Google Health Teaser

Google recently developed a partnership with the Cleveland Clinic to test its Google Health application.

Today, Google released a few teaser screenshots!

Modigliani-Miller Theorem Explained

"Think of the firm as a gigantic tub of whole milk. The farmer can sell the whole milk as is. Or he can separate out the cream and sell it at a considerably higher price than the whole milk would bring. (That's the analog of a firm selling low-yield and hence high-priced debt securities.) But, of course, what the farmer would have left would be skim milk with low butterfat content and that would sell for much less than whole milk. That corresponds to the levered equity. The M and M proposition says that if there were no costs of separation (and, of course, no government dairy-support programs), the cream plus the skim milk would bring the same price as the whole milk."

- Merton Miller from "Financial Innovations and Market Volatility"

Should your PCP be your Friend?

“The real price of everything, what everything really costs to the man who wants to acquire it, is the toil and trouble of acquiring it.”
--Adam Smith

It depends on if you think your car mechanic should be your friend. You see either professional about as frequently, mainly in times of distress. But the key difference is that your primary care practitioner (PCP) is your gatekeeper to the rest of the medical world, so it is worth your while to develop a strong relationship with one. You'll realize just how important this r'ship is when you move out of town, change your insurance, and oh yeah, get sick.

PCP shopping is essential. I just posted about the website, Vitals, which helps you do just that. There are many other sites that do the same, including the one your insurer most likely provides you (the most important!). You'll get a pretty long list of internists, family practitioners and general practitioners in your area and pretty soon you'll be scratching your head wondering just who to go to. Its pretty hard to compare doctors the way you compare cars and electronics. There's no consumer reports for physicians...at least not one that's agreed upon. But in general, keep in mind the following when making your choice:

1. Call and see how long the wait is before the next appointment. If its longer than 3 weeks, they're either really good or really inefficient. Double check if the doctor is on vacation or on service at a local hospital. That should give you a better idea of how they allocate their time. Then its up to you if you want someone reputed or someone reliable.
   
2. If you do choose the busy doc, ask who will take care of you instead when you absolutely have to come in. It could be another doctor, the head nurse or a resident. Either way, you have that much more information to work with.
   
3. Ask the secretary for a recommendation, then call again the next day and ask a different secretary. See if they'll let you speak briefly to a nurse and get her recommendation. This'll also let you know if they do phone consults either with the physician or the nurse. This way you can get triaged in quicker when you're sick.
4. See if they have an electronic medical record (EMR). This indicates many things about the practice; they're up-to-date, they're willing to spend the money to stay that way, and they want to be organized.
5. What about a website?? Do they partner with your preferred pharmacy? Can you refill your prescriptions online? Make an appointment online? Get test results online? Do they provide a personal health record (PHR) to help you organize your own health record and communicate your problems as they're happening?

Notice how none of the above goes into quality of care or bedside manner. There's very little out there to provide you with such metrics...again, its forthcoming. Who would've thought picking a doctor would be such a chore!? But its like anything else. You get what you put into it. And that all depends on how you answer the question above.

Get your Vitals Taken

George Van Antwerp posted a positive review for this site, Vitals.com, and I have to agree with him. I looked up some of the physicians I had worked with in the past and found out more about them than I ever knew before. It was startling at first to see their age, years of experience, and where they went to college. Then I started thinking about the ever-steady finding that more experienced physicians are simply better practitioners, so why shouldn't patients be aware of these characteristics?

Anyway, overall the site is really user-friendly. You can find a doc, figure out who to see for your problem and even rate the physician after your visit. Now it just needs critical mass.

More Rhetoric, Little Evidence

"When you encounter seemingly good advice that contradicts other seemingly good advice, ignore them both."
--Al Franken

This Valentine's Day NEJM article, "Does Preventive Care Save Money? Health Economics and the Presidential Candidates", speaks for itself.

"Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical. Such analysis could identify not only cost-saving preventive measures but also preventive measures that deliver substantial health benefits relative to their net costs; this analysis could also identify treatments that are cost-saving or highly efficient (i.e., cost-effective)."

A visual always helps too:

Capitalism Entrapment

"The power of vested interests is vastly exaggerated compared with the gradual encroachment of ideas."
--John Maynard Keynes

I don't think there is such a legal term, but there should be. Or even better, it should be in the DSM-IV.

Capitalism's primary tenet is to promote efficiency in the interaction between buyers and sellers in a given market. Nobody really cares who is doing the selling or buying as long as they continue (and never stop) doing it. Its about the product, not the person.

I'm specifically thinking of Britney Spears. Young, talented and pretty, she makes it big on the world scene when she's 17 and now, a failed marriage and two kids later, she's suffering from a major drug problem. And selling. She sings about her problems and sells. She sings about being able to sell even though she has problems...and sells! We don't care about what's going on with her personally, we just love her music. She's enrapturing. She's entrapped.

The right or wrong of it is never clear. You can point to Bill Clinton's infidelity or Robert Downey's Jr.'s addiction or Ken Lay's corruption. But it depends which side you're on, the side that made money or the side that didn't. And money has the tendency to blind people to the hypocrisy in others' actions.

Bottomline is that as mega corporations continue to drive the mom's & pop's out of business, there's a growing disassociation between the seller and the product. To condone the behavior we want, we must ourselves live and breathe it. Eat better and exercise more if you want to curb the obesity epidemic. Become a socially responsible investor to avoid blindly funding oil, cigarettes, and fast food. Take responsibility and make yourself accountable for it, because everyone learns by example!

EDIT: How could I forget Martha Stewart!?

YOU determine the Value of YOUR Health Care

"Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened."
--Sir Winston Churchill

Heath Ledger's death was such a tragedy, especially considering the cause of his death; accidental overdose of prescription medication. Its so infuriating! We're always talking about asymmetry of knowledge and medication compliance, yet considering the scope of funding in health care, there's very little procured to make the physician-patient interaction more valuable.

We get very little time with our physicians, an average of about 10 minutes to discuss our problems. Considering a physician sees approximately 20 patients or so a day, you, as a patient, have to be succinct and clear in your relay of information and hope the doctor is a good listener. Beyond that, there's little you can change at the point-of-care.

But think of all the things that happen before you even get to see the doctor.

1. You call to make an appointment - insurance registration
   
2. Fill out forms - reason for visit, current medications, medical history
3. Sign some important looking papers - HIPAA, release of medical records
   
4. Get your vitals taken - base health status
   
5. Meet with the nurse - history of present illness (HPI), review of symptoms (ROS)
   

There's potential for breakdown and success on all these counts.

#1. Very little is more hazardous to your health than getting a huge bill from your doctor. Problem: Most likely the breakdown happened when the billing department forgot to call your insurance company and precertify you for services and procedures during your visit. Providing your insurance info is the first part of this whole process!

Solution: No matter how good your doctor's office is, check with the insurance company yourself! Make sure you know your copay and get your deductible information before you go in. After the visit, if you're prescribed a test or medication, check with the insurance company again to see where you should go. Sometimes the pharmacy or imaging center recommended by the doctor's office isn't covered under your insurance (or might not be the cheapest option!).

#2. This is probably the most important of all. Problem: You've written the same thing over and over again going to different doctors, but still you forget what that medication with the long name is called. Or you forget that you finished the course of your antibiotic treatment a few weeks ago. Or you decide that the headaches you've been having every so often are not important for your dentist to know. And did you fax your records from the previous 5 doctors you saw? Do you even remember the second one's name!? The list continues.

Solution: Get all your medical info in one place. Find a doctor that offers a personal health record (PHR) or web portal. Go online to HealthVault, RevolutionHealth, WebMD and fill in the blanks. These sites have put in a lot of work to make it easy for you. If you prefer paper, get a file folder and drop all your info in there. Take a CD, print out your record or take the file folder with you to the doctor's office so you don't forget anything!

#3. Complicated legal forms are a necessary evil. Problem: You don't really care about what you're reading so you sign and date at the bottom and hand them in. The front desk secretary files it away along with your ins. card and photo ID and when you come in the next time, for some reason you have to repeat this process.

Solution: Fill out your medical forms first and hand them to the secretary. Take the time to read what HIPAA is all about and fill out your PCP's name in the medical release form so he/she is notified of the current visit. If you can, check if the doctor's office has an electronic medical record (EMR). This avoids the practice losing papers (because they get scanned in electronically) and saves you time from filling out everything all over again. Also, request a copy of your medical records so you can enter them online or put them in your file folder. A doctor's office has to comply with your request within 30 days (10 if you're from NY)!!

#4. Don't worry about white coat syndrome. You're here to talk about what's wrong and get a medical opinion. On top of that, you came prepared! So relax and let the nice ladies fuss over you.

#5. This is where the nurse will go over everything you wrote down. Problem: There's a game of telephone being played here where the front desk talks to the MA who talks to the NP who talks to the doctor. To their credit, most of it is documented.

Solution: Your job is to be repetitive and stick to your story. Keep in mind the top 3 things you came in to discuss. Don't go on and on about how tired you felt after the Giants tailgate. Nurses usually ask you about pertinent things you might have overlooked like recent minor illnesses, allergies, or over-the-counter medications you're taking. Pay attention and be detailed about your answers.

By the time you get to see the doctor, both of you will have a clear idea of what your record represents and what you're coming in about. After restating the top 3 issues, the repetition can stop. Let the doctor ask the questions, be concise in your answers and ask for further explanation if you don't understand something. By the time you leave, you should have a general understanding of your treatment plan. Ask a nurse or MA for definitions and medical pamphlets after to make sure you have a full understanding . Remember, you're on the clock, so coming in organized prepares everyone for what's important; your health care!

McMe, Myself, and I

"Caveat emptor; 'Let the buyer beware'"
--Laidlaw v. Organ, John Marshall

Super Size Me is a good movie in presentation. A great movie in fact. I haven't eaten McDonald's in a very long time - at least 6 years - and now I definitely know I'm better off for it.

(Weird thing is, I ended up craving some Mickey D's by the end!)

The Last Bite

"Probably the difference between man and the monkeys is that the monkeys are merely bored, while man has boredom plus imagination."
--Lin Yutang

If you like something, do you want more and more of it? Most people generally believe that to be the case. Money, sex, food, friends, free time; in general, the pleasures of life that bring us happiness. But sometimes actually having more of that thing we like doesn't leave us as satisfied as having one less of that thing and wanting one more.

Think about it. Experiencing that mental and emotional desire of meeting a budgetary goal, enjoying a romantic night with your beloved, and craving that last bite of dessert is much more potent than getting as much of those things as we want. You meet a challenge, distance does make the heart grow fonder and too much dessert is bad for you. Its what whets your appetite for more that's enjoyable, not binging on your favorite dish (which just leaves you feeling bloated and sick).

This can be applied. Next time, get one less scoop of ice cream than you want, have one less drink, stop before you're full, spend five minutes less in the shower, get home a little earlier from the bar, watch one less hour of TV. You'll keep craving that activity to the point when you just have to have all of it. And that's one of the greatest feelings in the world.

What's up with the Food Pyramid?

"If you can't easily trace a food back to its source in nature, don't eat it."

--Gregg Avedon

While tracking the evolution of the food pyramid, I became delighted, confused and shocked all at once. What was once holy 15 years ago has now turned completely on its head. A few pictures will help...



What's going on here!? The red meat is now split at the top with white bread, rice and pasta to be used sparingly when before the steak image was lumped in with nuts and fish at 2-3 servings/day and the bread, rice and pasta were at 6-11 servings/day!! Quite the shift don't you think?

Look towards the bottom for daily exercise and plant-based oils as a major component and also the addition of alcohol in moderation. This is in line with what we've all been hearing over the years, but what strikes me is how long it took to get the message out there. I remember my sister and cousins being taught the old pyramid only 4 years ago in middle school and high school. Even if parents have been keeping up with the latest news and research, how are they supposed to explain to their kids that what they're being taught in school is wrong?

If you visit USDA's food pyramid site now, you'll find the most latest version called, MyPyramid. It basically allows you to customize the pyramid based on your age, sex, weight, height and level of physical activity. After inputting all the relevant values, the site provides detailed recommendations and even lets you pick a plan that will lead to a healthier weight (based on your original values). Definitely worth a look. About time they decided to shy away from a one-size-fits-all model.



If you're interested in the progression of changes in the pyramid and want to learn more about why it was so flawed to begin with, check out this page.

EDIT: Here's even more from the Harvard School of Public Health on USDA's flawed methodology in constructing the original food pyramid and how to determine what really is good for you to eat.

A Marketplace for Health Care

"Consumption is the sole end and purpose of all production; and the interest of the producer ought to be attended to, only so far as it may be necessary for promoting that of the consumer."
--Adam Smith

Carol is a health care marketplace that basically allows you to purchase care packages for what you need. Say you have a sore throat and you're worried it might be something worse. Using Carol's body chart, you click on the throat region, scroll down to sore throat and click on the test, treatment or procedure that most suits your condition. In this case, the options are mononucleosis (mono) symptoms: evaluation & treatment and sore throat: evaluation & management. Clicking on the latter leads to a "compare care packages" page where you can select a vendor based on price and facility.

This is a really innovative way of shopping for health care services. With a "shopping bag" as the checkout cart, bright colors and stylistic fonts, it feels more like you're shopping for clothes on Macy's site than buying an MRI for your knee. The prices are within reason but for now I only see people using this as supplemental insurance (especially for dental care) or if they're lacking insurance for some time. If I were old or poor though, several things would prohibit me from taking advantage of this service; (1) ready access to the internet, (2) tech-savvyness (3) scope of care...oh and the fact that Medicare and Medicaid exist.

What's hard for everyone is terminology. I had no idea what blepharoplasty was until I clicked on it (its eyelid surgery). On the other end of the coin, now I know exactly what it is! Its a great way to learn about health care; the real costs, different insurance models, and how it can be delivered.

Right now we have very little choice. Not anything that's affordable for sure. Carol, while a work in progress, is making headway in providing consumers options to choose from. Making health care more transparent is business everyone benefits from.

EDIT: For a lot more on Carol, check out Scott Shreeve's insightful & detailed commentary here.

Use-Now-Adapt-Later

"I hear and I forget. I see and I believe.
I do and I understand."
-- Confucius

On my hunt for decent (and free) project management software, I discovered the "Use-Now-Adapt-Later" principle. Google promotes this approach through its retrospectiva, a web-based software project management tool it offers as a free d'load. In the end, I went with Access 2007.

