Today’s been a big day in Health IT. First Kaiser Permanente has opened a very flashy Center for Total Health in DC. I took a tour today and lots of it is focused on the use of and extension of their Epic-based medical record (including adding lots of applications to that platform). But it’s open in DC in order to show the DC crowd what can be done. Meanwhile if you don’t have $6 billion lying around to put in a medical record, perhaps spending nothing may be a better option. And today free EMR “vendor” Practice Fusion got $23m in venture funding which will help them give away a whole more EMRs which will soon have a whole lot more applications attached to that EMR.

Filed Under: micro

Apr 5, 2011

Two factors play very important role in causation of high blood pressure. They are diet and genetics (although exact cause of hypertension is yet to be discovered and for that it is still called essential hypertension). Unfortunately we do not have any control on genetics, but diet is within our control and a healthy diet is essential for healthy life. Diet is a major player in hypertension is clear from the fact that certain in certain communities’ high blood pressure are not common. The dietary role of hypertension is also clear from the fact that the prevalence of hypertension is more common among the Japanese settled in USA for last few generations than the Japanese who live in Japan.

Proteins:

Protein intake should be like for normal people and excess intake of protein should ideally be restricted (this is mainly for the presence of high saturated fat and sodium in the food sources of high protein). Excess protein may also cause a burden on the kidneys and hypertensive patients are prone to develop nephropathy.

Carbohydrates:

Take carbohydrates which are complex like starch and dietary fibers, rather than simple carbohydrates like sugar.

Fats:

The total amount of fat intake should be reduced and low energy diets should be taken (low energy diets contain low fat content as 1 gram of fat gives 9 Kcal of energy in compare to 4 Kcal by proteins and carbohydrates). Fats should be of plant origin and not animal origin. Fats of animal origin are rich in saturated fatty acids and plant origins are rich in unsaturated fatty acids. Fats of plant origin are soy oil, groundnut oil, sunflower oil, mustard oil and corn oil. Fats from animal origin such as ghee, butter etc. and these should be restricted.

Other minerals:

Two other minerals (other than sodium), potassium and calcium, are important in relation to hypertension. An adequate potassium intake is an essential part of treatment which can be done by including sufficient amounts of potassium rich foods like milk, fruits and vegetables (if needed potassium supplementation can be done). Adequate amount of calcium may be beneficial in treating high blood pressure. Some of the calcium rich foods are milk and diary products, leafy vegetables etc.

Energy:

The total calorie intake should be reduced, especially for obese persons. Sometimes hypertension can be controlled by simply reducing body weight to normal and maintaining it. Even normal weight individuals can benefit from slight weight reduction. Reduction in energy intake should be combined with regular exercise.

Sodium restriction is an essential part of management of hypertension. Ideally the total sodium intake should be not more than 3 grams per day.

The objectives of preparing diet for hypertension:

• To maintain adequate nutrition.
• To reduce intake of sodium chloride (common salt) and also fat intake (depending on lipid profile).
• To achieve gradual weight loss, if overweight and to maintain ideal body weight (BMI of 18.5 to 23) or as near to the ideal body weight as possible.

Related posts:

Dietary Advice for Hepatitis

Protein Requirement for Us

Dietary Advice for Diarrhea

Factors that alter Energy/Nutrients Need

Fat, Carbohydrate and Water Requirement

Know about Sources of Protein

Diet and High Blood Pressure

Prevention of Specific Kidney Stones

Vitamins and Minerals in Your Diet

Know about Unintentional Weight Loss

Enlarge Josh Roulston/Flickr

Red #40, Blue #1, Yellow #6 - a rainbow of food dyes.

Josh Roulston/Flickr

Red #40, Blue #1, Yellow #6 - a rainbow of food dyes.

Artificial food dyes are everywhere. Even if you pass on the brightly colored candies, you may get a dose from baking mixes, mouthwash or canned vegetables.

On this week's podcast, April Fulton gives us the straight dope from a meeting of experts advising the Food and Drug Administration about a controversial link between food dye and hyperactivity in kids.

April and fellow host Rebecca Davis also discuss aches and pains. Experts say jogging doesn't necessarily cause knee pain, and a 100-year-old posture technique could ease back pain.

All that, plus Scott Hensley rounds up the week's blog posts â€" doctors asking kids about Facebook, the pluses and minuses of compounding pharmacies, and the Gross-Out Award goes to ... clarinet bacteria.

You can find the podcast at the bottom of the page under the podcast heading. To subscribe to the Your Health podcast click here.

