Nowreach: October 2010

Sunday, October 31, 2010

IPhone: 4% of the market, 50% of the profits - WCTV

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Verizon put to test a number talk unlimited text to any network

by admin the 31 October 2010.

At a time when unlimited rarely simply means that it is good to know that a plan may emerge that more closely resembles what it promises.

Verizon begins testing plans mobile to mobile, unlimited in Oklahoma, Arkansas, Louisiana, Mississippi and "markets to select" Texas, Tennessee Floride.Allant $ 60 to $ 130 and available for families or individuals, the plans will vary with the amount of non-mobile minutes included.

Trial plans will last until the end of the year, while we can only hope Verizon decide to make them available to the rest of their client base.

[via Engadget]

Tagged as: network, Talk, text, testing, unlimited, Verizon

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Motorola Sues Apple for violating Smartphone patent - Wall Street Journal

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iPhone for Verizon Wireless beginning 2011 confirmed? -infoSync World

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Samsung SP - H03 - PC Magazine

by admin on 30 October 2010

Samsung SP - H03
PC Magazine
Bottom line: The Samsung SP - H03 is small enough for a projector pico, better than most and offers great flexibility for the sources of the image of computers ...

"and more".

Tagged as: magazine, Samsung, SPH03

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10 More wild and Crazy food vending machines

A few days ago, we have developed a collection of 10 wild and Crazy food vending machines. In the meantime, keep us find more and could not resist to share with you. If books, eggs, medical marijuana, beer and bicycles are already sold in vending machines, all machine sale possible economy far?????

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Saturday, October 30, 2010

Manhattan is home of chickens, bees and a lonely cow

While bees and chickens are becoming a rarity in Manhattan, even the most ardent farmers urban aspirants would be hard-pressed to attentive to the space (and necessary permits) to a cow. But quite unlikely, there is a real cattle live on the island of Manhattan, such as the Wall Street Journal reports today.

Rather pleasant history, the name of the cow is Othello, "and he lives happily in the food chain at the Central Park zoo" Othello is not likely to get any company: although cows were part of the city until the end of the 19th century (and district) meat, until the 1980s, city ordinances and obvious space issues are in place to prevent any fanatical dairy DIY ideas. As the guardian of Othello, city of New York Zoo Director Jeff Sailer, said "you failed to get the food emporium hay."If true.Mais we still dream.

At one end or news related to the restaurant? email to fork@villagevoice.com.

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Large used features Mobile Nokia 1100

by admin on 30 October 2010

Old or new mobile Nokia is the best. When we looked for new mobile phone the Nokia brand hits first in our minds from the same if we think we used mobile then we prefer Nokia mobile first. You really in search of the used mobile Nokia then how you can forget the small and amazing mobile Nokia 1100?Thus, this mobile is available in a new stock of mobile phones Nokia .but there at your disposal in the used mobile section.

Mobile Nokia 1100 is the low cost and launched at the end of 2003.The phone is incorporated with all interesting technical characteristics and Nokia was first introduced with flashlight under the direction of very interesting feature. He has gained in popularity in the year 2006 and became affordable for any mobile phone worldwide such as Rickshaw Wala Cobblers etc..It was the first handset made by Nokia, especially for Indian consumers. Mobile Nokia sold over 200 million of 1100.

Specifications and used nokia 1100 mobile features are discussed. The phone is accompanied by all the advanced features. OK fine that is not true, but the device has decent features.This used mobile Nokia is delivered with display full screen saver, font size dynamic, scroll key 2-way SMS, games, T9 for 10 languages, calculator, stopwatch, Picture, messaging, flashlight and it can store 50 entries in the phonebook and keep them 10 outgoing call recording, received, 10 calls manqués.Ce phone is loaded with very basic functionality, but the main attraction of this used 1100 mobile Nokia is the back of the battery. Yes you were never recharge the battery before 1 week is better than brands such as the blackberry.The weight of the phone is 89 grams.

Probably not comparable with the eyes, it is now out of fashion and functionality.But if you are looking for the used Nokia mobile with voice and text chat is the best choice for you and greater value for the money of .c ' is the Green model never mobile.Utilisé mobile Nokia 1100 Nokia is rare to find best mobile.Le market for Nokia 1100 mobile used by navigation internet.Vous can find it easily in sites Web announces free online your home only.

Tagged as: 1100 stories, General, mobile, Nokia, used

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Verizon put to test a number talk unlimited text to any network

by admin on 30 October 2010

At a time when unlimited rarely simply means that it is good to know that a plan may emerge that more closely resembles what it promises.

Trial plans will last until the end of the year, while we can only hope Verizon decide to make them available to the rest of their client base.

[via Engadget]

Tagged as: network, Talk, text, testing, unlimited, Verizon

View the original article here

Posts of the week

Finally, on Friday afternoon. In the early evening, indeed. So without further delay, here a retrospective look at the week that was.

Ty of Kittichai Bellingham spoken Thai, feeding of children, and his curry paste guys.

FAT Friday pants Cinnamon pastry blow.

Our 10 Halloween Best Trick-or-Treat candy.

The McRib returned and our Man Sietsema form on the thing.

Battle of the Midtown seasonal Apple Cupcakes: crumbs v. Robicelli.

Sarah says so long and thanks for all the fish.

Make ginger squash soup with cream of pepper the Jamaica and the Spice market soy milk.

Here's the word start at City Sandwich in hell's Kitchen.

The Club of Hurricane Richard Leach spoken tiki, a new box of night and pastries in cocktails.

Best dog food costumes of Tompkins Square Park.

Cleaning of carpets Amilcar Flushing will clean your carpet and sell you the wine.

At one end or news related to the restaurant? email to fork@villagevoice.com.

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The week in food Blogs: terrible kitchen accidents; Seasonal beer drinking

This week in food blogs...

Display Eater strangest sandwiches New York map.

Grub Street discovered some horror kitchen really terrible stories of leaders accident-prone.

Favorite places listed Seamus Mullen feast: Osteria Morini, sushi Zen and Dutch non-still-even-open.

Newspaper addressed the question of what to do when girlfriend your brother hijacks Thanksgiving.the Diner

Atlantic food has explored the meaning of the candy Halloween psycho stories.

Midtown lunch gave a shout out Big Gay ice cream truck and Kelvin Slush are blurred open shop for the winter.

Feed displayed guide of its seasonal alcohol beer lover.

Cut into slices had a chat with Andrew Carmellini on pizza.

Have a restaurant or other news of food tip? email to fork@villagevoice.com.

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Friday, October 29, 2010

Health insurance and life

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October 28, 2010

Health Insurance and Life Expectancy

By JOHN GOODMAN

Did you know that Hispanic Americans live longer than non-Hispanic whites? If that doesn't knock your socks off, consider this: American Hispanics are three times as likely to be uninsured as non-Hispanic whites.

If you're still not blown away, maybe you haven’t been following the twists and turns of the health policy debate. As I wrote at my blog the other day, the Centers for Disease Control (CDC) discovery that Hispanics (one-third of whom are uninsured) have a life expectancy that is 2 1/2 years longer than whites (90% of whom have health insurance) makes mincemeat out of the oft-repeated idea that the uninsured get less health care and die earlier than everyone else.

In support of the conventional wisdom, for example, the Physicians for a National Health Care Program (PNHCP) went so far as to claim that a whopping 45,000 people die every year because they are uninsured. That figure, repeated as though it were unquestioned fact by President Obama and most of the health care media, is almost as large as the number of American soldiers killed in the entire Vietnam War!

Families USA went so far as to make the astounding claim that 6 people die every day in Florida because they are uninsured. Eight die every day in California; and 25 die in New York. In Texas, the report implies that more people die every two months from lack of health insurance than the number killed at the battle of the Alamo (counting only losses on our side, that is). Nationwide, says the PNHCP, an uninsured person dies every 12 minutes.

With all this carnage, you might wonder whether there are any uninsured people left alive.

All of this nonsense is critiqued here. But don’t get me wrong. One of the joys of health economics is that you just don’t get this kind of entertainment in other economic fields. For sheer comedic amusement, health economics is sui generis.

The latest government report also completely blows out of the water a whole slew of international comparisons that cause a lot of commentators to froth at the mouth. Take the 1,000 or so U.S.-health-care-system-bashing studies, essays and opinion pieces (or is it 10,000? I can't remember) that claim we're getting short-changed because we spend more and die earlier. Turns out, these comparisons were mainly focused on insured people. Had they looked instead at the U.S. ethnic group most likely to be uninsured they would have had to eat their words. American Hispanics probably spend less on health care than people in other developed countries and they live longer!

As the table below shows, American Hispanics outlive Canadians and the British, to say nothing of Germans, the Irish, the Finns and the Belgians. Overall, Hispanics in the United States live a year and a half longer than the OECD average life expectancy. (All numbers are from 2006, to conform to the CDC study.)

Sources: OECD Health Data 2008 and CDC.

It is not known why so many Hispanics are uninsured, but the phenomenon is not explained by lower incomes. Census Bureau statistics show that at every level of income, Hispanics are two to three times as likely to be uninsured as the population as a whole, and the higher the income level, the greater the discrepancy.

Now if we did research at the NCPA the way Families USA does research, we would be claiming that lack of insurance actually makes people live longer! I can see the press release now….."90,000 People Alive Today because They Didn't Insure, Says Study"….. An estimated million, billion, trillion extra life years, all because of….. 12 extra people walk the streets of Florida every day….. That's XXX people who didn’t die every minute…..YYY every second…..ZZZ every nanosecond…..

John C. Goodman is president and CEO of the National Center for Policy Analysis.? He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s health policy blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.

October 28, 2010 in Health insurance, Hispanics, John Goodman | Permalink

Comments

Or,alternatively...If Hispanic Americans had a lower uninsurance rate, the difference between their life expectancy and that of White Non-Hispanics would be even greater.

Posted by: Roger Collier | Oct 28, 2010 5:44:03 PM

This is not news to Americans of Hispanic descent, the reality is that Hispanics have less "Stress".

Thank you,

Rudy Lehder Rivas, President
Hispanic Insure.com

Posted by: Rudy Lehder Rivas | Oct 28, 2010 10:37:47 PM

Happiness is believed to be traversable; this is true to some extent. When a person is happy he has the ability to make others happy too and a person is usually happy when he enjoys good health and has all the required materialistic facilities and company. Well in this article we are going to focus on health of a man which keeps him going and contended. This can make a difference in the environment and create a positive ambience. In order to enjoy such good health and environment there are certain factors explained below.

Habits:
Good habits in an individual can help that person to be contended due to his good deeds. If an adult follows good practices it serves as an inspirational factor to younger members who often notice such deeds. Good habits in terms of health, profession, education and social life can help in attaining good status and contended life. It is habits that determine an individual’s character or personality. It is also a matter of fact that habit persists for a long time and it is difficult to ebb them away; hence it is essential to observe good habits which may be beneficial in all aspects.

Eating Habits:

A fine eating habit is a healthy manner to live contended life. Good nutritional eatables have less or no alternative. It results in good health conditions, longer life span as well as it teaches the younger generation about good nutritional values too. Some basic values such as keeping the hands hygienic before eating your meal, drinking sufficient water and consuming correct foods are good manners to keep yourself fit and healthy. As an adult it is your duty to make a good environment; hence, fine eating habits is a better lifestyle habit.

Posted by: Medexpressrx | Oct 28, 2010 11:07:01 PM

living longer is a matter of having a good lifestyle.socializing with friends and as much as possible staying in the positive outlook in life. and watching what you eat.insured people worry too much about their health and how long they would live. causing them stress which is a sign of early aging.

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Posted by: f.vanderlugt | Oct 29, 2010 2:16:10 AM

If you read the report, it says a couple things worth noting:

(1) The authors say that the mortality advantage observed for Hispanics holds up when you adjust for socioeconomic characteristics - they DON"T say that it disproves the relevance of those factors or that they don't matter. It's more accurate to say that Hispanic mortality appears lower DESPITE the relative levels of disadvantage (including lack of health insurance) among Hispanics, due to factors that the CDC can't account for.
(2) One of those factors they can't account for is what they call the "migration effect" which basically means that the population of Hispanics for whom they have data on health insurance status may be quite dissimilar from those for whom they have mortality data (e.g. Hispanic immigrants may be more likely to have no health insurance, and also more likely to return to their home country before they die). They say there's no definitive evidence of that, although to me it seems plausible - one reason to regard the findings of this study with some caution until more research is done. As they say repeatedly in the article, it's only recently become possible to do analyses like this due to improvements in the collection & coding of ethnicity data, so this whole topic is just beginning to get really rigorous study.

Posted by: TW | Oct 29, 2010 3:48:56 AM

For the record, the argument that Families USA has been making isn't refuted by any of this: evidence that things other than health insurance affect mortality doesn't in any way weaken the argument that having health insurance by itself affects mortality.

Based on your posts here, of which this one's a good example, I think you shouldn't be so sanctimonious about how Families USA uses data. I largely agree with most of their policy positions, yet i'll readily concede that as advocates they can be guilty of using data selectively & over-interpreting findings that happen to support their policy preferences. But you're doing the exact same thing here, and do so regularly on this blog. Actually what you're doing here is worse: you criticize Families USA for over-interpreting research on the insurance-mortality link, in the same post where you're fundamentally misrepresenting both that research and this new research on the ethnicity-mortality link. You're free to speak your mind, but you should be among the last of the regular posters on THCB to be lecturing anyone about argumentative misuse of data.

Posted by: TW | Oct 29, 2010 3:49:33 AM

Hey John, seems most citizens with government run/controlled/single-pay live longer than U.S. citizens. What are we to draw from that - it works at lower cost?

Posted by: Peter | Oct 29, 2010 3:51:26 AM

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Confessions of a literacy health expert

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October 28, 2010

Confessions of a Health Literacy Expert

By HILARY SELIGMAN, MD

I?have a patient who I will call Antonia.

Antonia is in her early 70’s.? She came to the United States from Guatemala many years ago, but never learned to speak much English.? This doesn’t cause her much of a problem; her community is small and tightly-knit, so she doesn’t have much need to speak English in her home or her neighborhood.?? And she has a large family—children and grandchildren and great-grandchildren—who live close by.

Antonia is one of my favorite patients.?? We communicate in different languages, and taking care of her is a series of endless frustrations.? But I love her contradictions.?

She seems so little when she sits in the chair in my exam room, feet up on the bar supporting the chair’s legs, her body folded up around the purse clutched tightly in her lap.? But when she talks, she shines; she is larger than life.? We enjoy ourselves.? I like her, and I like being her doctor.

Here is Antonia’s medication list:

For diabetes:
Metformin?1000 mg: 1 tablet 2 times daily
Glyburide?5 mg: 1 tablet 2 times daily

For pain associated with neuropathy (a complication of her diabetes):
Gabapentin?300 mg: 1 tablet 3 times daily

For high blood pressure:
Hydrochlorothiazide?25 mg: 1 tablet 1 time daily
Benazepril?20 mg: 1 tablet 1 time daily

To protect from heart attacks:
Aspirin 81 mg: 1 tablet 1 time daily

For a recent bout of depression:
Escitalopram?10 mg: 1 tablet 1 time daily

For heartburn:
Omeprazole?20 mg: 1 tablet daily

For osteoporosis:
Os-cal?500mg: 1 tablet 2 times daily

For cough of unclear etiology (maybe asthma?):
Albuterol Inhaler:?2 puffs four times daily as needed for cough

Despite these ten medicines on her official list, Antonia’s blood pressure is often too high when she comes in to see me.?? Her blood sugar is?way?out of control.? And she has had a cough now for many months.? I don’t know why she has a cough, because she has not completed most of the tests I have ordered for her.?? All of this troubles me.

Without a doubt Antonia has limited health literacy. As an “expert” in health literacy, I know how to approach Antonia.? So here is what I have done:

1.?Recruit her family members to help with her care:?Check.? Her granddaughter now accompanies her to most of her appointments and (at least by report) checks in on her grandmother twice a day to make sure that she has taken her medications.?? The granddaughter is also my patient, however, so I happen to know that her granddaughter has many of the same challenges as Antonia….

2.?Use the “teach back” method:? Check, although with only mixed results.? I usually get only smiles and expressions of deep appreciation for my care when I ask her to report back to me the changes I have made in her medication regimens.?? When her granddaughter accompanies her, however, I am a little more confident that she understands my instructions—at least for that moment.

3.?Use aids to help her with her medicines:?Check.? She has a weekly medication box at home, which apparently her granddaughter fills, but they have never been able to bring the box in to show me.

4.?Simplify her medication regimen:? To some extent, I have done this.? Her blood sugar was repeatedly dropping too low while she was on insulin, so I stopped the insulin completely.? I also stopped her cholesterol medicine and one of her osteoporosis medicines because I decided they were not essential.

But now I am stuck.? I know what I am?supposed?to do.?I am supposed to start peeling off more medicines to find a simple regimen for her (one medicine? two medicines?) that gives her the biggest bang-for-the-buck.? I advise the residents in our clinic this way all the time.? But what does that mean for Antonia?

I can divide Antonia’s medicine into three categories: those that improve her quality of life (like her pain medicine and her depression medicine), those that may make her live longer (like her blood pressure medicines and her aspirin), and those for her diabetes (which at her age treat mostly symptoms associated with too-high blood sugar—urinary incontinence, poor wound healing, and possibly confusion).

So which medicines should I stop?? You be the doctor.? Stop the medicines that make her feel better, or the medicines that make her live longer?

