended balances. For example, the bill provides $1 billion for Community Development Block Grants (CDBG), which already have $16 billion on hand. And, this year, Congress has plans to rescind $9 billion in highway funding that the states have not yet used.

9. In 1993, the unemployment rate was virtually the same as the rate today (around seven percent). Yet, then-President Clinton's proposed stimulus legislation ONLY contained $16 billion in spending.

10. Here are just a few of the programs and projects that have been included in the House Democrats' proposal:

· $650 million for digital TV coupons.
· $6 billion for colleges/universities - many which have billion dollar endowments.
· $166 billion in direct aid to states - many of which have failed to budget wisely.
· $50 million in funding for the National Endowment of the Arts.
· $44 million for repairs to U.S. Department of Agriculture headquarters.
· $200 million for the National Mall, including grass planting.
· $400 million for "National Treasures."

11. Almost one-third of the so called tax relief in the House Democrats' bill is spending in disguise, meaning that true tax relief makes up only 24 percent of the total package - not the 40 percent that President-elect Obama had requested.

12. $825 billion is just the beginning - many Capitol Hill Democrats want to spend even more taxpayer dollars on their "stimulus" plan.

Thursday, January 8, 2009

CMS Nursing Home Quality Measures

Here is a table of Nursing Home quality measure as defined by CMS.

Quality MeasuresMDS Observation Time Frame *

Long Term Measures

Percent of Long-Stay Residents Given Influenza Vaccination During the Flu Season

October 1 thru March 31

Percent of Long-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination

Looks back 5 years

Percent of Residents Whose Need for Help With Daily Activities Has Increased

Looks back 7 days

Percent of Residents Who Have Moderate to Severe Pain

Looks back 7 days

Percent of High-Risk Residents Who Have Pressure Sores

Looks back 7 days

Percent of Low-Risk Residents Who Have Pressure Sores

Looks back 7 days

Percent of Residents Who Were Physically Restrained

Looks back 7 days

Percent of Residents Who are More Depressed or Anxious

Looks back 30 days

Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder

Looks back 14 days

Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder

Looks back 14 days

Percent of Residents Who Spent Most of Their Time in Bed or in a Chair

Looks back 7 days

Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse

Looks back 7 days

Percent of Residents with a Urinary Tract Infection

Looks back 30 days

Percent of Residents Who Lose Too Much Weight

Looks back 30 days

Short-Stay Measures

Percent of Short-Stay Residents Given Influenza Vaccination During the Flu Season

October 1 thru March 31

Percent of Short-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination

Looks back 5 years

Percent of Short-Stay Residents With Delirium

Looks back 7 days

Percent of Short-Stay Residents Who Had Moderate to Severe Pain

Looks back 7 days

Percent of Short-Stay Residents With Pressure Sores

Looks back 7 days

Wednesday, January 7, 2009

Telemedicine Resource Part II

Writing a telemedicine business plan:
ATA Business & Finance SIG
- Business Plan Template document
- Business Plan Budget (xls)

Telemedicine Reimbursement

Getting Medicaid to cover more telemedicine services in your state

Not all states provide reimbursement for telemedicine services. Here is a document from the ATA,
Medical Assistance and Telehealth - An Evolving Partnership that outlines steps that one can take in order to get reimbursement from the state Medicaid payers.

Tuesday, January 6, 2009

Interface Terminology for Medications: RxTerm

I came recently across RxTerms. It is meant to complement RxNorm.
It is described as being more focused on usability and efficiency as opposed to RxNorm, which is more of a reference terminology.

Potential applications are in prescription writing or medication history recording.

See the presentation here. Download the data files here.

Sunday, January 4, 2009

"Ultrasound used to Enhance Chemotherapy" guest posting

Here is a Guest Posting by Sarah Scrafford, who writes regularly on the topic of
Online Ultrasound Technician Schools.

Ultrasound used to Enhance Chemotherapy

It’s the worst kind of curse to be afflicted by cancer – sometimes the only cure option available is chemotherapy which comes with its own side effects. The drugs that are used to kill the cancerous cells in your body end up damaging healthy tissue as well, causing adverse reactions like nausea, fatigue and pain. But there’s a way around this painful situation according to a study published in the Journal of the National Cancer Institute.

Scientists have discovered a new delivery method that makes it possible to target only the areas affected by the tumor by using special packets called nanobubbles to store drugs like doxorubicin that are used in chemotherapy treatments. When injected into mice, the bubbles traveled through their blood and accumulated in their tumors where they formed larger microbubbles. These areas, when exposed to an ultrasound scan, were open to imaging because of the echoes generated by the bubbles. The ultrasound also generated enough energy to burst the bubbles and release the drug directly onto the tumor.

The nanobubbles ended up serving two purposes – they helped image the tumor and also allowed the drug to be delivered only to the tumor-affected area thus preventing healthy tissue from being killed in the process.

Ultrasound is extremely popular as a diagnostic and imaging tool because it offers various advantages, the most significant of which is the fact that it uses no radiation to form images and so, is extremely safe even for children and unborn fetuses. But with the innovations that are being made in medicine day by day, new uses are being discovered for ultrasound, and the treatment of cancer is just one of them.

For patients who have been diagnosed with the dreaded disease and their families, this piece of news comes as a ray of hope – they can undergo chemotherapy without having to worry about or fear the horrible side effects of the drug. And for the rest of us, we can take heart in knowing that this is one more battle won in the war against disease that mankind is waging.

This article is contributed by Sarah Scrafford, who regularly writes on the topic of
Online Ultrasound Technician Schools. She invites your questions, comments and
freelancing job inquiries at her email address: