By NEIL VERSEL

As a journalist who for the last decade has covered the use of information technology in health care, I’m rather disgusted at some of my brethren in the mass media. I’m none too happy with the medical establishment, either. Both seem hopelessly stuck in the past, refusing to look beyond the status quo. And the public suffers because of it.

This fall, for example, the Los Angeles Times and other news outlets covered a Yale University study that sought to determine whether or not “telemonitoring” heart failure patients recently discharged from the hospital would reduce heart attacks or readmission. The study, published in the New England Journal of Medicine and presented at a November meeting of the American Heath Association, concluded that that telemonitoring, which involved patients calling in their weight measurements and health symptoms after being discharged, made virtually no difference in the outcome. The Times called the trial “a good, commonsense idea that simply didn’t work out.”

Was it, really?

Keeping in touch with one’s physician on a frequent basis after being hospitalized for heart failure is a fine idea, as is monitoring one’s weight. But, as happened in the Yale study, patients generally don’t stick with the program. One in seven study participants never called their doctors, while just 55 percent of patients were making at least three calls per week six months after discharge.

“We had a lot of faith and hope that providing increased information could improve outcomes,” study leader Dr. Sarwat I. Chaudhry of Yale told the Times. “Obviously that wasn’t enough.”

Of course it wasn’t enough. Chaudry was relying on an old form of technology, namely the telephone. Worse yet, he counted on patients to make the calls.

Calling this “telemonitoring” and “telemedicine,” as the Times did, represents twentieth-century thinking. Instead of blindly complimenting the good intentions of an experiment that was, in fact, almost bound to fail, the Times should have been asking about more modern forms of telemedicine, such as active monitoring from portable sensors that take readings in real time, just like telemetry equipment in hospitals.

There’s a new generation of sensors designed to be worn around-the-clock by patients with chronic diseases like heart failure or diabetes. Many of these devices are wireless-enabled for easy connection to a home network or to a cell phone, and automatically send alerts to caregivers or on-call nurses whenever there’s an abnormal reading. The right sensor can detect a heart murmur or dangerous change in body temperature, for example, before the wearer even notices something might be wrong. And all the patient has to do is make sure it’s on. There are no calls to make and no readings to write down. Sure, this technology is pricey, but if it keeps people with chronic diseases and post-operative patients out of the hospital, it just might pay for itselfâ€"and offer users a better quality of life. Several health insurers and private institutions have studies underway hoping to prove this theory.

A Spanish study, presented at the European Society of Cardiology’s Heart Failure Congress in Germany last June, showed that a home-based, active-monitoring system, plus remote access to healthcare providers over broadband Internet connections, reduced hospitalization rates by 63 percent, cut inpatient days by nearly 75 percent, and significantly boosted quality of life for patients with heart failure. A similar remote-monitoring program at the Henry Ford Health System in Detroit decreased hospital admissions by 36 percent over a six-month period, while producing a more than 2-to-1 return on investment. A Department of Veterans Affairs hospital in Clarksburg, W. Va., has slashed inpatient hospitalization days and visits to the emergency room with wireless monitoring of patients with diabetes, congestive heart failure, pulmonary disease, or hypertension.

Skeptics such as Forbes magazine’s health editor, Robert Langreth, may call remote patient monitoring “overhyped” because the Yale trial and one other study from Germany “show, shockingly, that better communication may not be enough.”

The problem with assessments like Langreth’s is that he’s comparing apples to oranges. Cutting-edge forms of telemonitoring collect real vital signs in real time, then automatically transmit that data to an electronic medical record or alert a caregiver in case something is abnormal. All the patient has to do is wear or step on the device and make sure everything is turned on. There’s no transcribing of readings and no manual calls to be made.

That’s the promise of telehealth, telemedicine, telemonitoring or whatever “tele-” phrase you prefer. Here’s a good, commonsense idea for reporters: Think about the technology you see pretty much everywhere but the hospital or doctor’s officeâ€"on smartphones, in video game consoles and even at the self-service check-out at the grocery store that knows if you’ve bagged the item you just scanned. And start asking the health-care organizations you cover why they still rely on old-fashioned telephones and fax machines.

Neil Versel is a professional healthcare IT journalist. He has been covering healthcare IT since 2000, across a wide range of publications including his blog, Meaningful HIT News with Neil Versel.

Filed Under: THCB

Tagged: Neil Versel, Telemedicine, Telemonitoring, Wireless, Yale Mar 16, 2011

If you are suffering from constipation you should have a proper diet plan to reduce problem of constipation. Try to make it your habit for benefit to be longer lasting. Constipation is a common health problem in most people living in developed countries due to intake of low fibers, which is mostly due to eating less fresh vegetables and fruits. The following diet plan is very helpful for constipation:

Early morning:

In the morning after getting up, you should make it a habit to take a glass of lukewarm water with lemon approximately 300 â€" 400 ml of water is recommended.

Breakfast:

Your breakfast should consist of a cup of tea or a glass of milk, bread (preferably brown bread) with butter or cheese, vegetable sandwich and some fruits like apple, orange, strawberry etc. (try to avoid banana, which contain high iron and may lead to constipation).

Lunch:

Lunch should be with plenty of vegetables and fruits (depending on the local availability of fruits and vegetables) and whole grain cereals (depending on the culture and tradition it may be bread, rice or food made from whole wheat powder etc.). There should be liberal amount of salad with cucumber and tomatoes etc.

Evening snacks:

It should be with tea/coffee with some fruits and milk shake.

Dinner:

Dinner should be with vegetable soup, vegetable noodles, whole grain cereals, bread, and mixed vegetable salad.

Important points to remember in constipation:

• Avoid foods with high iron content (some example of food with high iron are banana, juggery, egg plant, French beans etc.).
• Drink plenty of water or fruit juice.
• Consume high fiber foods and avoid low fiber foods (high fiber diets are generally natural foods and low fiber diets are generally processed and refined foods). Meat and other animal foods also contain less fiber and should be restricted.

Related posts:

Some Dietary Advises on Constipation

Diet Plan for NIDDM

Constipation: the Solution

What Complications may Arise due to Gluten Free Diet?

The Burden of Constipation

Constipation: The Problem

Dietary Advice during Pregnancy

Basics You Need to Know about Gluten Free Diet?

Nutrition facts about Mediterranean Diet

Why Anal Fissures Occur?

Enlarge iStockphoto.com

Out for a walk? Stow the cell phone for safety.

iStockphoto.com

Out for a walk? Stow the cell phone for safety.

If you're 60 or older, there's another health issue you might want to put on your worry list: crossing the street.

Now there are streets, particularly busy streets that we have to cross every day. And, if, like most Americans, you're doing "something else" while crossing, like listening to music on your iPod for example, or talking on your cell phone, you should be especially careful.

Researchers from the University of Illinois report that individuals over age 59 face an increased risk of injury when crossing busy complicated streets while multitasking. The study appears in the journal Psychology and Aging.

 

The study was small but provocative. Researchers compared 18 undergraduate students aged 18 to 26 years to 18 older adults aged 59 to 81 years during a simulated street crossing exercise.

Participants walked on a treadmill while watching three computer viewing screens which displayed a busy street between two large buildings. Participants were asked to cross the road as they would normally, at whatever speed they wanted without running.

After crossing the street, participants then walked through another alleyway and through a gate. Then, a new trial began and the participant had to cross another street. Participants crossed the virtual street in three ways: unencumbered, while listening to music on an iPod or while talking on a hands free cell phone.

Researchers found that the older adults were bad at navigating the most challenging busy streets, and it got worse if they were also talking on a cell phone. They were either more likely to be "hit" in a simulated car crash or unable to cross the street in the time allotted by researchers.

This may come as no surprise to those of us with teenagers, but the young participants crossed the streets swiftly and without incident.

Now we're certainly not advocating texting and driving, but the study showed the students had far fewer walking "collisions" and were almost always able to cross in the allotted time. They had no greater difficulty when multitasking, such as listening to music or talking on their phone.

The findings support earlier research which suggests older adults have difficulty multitasking. Other research finds cognitive control and the ability to take part in numerous activities at one time diminish with age.

So, what does this mean if you're over 60? You might want to slip the phone in your pocket for a little while and focus on getting safely to the other side.

National Review and Forbes writer Avik Roy believes that Medicaid is a “humanitarian catastrophe” which is actually worse than no insurance at all. Now Scott Gottlieb has taken up the argument in the Wall Street Journal. I’ve noted before that this is a bad argument. Medicaid should certainly provide better coverage. I’d also like to see the new exchanges provide poor people with better options outside of Medicaid. Yet the claim that people would actually be better off uninsured than they would be with Medicaidâ€"this strains credulity.