Despite my years of studying health literacy, I don’t know the answer to this.?I usually lean toward stopping the medicines that make her live longer, but why does Antonia not deserve the same high-quality care all my other patients get?? Does she not deserve the mortality benefit of the aspirin because she has limited health literacy?? Of course not.

So maybe I should stop the medicines that improve her quality of life instead?? But then why am I her doctor if I am not able to make her more comfortable, to treat the aches and pains that she comes to see me for?
I know the answer, but it is not an easy one.? The answer is neither of these options.

You see, like most patients in my clinic with limited health literacy, Antonia doesn’t?onlyhave limited health literacy.? She also probably has some mild dementia;? and some mild depression; and we do not speak the same language (Spanish, of course, but also the language in which she frames her health issues); and she only shows up for about one out of every four appointments I make for her.? And even when she does show up for her appointments, I still only have 20 or 30 minutes to spend with her at best (and that’s if I resolve to skip lunch and make all my other patients wait).? But even then she leaves my exam room, she goes home, and I don’t see her again for weeks or even months.? And it is during those in-between times I need help.

So what is the answer??The answer is that I need?solutions?to Antonia’s problem that are bigger than me and my response to her limited health literacy.? I need a nurse to go out to her house once a week to fill her medication box and spend the time to communicate with her in a way she understands.? I need someone to call Antonia and her granddaughter the day before every appointment to remind them to come in—and to send a few bus tokens if they have run out of money.? I need nutritious meals delivered warm to her apartment every day.? I need someone to take a walk with her every afternoon because she is afraid of falling if she goes out alone.? I need a mental health counselor to talk to her about her depression.

And yet, in Antonia’s case, I do not have these tools at my disposal.

We have to start thinking about health literacy in a broader framework.? We cannot approach health literacy in isolation, because rarely do we encounter limited health literacy in isolation.? We see limited health literacy in the context of poverty, or dementia, or limited English proficiency, or depression.?? So our clinical responses to health literacy must be similarly broad.? I cannot solve Antonia’s problem on my own, plugging away in the exam room with her month after month and year after year.

So Antonia remains on her ten medicines.? I cringe every time I see her medication list and berate myself for being a poor doctor.? But really I have Antonia on these medicines because I think it is good medical care, and, if nothing else, this is what Antonia deserves.

About Dr. Seligman

Hilary Seligman, MD MAS is an Assistant professor of medicine University of California San Francisco. In addition to matters of health literacy, Hilary studies the role of food insecurity, or access to enough food for an active, healthy life, in the development and management of obesity and chronic disease.

October 28, 2010 | Permalink

Comments

I saw lots of discussion of high sugar levels and medications, but I saw no mention at all of her diet.

Does this lady eat properly?

Posted by: James | Oct 28, 2010 9:13:37 AM

And of course, by pay for performance standards, this makes you a very bad doctor and you should be punished financially.

But, then, Antonia's not an e-patient, so who cares?

Posted by: pcp | Oct 28, 2010 10:45:43 AM

Wonderful post, and can speak to a host of issues.

Translate this to care transitions and unneccesary readmissions for one.

If Antonia winds up in the ED, where is the root cause, how good or large of a safety net can we provide?

That is not to say we cant do much better as a system, but an excellent illustrative example of how difficult it will be make lighting in a bottle happen.

Well done, and it sounds like you are a very caring doc.

Brad F

Posted by: anon | Oct 28, 2010 10:54:08 AM

For unexplained cough, stop her Benzapril. See if she is in CHF and have pulmonary function studies done so you know what you are doing. Might save her from albuterol

For quality of life or length of life, ask her what she values.

What is her family history? You cannot change her genes. If her family lives long,, don't worry so much about lengthening her life. If they don' have a long life span, there is precious little you can do to thwart that.

For "heartburn" in her early 70's, she needs a Cardiolyte stress test.

Her diabetic control would be better illustrated by a Hemoglobin A1C.

Aspirin is dirt cheap.

Generic metformin is cheap.

HCTZ is cheap.

Why did she start seeing you in the first place? Was it for you to become her nanny? You are in the advice and access business. Are you so sure of your regimen you would invade her home to enforce it? Is she seeing more than one doctor? Are you sure?

If she has been here "many years" we deserve that she learn English.

She needs to warm her meals. Her friends and family need to fill her med box. Maybe she doesn't want to talk to anyond about her depression. You have said you need all these things. Does she need them or want them? If so, she need to move into assisted living.

Have you discussed advanced directives? Does she have a living will or a healthcare power of attorney or a durable power of attorney?

You have presumed she has no resources. Are you sure? People brave enough to immigrate are usually survivors, usually not helpless.

Posted by: MD as HELL | Oct 28, 2010 11:26:12 AM

Commentators who are offering their own medical tips for managing Antonia are clearly missing the point. Juggling medicines on the margins isn't the real answer to Antonia's care, but it is the thing we physicians can do. A reminder, again, that the context of a person's life is so much more dominant than our learned interventions.

Posted by: Hub Mathewson, MD | Oct 28, 2010 12:02:33 PM

MD as Hell was the only one to mention cost issues. Is she missing meds because the copays for 10 drugs adds up to a substantial sum out-of-pocket every month, especially if they are brand names?

At 70, she is on Medicare, and presumably has a Part D plan.

Since they outlawed CFC albuterol, you can only get it in non-CFC (HFA) delivery form, and it's a Tier 2 drug nowadays, not a Tier 1 generic anymore. Os-Cal is a brand, too, and probably on Tier 2. How many other of these drugs are on Tier 2 or Tier 3 or Tier 4 for her insurer -- if she even has a Part D plan?

Part D plans are required to offer patients medication therapy management (MTM) to patients with multiple diagnoses and multiple prescriptions. Antonia is clearly qualified, which means she gets a free consult with a clinical pharmacist who can advise her on how to properly take her meds, and consult with her doc (which is you) on how best to adjust dosages, and which meds can safely be dropped, or which scripts can safely be changed to a generic in the same therapeutic class.

