Weekend Quotes

The report's authors "estimate that in order to provide services to these medically disenfranchised Americans, as well as current patients, health centers will need up to 60,000 more primary-care professionals, and up to 44,500 additional nurses."

-National Association of Community Health Centers (article link)

If pure thought is a body, it is our emotions that supply the heart that can really bring it to life. Our thoughts and feelings exist in relation to one another, and they form a feedback loop through which they communicate and empower each other.

-Daily Om: Undistracted Energy

“Redefining smoking not as a behavioral habit but as a pharmacological addiction may sound like good public policy, but it works against the public health when it reaches people that it is impossible to quit. Indeed, instead of having the intended effect of steering potential smokers – that is, children – away from cigarettes, demonizing cigarettes via nicotine reinforced smokers’ feelings of pharmacological enslavement and undermined their will to quit.

The tobacco habit should be characterized as an habituation rather than an addiction…”

-Smoking, A Behavioral Analysis, published in 1971

Dog Training Ourselves

Ian Dunbar gets dogs, but he also gets human behavior. I'll timestamp the latter first just because it's so on about relationship skills and interaction skills.

12:00: Training ourselves to be better at relationships
7:35: Insights on punishment without force
4:00: Really simple dog training techniques

Reminding Patients To Take Their Medication

Patients being non-compliant with taking their medication negates the value of going to the doctor, creates confusion in setting up treatment plans and in the case of antibiotics teaches the exact bacteria you're trying to kill how to fight back (MRSA).

Luckily, next generation devices such as Zuri aim to help remind patients to take their medication and also provide an electronic record of time and dosage to the doctor. Real-time interfacing with your medical provider is the only way to monitor medication activity successfully.

Here's more from the WSJ.

...the Zuri, an iPod-sized device that sends patients reminders to take their medications and records their compliance, which users and, if they choose, their doctors can track through a companion Web page.

Intel's care-management tool, called Health Guide, combines an in-home patient device with an online interface that doctors can use to monitor and remotely manage care. The in-home patient device collects readings from specific models of wired and wireless medical devices, such as blood-pressure monitors and glucose meters. It then displays the data for the patient on a touch screen and sends the readings to a secure host server, where health-care professionals can review the information and provide feedback via video conferencing and email.

Meanwhile, Microsoft is working with home-health and fitness-device makers to integrate vital-signs data into HealthVault, an online service the software company recently launched that allows consumers to store, manage and selectively share medical data.

Uplifting, Thought-Provoking Daily Inspiration

Daily OM is a great service. Sign up.

August 20, 2008
Being Clear About Desires
Getting What We Want

The best way to get what we want from life is to first know what we want. If we haven’t taken the time to really understand and identify what would truly make us happy, we won’t be able to ask for it from those around us or from the universe. We may not even be able to recognize it once it arrives. Once we are clear about what we want, we can communicate it to those around us. When we can be honest about who we are and what we want, there is no need to demand, be rude or aggressive, or manipulate others that are involved in helping us get what we want. Instead, we know that we are transmitting a signal on the right frequency to bring all that we desire into our experience.

As the world evolves, humanity is learning to work from the heart. We may have been taught that the way to get what we want is to follow certain rules, play particular games, or even engage in acts that use less than our highest integrity. The only rules we need to apply are those of intention and connection. In terms of energy, we can see that it takes a lot of energy to keep up a false front or act in a way that is counter to our true nature, but much less energy is expended when we can just be and enjoy connections that energize us in return. Then our energy can be directed toward living the life we want right now.

Society has certain expectations of behavior and the roles each of us should play, but as spiritual beings we are not bound by these superficial structures unless we choose to accept them. Instead, we can listen to our hearts and follow what we know to be true and meaningful for us. In doing so, we will find others who have chosen the same path. It can be easy to get caught up in following goals that appear to be what we want, but when we pursue the underlying value, we are certain to stay on our right path and continue to feed our soul.

The Secret To Happiness

8:00: What's bad about having too many choices
15:06: The Secret to Happiness

The whole thing's worth watching.

Hellooooo Health!

