Category Archives: EMRs

From Managed Care to ObamaCare to “Smartphone Medicine”

Healthcare Hashtags & Social Media Analytics

Healthcare Hashtags & Social Media Analytics

After suffering through Managed Care and now living through remedial intended ObamaCare, the United States has entered the first truly exciting times of global healthcare.  The innovative spirit prevalent in the United States is due to the convergence of eHealth and mobile health, the emergence of healthcare entrepreneurs combined with the proliferation of global health care social media platforms such that technology has democratized the practice of medicine for healthcare professionals, patients, institutions, pharmaceutical companies and health insurers.  Given the role of the Smartphone in this transformation, I think it is apropos to refer to this pioneering period of healthcare as “Smartphone Medicine.”    

Managed Care

Pardon my candor but Managed Care sucked.  It sucked for patients, doctors and hospitals.  Other than that, it worked just fine.  More seriously, if you did not obtain the appropriate “referral” prior to seeing a specialist (even in an emergency), the cost of seeing that specialist was either not covered by the health insurer or it was reimbursed at a significant lower amount than the actual charges you had to pay.  There were also pre-defined “in-network” physicians and a formulary of drugs, and with few exceptions, your medical universe was defined by various managed care contracts, the negotiation of each you did not participate in.   If you had surgery, it was common for your managed care insurer to have “in-network” contracts with some, but not all, of the anesthesiologists working at that hospital.  However, you had no control over which anesthesiologist treated you. Therefore, the actual cost of your surgery wasn’t determined until the medical bills started piling up in your mailbox. If you tried to politely request a specific anesthesiologist within your managed care health insurance network to somewhat control the cost of your surgery, you were taken as seriously as Kim Kardashian showcasing her acting chops on “The Kardashians” as her audition tape for a new Martin Scorsese Oscar buzz-worthy movie.

If you had a long-standing relationship with your primary care provider, there was no guarantee you’d be able to continue that relationship.  It all depended upon whether or not he or she “participated” in your insurance plan and was considered an “in-network” physician.  Some devious physician staffers would address such telephone queries with the vague declaration that their physician “participated” in your plan but they passively omitted the detail that he or she participated in your plan as an “out-of-network” physician!

Then there were similar passive “omission deceptions” on your health insurer’s website such that you’d be confident the post-operative occupational therapist you chose from your insurer’s website was “in-network” only to find out later her contract had expired and your insurer had not yet updated its website when you made your selection.  Despite this material error by your health insurer, you were nevertheless liable for the total cost of the occupational therapy, as if you purposely chosen someone “out-of-network” due to their unique high level of expertise, and were willing to pay extra for that added benefit.

The physician “con job” referred to above stung me only once when I had a very expensive Crohn’s Disease surgery based on that deceptive representation.  It wasn’t until I formally alleged “Criminal Fraud” in one of the MANY appeals I had to pursue seeking 100% reimbursement of the cost of the surgery (i.e., as if the doctor was, in fact, “in-network” with my health insurer) when I finally prevailed and exposed this misleading representation.  But many smart patients were directly or indirectly taken advantage of by money-hungry or irresponsible doctor offices and health insurers who banked on the arduous hassles of the appeals process being too steep a barrier for the patient to initiate, and keep pursuing, a meaningful appeal seeking reimbursement based on fraudulent representations.

There were also financial limits on how sick you could be, as if knowing these actuarial generated projected financials would impact your decision to, for example, undergo chemotherapy, when it was recommended by your doctors as the only way to save your life, and by doing so you would surpass your lifetime allocation of financial health benefits and be liable for the balance.  Finally, if you had a chronic illness prior to obtaining your managed care health insurance plan, it was probable that any charges accrued in treating that “pre-existing condition” would be excluded from your health insurance coverage.  Since the increasing costs of managing that pre-existing condition was likely the primary reason you sought health insurance, the fine print of many managed care health insurance plans made as much sense as selling Sexual Harassment Insurance to radio personality Howard Stern’s female sidekick, Robin Quivers.

ObamaCare

ObamaCare, a/k/a, The Affordable Care Act (the “Act”), identified the aforementioned Managed Care issues and sought to improve upon them so that more people could obtain more reasonable health insurance coverage at a more affordable price.  ObamaCare also sought to correct the gross inefficiencies present in American healthcare as a result of a Managed Care system which was largely unaccountable to any laws or governmental agency.  The Act utilizes market forces to stabilize the cost of health insurance policies and mandates that all health insurance plans include reasonable wellness provisions.  Finally, as a self-policing measure, ObamaCare created “Accountable Care Organizations” (“ACOs”) to ensure that larger medical practices and institutions routinely examined their costs and expenditures in a practical attempt to eventually reduce the aforementioned gross inefficiencies prevalent throughout the American healthcare system.