Next time she's in, find out which Part D plan she has, and advise that she call them and ask to be signed up for a Medication Therapy Management program (and ask for an interpreter). Maybe have the family help her with it. You'll know she did it when the clinical pharmacist calls you.

This will take some of the burden off you, and give you another knowledgeable source to consult with. The insurer will likely also do some outreach/reminder calls with her.

Posted by: Rick | Oct 28, 2010 12:05:51 PM

It is great to know that there are still Doctors like you that care enough about there patients and take the time to actually research and ask online. I think you must be a great doctor. Best Wishes!

Posted by: Diana | Oct 28, 2010 12:55:14 PM

" I don’t know why she has a cough, because she has not completed most of the tests I have ordered for her. '

How many thousands of dollars of tests did you order?

The ace inhibitor is causing the cough. Stop the ACE inhibitor, and then you can stop the albuterol.

You being a professor at UCSF, I would think that you would know to give the patient and ACE holiday. What did your computers tell you to do?

Is this case a joke? Now I know how nuch EMRs are screwing up me3dical care.

Posted by: Alicia Stevenson, Md | Oct 28, 2010 2:40:56 PM

A couple of visits by a home-care nurse would probably do more for this patient than anything. The most competent and caring of physicians will never develop the context needed in her office. You are doing a great job within the very limited scope that our office-based medical culture allows--but until physicians have other avenues available to them, they will continue to spin their wheels with patients like this. What's the point of repeating this ineffective drama over and over? We spend so much money but are hamstrung by the payment system from providing the kind of care that can make the most difference in many cases.

Posted by: botetourt | Oct 29, 2010 2:19:38 AM

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Alexandra Drane being committed with thanks to TEDMED

28 October 2010.

Alexandra Drane being committed with thanks to TEDMED

By Matthew Holt

A photo of TEDMED, a really fascinating conference where I was this week (RWJ courtsey).Is Alex Drane Za history and featuring the committed with Grace Institute has been remarkable.

28 October 2010 to Matthew Holt |Permalink

Comments

Looks and sounds remarkable.Thank you

Posted by: Rob |Le 28 October 2010 2: 53: 44 PM

Never been before TEDMED - but am always surprised at the evolution of technology and the médecine.Tiens that I could be approximately 100 years to see how they complement one another.

Posted by: David h. |Le 28 October 2010 3: 28: 59 PM

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The shame of Malpractice lawsuits

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October 27, 2010

The Shame of Malpractice Lawsuits

By PAUL LEVY

This posting is not about tort reform. It is not about defensive medicine (e.g., MDs taking too many tests to avoid the chance of lawsuit.) It is not about controlling costs or improving the quality of care. It is not even about whether malpractice lawsuits are fair. It is about the emotional effect on a doctor when he or she is sued for malpractice.

A friend of mine (I'll alternate genders to help maintain confidentiality) recently found herself in this situation. By any measure, this person is an excellent physician. She has impeccable clinical judgment when it comes to both diagnosis and treatment. She has superb interpersonal skills and bedside manner. She is highly respected by her peers, by the nurses, and by all who know her.

Recently he found himself as a defendant in a malpractice lawsuit. The details and merits of the case don't matter all that much. The patient had been under his care for many, many years and was always satisfied with the quality of care offered. After the patient died, the patient's children sued.

Even though she knew that she had done nothing wrong, my friend's main emotional response to the lawsuit was that she was ashamed. She did not want anyone to know about the case -- whether colleagues in the hospital or social friends. I was stunned. Without knowing any of the evidence in the case, I was confident that this doctor had done her best in treating another human being and would be appalled to think she had done anything to create harm. I also knew this person to be as well trained and well intentioned as anyone I could imagine.

And, yet, he felt shame in being named as a defendant in a case that accused him of negligent treatment. As I talked to other doctors, I learned that this was a common reaction to such lawsuits. Another friend talked of the scars left from a case 20 years ago. He was found not to be at fault, but he could still vividly recall the weeks of shame he felt while the case proceeded.

What is it that makes doctors respond in this way? Are they so naive about the legal system that they are not able to absorb its brickbats with equanimity? After all, people in other fields are sued all the time, and while they feel many emotions, usually shame is not at the top of the list.

I think it is this. Doctors devote their lives to alleviating human suffering caused by disease. They spend decades in training. They disrupt their family lives to be available to help others. For them, this is a calling. It is not part of their life. It is their life. They measure their worth to their community and ultimately value themselves by their unfettered dedication to this cause -- and by society's appreciation for it.

A malpractice claims shatters this construct. In the doctor's mind and heart, it says, "Society does not value all that I have devoted my life to. They do not believe I am worthy of trust that is granted to me, notwithstanding the effort, energy, and dedication I have given to this calling." And perhaps he even says, "Maybe I am not really as good a doctor or as good a person as I think I am."

For someone who has spent his or her whole life basking in the gratitude and admiration of individuals and society, this can be a devastating experience. Even when the verdict is issued, clearing the doctor of all wrong, it can leave a terrible scar.

As this particular case proceeded, I was really pleased to see an evolution in the doctor's feelings. After watching the opposing witnesses misrepresent the clinical evidence in the case, she got really, really angry. Her sense of shame evaporated. It was replaced by an outrage that the patient's children, the plaintiff's lawyer, and members of her own profession were causing her to spend hours away from the care of other needy patients. With the arrival of anger, her confidence returned.

Sure enough, he was cleared of all allegations. He came back to work, and I was heartened to see that caring smile return to the floors of our hospital. I hope he never has occasion to feel unwarranted shame ever again.

October 27, 2010 | Permalink

Comments

As a physician I don't see the problem with what the fire department did. There is only so much free care and then you have to pay.

Posted by: Ross Franklin | Oct 27, 2010 5:30:09 PM

If government licensing was removed along with its false sense of secruity and people put more effort into their own healthcare decision making, lawsuits would not occur as much. People should be able to sue and have no caps on damages, but government licensing and price insensitivity on behalf of the consumer have created a monster of a healthcare system in this country.