Jay Parkinson to me is the definition of a brazen careerist. Health care is a very conservative sector that's eons behind in technology, rife with political machinations and just filled with complexity on all ends. Dr. Parkinson has single-handedly taken on the industry and changed the paradigm from health care to patient care in less than a year. There's a lot of history behind this, and rather than rehash it in prose, I'll hyperlink to milestones that have led to the launch of Hello Health, Jay's company. Safe to say, this model of care delivery is not going anywhere and may spark a revolution in the years to come.

• Original Website & Philosophy - In a nutshell, doctors making house calls like the old days with an iPhone packing in the patient records instead of a briefcase.
  

• The Video Brief - Think medical Facebook. Why not just add your doctor as a "friend" on a privatized network and message him with a problem?
  

• Summary Article on Hello Health Launch - Scalability is occurring one doctor at a time and I only foresee trailblazing growth in the future.

Bottomline: While most of us are used to email, IM, Facebook, iPhone, Google and overall internet-based communication, health care has only just turned on the computer. Jay Parkinson has skipped decades by providing patients real-time access to primary care services. The progress is exponential considering the industry context. The start-up's in Brooklyn, but at this rate Hello Health might be in your neighborhood sooner than you think.

TALK Patient, LISTEN Doctor, COMMUNICATE Healthcare

Here are some excerpts from a disturbing review of the doctor-patient relationship in the NYTimes Well section. This is important.

...there is a disconnect between the way doctors and patients view medicine. Doctors are trained to diagnose disease and treat it, he said, while “patients are interested in being tended to and being listened to and being well.”

The reasons for all this frustration are complex. Doctors, facing declining reimbursements and higher costs, have only minutes to spend with each patient. News reports about medical errors and drug industry influence have increased patients’ distrust. And the rise of direct-to-consumer drug advertising and medical Web sites have taught patients to research their own medical issues and made them more skeptical and inquisitive.

Keep in mind that EVERYTHING revolves around the communication between a patient and physician; need for lab tests and procedures, need for prescription medication, referral to specialists who then may refer out to more specialists, the odds of the doc getting sued, chances for the copay to get waived, whether the insurer finds reason to deny treatment, what your stress level will be that day (and maybe for a long time afterwards).

Going to the doctor has one of the highest potentials for changing your life (what else is there? job interview, meeting the parents, going to court). It all boils down to interaction, so its worth your while to make sure you find a doc that suits your personality, understands your lifestyle, and listens(!!). The article also gives a few more pointers.

Patients who don’t trust their doctor should look for a new one, but they may be able to improve existing relationships by being more open and communicative.

Go to a doctor’s visit with written questions so you don’t forget to ask what’s important to you. If a doctor starts to rush out of the room, stop him or her by saying, “Doctor, I still have some questions.” Patients who are open with their doctors about their feelings and fears will often get the same level of openness in return.

Is Blogging becoming a crutch?

I’m amazed by bloggers who can post 3 times a day (Tyler Cowen) with relevant content but find it pretty unrealistic unless there's some major incentive involved; money, larger audience, branding, etc. Done pro-bono, blogging still serves a personal purpose but at what point does it take away from spending an hour doing something else? What’s the opportunity cost? When does it start becoming a conversational crutch?

Its happened a lot that I preface what I’ve blogged in conversation, and that’s a huge pro to blogging; it organizes my thoughts around a specific topic really well. Sometimes though, I have a great conversation with someone that provides a similar organizational benefit and I end up taking hours blogging about it.

For the average blogger with a friend/family/coworker audience, it might be more beneficial to just keep sharing the learning points at a company picnic, family get-together, or house party. Blogging may just be getting in the way of something that’s already become clear to the blogger and probably will not reach a larger audience outside their personal scope anyway.

Even if you’re journalizing your thoughts, the cumulative hours spent typing away may not be worth the effort. To avoid letting the process of blogging get in the way of life experience, a friend of mine uses a private twitter account to document momentary occurrences. A quick 140 word text gets the job done 90% of the time. The rest is blogged. Brilliant!

Bottomline: A journal can be a blog, but a blog is not necessarily a journal. Some conversations are just more worthwhile having in real life with people you know. If you have enough of an audience to test out your new ideas before exploring them in conversation, then go for it. I don’t believe this represents the majority of bloggers though. As a litmus test, ask yourself this; “if my computer (and blog server) crashed right now and I lost what I was writing, would it really be worth writing again?”