By MARGALIT GUR-ARIE

One day before the first of April, HHS published the much anticipated rules defining the creation and operations of Accountable Care Organizations (ACO) spanning 429 pages of business regulation, analysis of various options available, proposed solutions and ways to measure and reward (punish) success (failure) in achieving HHS seemingly incompatible goals of providing better care for less money. I am fairly certain that health policy experts, health care economists and the multitude of industry stakeholders will be dissecting and analyzing the hefty document in great detail in the coming weeks. I started reading the document with an eye towards the ACO implications for HIT, which as expected are many, but something on page 108 made me stop in my tracks. HHS is proposing to share personally identifiable health information (PHI) contained in Medicare claims with ACO providers unless patients “opt-out”.

Beginning on page 108 and through 22 pages of tortured arguments, HHS makes the case for the legality and benefits of providing ACOs with PHI contained in Medicare claims, unless the patient actively withdraws consent for this type of transaction. The argument for the legality of claim data sharing rests on the nebulous HIPAA clause which allows disclosure of PHI for “health care operations” within a web of covered entities and business associates connecting the ACO with Medicare and other providers of health care services for a particular patient. HHS is proposing to make available four types of medical information to participating ACOs:

Aggregated Data, including ACO generated and non-ACO generated data, stratified and analyzed to obtain quality measures, population risk scores and indicative behaviors such as emergency room visits, hospital discharges, prescriptions and physician visits. Although this data is presumably de-identified, in a small ACO with 5000 patients, it shouldn’t be too difficult to attribute this data to particular patients. HHS proposes to provide such data to ACOs on a quarterly basis.

Four Personal Identifiers â€" name, date of birth, gender and Medicare ID â€" for all historically ACO-assigned patients included in the aggregate data reports above. To circumvent the Privacy Act which prohibits Federal records systems from disclosing identifiable information without written permission, HHS is invoking the allowed exception for purposes of “routine use”, which requires a notice to this effect to be published in the Federal Register, after which these four identifiers may be released without consent.

Personally Identifiable Claim Data â€" Here HHS is proposing to provide participating ACOs, upon request, Part A and Part B claim data on a monthly basis. The data elements that will be provided are: “procedure code, diagnosis code, beneficiary ID; date of birth; gender; and, if applicable, date of death; claim ID; the from and thru dates of service; the provider or supplier ID; and the claim payment type”. This data will be provided for patients who have had a visit with a primary care physician participating in an ACO during the performance year. Alcohol and substance abuse records are excluded from disclosure.

Prescription Data â€" A subset of Part D medications claims data is also proposed to be disclosed similar to Part A and Part B data above. The minimum set includes “beneficiary ID, prescriber ID, drug service date, drug product service ID, and indication if the drug is on the formulary”.

The first two disclosures (aggregated data and the four identifiers) are proposed to occur regardless of patient consent or lack thereof. The ACO rules propose an opt-out mechanism for patients who want to prevent disclosures in items #3 and #4 above, and it seems that the opt-out option is not a legal requirement, instead it is based on a belief system at HHS: “Although we have the legal authority within the limits described previously to share Medicare claims data with ACOs without the consent of the patients, ………. We nevertheless believe that beneficiaries should be notified of, and have meaningful control over who, has access to their personal health information for purposes of the Shared Savings Program”. [Since the Medicare ACO model is intended to be adopted by payers other than CMS, one is left to wonder about the belief systems prevalent at those private organizations.]
The actual opt-out process proposed in the document consists of a conversation with a provider during which “the beneficiary would be given a form stating that they have been informed of their physician’s participation in the ACO and explaining how to opt-out of having their personal data shared. The form could include a phone number and/or email address for beneficiaries to call and request that their data not be shared”. So it’s not as simple as checking a box in your doctor’s office.

For over a year ONC’s Policy Committee has been grappling with privacy issues as evidenced by the tremendous work occurring both in the Privacy & Security Policy group and Privacy & Security Tiger Team. The issue of consumer/patient trust in Health Information Exchange (HIE) and Electronic Health Records (EHR) has been repeatedly recognized as a necessary ingredient to widespread HIT adoption, and much effort has been invested in devising policies and standards to allow consumers control of their medical records in general and sensitive parts of their medical records in particular. The recent report from the President’s Council of Advisers on Science and Technology (PCAST) includes recommendations to allow patients to attach privacy controls to each separate data element in their medical records. An ONC specially appointed workgroup tasked with analyzing the PCAST report has identified privacy as an issue of concern in a possible implementation of the PCAST recommendations.