Roy’s response to my initial column includes the following:

Many of the factors Harold raises as flaws of the study are actually flaws of Medicaid. It’s Medicaid that restricts access to the best hospitals and the best doctors and the best treatments. It’s Medicaid, i.e., welfare dependency, that leads to family breakdown and social disrepair. (For those who seek a more extensive discussion of this problem, read Charles Murray’s landmark book, Losing Ground: American Social Policy 1950-1980.)

I took umbrage at that, as indicated below. Roy then took umbrage at my umbrage, writing:

One aspect of Harold’s post is wholly unjustified, and a bit of a cheap shot: his assertion that I am “disrespectful” and “disparaging” to welfare recipients, because I’ve highlighted the corrosive effects of welfare dependency (something Harold dismisses as a “bromide”). We’ll never have a constructive debate on Medicaid policy if we can’t get past this kind of nonsense. The entire point of my series of posts on Medicaid is that Medicaid beneficiaries are the victims of an uncaring and bureaucratic system, and also the victims of those who, for ideological reasons, ignore the very real problems that Medicaid has.

Roy may not regard references to “family breakdown and social disrepair” as disparaging or disrespectful. I do. I would also note that liberal health policy analysts discuss Medicaid’s shortcomings all the time. No code of political correctness that prevents liberals doing this.

Personal experience provides another reason to take umbrage. As I noted in a previous post, my in-laws needed Medicaid benefits to care for my brother-in-law at home. Welfare dependency, family breakdown, and social disrepair played no part in their story or the story of millions of other people who rely upon Medicaid-funded care.

It’s particularly unfortunate that Roy invokes Charles Murray’s conservative polemic, Losing Ground. (For the youngsters: Yes this is the very same Charles Murray who co-wrote The Bell Curve.) Losing Ground appeared a quarter-century ago as a slam against the traditional welfare systemâ€"Aid to Families with Dependent Children (AFDC). That system doesn’t exist anymore. The 4.3 million people who participate in Temporary Assistance to Needy Familiesâ€"the program that replaced AFDCâ€"comprise less than 10 percent of Medicaid’s current caseload of 58 million people. The typical Medicaid recipient making serious use of medical services is elderly or disabled, or resides in a household headed by low-income people in the workforce.

I’m sure Roy has smart things to say about other aspects of clinical trials and health policy. Yet I hope he takes the time to ponder how he presents himself as a privileged financial analyst-blogger spouting, yes, bromides on welfare dependence within communities that seem very distant from him.

I’ve spent twenty years researching HIV prevention, substance abuse, and other public health challenges in urban communities. Last year, I oversaw a randomized trial of violence prevention services in 15 Chicago Public Schools. I’m rather familiar with many challenges in these communities: youth violence, high school dropout, substance abuse, unemployment. I’ve conducted or analyzed several surveys of young, poor minority single mothers.

Some of these women resemble the suspiciously archetypal picture that accompanied Roy’s post. I don’t see how Medicaid has made these problems worse. For many women and their children, Medicaid is an essential resource in staying healthy and traveling the path to economic self-sufficient. Whatever one believes about Charles Murray’s original account of welfare dependence, it has little pertinence to the Medicaid-health linkages now under dispute. Medicaid often provides a way out of welfare dependence, allowing people who take low-wage entry jobs that could not support health benefits for adults or children.

When critiquing Medicaid, Roy writes as if his main goal is to find ways to improve the program to save lives and promote health. Yet when you scratch the surface, he opposes the provision of greater resources to addressing the very programmatic problems he identifies. He repeatedly and rightly notes that Medicaid constraints recipients’ access to primary care doctors and specialists. Yet when the rubber meets the road in changing Medicaid policy, Roy writes:

[Pollack] does helpfully cite his own recommendation to increase Medicaid reimbursement rates: something that could help address the issue of access to high-quality physicians, but is incompatible with our present fiscal situation, unless it is accompanied by a significant contraction of Medicaid’s eligibility rules.

If Roy feels so constrained by “our present fiscal situation,” I’m not sure why he laments Medicaid’s administrative difficulties or why he laments our implicitly two-tiered insurance system. Medicaid has the problems it does because it must finance the care of 58 million people within a rickety state-federal partnership that does not provide the required resources.

I’m especially concerned by the rhetorical frame Roy embraces. He begins with a genuinely pressing on-the-ground question sparked by a specific study: Why are medical outcomes so poor among Medicaid surgical patients? Yet when the conversation turns to potential policy solutions, he suddenly changes the subject to issues of “welfare dependence,” “family breakdown,” and “social disrepair.” Suddenly, Medicaid moves from an imperfect vehicle to finance pap smears, nursing home stays, and gall bladder surgeries to a morally problematic program that undermines character and damages family life.