But I just the found the principle so intuitive and simple. I mean its nothing more than learning by trial-and-error. You buy a new tv or a computer, what's the first thing you do? Turn it on and start using it! Who really reads the instruction manual right away? I learned most of Excel, Access and even building a blog this way.

You always need the by-the-book folks (they're the ones who write the instruction manuals!), but to really learn and retain something, it has to be contextualized. Yet rarely do we go on an excursion or start a project without a plan. "Think before you act" is overdone. We think too much! Sometimes you just have to jump in and feel it out.

The Doctor-Patient R'ship

How hard is it to find a physician in a new city!? Even if you have access to your insurer's tome (or maybe a small pamphlet) of participating physicians, its tough to know who to pick when you don't have a point of comparison. Even if you ask a neighbor or friend, word-of-mouth is unreliable because there are just too many factors that can make a visit go from great to terrible. Not considering that every patient is literally unique, from genetics to demographics to presenting symptoms. A fact of medicine that's too often overlooked.

Comparing physicians on efficiency though is hard. Dr. Thomas Lee's put together a quick FAQ to explain why. Click below for a better view.

Basically what patients want physicians just aren't ready to give, and for good reason. "Assymetry of information" gets thrown around a lot and its true. The knowledge gap between physicians and patients is enormous, and middleman websites can't make up for 10 years worth of education. Zagat wants to rate physicians on trust, communication, environment and availability. I'm not sure if our loved ones would pass that test. The bridge has to be built on effective communication, where the definition of "effective" is agreed on by both parties. Not third party payers, vendors, clearinghouses, or websites. Its not a round table discussion; its a one-on-one meeting.

Quick! Fill in the blank!

Get rich ____, grab a ____ bite, get in a ____ workout. Everyone's in a rush! All the Zen, the yoga, the meditation fly out the window when there's a deadline to meet, dinner to cook, and people to meet. Like taking prescription pills, we do "healthy" things as necessary, to counteract all the un-healthy things that make up our daily lives. Unfortunately one thing doesn't completely offset the other.

Breathing isn't something that needs to be jotted down in our day planners (remember those!?), whoops, blackberries. As we are forced to focus on the opportunity cost of time more and more regularly, setting priorities make us better decision-makers in every arena, whether it be work, home, or the grocery store.

This great post by Jane Sarasohn-Kahn on slow food and overall slower living kindled the idea for this post. She ends with suggesting a "slow health" movement:

There are certain aspects of modern life that require more than a minute or two of our time. Health is one. Perhaps we should start a Slow Health movement? One contributor to a Slow Health movement would be to pay primary care clinicians to spend more time with patients to listen and to advise. For now, though, let's at least work on ourselves and with those whose lives we touch (who may be consumers or other health stakeholders) to slow down when it comes to analyzing and consulting with health information. Oh, and while I'm thinking about it, cooking and eating as well....

"Code Blue" stat!

Hospital red tape makes casinos and airports better places to have a heart attack and survive! All due to a delay in providing an electic shock with a defribillator. The NYTimes article comments:

In the real world, doctors and nurses do not always run fast enough. Expert guidelines say the shock should be given within two minutes after the heart stops, but the study found that it took longer in 30 percent of the cases.

Certainly disappointing, but hospital guidelines that require a physician's presence at the time of defibrillation are not necessarily to blame. There's a purposeful hierarchy in hospitals that helps faculty and staff work together to make life and death decisions more effectively on the fly. But there's no question that staff can receive better training that can then help them distinguish when a physician's presence is absolutely required.

The article makes a great case for basic defribillator training that could prove true for many other technical functions performed in hospitals.

Dr. Saxon said the automatic defibrillators should be used more, along with the type of heart monitoring now given mostly to cardiac patients. Not everyone needs such monitoring, she said, but it may be in order for those who are very ill with kidney problems, diabetes or pneumonia, even if they have no history of heart problems. Their information would be transmitted to a computer network that would send out an alert if needed. In addition, she said, automatic defibrillators could be installed in every hospital room.

“You can get them for $500 on eBay,” she said. “It wouldn’t even take a nurse. You could train the cafeteria workers if you wanted to.”

So maybe, as in most strict bureacratic organizations, the hierarchy could benefit from being a little more flexible...

Rethinking the school Lunch

I've been thinking about how horrible food is in school cafeterias since I was in middle school. I'd bring food from home and still be tempted to grab a tray full of chicken nuggets, french fries, one of those tiny cups of ice cream and maybe even a discounted soda all for less than $5. I used to wonder why instead of fries and a soda, fresh fruit and milk weren't a viable option. I would later learn that it's simply a cost issue; fruits and veggies are just more expensive than canned or commodity produce subsidized heavily by the gov't. But change is on the horizon.

• Here's what a chef from Berkeley is doing to help.

• Mayor Bloomberg's on a crusade to get whole milk out of New York schools.

• Brian Klepper is promoting doctors to lead the charge on this issue before it gets out of hand.

icons

Ask Better questions, get more Involved!

Online social networks like Friendster, MySpace and the more recent Facebook have been around for a while now, just about 5 or 6 years. In internet years, that's ancient history! One of the greatest positive externalities to emerge though has been online patient forums like PatientsLikeMe, where people with various diseases have found others to share stories with and talk in general about their personal experiences.

With health care now a 2 trillion dollar industry, everyone wants a piece of the pie. Patients are slowly realizing that they are the centerpiece of the equation and networking sites, medical specialty resources, patient advocacy programs, you name it are all helping them get a stronger foothold by asking the right questions.

Doctors are essential in tearing down the paternalistic structure and increasing the value of patient-physician interactions. With so little time spent with a patient in an exam room, a physician must ask extremely pertinent questions hopefully with foreknowledge of the patient's concerns. Technology is key here; fax, email, best case a web portal to communicate to the doctor the reason for the visit prepares both patient and physician to get past the "sooo, what brings you in today?" phase. Having a mental framework in place allows for treatment options, medication compliance and follow-up to be that much more on target.

There are a lot of people campaigning for this kind of change. NYTimes has a wonderful piece that fleshes out the responsibilities of both patient and doctor even before they meet called "On the Same Wavelength With the Doctor". This is the perspective we need to shake up how things have always been done.

Debating Recession, Building Snakes

Merrill Lynch (but not other banks) think we're already in a recession. They sardonically refute the other banks with,

"To say that the backdrop is 'recession like' is akin to an obstetrician telling a woman that she is 'sort of pregnant'," the report said.

Got it. Most people do think we're headed towards some sort of downturn though. A definition is appropriate here :

The NBER defines a recession as "a significant decline in economic activity spread across the economy, lasting more than a few months".

It bases its assessment on final figures on employment, personal income, industrial production and sales activity in the manufacturing and retail sectors.

On the health care end, we're figuring out ways to avoid using the knife altogether. The i-Snake is a new tool being developed for minimally-invasive heart bypass surgery. I've seen the scars resulting from the old way of doing CABGs, and what they're trying to do here is have "smaller scars, reduced hospital stays and shorter recovery times." Pretty amazing...

Also, if you're having trouble waking up, maybe the SnūzNLūz alarm clock might help. For every push of the snooze button, it sends an amount of money you preset to your most hated charity. Love the common usage suggestions at the bottom of the article,

Are you a butcher? Set your SnūzNLūz to donate to PETA
Are you a republican? Set your SnūzNLūz to donate to the ACLU!