What really gets me is when stupid judges actually CRIMINALIZE negligence or errors resulting from process issues, not the individual. This only encourages hospitals and practitioners to hide errors even more than they already do.

Posted by: PharmerJoshua | Oct 27, 2010 5:53:31 PM

Thank you for writing this. Sums it up perfectly to me. I have yet to be sued, thanks to whatever fates have supported me thus far in life, but this is what I have heard equally from colleagues who were wrongfully sued.

We do this as a calling. I just hope someone who doesn't get this tries to write something shameless and rude.

You never know when that adage comes back at you: what goes around comes around!

Posted by: DeterminedMD | Oct 27, 2010 6:17:10 PM

In medicine we physicians are taught that the patient and family's welfare is a priority even before the physicians' own welfare. We have been abused badly by our system. In many many cases a bad outcome is inevitable. Good Health is a gift and it cannot be assigned to the physician. We merely stand in the way of inevitability and in some cases succeed. We physicians cannot guarantee health. I don't know the specifics of this case, nor what the merits were. I hope you have your physician back for good. Nice to know he (she) had such great support from the hospital admin as well. At times this is not the case and we are divided and torn apart and no one comes out for the better

Posted by: Gary Levin | Oct 27, 2010 6:21:55 PM

A bad outcome is not necessarily medical malpractice as we have all opined many times before, and in the book: "Risk Management and Insurance Planning for Physicians and their Advisors."

http://www.amazon.com/Insurance-Management-Strategies-Physicians-Advisors/dp/0763733423/ref=sr_1_3?ie=UTF8&s=books&qid=1275315795&sr=1-3

Courage!

Dr. David Edward Marcinko, MBA
www.MedicalExecutivePost.com
Atlanta, GA

Posted by: Dr. David E. Marcinko MBA | Oct 27, 2010 6:39:57 PM

Thank you for writing this. I too have seen physicians sued who were, by all measures, top notch. The experience for them of being dragged through years of depositions and legal wrangling was devasting. They never knew whether all they had worked for would be wiped out by a single jury verdict who felt sorry for someone who happened to have a bad outcome regardless of the quality of the care that was delivered. It's not simply one's reputation that is at stake but personal financial assets if the jury award is greater than one's malpractice coverage. Watching others experience this nightmare has only served to make me much more tentative and reluctant to take on tough cases. It certainly has not made me a better physician because I see that ever possible well-intentioned effort could be second-guessed and twisted around at a moments notice. Certainly patients deserve to receive compensation when a mistake actually occurs and they require ongoing treatment and care as a result. But terrorizing well-trained and well-intentioned physicians with the spectre of frivolous lawsuits does no good for anyone.

Posted by: A. Nony Mouse | Oct 27, 2010 11:08:01 PM

Interesting article and human perspective. I have to ask that within the enviromental and cultural peer review. Is it possible that within this bubble; You have created a false sense of Security and a buffer from real world realities?

Those of us who work in the private sector deal with being rejected, questioning our motivations and being sued. We also make our mission to serve:putting ourselves last. To provide for our customers as well. Anyone who has any pride in their Profession of choice share the Same Feelings. Therefore I see no real differences in Health Care.
Lawsuites are seldom enacted unless some form of strong proof has been revealed.Lawyers are like used Car salesman who only sue on a sure thing. Besides,Doctors have more to fear from insurance Companies sue than Patients.
I agree that Good Doctors are often grouped in with some whom have a doubious Distinction of being Honest. Let alone having morals.Unfortunate as it is;Doctors are not alone.

Posted by: Gary Lampman | Oct 28, 2010 11:57:36 AM

"It is about the emotional effect on a doctor when he or she is sued for malpractice."

And about the emotional effects on injured patients, not to mention the financial ones.

"The details and merits of the case don't matter all that much."

Oh, but they do.

"After all, people in other fields are sued all the time"

By doctors?

"Sure enough, he was cleared of all allegations"

Then the system worked, didn't it.

Posted by: Peter | Oct 28, 2010 4:39:50 PM

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Thursday, October 28, 2010

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Wednesday, October 27, 2010

Acer liquid metal s120 hits the FCC: note Froyo + AT & T strips

If you like aluminum as much as you like Android, AT & T and Acer and the FCC has good news for you: the liquid metal s120 has just been confirmed as play nice with GSM/EDGE 850/1900 and WCDMA band II and V - the count in the audience will notice that makes it a worthy of the AT & t.

We do not yet a complete list of specifications to accompany the s120, but we know there a 3 6″ 800 × 480 screen, Qualcomm MSM7230-1 800 MHz processor (the same as in the T-mobile G2) and the usual WiFi b/g/n, Bluetooth, and GPS 3.0.

The phone is expected to launch at the end of October, United Kingdom but no date u.s. was spotted immediately, but should not be far.

[via Engadget]

Tagged as: Acer, AT & T, bands, Froyo, hits, liquid, Metal, s120, represents

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SureScripts, A Defacto NHIN

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October 26, 2010

SureScripts, A Defacto NHIN

By JOHN MOORE

Yesterday in New Orleans, SureScripts announced a new line of business: Clinical Interoperability. Leveraging their existing ePrescribing solution platform, currently serving over 200K physicians nationwide, and combining it with the technology stack of messaging solution provider Kryptiq, SureScripts will offer providers, EHR vendors, HIEs and other stakeholders the opportunity to securely share clinical information across town, the state, a region and the country. In this combination, SureScripts will provide the rails and Kryptiq will address the last mile of connectivity.?This announcement has some pretty big implications for the HIE market. ?Chilmark was briefed prior to this announcement by both SureScripts and Kryptiq, following is what we learned.