On Roy’s telling, improving poor people is the critical challenge facing Medicaid and (I presume) other assistance policies. This is not a new argument, or one that suddenly emerges from any one or even a handful of studies. This is one of the oldest arguments in American history: Do we help poor people or do we hurt them when we offer them different forms of economic support? How worried should we be that we will damage people’s character or self-reliance when we offer them imperfect, but publicly-funded access to medical services? Is it smart or political possible to expand the scope of these efforts?

I suspect my deepest disagreements with Avik Roy reflect our different answers to these basic questions.

Harold Pollack, PhD, is the Helen Ross Professor at the School of Social Service Administration and faculty chair of the Center for Health Administration Studies (CHAS). He has published widely at the interface between poverty policy and public health. Dr. Pollack regularly blogs for the Reality Based Community and other publications, as well as The Century Foundation’s Taking Note, where this blog first appeared.

If you are suffering from constipation you should have a proper diet plan to reduce problem of constipation. Try to make it your habit for benefit to be longer lasting. Constipation is a common health problem in most people living in developed countries due to intake of low fibers, which is mostly due to eating less fresh vegetables and fruits. The following diet plan is very helpful for constipation:

Early morning:

In the morning after getting up, you should make it a habit to take a glass of lukewarm water with lemon approximately 300 â€" 400 ml of water is recommended.

Breakfast:

Your breakfast should consist of a cup of tea or a glass of milk, bread (preferably brown bread) with butter or cheese, vegetable sandwich and some fruits like apple, orange, strawberry etc. (try to avoid banana, which contain high iron and may lead to constipation).

Lunch:

Lunch should be with plenty of vegetables and fruits (depending on the local availability of fruits and vegetables) and whole grain cereals (depending on the culture and tradition it may be bread, rice or food made from whole wheat powder etc.). There should be liberal amount of salad with cucumber and tomatoes etc.

Evening snacks:

It should be with tea/coffee with some fruits and milk shake.

Dinner:

Dinner should be with vegetable soup, vegetable noodles, whole grain cereals, bread, and mixed vegetable salad.

Important points to remember in constipation:

• Avoid foods with high iron content (some example of food with high iron are banana, juggery, egg plant, French beans etc.).
• Drink plenty of water or fruit juice.
• Consume high fiber foods and avoid low fiber foods (high fiber diets are generally natural foods and low fiber diets are generally processed and refined foods). Meat and other animal foods also contain less fiber and should be restricted.

Related posts:

Some Dietary Advises on Constipation

Diet Plan for NIDDM

Constipation: the Solution

What Complications may Arise due to Gluten Free Diet?

The Burden of Constipation

Constipation: The Problem

Dietary Advice during Pregnancy

Basics You Need to Know about Gluten Free Diet?

Nutrition facts about Mediterranean Diet

Why Anal Fissures Occur?

National Cancer Institute

On this week's podcast we hear about needle biopsies, a less costly and less invasive alternative to surgical biopsies for breast cancer.

On this week's podcast, we get up off our couch, put away our video controllers, and ask, "Just how sporty is Wii Sports?"

Special guest Nancy Shute visits to explain which popular "active" video games actually help kids get real exercise, and describes some new technology making its way into elementary school gyms.

Plus we discuss a new drug for lupus, and an experimental treatment for cancer (in mice) that uses tiny, tiny diamonds.

And we hear two stories about changes in cancer diagnosis. Doctors are questioning one of the warning signs for prostate cancer. And women are opting for less invasive breast cancer biopsies.

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 PAUL LEVY

As I share this view from my room in Tel Aviv after leaving the conference in Haifa, it is a good chance to consider the features of the Israeli health care system and draw some comparisons with that of the US. You can find a full description here, but let me hit the highlights as I understand them, based on discussions over the last two days.

Israel has had universal coverage for many years. It is provided by four HMOs, one with about 55% of the market, another with 20% or so, and the remaining two splitting the rest. The competition that exists is not based on price. Indeed, the cost of care is covered by a payroll tax and other government funding in the form of a capitated payment to each HMO based on enrollment. People are free to shift from one HMO to another as often as every two months, but only a very small percentage (well under 2%) shift each year.