The evolution of a Process

Interface -> Interoperate -> Flow. That's the gist of what makes a system go from local to global. You have to speak the same language - interface - before you can work together as a culture - interoperate - and have a smooth, efficient, cross-functional machine - flow. Each of these terms encompasses hundreds of thousands of people doing different jobs to make it all work in sync.

The financial sector is a step ahead of the rest. Financial Times says a model for direct trading across global borders is projected towards the end of the year, mainly because the interfacing component is coming together quickly:

"SEC staff have been working on a proposal for “mutual recognition” between the SEC and other regulators that would allow the US watchdog to rely on foreign regulators’ standards as US investors trade abroad...

...As part of the new SEC approach, a foreign exchange would be allowed to install a trading facility on the desk of a US broker, provided that the exchages’ home-country regulators’ rules were deemed “comparable” to the SEC’s."

There is a huge demand for this type of service:

"The policy shift, backed by SEC chairman Christopher Cox, has been prompted by the increasing appetite of US investors for foreign securities.

Nearly two-thirds of American investors have holdings in non-US companies, a 30 per cent increase from five years ago."

The odd thing to note here is that while you must interface first before you can interoperate, the demand for interoperability - the desire for culture change - is what leads to interfacing - the desire to speak the same language.

It's what the education and health sectors are lacking. Parents have to want to have the same standards across all public schools, patients have to want to have their records be available everywhere. This isn't as personally sensitive as money, so either we don't care or we're not being informed about the potential of possibility.

At least someone's trying to bridge the GAAP.

Why health care is a Different animal

What an amazing post by Bob Wachter on The Health Care Blog!! It talks about why, compared to other industries, health care is a different animal...with a few similarities of course. Aviation and finance are commonly (and too casually) presumed analogous to health care. Bob really breaks down the thought process of why this isn't the case most of the time but also why this may be a fair analogy some of the time. You need at least a little perspective to work from. Excerpt below.

I continue to find analogies from other industries useful, but we must recognize their limitations. Simple solutions that worked so well in the [fill in the blank] industry often fail in healthcare because our workplace is like a dozen industries rolled into one. For example, a busy hospital and its workers may face these challenges:

• How to move a part (like a pathology specimen) seamlessly down an assembly line, just like Toyota does.
• How to get an important piece of data (like a discharge summary) from place to place, just like FedEx does.
• How to make difficult, weighty decisions (like whether to do open up an abdomen) under conditions of overwhelming uncertainty, just like a field general or a business CEO does.
• How to deal with major and only partly predictable changes in capacity needs (like when the “bus shows up” at 7 pm in the Emergency Department), like McDonalds does at lunchtime.
• How to providing “expectation-surpassing” customer service (so that we ace our Press-Ganey survey), just like the Ritz Carlton or Nordstrom does.
• How to innovate, both with processes and technologies (a consuming interest in an academic medical center like mine), just like Apple does.
• How to teach wildly disparate learners (like the ones on my team when I’m ward attending), just like a high school teacher does (or would do, if her class included freshman, sophomores, juniors and seniors).

Think about it for a second. Can you conjure up another industry that confronts more than two or three of these challenges? I can’t. And not only are all these conditions present simultaneously in most healthcare organizations, there are times when a single doctor or nurse confronts all of them!

Status quo No More

Know someone who doesn't manage their money well? Doesn't pay bills on time, has a lot of credit card debt, maybe loans that are piling up? What happens if you give that person Quicken or some sort of personal finance software? Does that help?

The expected answer is yes. Financial awareness alone has to help in some way. Knowing that you're spending $250/month on Starbucks can be an eye-opener. But over time, the effect of an IT intervention wears off. A lasting effect has to be behavioral, not just technical. Automating poor money management skills won't improve them. Habits have to change. A regular routine must be set. Moderation must be practiced. We all know it, but its tough to find the incentives to get us there.

In some ways, this is the challenge health care is facing with electronic medical records. From major hospital systems to small private practices, conversion from paper to electronic systems is happening at a rapid pace to meet Bush's 2014 deadline for all Americans to have electronic medical records. Everyone is in a state of adoption.

Yet adoption alone, as in the personal finance case, doesn't solve the inherent problem of bad habits and poor management. IT is not the panacea. Rather its the ability to respond and adapt well to change and move yourself or your organization's culture to the next threshold that will keep you competitive. The next best thing will always be around the corner. Its not what will get you there that will matter, but how well you've prepared yourself to be open to a new perspective that will make the difference.

Funding THE PLAN

NYTimes has a great article called, Health Care Expansions Hit Roadblocks, describing the latest major roadblock as cost control for a universal plan. I always thought this was THE greatest roadblock. As the California, Massachusetts, and Pennsylvania plans mature, its slowly becoming clear that unions, insurance companies, politicians all pale in comparison to cost when it comes to providing health insurance for all. The article's flow is choppy, so I chopped it up to make sense out of it. Excerpts are below.

"The downside, and one noted by states with widening budget gaps, is that the program is expected to exceed its first-year budget by at least $150 million. And state officials are struggling to prevent double-digit premium increases next year."

"And though the rate of growth has slowed, the cost of employer-sponsored premiums still rose by 6.1 percent in 2007, more than double the inflation rate, according to the Kaiser Family Foundation."

"[The Plan] would raise money to subsidize policies for low-income residents through what Mr. Schwarzenegger calls shared responsibility — a tax on hospital revenues, a hefty increase in tobacco taxes and assessments on employers who do not contribute to their workers’ health care."

"Illinois’ Democratic governor, Rod R. Blagojevich, got nowhere with his proposals to pay for universal access to insurance by taxing gross business receipts and assessing employers who do not offer coverage to their employees."

“It remains incredibly difficult for states by themselves to get all the uninsured covered,” said Robert Blendon, a Harvard professor of health policy and political analysis. “There just is not a consensus on who should pay.”

Kids being Dangerous

Gever Tulley says there are 5 dangerous things you should let your kids do.

1. Play with fire
2. Own a pocket knife
3. Throw a spear
4. Deconstruct appliances
5. Drive a car

I see what he's getting at, but I remember doing most of these things in technology or gym class. Then again, I also remember the school discontinuing technology because of changing budgetary priorities. So maybe his Tinkering School does have its place.

Check out the full presentation on TED. And because of my thrill for 4a, here's howstuffworks!

The Mitchell Report on Healthcare

Baseball's Mitchell Report has already become infamous for naming names of baseball elite who took or were somehow involved with steroid use. A bit of a formality as most fans are already well aware that baseball players juice up. Home runs fill the seats, and filling the seats means more money for everyone in the MLB.

Not so different from what brings in outpatients to clinics. A little bit of supply induced demand, a dash of fee-for-service, and a (generous) pinch of cost subsidization all generate large sums of revenue for the health care system.

But what is the fundamental issue? Quality. What makes a hit a hit in baseball? Does it still count if Barry Bonds hits the home run or is Edgar Renteria's HR% more real?

Same with quality in health care. What determines quality of care in medicine? What are the metrics? The standards? AHRQ has a lot to say but very little is agreed upon, let alone applied.

The Mitchell Report as I said earlier is a formality, just like all the quality boards and insurer rating systems. They make people aware of the issue, but don't do anything about it. Change happens through culture! Naming names, installing IT systems, ranking doctors are not the solutions, they are the precursors to a solution. They're advertising. But are they really doing a good job of getting our attention?