What is the purpose of all this hard work, all these committees and workgroups, all expert testimonies and public comments, hearings and debates, if CMS, in its capacity as a payer, can assume legal authority to bypass all privacy controls embedded in EHRs and HIEs and disclose medical records information, as reflected in claims data, based solely on what CMS, or any other payer, believes is necessary and proper at a particular time?

Filed Under: THCB

Tagged: ACOs, Data, HIPAA, Personal Identifier, Privacy Apr 3, 2011

Two factors play very important role in causation of high blood pressure. They are diet and genetics (although exact cause of hypertension is yet to be discovered and for that it is still called essential hypertension). Unfortunately we do not have any control on genetics, but diet is within our control and a healthy diet is essential for healthy life. Diet is a major player in hypertension is clear from the fact that certain in certain communities’ high blood pressure are not common. The dietary role of hypertension is also clear from the fact that the prevalence of hypertension is more common among the Japanese settled in USA for last few generations than the Japanese who live in Japan.

Proteins:

Protein intake should be like for normal people and excess intake of protein should ideally be restricted (this is mainly for the presence of high saturated fat and sodium in the food sources of high protein). Excess protein may also cause a burden on the kidneys and hypertensive patients are prone to develop nephropathy.

Carbohydrates:

Take carbohydrates which are complex like starch and dietary fibers, rather than simple carbohydrates like sugar.

Fats:

The total amount of fat intake should be reduced and low energy diets should be taken (low energy diets contain low fat content as 1 gram of fat gives 9 Kcal of energy in compare to 4 Kcal by proteins and carbohydrates). Fats should be of plant origin and not animal origin. Fats of animal origin are rich in saturated fatty acids and plant origins are rich in unsaturated fatty acids. Fats of plant origin are soy oil, groundnut oil, sunflower oil, mustard oil and corn oil. Fats from animal origin such as ghee, butter etc. and these should be restricted.

Other minerals:

Two other minerals (other than sodium), potassium and calcium, are important in relation to hypertension. An adequate potassium intake is an essential part of treatment which can be done by including sufficient amounts of potassium rich foods like milk, fruits and vegetables (if needed potassium supplementation can be done). Adequate amount of calcium may be beneficial in treating high blood pressure. Some of the calcium rich foods are milk and diary products, leafy vegetables etc.

Energy:

The total calorie intake should be reduced, especially for obese persons. Sometimes hypertension can be controlled by simply reducing body weight to normal and maintaining it. Even normal weight individuals can benefit from slight weight reduction. Reduction in energy intake should be combined with regular exercise.

Sodium restriction is an essential part of management of hypertension. Ideally the total sodium intake should be not more than 3 grams per day.

The objectives of preparing diet for hypertension:

• To maintain adequate nutrition.
• To reduce intake of sodium chloride (common salt) and also fat intake (depending on lipid profile).
• To achieve gradual weight loss, if overweight and to maintain ideal body weight (BMI of 18.5 to 23) or as near to the ideal body weight as possible.

Related posts:

Dietary Advice for Hepatitis

Protein Requirement for Us

Dietary Advice for Diarrhea

Factors that alter Energy/Nutrients Need

Fat, Carbohydrate and Water Requirement

Know about Sources of Protein

Diet and High Blood Pressure

Prevention of Specific Kidney Stones

Vitamins and Minerals in Your Diet

Know about Unintentional Weight Loss

By PAUL LEVY

At a seminar last night at the Center for Public Leadership at Harvard’s Kennedy School, one of the students asked a question along the lines of, “How do you know when you have done too much with regard to transparency?” My answer was that the question presupposed the wrong approach to transparency, that it was being driven by the CEO without proper attention to the efficacy and appropriateness of what was being measured and disclosed. Instead, I suggested that it should be driven by the leadership of the organization, but based on metrics that were viewed as useful and appropriate by the clinical staff. In such an instance, transparency serves the function laid out by IHI’s Jim Conway, as summarized here in an article discussing the BIDMC experience:

[P]ublic reporting created what management guru Peter Senge calls creative tension, a key in getting an organization to change. Announcing a daring vision â€" the elimination of patient harm â€" combined with honestly publicizing the problems, fuels improvement, he said.

I expressed the concern last night that the general recalcitrance of the medical profession about engaging transparency will inevitably lead to fiats about disclosure from government regulatory agencies. The problem with those fiats is that they will be grossly constructed and force hospitals and doctors to focus on the wrong things, in a manner not consistent with widely established principles of process improvement. (See, for example, this approach in Maryland.)

Now comes the Veterans Administration, proving the case with panache! You may recall my complimentary post on the VA back in January. Thomas Burton’s article this week in the Wall Street Journal â€" “Data Spur Changes in VA Care” â€" documents this in more detail. Some excerpts:

Hospitals serving U.S. military veterans are moving fast to improve care after the government opened a trove of performance dataâ€"including surgical death ratesâ€"to the public.