As the Wordle Churns

If you haven't already, check out Wordle! Basically, you type in a few words in a text box and it generates a cloud image of those words. You can wordle any website or del.icio.us feed as well. My clouds are below.

This blog:

My del.icio.us tags:

Words I used to create a collage for a friend's wedding:

Universal Health Care: Right, Privilege or Commodity?

Must-read intelligent and clear-cut article on the different perspectives behind universal health care. If you've ever wondered why the U.S. is having trouble solving the 47 million uninsured problem, this article gives you a glimpse into why. Here's an excerpt:

We Americans are truly a spoiled lot when it comes to consumerism - the medical industry is not spared. We want to go to the best doctor possible. We want choice, and we will pay for choice. If there is a special procedure, we want it done. What we do not realize is that those choices and tiers of medicine are only availed through a profit-driven capitalist medical industry. Where do we think all of those drug and device discoveries are coming from? From the company that spent billions of dollars researching it and who sells it at a handsome profit and whose stock is listed in the public markets!

Everyone deserves to be in the Credits

Movies are such a grand affair to make: lighting, makeup, production, set design, casting, assistant to the 2nd cameraman, and the list goes on. Why are we familiar with these terms? Because they're in the credits! Mind you, most of us don't watch the credits because we're really there for the big show, but it really really matters to the people involved in the making. They tell it to their family, friends and even acquaintances with a sense of pride and accomplishment. In fact, I was an extra in The Namesake for about seven seconds and its become one of those things that just gets mentioned off-hand in conversation. The notion of credits is very transferable to other arenas, especially in the work world.

No matter how hoaky, being mentioned at a picnic, a newsletter, a party, or conference has a very lasting effect on people. No one's really immune. The very best companies make use of this concept heavily in other ways as well through sophiscated-sounding titles, celebrations, and leadership opportunities (in anything; from taking charge of team projects to managing the company softball team). Whatever work efforts we're involved in, there is a beginning, a middle and an end. Focus is almost always on the first two; start-up and maintenance. Yet companies evolve just the same as TV sitcoms do. The "end" with credits and all is the shifting point to antoher theme, product or customer; think Apple, Google, Microsoft but also Johnson & Johnson, GE and Procter & Gamble.

Bottomline: Acclaim matters. Make it a part of your work and personal life. Commend yourself and others upon meeting deadlines, reaching milestones, achieving goals. Change has to be a part of the system (more on that in another post). Employees and customers continue to stay interested only if you remain interesting. Figure out how to get you and your organization there. Credit opportunistically and you'll only create more opportunities to credit.

You're Not Really As Old As Your Age

Preemies or premature infants are tracked closely during their first few years of their life to see how they develop. Weight, size, and head circumference are some of the growth factors used to adjust their age and calculate what’s called a “real age”. For example, a 6 month old baby who scores low on these metrics may be adjusted to an age of 4 months. It’s in this light that I’ve been thinking of adult age as being adjusted by maturity level. We’ve all seen or taken those “real age” tests that tell us our real age is 21 or 32 even though we might actually be 25. I want to explore the principle behind this a little more, but in the sense of how mature other adults (40+) view us to be.

The idea originates from the fact that we now live much longer lives and our personal and work lives have changed dramatically because of it. We have more time room to maneuver in. We don’t have to be “settled” at 24 anymore (ha!). A career isn’t forever and we explore possibilities related to our hobbies and interests rather than something we picked in our adolescence. This extension in our settlement as adults has a larger effect though on how we are perceived by other adults. Their generation did have to grow up fast (relatively) and we’re largely held to a similar framework. If we don’t meet expectation, then we’re treated, well, like children. Unlike the preemies, who are given the attention and care to catch up to their age, 20 and 30-somethings in a state of maturity flux (in school or changing careers) are pushed further down the “adult” totem pole.

A simple example is a 28-yr old married postgrad (med/law/PhD) with two kids. He/she obviously pays bills and has gone through some major “adult” experiences (marriage, childbirth) but being a student really cramps mature interactions with other adults. Or to turn it around, there’s the 24-yr old single marketing professional without any kids who still starts his/her weekend on a Wednesday night. Comes to work on time, is ambitiously climbing the ladder, but due to lifestyle choices is held to a lower maturity level. Both are well-functioning citizens of society and because they don’t fit the old career paradigm, they’re not afforded the same respect as adults who’ve made more PC choices.