Get to the Source

"Not everyone in medicine can be constantly making calculations about the value of the information. You'd go crazy. But if you are in a subspecialty field, as you train, you not only need to know what people know, but how they know it. You have to regularly question everything and everyone."

-Dr. James Lock from How Doctors Think by Jerome Groopman

A Trend in the Mass Conscience

Google Alerts basically allows you to search for a given keyword or phrase say, "education", "the war on terror" or "justin timberlake" and sends you alert emails with a comprehensive list of links from news, blogs and the web. Its a really great way to keep track of what you're interested in or curious about.

I've had a google alert for "health care" on since the alert function began earlier this year. I'm used to getting about 5 links for every email alert I get, but recently it has grown exponentially to 10 and sometimes more than 20 links at a time. I assume this means that more people are writing about health care and more people are searching for it as well.

Unsurprising as health care is one of the hottest topics in the upcoming election, yet an unexpected discovery within the google alerts application.

What does Art have to do with Health?

A lot, if you think about it. Asian cultures have been stressing the importance of environment and ambiance on one's health and happiness for ages; feng-shui from China and vastu shastra from India being a few examples. Makes sense that the setup of our room, apartment, or house has a lot of effect on us. So why not the same for patients in hospitals? Get rid of the bland, pasty, grey walls and put in some color!

That's exactly what Women & Children's Hospital in Buffalo is doing. Through grant funding from the Oishei Foundation, the hospital is collaborating with the local Center for the Arts to sponsor

"an intensive training program facilitated by the University of Florida's CAHRE program where local invited visual artists, musicians, poets, dancers, and storytellers will be trained to work with patients, families, and staff in health-care settings as integral members of the healthcare team."

"...studies have shown that integrating the arts into these settings helps to cultivate a healing environment, support the mental and emotional recovery of patients, communicate health and recovery information, and foster positive working conditions for caregivers to improve satisfaction and retention."

The Pebble Project conducts similar health design studies on a much larger scale with multiple hospitals. I got a chance to view first hand some of the benefits when I worked at Weill Cornell Medical College in NYC. In fact, a new building called the Greenberg Center was specifically built with the findings of the project in mind. The goal is

"to create healing environments [that] can impact patient satisfaction, staff satisfaction, nurse retention, medical outcomes, safety, quality, financial performance, and more."

Antibiotics face the Tragedy of the Commons

The evolution of antibiotic resistance is just scary. Through careless prescribing and poor compliance, we've gotten ourselves into a trap referred to as the tragedy of the commons. While each individual faces to gain a large benefit, the cost of that individual benefit is shared across the entire population. Since the individual doesn't see or bear the cost, he/she will continue to do whatever is necessary to reacquire that benefit without public conscience. Hence the tragedy.

Every time an antibiotic is prescribed, the risk of resistance increases. Does this mean we shouldn't be prescribing them? Of course not. But their usage should be governed by special circumstance or how effective they'll be for that individual. Offhandedly prescribing antibiotics for the cold or flu (for which they have no effect because they're viral, not bacterial) has frankly become dangerous. Same with not completing the full regimen prescribed. The FDA provides a brief, informative fact page here.

MRSA or Methicillin-resistant Staphylococcus aureus is a great example of this phenomenon. Methicillin's the antibiotic and S. aureus is the infectious bacteria. This type of staph has become resistant to the antibiotic that killed it and is causing the most havoc in hospitals where bacteria and its killers are in a constant battle. In this case, the bacteria won and now we're recouping for another fight where we've lost the higher ground. This is serious and current!

There's a great sidebar in this USA Today article, "Hospitals marshal resources to wipe out MRSA", that describes how to avoid MRSA. Below are a few excerpts.

"...hospitalizations related to MRSA nearly doubled between 1999 and 2005, from 127,000 to almost 280,000."

"At the University of Texas Medical Branch in Galveston, the main battle strategy against MRSA is what it calls the "search and destroy" method. The hospital screens all adult intensive-care-unit patients each week for MRSA and places those testing positive in isolation."

"Watch before and after an examination. Do doctors wash their hands? If not, ask them to do so. Look around. Is the hospital clean?"

"After any procedure, be persistent about cleanliness. If a catheter is in place, inquire whether it's still needed. Bacteria can enter the device and quickly spread through the body."

The Arbitrageur Next Door

On my flight down to DC a couple weeks ago, I met an arbitrageur. It was in fact the guy sitting next to me, a Canadian driving to Buffalo to take a flight down to North Carolina to buy a truck that he planned to drive all the way back home to...Canada. He was casually indifferent about the whole thing, as if this was a run-of-the-mill endeavor. But really, why go through all this trouble?

At the time, the US$ was worth 92 cents Canadian (CAD). Yet car salesman in Canada hadn't adjusted to the new rates. They were still selling cars at rates about 1.5x the US dollar, which matched the exchange rate almost 4 years ago! A Chevy Silverado that cost around 42,000 CAD was selling for $30,000 in the U.S. My fellow passenger looked to save over $10,000, no matter how you measure it!

That's arbitrage for you; exploiting a price differential between markets. Just because the Canadian auto market is inefficient doesn't mean a consumer needs to lose out. Simpler examples of this concept can be seen at checkouts where all the lines are usually the same length because if one was shorter, someone would leave their spot in the longer line and move to the shorter one. Or in traffic, where all the lanes move at about the same speed, because if one moved faster enough people would switch over until the speeds matched once again.

This is also a great reason not to buy into all the investment advice by so-called "experts" (who are no better at picking stocks than monkeys anyway). If they really knew about the "hot" stock, wouldn't they have told their families and buddies first before informing you!? I'm sure the suggested stock is doing well, but who catches the windfall? The first people to get there. The first to find the shorter line or the faster lane. After that, any major gains are absorbed into the market leaving very little benefit behind.

So my friend in the seat next to me saves $10,000 and enough people will do what he did until Canadian car salesman realize they're losing out, or American car salesman raise their prices.

Pay for Preference

Greyhound's new priority seating option is another example of good economics. If you've ever ridden on Greyhound (especially from NYC!) you know how bad the lines can get and as a result how irritated people can get. In some senses, I think they're replacing poor management with a cost-benefit exchange, but that doesn't change the fact that it makes sense.

Movie theaters in major urban centers do the same thing by allowing movie-goers to reserve seats in prime locations of the theater, sometimes even with a snack/beverage service. Its been this way on Broadway and stadiums and airlines all along, so why not?

Repugnancy costs originating from cultural mores. That's the answer. But is it a good one?

As the Wii is to Canada, the PS3 is to America

The demand for Nintendo's Wii has not diminished since its revolutionary arrival last Thanksgiving. Yet Nintendo is still hesitant to increase its supply or raise the price of the Wii to reach some form of market equilibrium. This has led to long waiting lines outside toy and gaming stores, sometimes at odd times like Sunday at 8 am to weed out the casual gamer.

For some reason the Wii is being rationed, similar to how health care is rationed in Canada or the UK. There is ample demand in Canada, yet few monetary or policy incentives to increase supply. With limited (funding for) clinics, hospitals and new technologies, doctors have little motivation to open up shop and patients sometimes have to wait 3-6 months for a surgery or visit. Its one of the best representations of the saying, "there's no such thing as a free lunch". Government-regulated single-payer health care may seem "free" on the surface. But you end up paying for it in time and taxes.