Details:
SureScripts primary focus has been to provide the network that would support physicians transition to ePrescribing. Therefore, SureScripts has been focused on transmitting NDP data and not clinical notes. SureScripts got into the transmission of clinical summaries from one of its larger customers, MinuteClinic wanted to send clinical summaries of patient visits directly to primary care providers. In the past year SureScripts has facilitated the movement of over 0ne million patient summaries for MinuteClinic to primary care physicians using CCR. Seeing an opportunity, SureScripts sought a partner that could take this capability to the next level.

Kryptiq, a company profiled in Chilmark’s forthcoming HIE Market Trends Report due out next month, can be characterized as vendor of HIE capabilities that allow for the organic growth of an HIE without the overhead.?Kryptiq has worked behind the scenes for a number of EHR companies to provide secure, structured messaging services within these EHRss ecosystems of customers connecting them to one another as well as to other systems, including SureScripts to facilitate care coordination.

SureScripts has made an equity investment in Kryptiq?(undisclosed but likely in the range $7-9M over the next few years) to build-out Kryptiq’s technology stack for SureScripts. The Clinical Interoperability solution will combine SureScripts foundational technology (provider directory, security, authentication, master patient index, etc.) with Kryptiq’s connectivity toolset (interface technology to various EHRs), secure messaging framework and clinical portal.

SureScripts will release the first wave of Clinical Interoperability products in early December. Pricing will be subscription-based (monthly) and depend on the level of service a given practice desires.

Implications:
SureScripts is the closest thing the US has to a de facto National Health Information Network (NHIN). With the rapid growth in ePrescribing (181% in 2009) representing over 600M prescriptions and now over 200K physicians connected to SureScripts, SureScripts has a network in place, particularly in the ambulatory sector, that few if any can boast of. Sure, Epic has its walled garden of Epic Everywhere and its future release of Epic Elsewhere will attempt to connect physicians using other EHRs, but the walled garden has not proven itself to be sustainable over time. Just look at AOL’s walled garden: fine in the early days of the Internet but was simply unable to innovate fast enough to satisfy market needs and wants.

As an EHR vendor neutral platform that actually puts EHR vendors through a rigorous process to provide them with SureScripts certification, SureScripts is not a threat. If anything, and this is highly dependent on what SureScripts may do in expanding its Clinical Interoperability product and services suite, SureScripts may provide a common foundational and commercial NHIN framework that will allow others, including EHR vendors to provide innovative solutions upon. This may lead to a Platform as a Service (PaaS) model facilitating the adoption of distinct modules that sit upon the SureScripts/Kryptiq communication network.

While both SureScripts and Kryptiq stated that they did not see themselves competing directly with HIE vendors, Chilmark sees quite the opposite. Through its ePrescribing services, SureScripts already has established data connections and relationships with a number of EHR vendors. Kryptiq, through its services, has the technology that provides the interfaces to a wide range of EHRs, many of them in the ambulatory sector where SureScripts is also strong. The combined SureScripts-Kryptiq solution suite will impact many an HIE vendor’s bottom-line for these HIE vendors generate a significant portion of revenue on EHR interfaces and their portal solutions. The SureScripts announcement is likely generating a significant number of internal meetings among HIE vendors as they assess what their game plan will be moving forward. If they are wise, they will seek out SureScripts and look at opportunities to collaborate, offering distinct value-added services on the SureScripts network.

While Chilmark was briefed prior to this announcement by both SureScripts and Kryptiq the briefing was short and details few. A more in-depth briefing will occur in the next week or two, including a deep dive into the technology stack. We’ll keep you posted.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

October 26, 2010 in EHR, HIEs, John Moore, NHIN | Permalink

Comments

John, Great write-up and analysis.

One subtle but important point...

You are correct that the Surescripts network becomes a "nationwide health information network" (nhin)

but not the "Nationwide Health Information Network" (NHIN) -- the envisioned network of health information exchange networks.

Expect competing nhin's. That said, I think Surescripts gains some important first mover advantages with their announcment.

Overall, this is great news for advancing the vision of interoperable, modular, open health data exchange!

Posted by: Vince Kuraitis | Oct 26, 2010 11:16:50 AM

This is a very exciting development that's taking place without governmental regulation, how novel.

Posted by: Zach Evans | Oct 26, 2010 6:29:55 PM

Zach, do you think HITECH and PPACA have nothing to do with Surescripts doing this? Hardly.

Posted by: jonathan (jd) | Oct 26, 2010 6:39:48 PM

jd,
I'm sure HITECH accelerated this somewhat, but this development was pretty much inevitable for Surescripts and, as I pointed out here last week, the next "thing" to watch are the claim clearinghouses and the payer networks - all very well positioned for national information exchange.

There are two recent developments pointing in that direction
The NaviNet EHR - http://bit.ly/bvqu9B
The RelayHealth ONC certification - http://bit.ly/9eEXTi

Posted by: Margalit Gur-Arie | Oct 26, 2010 7:57:27 PM

Margalit, it's hard to debate counterfactuals, but I do think the government push towards data exchange and care coordination is a major factor on both the timeline and the content of these developments.

Remember, we've been hearing forever that the business model isn't there to support clinical data exchange. What hospital (paid episodically) would spend money to make it easier for potential patients to avoid visiting it, or avoid exams and tests that were recently done? In fact, I can remember on this very blog not too long ago people poo-pooing efforts to build RHIOs on these grounds, among others. And yes, I realize the three companies you mentioned are not RHIOs in the standard sense.

What is changing now with ACOs, Medicare/Medicaid subsidies for EMRs, and other legislative developments, is that we know the next 4 years are going to be a time of rapid growth in EMRs and that these new EMRs will be interconnected sooner rather than later. As a business, you now know that there will be customers in 2-4 years rather than 10-20 if you can build a better data exchange platform.

I do agree that what Surescripts, NaviNet and Relay are doing is encouraging and a natural move given their existing strengths and abilities, once it became clear that if you build it, they will come. Without that, we would still be in the land of endless pilots.

Posted by: jonathan (jd) | Oct 26, 2010 10:23:00 PM

So what does this mean for the hundreds of start-up community HIEs spawned by HITECH - all busied working on their strategic and operational plans, and trying to build value and sustainability?