Bottomline: Your boss can boss you around because you’re not working, but can’t parent you because you choose to play world of warcraft in your free time. Your professor can teach you his/her expertise, but can’t make you come to class (you’re paying for it!). Stick to roles and don’t adjust people’s age by your perception of their maturity level. Yes, a boss can be a parent and a professor can guide behavior, but not until they’re asked. Relationships are mutual agreements and too often adults take on added unasked-for responsibilities just because they think they can. If you’re a recipient of this sort of behavior, make your age and maturity clear. There’s no set definition for “adult.”

On the Ground instead of in a Parachute: How to Think when Choosing a Career

Most career books advise imagining a circumstance where you have an infinite or an unbelievably large sum of money and have no need to work. They ask; what would you do then? Where would you want to be? How would your ambition change? The answers to these questions are supposed to guide you to your calling or that daily endeavor that holds true personal value.

Make it more real. The questions are legit, but the hypothetical scenario suggested is just too fantastical. Think about it in terms of what you earn now (which also eliminates that initial desire to go on a superfluous shopping spree). If you could have the salary you have now without having to do the work you do now for it, what then? Say you earn $50,000/year and it was guaranteed no matter what. How would you plan your day to day?

Bottomline: Our imaginations are powerful and may be a little too convincing. Who hasn’t dreamed about possibly earning a million dollars? Planning out career options based on that dream though is a little far-fetched and unrealistic. Work with the numbers you have now because they actually affect your lifestyle. It’s a clearer perspective when you can understand it on today’s rather than tomorrow’s terms.

Prenup Economics: A friendly conversation on losing your shirt and then some

I had a conversation with a friend the other day about who a prenup matters to most. Someone with $80M dollars or someone with $20,000. Assume net worth here, and also assume that without the prenup, each person potentially faces to lose half their net worth.

My friend’s theory was the person with $20,000 has a lot more to lose without a prenup because his purchasing power decreases at a much greater magnitude than the person with $80M. The wealthier party’s lifestyle isn’t too dramatically affected by a 50% loss, whereas the opposing party most likely won’t be able to pay the bills anymore. So the poorer person should care about the prenup more.

I disagree and on the same basis of purchasing power. First of all, $10,000 is a lot easier to recover than $40M. Regardless of the person’s working capabilities, it will certainly take much less time for any given individual to redeem the smaller amount. Second, and the guiding principle behind my argument; the wealthier person can just do that much more with more money. This isn’t about buying cadillacs and islands, its about translating purchasing power to production power.

$10,000 will pay the bills and could possibly be invested/gambled/leveraged to produce more money. Considering the wealthier person’s expenses are proportional to the less wealthy person, the $40M will also be used to pay the bills, but the remaining balance will still produce greater relative purchasing power. So the wealthier person should care about the prenup more.

Bottomline: Prenups have a relative repugnancy cost depending on culture. Net worth may not be as important as other personal costs in determining the need for a prenup. Based on divorce rates upwards of 50% in America, it bodes well for most people to get a prenup. As the argument stands though, the wealthier person should care more about the prenup and not necessarily for the most obvious reasons.

1975-1985: The Liaison Generation

I use the computer for everything now, but I remember waiting in lines to sign up for courses and using library cards to find books and turning my homework in on paper! I’m not as plugged-in as 12 year olds, but I’m not adapting as much as someone 40+. Of course this is a generalization with quite a few outliers (one of my favorite people to work with is a 56-year old grandmother who is also a systems analyst for a 250-member physician group), yet I’ve found that people born between the 1975 and 1985 tend to share similar traits due to similar transitional experiences as they were growing up. They’re liaisons bridging the “old” and the “new” way of doing things.

The biggest disadvantage for this liaison generation is not belonging to either group. Just think of all the buzzwords that have emerged for the identity roadblocks faced earlier than ever before; quarter-life crisis, career angst, job hopping, corporate distrust, etc. The decade’s worth of experience with one mode – the “old” way – is lacking and the innate response to use technology as the first mode for anything – the “new” way – is also lacking.