Now take the PS3. Sony's debut of the PS3 occurred at the same time as the Wii, but (due to marginal cost) it was priced 3x higher (originally $799, now $399). No waiting lines here! In this case, the exorbitant price left only the hardcore gamers interested and not until the cost of producing such a high-end system went down did consumers see a reduction in price.

In this way the PS3 is akin to the American health care market. A quality product rationed by price. The high-end users (the sickest patients) are most indifferent to price and will purchase care at any cost simply because they need it (its the job of the insurers to reduce the financial burden in such a time of need). Other medium to low-end consumers can make a personal decision based on price and predicted value.

This simple analogy gives a brief glimpse of why international health care markets differ and how single-payer systems ration care. The PS3-America analogy wouldn't be complete without mentioning third-party payers though. Health insurance in the U.S. doesn't function like car or life insurance. Rather than providing catastrophic coverage and raising premiums based on client risk, health insurance subsidizes cost of care at the episodic level. This breeds overuse. It would be similar to someone giving you the PS3 at half the price when it just came out!

Pricing matters, whether its through premiums or taxes. When presidential candidates hint at universal health care, they should provide more than just hints about how much it will take out of your paycheck each time to support the high-end system we are fortunate to have in the U.S.

EDIT (12/14/07): PS3 sales have skyrocketed by 300% since the price changes in mid-October. Here's the article.

Continuous Life Learning

Looking back on my notes from last semester I found pages with the title "New Things To Learn". I used to write these look-up-later notes during classes or at seminars. Kind of like jotting down words you don't know when you're reading a book. Surprisingly I actually recalled the ideas or people or articles I had written down to look up more than 6 months ago. I guess this technique worked for me.

Managing time, improving recall, and continuously adding layers to our knowledge base has become harder in today's one-click-learn world. Anything we want to know is now available to us anywhere, anytime. But is it retained? Or recalled when you most need it? Developing the right habits is key, and it all starts with curiosity, the kind of desire to learn we felt when we were 5 and saw lightning for the first time. Being a life intellectual isn't easy, but its become a necessary skill set in order to be "in the know" nowadays. Ben Casnocha espouses and promotes this kind of learning and Ed Boyden provides a detailed methodology for applying it.

The question now is not if you have to be aware and keep up with modern technology and emerging trends, but rather how you're going to do so.

Arnold Kling on Universal Health Care

"Government is not as efficient as it might seem. While the government can operate without profits, it cannot operate without taxes. Taxes discourage work, thrift, and risk-taking. The deadweight loss from taxes as a percentage of revenue is higher than insurance company profits as a percentage of their revenue."

The full article can be found here.

The Different Ways Technology and Health Care work Together

When I met Dr. Bernardo in 2004, he was working on a virtual reality simulation program educating surgeons to navigate the convoluted areas of the brain during surgery. Overlapping a 3D layer on top of an actual recorded surgery, he created a step-by-step tutorial by re-performing the surgery with simulated tools. It had to be the one of the most remarkable things I'd ever seen. Now that it's done, the course in skull base surgery is being offered at Weill Cornell Medical College in New York City.

This remarkable way of teaching using online and virtual programs has expanded to many other areas. Medical students are now watching short videos on iPods to learn how to perform ultrasounds. Nurses are using an online virtual reality network to learn how to diagnose and treat patients in the ER. Even patients are benefiting from information online. The internet has been cited as contributing factor in the recent decline in cancer rates, primarily due to early diagnosis.

This is how technology and health care are going to combine and grow, through consumer and provider engagement. Hospitals, insurers, employers all have their own incentives to be involved, but none as pure as the patient or physician's desire to improve health directly.

Overmedicated America: Reason One (continued)

NYTimes has an article out today called, Dr. Drug Rep. Its one psychiatrist's revealing story of working for Wyeth Pharmaceuticals on the side to promote certain antidepressants. Such blatant drug-pushing and doctor-marketing makes us more susceptible to taking stuff we shouldn't, or even choosing dietary, exercise or behavioral alternatives instead.

Paying attention to what outcomes are being looked at is extremely important. Mortality vs. survival rates, remission vs. response rates all make a difference in how one's study comes out. When big money is involved, there's no reason to quote results on all outcomes, just the ones that are convincing. Dr. Calter from the article elaborates...

"In his study, he emphasized the remission rates and not the response rates. As I listened to his presentation, I wondered why. Was it because he felt that remission was the only really meaningful outcome by which to compare drugs? Or was it because using remission made Effexor look more impressive than response did?"

Below are some further quotes that might entice a full read.

"Was I swallowing the message whole? Certainly not. I knew that this was hardly impartial medical education, and that we were being fed a marketing line. But when you are treated like the anointed, wined and dined in Manhattan and placed among the leaders of the field, you inevitably put some of your critical faculties on hold."

"How many doctors speak for drug companies? We don’t know for sure, but one recent study indicates that at least 25 percent of all doctors in the United States receive drug money for lecturing to physicians or for helping to market drugs in other ways."

"The term “decile 6” is drug-rep jargon for a doctor who prescribes a lot of medications. The higher the “decile” (in a range from 1 to 10), the higher the prescription volume, and the more potentially lucrative that doctor could be for the company."

"The American Medical Association is also a key player in prescription data-mining. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money."

"At that moment, I decided my career as an industry-sponsored speaker was over. The manager’s message couldn’t be clearer: I was being paid to enthusiastically endorse their drug. Once I stopped doing that, I was of little value to them, no matter how much “medical education” I provided."

The Resistance Evolution

What a shocking read! Stephen R. Palumbi's article talks about antibiotic and HIV resistance to drugs and plant and insect resistance to pesticides. Here are some stats:

That's about a 14 year difference between the year resistance was developed and the year the antibiotic or herbicide was deployed. This was written in 2001 by the way! Imagine where the cycle is now, 7 years later.

Here's the kicker:

"Up to one-third of U.S. pediatricians report overprescribing antibiotics to assuage patient concerns, particularly in cases of viral childhood congestions that cannot respond to the drug (32)."

I wonder how patients will respond when they find out they received not just a placebo which didn't do anything, but an actual drug that will now work less effectively if they have a bacterial infection.

Overmedicated America: Reason One

Incentives to prescribe and specifically prescribe certain brand names exist in subtle forms of bribery everywhere in health care. Representative DeFazio seeks to solve this with legislation requiring Rx companies to "list both gifts of $25 or more and the physicians who receive them."

I wonder if sponsored seminars, lunches, dinners and sometimes vacations count on that list. Physicians are smart enough to know they're being bought, but once the seed has been planted...

Physicians, Patients and Online Video

iHealthBeat recently featured an article called, "DrTube: Physicians Tap Online Video To Communicate With Patients". Click on the link to directly view it.

The paradigm shift in physician thinking from independent contractor to entrepreneur is a key point in the article. Connecting with patients on their level, assessing demand for services and supplying to that demand in simple terms is basic marketing but a relatively new concept in modern medicine.

Here's the bottomline:

• Seeing is believing, so utilize online video to educate, discuss and connect with your patients

• Personalize your practice by giving patients an inside view even before they come to your office

• Help patients connect to each other through online support groups and video forums

Advertising in health care results in two money transfers. One, it reduces cost to the consumer since an informed patient makes better choices. And two, it increases willingness to pay for the same informed patient who now feels more comfortable with the service he/she is receiving.