The Act seems to be making a substantial improvement in restructuring and regulating what was one of America’s fastest growing but difficult industries in terms of tracking and appeasing its diverse stakeholders.  However, there are political influences which prevent ObamaCare from being universally implemented and that likely affects its projected initial performance.  This largely remedial Initiative was also hampered by a slow and glitch-filled roll-out which has affected its acceptance by Americans as “the law of the land” and, instead, in some parts of the United States it is viewed by many as a law in effect because of the current political party running the country.  That said, even the most skeptical of patients and doctors would have to agree that ObamaCare is better than Managed Care and it has at least identified American Healthcare as a viable and potentially profitable industry.

Practical changes, as opposed to political “considerations,” must be made to the Act, however, to refine it, just like with any other remedial official government measure.  But at least ObamaCare is a start in the right direction and it also has the good fortune of being implemented at the same time technology and electronic medical records have improved convenience and enhanced quality of healthcare experiences and opportunities.  These experiences and opportunities have attracted healthcare and technology entrepreneurs who have combined their efforts to, in essence, create “American Healthcare 2.0” which includes innovative electronic (“eHealth”) and mobile health (“mHealth”) products and services.

Smartphone Medicine

The aforementioned eHealth and mHealth opportunities seem to be driven by the technology enhanced Smartphone because it has become the tool which has democratized the practice of medicine to the point where the doctor-patient relationship is now one of collaboration and mutual respect.  The proliferation of different global health care social media platforms has created empowered patients who conceivable use their Smartphones more to engage in healthcare Tweetchats than in telephone conversations.  Furthermore, there has been an explosion in the number of useful and generally accepted “Medical Apps” available on the different Smartphone operating systems like the Hospital Patient Picture-Sharing Medical “App,” “HospitalPIX,” which was developed by Dr. Jacques Durand (pictured below) [you can click thru the picture and watch my interview with Dr. Durand from this year’s “Doctors 2.0 & You” in Paris, France].

HospitalPIX Medical Smartphone App

Additionally, bold and innovative initiatives like “The Healthcare Hashtag Project,” by the company Symplur  [you can click thru the picture above, before the first paragraph and watch my interview with Thomas Lee of Symplur from this year’s “Doctors 2.0 & You” in Paris, France], have transformed the Twitter experience when it is used for healthcare purposes so that it’s more accessible and more time efficient for healthcare providers and for the healthcare community as a whole.  Since people tend to use their Smartphone to tweet and use Twitter, this is another example of Smartphone Medicine.

Smartphone Medicine enhances the Lifestyle of the Chronically Ill

For a chronic patient like me with the autoimmune illness Crohn’s Disease, using my Smartphone in conjunction with hashtags creates a global support team to whom I can turn with questions about new treatments for Inflammatory Bowel Disease (“IBD”), side effects of new drugs, recommended doctors for a specific procedure, a list of hospitals with IBD Centers and recommended IBD specialists in an area of the world where I might be vacationing, etc.  Moreover, I can load my Smartphone with all of my electronic medical records along with years of blood test results, Operative Reports from my 25+ surgeries and a list of the drugs I am currently taking.  I can also always use my Smartphone to contact my doctors whose information is always only a few strokes away.

The Power of the Hashtag in Smartphone Medicine

In terms of the use of hashtags on Twitter, according to Symplur: “By lowering the learning curve of Twitter with a database of relevant [healthcare] hashtags to follow, we hope to help new and existing users alike to find the [medical] conversations that are of interest and importance.”  Accordingly, whether directly or indirectly as a result of Symplur’s extraordinary success simplifying Smartphone Medicine through the use of hashtags, the hashtag is now routinely used in powerful global social media platforms such as Facebook, Google+, Twitter and Instagram.

Conclusion:

Because of Smartphone Medicine, the Prognosis for Global Healthcare has never been more Promising

The bottom line is that the convenience of Smartphone Medicine is liberating for patients who suffer from chronic, serious or autoimmune conditions which would otherwise require substantial record-keeping in different locations. Thanks to the efforts of companies like Symplur, the hashtag simultaneously encourages the use of global connections and conversations while also arranging them so they are directly on-point and easy to access.  Smartphone Medicine appeals to healthcare professionals because it is innovative, efficient and makes for better educated professionals who then can service their patients to the best of their abilities.  It has certainly been a long, strange trip from Managed Care to ObamaCare to Smartphone Medicine, but isn’t it always about the journey and not the destination?  In that regard, we don’t know what will come next but at least we do know that the prognosis for global healthcare has never been more promising.

Smartphone Medicine

Smartphone Medicine

Doctors passing onto Patients the cost of adopting EHR systems

 

For so many years, the business of healthcare was managed pursuant to the handwritten notes of medical professionals.  However, the advent of technology and recent legislation has made the adoption of “Electronic Health Records” or “EHRs” mandatory.  It is my contention that medical practices adopting EHR programs are simply a “cost of doing business.”  So, why are some Doctors sending out letters to their patients asking them to choose an EHR “plan” and pay accordingly?  Also, is it fair for Doctors to pass on the cost of adopting Electronic Health Records to their patients when all they are really doing is bringing their medical practices into the 21st Century Age of Technology?  This 2-3-minute Video examines these questions from my personal Patient experience.