The information was released at the urging of VA Secretary Eric K. Shinseki. Among other things, it presents hospitals’ rates of infection from the use of ventilators and intravenous lines, and of readmissions due to medical complications. The details have been adjusted to account for patients’ ages and relative frailty.

“Why would we not want our performance to be public? It’s good for VA’s leaders and managers, good for our work force, and most importantly, it is good for the veterans we serve,” Mr. Shinseki said in an emailed statement.

At VA hospitals in Oklahoma City and Salem, Va., the rate of pneumonia acquired by patients on ventilators was shown last fall to be significantly higher than the national VA average. The Salem hospital says a relatively low number of patients on ventilators skewed its infection rate higher, but staff members at both facilities say the numbers prompted action.

Seeing the data helped, says the Salem hospital’s chief of surgery, Gary Collin, because “you can become kind of complacent.”

In contrast, notes the article:

This unusually comprehensive sort of consumer information on medical outcomes remains largely hidden from the tens of millions of Americans outside the VA system, including many of those in the federal Medicare system.

And, as I reported last month,

A November 2010 report from the Health and Human Services inspector general concluded that one in seven Medicare patients is harmed by medical care, nearly half of those avoidably.

Conway is right. Senge is right. The veterans have figured out how to start winning the war for patient safety and quality and process improvement. The rest of the profession is in retreat and is letting the wrong people design the battle plan.

Filed Under: THCB

Tagged: BIDMC, Kennedy School of Government, Quality, Transparency, VA Medical System Mar 31, 2011

Human body utilizes the iron (to produce hemoglobin for carrying oxygen) from food supply and to some extent reuses the iron that is released after red blood cells break down. If an individual consumes less than required amount of iron per day or losing iron from body due to any reason, iron deficiency anemia can result. Common causes of iron deficiency anemia include lack of adequate iron in food, loss of blood (chronic or acute loss), pregnancy and inability to absorb iron.

Lack of adequate iron in food:

This is one of the most important as well as common cause of iron deficiency anemia. This is particularly important in underdeveloped countries, where diet may be generally poor in iron. Only approximately 5-10% of iron we eat is absorbed normally (although the absorption may be higher in iron deficiency anemia). The rest of the iron we eat is wasted.

Pure vegetarians are at higher risk of iron deficiency anemia, as vegetables are generally poorer in iron content and also less percentage of iron is absorbed from vegetable origin. Pure vegetarians need to plan their diet properly so the low absorption rate can be compensated appropriately. Foods of animal sources are generally rich in iron and also higher percentage is easily absorbed and individuals have less risk of iron deficiency anemia, if they consume food from animal sources.

Milk, including breast milk is poor source of iron and infants after weaning need iron rich foods for preventing iron deficiency anemia.

Loss of blood:

Loss of blood is the most common cause of iron deficiency anemia in developed countries. Because, hemoglobin is present in the red blood cells and blood loss due to any reason, there is loss of red blood cells and loss of hemoglobin as a result. Blood loss may be acute (due to injury as in road traffic accidents) or chronic (e.g. bleeding from gastrointestinal ulcer, heavy blood loss during menstruation in women, tumor of kidney, bladder etc.). In developing countries worm infestation is a common cause of chronic blood loss, as worms living in the intestine survive on blood and also there is bleeding from the site of sucking of blood in intestine.

Pregnancy:

During pregnancy there is increased demand for iron due to growing fetus as well as due to increase in blood volume. If the iron intake is not increased appropriately/adequately there may be iron deficiency anemia. Iron supplementation should be done routinely during pregnancy to prevent iron deficiency anemia, which is common during pregnancy.

Inability to absorb iron:

In certain medical condition there may be inability (or inadequate amount is absorbed) to absorb iron from intestine, such as Crohn’s disease or celiac disease. Iron absorption may also hamper in case of surgical removal of a part of small intestine to treat ulcer or cancer. Uses of medications which reduce gastric acid secretion also reduce iron absorption.

Related posts:

What are the Symptoms of Iron Deficiency Anemia?

What Complications may Arise due to Gluten Free Diet?

Factors that alter Energy/Nutrients Need

Causes of Chronic Diarrhea

Prevention of Specific Kidney Stones

Calcium Consumption and Osteoporosis

Chronic Disease, Physical Activity and Osteoporosis

Treatment of Chronic Diarrhea

Estrogen Status and Osteoporosis

Common Concerns & Their Solution during Pregnancy