Overall, information transparency contributes to the passive dialogue that occurs prior to the actual patient visit. This is a great strategy for attracting new patients and building a stronger physician-patient relationship.

Oh RHIO, Where Art Thou?

My experience at the State RHIO Consensus conference in DC was educational, but it lacked definition. Literally. A lot of great ideas were thrown around but everyone was reading from their own page when defining what a regional health information organization (RHIO) does or what health information exchange (HIE) should be all about. Then again, we were there to reach a consensus.

Convene. Coordinate. Operate. These three action items are the necessary steps to create a solid health IT infrastructure. They represented the template the conference leaders worked from.

A RHIO fits the first two and HIE the last. A collaboration of individuals representing the major health care centers convene to set policies, protocols and standards for HIE. They coordinate underlying parties and align objectives towards the common goal they reached when they were convening. Finally, the HIE represents the technical operations of setting up how the exchange will occur. The programming and technological tools that will make it work.

Beyond definitions, here are some of the neat ideas that emerged:

1. A council of states to set privacy, safety and quality standards
2. Getting rid of duplicate patient records and creating a Master Index
3. Concentrating on state borders for HIE
4. Setting up an accreditation board for vendors (beyond CCHIT)
   

RHIO

RHIO stands for Regional Health Information Organization. Its a mouthful for an initiative that local and state governments are working on to make your health information more accessible. Just like email, it'd be nice if you could view your medical records from anywhere; recent doctor visits, prescriptions, maybe your lab work. It'd be even nicer if a doctor could see your medical records, say if you hurt your leg hiking far away from home and were allergic to a certain anesthetic and didn't have the wherewithal (because you were in pain!) to tell him.

Local hospitals and clinics are doing an OK job getting an electronic version of what used to be all paper records installed in their offices. But with all the different Health IT (HIT) vendors out there helping this process along, somebody's gotta work on getting them connected. That's what RHIOs are for. Start small at the local to state level and work your way up to a National Health Information Network (NHIN). That's the basic idea.

I'm in DC for a State RHIO Consensus conference hoping to get more info right from the source. Stay tuned!

Virtually Life-like!

My friend Chris first introduced me to the idea of online economies 3 years ago. NYTimes ran a story about "virtual money" in a popular game called World of Warcraft this past summer:

"Every World of Warcraft player needs those coins, and mostly for one reason: to pay for the virtual gear to fight the monsters to earn the points to reach the next level. And there are only two ways players can get as much of this virtual money as the game requires: they can spend hours collecting it or they can pay someone real money to do it for them."

Now the idea has reached academia. Professor Bloomfield, from the business school at Cornell, is teaching a course on a game called Second Life. He calls the course "metanomics", the economics of the metaverse.

"In his course, Bloomfield says his goal is to get students to understand business and regulatory oversight in the metaverse using thought from the real world. Some students start with what Bloomfield calls the "immersionist" view of Second Life -- using their avatars in the metaverse, as if it were the only universe.

Another perspective he teaches is the "augmentationist" view -- considering the metaverse a new feature of real life and analyzing how the metaverse affects business and policy in the real world."

Sounds like an interconnected version of Sim City to me. Virtual simulation certainly offers strategic benefits for businessman and policy makers, but the model is as good as those who build it. Stay tuned!

Confound it!

Rudy Giuliani makes a mistake on his stats for surviving prostate cancer in the UK. Quotes 44%. In fact, the US is doing better, but not by that much; 82% vs. 74.4%.

Why don't politicians get it right the first time? Their staff has to be extremely specialized and well-informed. In this case, it might not be the people but rather the wide array of answers they get for one simple question.

In health care, its extremely difficult to control for confounding variables. Essentially, to get rid of underlying variables that may influence the answer to the question you're asking. The best example is the placebo effect. You want to figure out how to get rid of a cold. You take some medication and your cold goes away. Its very possible though that because you thought the medication would help you, you psyched yourself out of a cold. Its been proven time and again just by giving patients sugar pills and finding out a couple of days later that they feel great!

Anyway, comparing prostate cancer survival rates of two countries can be extremely confounding. Different people, different doctors, different education, different testing, different technology, the list goes on. I bet the survival rates in the south and north of US alone are different! Depending on what you confound, you're likely to get a different answer to the same question.

Bottomline: Countries are hard to compare. Maybe we should start smaller.

What is the health care industry really trying to accomplish?

Is the goal of health care actually to make people healthy? Its debatable. Look at insurer denials of coverage, defensive medicine and pharmaceutical advertising and you wonder what's really going on. Of course there's the other side of the coin too, the obviously patient-care oriented side; payer-sponsored PHRs, convenience clinics, and cheap generics just to name a few.

The point is that health care is so massively complex that rarely do all parties involved have one set goal in mind. Maybe it makes sense they don't. Different incentives lead to different pursuits, but there has to be something everyone's trying to accomplish?

Here's a thought, the goal of the industry is to make health care more affordable and accessible for consumers while keeping costs down for suppliers. Cost-efficiency. Delivery. Patient care. I believe this can serve as a good litmus test for what is really relevant to the advancement of health. Economists use ratios such as cost/life year gained to measure the cost-effectiveness of specific medical interventions. But it doesn't always have to be this rigorous. Next time you see a drug ad, presidential campaign ad, or policy ad on TV, question the incentives of the sponsors and see if they match with the overall goal above.

The emerging consumer-driven health care trend means we should get more involved. It all starts with perspective.

Convo: Short for Conversation. But is the Value of Conversation Shortening too?

E-mail worries me. Actually, its how we use it that bothers me the most. Think of email as little post-its left around for your friends, relatives and colleagues who must respond back to them with more post-its and you'll see the beginnings of a yellow brick road leading to an Oz where the wizard is none other than Adam Bosworth.

I have no problem with E-mail's original purpose of allowing people to passively communicate and remind each other of projects and grocery lists and stuff. But foregoing the meet-and-greet, face-to-face, in-person conversations for E-mail chat is another story.

For example, Netflix has basically allowed me to stop going to the movie theater unless its a must-see major blockbuster that really is worth the experience. That experience though, so often shared together with friends or family, has now become a lonely masturbatory affair in one's living room on a small flat screen and a worn-out couch with a permanent imprint of one's derrière.

Similarly, E-mail has made us loners (albeit very available loners), indifferent to the extreme of stepping out to knock on a friend's door when its so easy and convenient just to e-mail them. The impromptu get-together has become lost in the zany roads of the information superhighway. These days, we need video game consoles like the Wii to remind us to get a breath of fresh air and play outside for a change!

The Golden Rule

SCHIP is hard to argue against, especially when Bush is leading the veto effort and charities are so eager to remind you of the fund raising lure, "its for the children!" But Mike Leavitt makes the strongest case by arguing for preserving scarce present resources to anticipate for large-scale medical expenditures in the future, or in other words, saving.

The SCHIP argument primarily centers around which families will receive funding and how much they will receive. It seems that a resolution might just be around the corner, but its curious why Leavitt (and Bush) wouldn't want to help kids get easier access to medical care.