Out of this though comes the advantage of being translators. Connecting the “old” and the “new”, using what works best depending on the situation, and most of all helping others along the way. For the “new”bies, the liaison generation can provide a sense of origin, where things began and grew from and why. For the “old”ies it’s much more obvious; providing a simple way to adjust to ever-evolving technology and convert from desk to desktop.

Bottomline: What does all this mean and why is it important? It’s about defining a role. Offering one possible reason (out of many) for the confusion faced by an entire generation. There are business opportunities here, jobs to be created, organizations that face to benefit. A unification of perspective can only help this cohort of liaisons pave its path more certainly.

Health Care Undercover or: How to better manage the doctor-patient relationship

Undercover or fake patients seemingly pose ethical and annoying dilemmas for docs. How are doctors and practices rated? Is it fair for a fake patient to take up the time that could be used for a real patient? Is there a long-range view towards improvement or is this just hastily doled-out criticism?

These "mystery patients", similar to the mystery shoppers of retail clothing, come off as lone mercenaries; experienced patient-actors formerly found in med school classrooms looking to make a little more cash. There's no organization, no national quality board, no clear follow-up on the "dirt" they uncover. They're the symptoms of a larger problem of worsening physician-patient communication, lengthy wait times, and poor service by the administrative staff.

Why not just educate patients to be smarter medical shoppers? Teach them to look out for the same things the undercover types are meant to probe; waiting room ambiance, front-desk rapport, total visit time, total time with doctor, total wait time, bedside manner, clarity of medical explanations, the list goes on.

Why not give doctors the checklist of items they'll be evaluated on? Considering that physicians go into the business of patient care because they're humane and conscientious people, you can assume they seek to improve their health care services. If they were made aware of unmet patient expectations, they'd concentrate their efforts to meet them. How many of us go through life thinking we're doing right by our loved ones, friends and colleagues? In order to find out, all we have to do is ask.

Bottomline: Health care is defined by the relationship between a doctor and a patient. Everything else is either contributory or detrimental to that relationship. The problems may be complex, but the equation is simple. Instead of sprouting more and more side industries to correct the health care "problem", lets focus on the two sides that matter most and redirect all our time, money and energy towards their betterment.

Health Insurance Potholes To Watch Out For

Each insurance company is different so first thing figure out coverage restrictions.

• Do they cover routine visits or only sick visits?
• What's your deductible and how much do they cover before and after you meet it?
• How are inpatient hospitalizations covered?
• What about surgeries (major v. minor, inpatient v. outpatient)?

The first two are important to know from the get-go, but for the rest its good to just have the benefits and coverage guidelines printed out or bookmarked somewhere for reference purposes.

Few other things you'll come across after going to the doctor are prescriptions, labs, and image results.

• Does your insurer have a discounted formulary for prescriptions or pharmacies they contract with? (HUGE savings here)
  
• Does your doctor send your labs out to a company that's covered by your insurer? If not, you could owe a lot of money for processing your lab results. Worth checking both with your doctor and insurance company on this one!
• Who reads and interprets your images (MRIs, X-rays, CT scans, etc.)? Same as labs, if the diagnostic imaging company or the doctor interpreting your image results is not covered under your plan, you'll get a separate fee.

Whoa!...I know. I've lost $750 and several brain cells dealing with the issues above. Now I annoy secretaries, nurses and insurance representatives to no end BEFORE and DURING my doctor's visit so I can avoid major money and time headaches AFTER the fact. Its like the law. You don't realize how powerful it is until it impacts you personally. No wonder 59% of doctors support a single-payer national health insurance system!

What makes a company attractive?

Stock value? Growth rate? Philanthropic fundraising?

No. Its always the employees. And why? Because they do things like inject codes into their programs that have no intrinsic value but to entertain or put their dog in the company's founders profile as their mascot.

This makes the company a zany and fun place to work. When work is a life given, you need more than just money as a driver. An organization's social vibe affects its commercial value in the eyes of consumers and potential future employees. Personal happiness comes from interpersonal interactions.