Posted by: J. Stefan Walker | Oct 27, 2010 4:32:17 AM

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Dear Mr. Smith...

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October 25, 2010

Dear Mr. Smith.....

By DAVID DRANOVE

John Smith of Chicago (not his real name)?asked the following question in a recent?letter to a local newspaper:

“Over the last several years my annual deductible has increased from $500 to $2000…With higher rates, I have had to limit key diagnostic services that my physician recommended at my physical.? Does health reform cap deductibles…?”?

The?paper's response mentioned that many preventive services are covered under the new law and mentioned something about risk pools – a decent enough answer I suppose.? Here is what I would have written:

Dear Mr. Smith,

I understand that you are upset.? No one wants to spend money on something when someone else has been buying it for them.? Healthcare is no exception, and over the years we have gotten use to having our health insurance company buy everything our doctors ordered.? The upside of generous health insurance coverage is that we are better able to avoid the risk of financial ruin.? The downside is that we sometimes agree to receive medical services that we might not need.? The latter is really true – the research evidence is overwhelming – and this has contributed mightily to the cost crisis you have been reading about.

I am sure you will tell me that you really need the diagnostic services ordered by your physician.? Then you should find a way to pay for them.??I understand that these services can cost hundreds of dollars, but I would imagine that there are other things in your life that are equally costly – car payments, vacations, new clothing, and so forth. ?Don’t you give equal or higher priority to your health?? If so,?then perhaps by next year you will set aside the extra money you will will need?for these tests.?? If not, then how can you say that you really need them?? If you are unwilling to pay several hundred dollars for medical tests, then you must not hold your life dearly.? Why then should others pay for you?

I know that I sound excessively harsh, and if your financial situation is such that purchasing these services will push you over the financial brink, I apologize.? You are in a?rough situation for sure.? But consider that if your employer offered a more generous health plan, the premiums would have been thousands of dollars higher.? Think of how this would have affected your job situation.? Many employers, perhaps?most,?have to hold the line on wages when health insurance costs increase,?so you may well have seen a substantial wage cut.? If your employer could not reduce wages, then your very job might have been threatened.? I doubt you would have preferred either of these outcomes to the present situation. ?The real problem isn’t that your deductibles increased; the problem is that healthcare is so darn expensive.

All of this rational economic analysis may leave you cold, and I understand that you cannot possible like the present situation.? There are alternatives that you might prefer.? Under a government-run system, you wouldn’t have to pay for many diagnostic services.? But to keep costs under control, the list of free services would be chosen by the government, not your doctor.? The new health law moves us in that direction and many Americans like the new direction we are taking.? Others would prefer to let market forces work to control costs.? Part of that solution would require us to face more of the financial consequences of our healthcare decisions while still having protection against financial ruin.

There is no going back to the old days.? Pick your poison.

Sincerely,

David Dranove

David Dranove is the Walter McNerney Distinguished Professor of Health Industry Management at Northwestern University's Kellogg Graduate School of Management, where he is also Professor of Management and Strategy and Director of the Health Enterprise Management Program. He has published over 80 research articles and book chapters and written five books, including "The Economic Evolution of American Healthcare and Code Red". He has a Ph.D. in Economics from Stanford University.

October 25, 2010 in David Dranove, Health care costs | Permalink

Comments

A few years ago I wrote an opinion piece titled... "Other People's Money." I referenced a lady who called my office to ask if it was legal that her individual health insurance policy did not include maternity benefits – after all, she and her husband wanted to start a family. There ought to be a law, she thought, requiring insurance companies to sell individual policies (with $12,000 in maternity benefits) to any couple willing to pay $2,000 in premiums. In other words, she wasn’t willing to pay the price for having a baby; She wanted that paid with other people’s money.

Posted by: Devon Herrick, PhD National Center for Policy Analysis | Oct 25, 2010 3:21:55 PM

Or, he could simply defer the preventive care until he needs the costlier care that will be covered by insurance. A clever provider might offer these services at a lower cost, but jack up costs for the insured procedure that might come from the aforesaid tests.

Steve

Posted by: steve | Oct 25, 2010 3:25:09 PM

"Under a government-run system, you wouldn’t have to pay for many diagnostic services. But to keep costs under control, the list of free services would be chosen by the government, not your doctor."

Interesting that you say a government-run system does not allow docs to choose the free services, but where in this private system do docs get to choose the free services? Doesn't the insurance industry choose those services? Actually in the Canadian system I lived with, the docs chose the services, based on medical need not financial need, and the government paid for them, through taxes.

"I understand that these services can cost hundreds of dollars,"

Priced by the medical cartel. I'd actually insert "thousands of dollars". Sell the car, sell the house, put the kids into foster care and just pay for the damn stuff.

Posted by: Peter | Oct 25, 2010 5:45:14 PM

Welcome to thbe Age of Austerity. Be happy with what you still have and pay up.

Posted by: MG | Oct 25, 2010 6:15:09 PM

"the government paid for them, through taxes."

- And the federal government doesn't expect a fight when they propose a veiled taxation, through the AHCA. Trying to convince us that it will function effectively. All while completely failing to even try to bend the cost curve? Even worse, failing to at least identify the cost curve or attempting to convince us that it's the best option.

Not going past the argument of "those evil insurance companies", won't convince rational decision makers.

Posted by: Che | Oct 25, 2010 11:46:44 PM

177 million

Number of Americans covered by employer-based health care.

Posted by: Edwin | Oct 26, 2010 3:10:24 AM

"All while completely failing to even try to bend the cost curve? Even worse, failing to at least identify the cost curve or attempting to convince us that it's the best option."

The cost curve is because the prices are too high. I agree that this legislation will not bend the cost curve, but try to get lower prices past the well lobbied and financed providers. The present system hasn't even been willing to bend the cost curve, even with "evil" insurance companies.

Posted by: Peter | Oct 26, 2010 4:38:26 AM

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