One reason is the Dems' expansion would actually cost more to maintain than the initial $35 billion they desire. The other is that it doesn't make sense for a family of 4 making a total of $83,000 to be eligible. But the uber-reason is that a GOP-approved $20 billion expansion would save $15 billion for other important programs, such as the development of national standards for health outcomes, information transparency so the public is aware of such standards, and a national IT/exchange structure to maintain and update these standards. And I'm not talking about the Zagat-like rating system Wellpoint is offering, either. What a joke.

Bottomline: Saving for the future is important. The Golden Rule of cutting back a little now to benefit future generations later is even more important. The environment, the debt-ridden budget, social security and certainly health care all depend on it.

Sell, Sell, Sell!

StartupNation is one of my most favorite sites for entrepreneurship ideas and advice. From step-by-step guides for creating a business plan to 100's of self-starter business ideas the site covers a lot of ground.

Recently I received a feed from the site about doing an elevator pitch, in my mind the most important element in selling your business idea (and yourself). A quick 60-second synopsis of what, how and how much, the ability to deliver a mesmerizing and attention-grabbing pitch is an art. One I'm trying to master!

When it comes to new ideas, we're all like HR managers filtering through sheafs of resumes a day. How many sound bites and info bites do we hear in a day? An effective pitch will separate itself from the daily jargon and deliver an impacting message that will jar you from your reverie. Sort of what the business should be doing, right?

Think of the pitch as an extension of your idea. The better you can explain what you're about, the sounder your idea will seem to the person listening to it.

The Satisfaction of Discovering (already discovered) Ideas

My academic advisor, Matt, told me couple weeks ago of a new idea he had for automated prescription reminders. Software that would alert you via text message or email to take your medication or monitor your blood pressure based on whatever condition you might have.

Its a great idea, but to Matt's chagrin, this service is readily available in reminder form right on your cellphone. Also, Google Calendar allows you to received automated email reminders for events you've pre-programmed. For free!

Despite this fact, there's a sense of satisfaction that comes out of the process of discovery even if that discovery has already been made. The sigh for what could have been is mixed in with gratitude for the person who worked so hard to bring that service or product to life.

I had such a feeling when Netflix came out and much more recently when I discovered that the niche of health care blogging wasn't as empty as I thought. It sobers you and makes you realize just how much effort is involved in making an idea a reality.

Convenience clinics going Global

Cardinal Health's Medicine Shoppe is opening up 500 mini-clinics in the slums of India. Medically trained professionals, minimal fees (20Rs!) and a well-stocked pharmacy are some of the attractions not to mention diagnostic labs and imaging.

In a way, the medical system is reverting back to its mom-and-pop roots, but on a much grander scale. Convenience clinics offer basic, personalized care usually for low-income, elderly or uninsured populations thereby diverting them from going to the ER for non-critical issues. This way, rationing of medical care does not end up occurring via triage and long waits in packed ERs but instead in convenient care locations around town.

With allocation of scarce resources always a concern for health care, this is one great way to keeps costs down and provide increased access.

BI Health: Reading between the Health Care lines

Business intelligence (BI) in health care has been growing slowly not because it doesn't add value but because the conservative world of health care has been slow in acknowledging its value. Jill Dyche from Baseline Consulting has written several white papers on efficiency, process improvement , and the drivers of BI within health care.

This is the kind of work that fascinates me! Connecting hospitals and systems together to share information, making that information transparent to the open market of consumers and third-parties, and using that information to develop metrics to measure performance on various levels. Its a great blend of logistical and academic know-how.

In an industry filled with bureaucratic claims processing and a set hierarchy of decision-makers, you need folks who think outside the box constantly. The various facets of health care and their interconnections can be hard to grasp, and BI experts really try to break it down and make sense of it all in a very methodical and logical way. I'm excited to learn more about this world of liaisons and be a part of its growth in an industry hungry for the change.

Cold Medication for Children Under Review

Here's a NYTimes article on the possibility of children's cold medication causing more harm than good. The consensus of the FDA expert panel boils down to the fact "that if the drugs had not proven to be effective in young children, they should not be available." It seems that in the '70s regulators decided what works for adults should also work for children (using different doses of course). Since then though, many studies have shown the efficacy of these OTC cold drugs to be debatable and in the worst cases, causing serious harm.

Its shocking to me that medication like Robitussin, which I was given routinely for a cough when I was young, could have had an adverse effect. The numbers explain a lot: "Parents spend around $500 million every year buying nearly 95 million boxes containing 3.8 billion doses of medicine." Hence the manufacturer uproar against the possible ban on OTC drugs for children below the age of 6. Lobbying power makes all the difference in health care (and most other sectors as well).

The director of the FDA office of new drugs advises parents to be more careful reading labels, which while smart practice in general, is difficult to expect of parents who most likely aren't versed in medical terms and are worried sick about their children's condition. The gap in medical education is primarily the reason expert FDA panels have to be convened to pass such bans on drugs. Maybe pharmacists should start getting more involved.

Googlefficiency

Google has countless ways to make life more efficient. I'm a huge fan of Google's services: gmail, docs, calendar, reader, iGoogle, and of course Blogger to name a few. Its become so easy to organize my emails or load any document I've worked on anywhere there's internet or check out the weather in 5 different locations around the world with one click of a button. I only realize this when I see others not using the free apps Google offers. I figure they just don't know about it or they're skeptical. Well, if you fall in either of those categories, just give it a shot. Here's the link to get started: Google Apps.

Great Einstein quote

"There are some things that count that can't be counted. And some things that can be counted that don't count."

gPhone

Since the iPhone came out, there's been a lot of buzz about gPhone's debut. gPhone is Google's prototype of a mobile phone that would offer user-friendly search engine capability (www.google.com, what did you expect!?). In fact, this mobile OS functionality may be its primary attraction as there seem to be very few differences between the gPhone and the iPhone.

Google's also throwing the idea of free mobile service around. You would have to watch a 10-30 second ad before making a call. Surely that's worth $0.40!

Here's the Wiki.

On the Edge of Information

Web2.0, Health2.0, Life2.0.

There's so much information available at our disposable nowadays that keeping up with it can become a part-time job. We specialize because we have to. Yet being in the know can be a fantastic feeling. I've often called it being on the "edge of information"; following the news, blogosphere, local and global community events, social networking sites, and mainstream media just to name a few!

We're constantly absorbing and translating at exponential rates that we rarely get time to digest it all. Sound bites have become info bites, and while the quantity of information we hold in our minds has grown, the quality is debatable. Life2.0 must be self-defined. What does this information mean to us? What kind of impact does it have on our daily lives? We may be reading but are we retaining, processing, connecting...learning?

John Bogle on our Bottomline Society

Here's a link to Bill Moyers' interview of John Bogle, the founder of Vanguard and index funds. I ran across it since there is a brief mention of buyouts of nursing home by big private equity firms, but overall it turned out to be a pretty insightful interview. He makes a great Rome/America analogy. Below are some highlights:

"...ultimately, the job of capitalism is to serve the consumer. Serve the citizenry. You're allowed to make a profit for that. But, you've got to provide good products and services at fair prices."

"...the financial side of the economy is dominating the productive side of the economy."

"We have our own bread and circuses. And they're a little different than the bread and circuses they had in Rome. But, we surely have our circuses whether it's sports teams or casino gambling or the lottery in the states."

"China owns — I don't know the exact number — but, let me say about 25 percent of our federal debt."

"I've often said we're in a bottom line society. We're measuring the wrong bottom line."