Debt, repugnancy & the primaries

1. Hospitals auctioning debt online: its all about expectations. Not expecting patients to fall through on their credit, hospitals are being crushed under bad debt. Expecting a patient not to pay at least allows hospitals to provide charity care and write it off. In the meanwhile they're giving the highest bidder (mostly debt collectors) a chance to see if they can get the money back themselves.

2. NYC's idea for an organ-recovery ambulance: mile-long waiting lists for kidneys and livers drive this and legalized organ selling would certainly boost more entrepreneurial ventures in this niche. Only if we could get over our repugnancy costs.

3. Incredible interactive graphic breaking down voter demographics for the Democratic Primary: a very revealing data-driven perspective on differences in voting by age, race, gender, income and education. Make your own judgments on what this primary was really all about.

Should a doctor think like a clinician or a businessman?

In the U.S., most physicians often think like both. Oh wait, add accounting to the mix too. Clinical care, administration, and billing make up the 3-part mental framework of a physician in the U.S. The two business components represent all the paperwork doctors do after the patient leaves. Exact details of what the person came in for, documentation of the treatment protocol advised, and the appropriate billing code so doctors can get paid by the insurance company. Multiply this by say 30 patients and you have a typical day at the doctor's office. And that's just for one medical provider.

This is a lot of work. Many practices have an "administrative session/day" set up once a week when physicians can catch up on all this paperwork. A physician's day just seems so fragmented that I wonder how they concentrate on the one thing that matters; patient care. I explored this a bit through an international lens, seeing how other countries did it. Do nationalized health care systems like the ones in UK or Canada take away the business component or add more bureaucracy? What does a market-based system such as the one in the U.S. have to offer that they don't? Regardless of all the politics around which system is "better", I focused on just one thing; what occupies a physician's mind on a daily basis making the rounds and taking care of patients?

It comes down to incentives, in many cases monetary. In the U.S., most physicians get a good portion of their income on a fee-for-service (FFS) basis, whereas nationalized docs primarily tend to be salaried. I reached out to fellow blogger, Jason Shafrin of the Healthcare Economist, on this and he said,

"while salaried doctors may be more "objective" they do not have the incentive to innovate as would be the case in the FFS system. Physicians can invent new technologies to better care for patients if they know they will be reimbursed for their efforts in a FFS system. However, if the physician is salaried, the incentive to innovate is lower."

U.S. physicians certainly work harder. The more they do, the more they make. And that's where all the paperwork comes in. The insurance companies, along with Medicare & Medicaid, want to make sure they're not paying for frivolous tests and procedures. There's a very close watch over what physicians do in the U.S. Fraud litigation and skyrocketing malpractice rates are evidence of this. And ironically, the other major component of malpractice, medical errors, drives physicians to practice medicine more defensively and order more and more tests to cover themselves. Talk about a rock and a hard place.

In salaried systems this is less the case. We have a few major ones in the U.S. such as Kaiser Permanente originating from the West Coast and the government-run Veterans Affairs (VA) department. And countries such as Canada and the UK provide much larger-scale examples. From a basic day-to-day care perspective, these systems do provide freedom from the business side of medicine and allow physicians to focus on patient care. But as mentioned above, the trade off is less innovation and less incentive to work hard. On top of that, Jason mentions,

"while the physicians may be salaried, someone is being paid not on a salaried basis. The organization is usually paid on a per person basis (capitation) or fee-for-service. Even if physicians are paid on a salaried basis, management may compel them to increase or decrease procedure rates. For instance, the NHS may put managerial pressure on physicians to reduce utilization of services in order to reduce costs."

Bottomline: Even mental resources have to be allocated. If a physician isn't business-minded, someone else will be on his/her behalf. The economics don't necessarily favor a national or a market system since you lose drive for growth in the former and create drive to overdo in the latter. Maybe the U.S. could benefit from a nationalized sub-specialty system and a market-based primary care system. The hybrid methodology seems to be more favorable here, but that hasn't been tried and tested. The question of optimal patient benefit still remains within this incentive-based catch-22.