Supplemental insurance, privately paid, is also available. However, the basic coverage offered to the population is very inclusive, and the supplement is for the small number of elective items that are not of great interest to most people.

The HMOs offer a strong primary care network and then contract with the hospitals for secondary and tertiary care. Some hospitals are owned by the HMOs, but many of the patients go to hospitals that are not owned by the HMOs. These are either government owned or are private, non-profits.

Now, as we explore transactions among these entities, it gets interesting. What is the process by which the rates for the government hospital are set with the HMOs, for the services purchased by the HMO out of its capitated budget? This is a negotiation in which the government is a participant. But recall that the government also owns those hospitals for which it is negotiating the rates with the HMOs. The HMOs are not permitted to joint together to negotiate with the government.

The government has also established uniform salaries that can be paid by HMOs to their executives and doctors. Even accounting for exchange rates and different standards of living, the salaries paid to doctors are well below those in the US. This is possible, in part, because the cost of medical education is highly subsidized by the government.

Finally, if any of these institutions â€" government hospitals or HMOs â€" runs a deficit, the finance ministry makes up the losses.

For those in the US hospital and physician practice world who are aghast at the idea of rate-setting, you find it here in a very interesting form. In essence, there is little in the way of market forces in place determining the level of financial transactions within or among the major entities providing health care services. And, the whole system is subject to a budget that is set, directly or indirectly, by the parliament.

Regular readers may recall observations I made a few years ago about the Icelandic health care system. There, too, the annual national budget for health care, as a percentage of GDP, was set by the parliament. I asked my Icelandic hosts the following questions and derived a conclusion:

Is this percentage based on a quantified assessment of the actual health care needs of the public, i.e., is it driven by public demand (e.g., a growing aging population)? No. Does it take into account the government’s expectation for certain quantifiable levels of service quality, medical quality, or operational efficiency of hospitals and other parts of the system? No.

In essence, this appropriation by the parliament is a politically derived decision, just as it would be for any appropriation for a program of important national priority, and it therefore competes with other worthy national programs for resources.

Such is the case in Israel, too.

It is instructive to compare the differences among these systems, and it is worthwhile to understand the trade-offs that have been made in each political jurisdiction. There is no right or wrong way to do this. The system in each country is a composite societal judgment call.

It is important to recall, though, that all developed countries face similar structural challenges for the future: An aging population that is living longer and demanding more in the way of hospital service; a rapid introduction of technological innovation in diagnosis and treatment that tends to increase the cost of health care; a greater expectation on the part of the public of the “rule of rescue,” i.e., devoting more and more resources to the more unusual, but emotionally charged, medical conditions; and a growing base of consumers/patients who are better informed through social media and who therefore have higher expectations of the services provided to them.

These trends intersect with the ability of a society to pay for them, and the bulls-eye for that intersection will be the hospitals. Why? Hospitals are capital-intensive and staff-intensive organizations. In essence, they are characterized by large fixed costs or by variable costs that are hard to vary very quickly. In competing for business, hospitals are prone to engage in the “medical arms race,” prompted by their doctors, companies who cleverly market expensive devices and equipment, and ultimately by patients who want the latest and best â€" even if clinical efficacy has not been demonstrated.

Hospitals also often have an overlay of responsibility for medical education, the costs of which cannot be easily shed, and many also engage in research for which they are not fully compensated.

In contrast, the HMOs in Israel or the multi-specialty physician practices and primary care groups here in the US have the most potential to change their ways of delivering service to get ever more clinically effective and cost-effective. For one thing, they are not burdened by high levels of fixed overhead. For another, they are better situated to use technology to deliver care more efficiently. For example, they can start to use home-based, remote reading devices to check on a congestive heart failure patient’s weight and other vital signs â€" or they might use other types of remote testing devices to review a diabetic patient’s blood levels and other metrics. These technologies, in the hands of primary care doctors, will enable patients to get the care needed in a low-cost setting and help avoid hospitalization.

The hospitals that succeed in the future will need to do everything possible to avoid incurring large increments of capital expenditures. To do that and otherwise minimize cost increases, they will also have to learn to engage in front-line driven process improvement (whether of the Lean variety or something else) to redesign their work flows. A strong emphasis on quality and safety improvement will also be a virtue rewarded over time. These latter steps do not happen without a strong commitment to transparency: You can’t improve unless you acknowledge where you are failing.

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.

Filed Under: Paul Levy, THCB

Tagged: HMO, Israel, Israeli health care system Mar 10, 2011