Eye-opening views from around the web

1. Scobleizer on using technology to get what you want out of life.

2. Bob Wachter providing a very detailed excerpt on the development of Google Health.

3. GPhone, or rather Android, demos!

4. A spiritual view of finding & fulfilling need (the business case for demand).

5. How mainstream media covers medical news.

Providing patients the means to monitor their own health

An elderly coworker recently mentioned her participation in a home-based, digital, disease management (DM) program sponsored by Blue Cross Blue Shield. At first I was astounded that an insurer would sponsor this. While there's always been a clear business case for prevention and monitoring to avoid chronic care costs in the long-term, insurance companies haven't been exactly eager to jump on board. They might be starting to see the win-win though:

"Keeping [at-risk] patients stable and quickly getting them care when it's needed can reduce hospitalizations and cut the insurer's medical costs. And since the savings come from improving the patient's health and quality of life, programs such as Blue Cross' "Your Heart Matters" are generally popular with participants."

That's from this article detailing how the above congestive heart failure (CHF) program works remotely from patient's homes.

"Every morning, Sedaris steps on a special digital scale beside the bed in her Raleigh home and answers a series of questions. Is she swollen or short of breath? Has she taken her medicines? The scale, provided by her health insurer, ships her weight and other data to a nurse's computer at Blue Cross and Blue Shield's disease management center in Winston-Salem. Any suspicious results -- an overnight weight gain of just a pound or two is a signal that Sedaris is retaining fluid that may strain her heart -- and the nurse is on the phone. She'll talk with Sedaris and, if necessary, send her to get medical attention.

The technology to remotely monitor patients' pulse, weight, blood pressure, blood-oxygen levels, general mobility and other indicators is already widely available. The declining costs and increasing use of high-speed Internet service should only accelerate acceptance of monitoring devices."

This is incredible! For more, here's another personal example from the Healthcare Economist.

Write It Down!!

I can't be any more clear. Whether you type it up, put it in a notebook, scribble it on a napkin, writing your ideas down has many benefits. I recently discovered this as I went through a spring cleaning of sorts through my computer's old files.

One, keeping a written record allows you to look back and see how you were thinking and articulating at a specific time period in your life. Its a personal benchmark for self-evaluation. For example, a lot of people feel they wrote a lot better in high school or college. Its possible. But many people just stopped writing when they began working. You can only observe patterns if you have something to look at. Whether it be ideas, short stories, poems, free-writing diatribes, it doesn't matter. It all becomes part of a personal portfolio of your work. To determine growth, you need reference points.

Two, as you gain experience and knowledge, the ridiculous can seem all the more plausible. As the saying goes, "one person's trash is another person's treasure". In so many ways, you are a different person year to year. What may not seem feasible at the time may be of great value to you later on. You can never tell in the moment so its worth writing it down!

Bottomline: In order to chart change and growth in your thought process (even after college!), you have to have some form of a written record. Blogging is one of the most efficient, least resource-intensive ways of accomplishing this. No matter how you go about it though, I guarantee you will find the experience rewarding.

Own What You Do

To buy or rent is a decision we all come across some time in our lives, usually in terms of cars or houses. Yet if asked, "Do you own your life?", the concept is a little more elusive. Ask an entrepreneur or independent contractor this question, and you will get a straight response; yes! In fact, its the question. The one that motivated them to produce, create, start something of their own. But that's just one way of looking at it.

We all own something (immaterial, of course!), whether we're aware of it or not. Its the thing we truly feel we have the power to effect, with a response equal to our will to effect it. Whatever it may be - leisure time, work schedule, planning the company picnic or the next major funding initiative - it should be acknowledged. Its an extremely self-empowering exercise!

What you discover through this process is that its all about how you approach it. The attitude you bring to the table. How many times have I heard, "same shit, different day" or "maybe I'll win the lotto this time". These are really defeatist statements. They shape your psyche and send a negative signal to those around you.

Bottomline: When you own what you do, you can take charge of the simplest daily routine with purpose in mind. Whether that purpose is change, growth, or maintenance doesn't matter. You simply believe in it more, because you're not renting your spot. As an employee, a father, a brother a husband. Any cap you wear applies.

Not Interested

At B&N the other day, I order my usual coffee with soy milk, and as soon as I see the barista about to pour what's left of the vitasoy into my coffee, I tell her to stop. I start to go into an explanation of how the really cold foamy dregs of milk at the bottom of the carton coagulate in very hot coffee and that...this is where the barista gives me a look and says, "so you want me to open a new carton...gotcha!"

I know at first it seems like I was trying too hard, but I had good reason since this had occurred before and I wanted to avoid 1) wasting a cup of coffee, 2) wasting mine and everyone else's time in line and 3) avoid having the barista go through the customer conciliation process that could have been avoided in the first place (coagulated milk&coffee is not a pretty sight!). But the barista was not interested in the why of the solution that would avert repeating the problem in the future; she only wanted the solution itself.

Prior education makes no difference. From the bookstore coffee stand to a physician's office to board of trustees of a major corporation, the why of it has become less important. And why I hope you would ask is this so? The primary reason given seems to be lack of time; everyone's too busy to spend time figuring out the why. I contend that its just the opposite: not taking the time to figure out why makes us more busy. And busy doing things that are duplicative and useless. The stop-observe-evaluate and then do mentality is becoming rare. Technology is being treated more as an added burden rather than a tool for efficiency.

Bottomline: Think what a day without cell phones, texting, google, twitter, facebook, and RSS would be like. Then plan the day out in a way that technology actually benefits it. Don't be beholden to your resources, make use of them as you best see fit to accomplish your goals.

Produce what you Consume

"The world brought me to my knees
What have you brung you?
Did you improve on the design?
Did you do something new?"

--Lupe Fiasco, ala "Superstar"

The "you attract what you think" principle has been proving itself quite well in the last few weeks. My recent interest in America's high consumer-to-producer ratio and how the web is contributing to lower it has led me into some very enlightening conversations off-line.

The real-time nature of the web makes you shift your thinking from "What am I contributing?" to "What am I contributing NOW?" (totally Tim Ferriss). The latter used to be too resource-intensive a question for any one individual to ask until the internet came along. Take Yoani Sanchez for example. Her blog helps to make the rest of the world aware of the way the Cuban government controls its citizens. Even though it is only one person speaking out, the validity of the outcry can be judged by the response. And this entire discussion occurs on a market-governed online forum.

Whereas the ability to vote used to be the single source of contributing one's personal voice to the global agenda, now one's online persona, free of anonymity, fuels the underlying free-market democracy developing exponentially online. This is incentive enough to become a member.

Bottomline: Turn off the TV, get off your butt, and do something. You never know who you'll meet, help, or learn from.

Your Future Doctor will see you Now

I wrote a post recently on needing a medical facebook (and medical twitter) to improve communication between patients and physicians. Jay Parkinson not only does this real-time for his patients, but he also sees them in their home, face-to-face for as much time as deemed mutually necessary. I wonder if the time saved from ridding himself of inefficiencies in communication has something to do with it.

"On the doctor side, I have a facebook-like platform that allows me to see and receive client updates and communicate via email, IM, video, and SMS with my clients and colleagues. We don’t do eVisits — we simply communicate normally via a whole range of communication options to help streamline healthcare delivery."

Hello Health!

Second-hand Health Care: Why Health 2.0 is Lagging

AMA is sponsoring a seminar called "Financing electronic health record (EHR/EMR) systems: Should your practice accept a donation?".

Looks like the open market making up for gov't inefficiencies. At first it seems like a salvation army effort to donate something that still works but isn't useful to the hospitals (like donating an old phone system), but look at it long-term and you see that it only slows down the transition from paper to electronic records.

Here's why: using a sub-par, used EMR system in your practice isn't going to help your practice if the doc next door buys a state-of-the-art system. Plus, interfacing not conversion is the more important issue. The EMR has to talk to other EMRs, pharmacies, scheduling systems. Old systems don't have this capability. The main reason I'm against this is because a practice's paper process indicates how well its electronic process will be. So if you make a lot of medical errors on paper, you'll probably do the same (if not worse) on an electronic system.

Bottomline: Bush passes initiative (in 2001) to have every practice/hospital on an EMR by 2014. He doesn't provide ANY financial help whatsoever to make this happen. Hospitals try to convert on the cheap and realize they need to upgrade within the next 5 years. Having an EMR becomes the cost of doing business, like having credit card machines at a department store. Financing (the money it costs to implement) is a NON-ISSUE. Do it well the first time, don't take hand-me downs and upgrade faster than the next guy. Adopting early makes you better off in the long run.