“The Medical Minute” (“TMM”) is a Continuing Series of Short Videos produced by veteran Crohn’s Disease Patient, Michael A. Weiss, which highlight informative aspects of chronic illness, healthcare and healthcare reform.  Mr. Weiss’ TMM Videos can also be found on the following YouTube Channels:  The Medical Minute, Health Care Reality and Pro Patient TV.

REAL Healthcare Reform = ObamaCare + eHealth + mHealth

ObamaCare is looked upon both positively and negatively as the end-all / be-all of Health Care Reform in the United States.  It is politically charged and subject to nationwide debate and likely repeated judicial challenge.  However, it need not be so divisive as it seems to have actually inspired and triggered other significant Healthcare reforms and Healthcare entrepreneurial advancements via legitimate Free Market Solutions, namely, “eHealth” [Electronic Health] and “mHealth” [Mobile Health].  This 4-Minute Video explains this interesting and ongoing technological development in Healthcare Reform.

 This is part of my “Two Minute Drill” Series of Healthcare Videos.  The phrase is taken from the NFL, i.e., United States Professional Football, and refers to that intense time of the last 2 minutes of the end of the 1st Half, or of the Game, when teams use a no-nonsense carefully timed 2-Minute Drill to most efficiently move down the field to score points.  With Television Commercials, the 2-Minute Drill often takes 10-15 minutes of “Real Time” and thankfully that affords me the ability to still use the phrase when my succinct Videos are sometimes 4 to 5 Minutes in length.  I hope you enjoy the Healthcare Content and that it provides you with mental stimulation and creative inspiration.

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Healthcare Reform = Combination of ObamaCare, eHealth and mHealth

ObamaCare is looked upon both positively and negatively as the end-all / be-all of Health Care Reform in the United States.  It is politically charged and subject to nationwide debate and likely repeated judicial challenge.  However, it need not be divisive as it seems to have actually inspired and triggered other significant Healthcare reforms and Healthcare entrepreneurial advancements via legitimate Free Market Solutions, namely, “eHealth” [Electronic Health] and “mHealth” [Mobile Health].  This Video explains this interesting and ongoing technological development in Healthcare Reform.

This is part of my “Two Minute Drill” Series of Healthcare Videos.  The phrase is taken from the NFL, i.e., US Professional Football, and refers to that intense time of the last 2 minutes of the end of the 1st Half, or of the Game, when teams use a no-nonsense carefully timed 2-Minute Drill to most efficiently move down the field to score points.  With Television Commercials, the 2-Minute Drill is often takes 10-15 minutes of “Real Time” and that affords me the ability to still use the phrase when my succinct Videos are sometimes 4 to 9 Minutes in length.  I hope you enjoy the Healthcare Content and that it provides you with mental stimulation and creative inspiration.

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WegoHealth.com asked: “What does ‘Health Technology’ mean to Me?”

This Picture was originally Published on the following Blog:  http://www.orangejuiceblog.com/2009/06/government-healthcare-review-reprint

Kudos to the Folks at WegoHealth.com for asking the Right Question at the Right Time.

First off, I think this is an incredibly TIMELY “Topic” and excellent Discussion Starter because I find that too many people and diverse groupings of Medical Professionals are trying to quickly figure out “Health Care Social Media” (“HCSM”) simply to monetize it and capitalize on what they think are its capabilities.  IMHO they are making the same mistakes made by the music industry when the Internet first made Digital Music so easy and enticing to download.  In hindsight, a “Wait and See” attitude would have been more prudent and served those music executives and litigious artists much better in the long run as the “newness” of instant digital 24/7 access initially made for a hot consumer commodity but soon wore off. Nevertheless, more open and technologically-savvy minds than the groovy cats  in the music industry, who incidentally made more money than they should have off of the creative work of others without taking anywhere near the career risks, grew the new medium availability of music into a viable business model.   This new iTunes-dominated business also changed Buying Behaviors and Consumer Consumption of Music.  “Collaboration” for maximum benefit to all interested parties (i.e., Fans, Bands, Writers, Music Publishers, Record Companies, Apple, iTunes, etc.) seems to have been the Lesson and still  drives the end-game even if the per-song percentage payout is less than that previously generated by retail.  But adapting to, and THEN learning how to utilize, new technology are keys to survival and profitability.  That Lesson needs to be carefully  monitored with respect to HCSM, especially at this point in time when it seems to be  purely a Patient-Driven medium.  Therefore, while the end-game for HCSM and its capabilities is not yet defined, I think the more productive conversation is about “Health Technology” since THAT is what we are really talking about.  What is it?  How can we use it?  Is it different for Patients and Medical Professionals?  Is HCSM the industry of “Health Technology” or just an Application of it?

Accordingly, when posed with the question, “What do the words Health Technology mean to Me?” I instantly make a Separation between Health Technology for Patients and Health Technology for Medical Professionals.

As somewhat of a “Professional Patient” having battled Crohn’s Disease for the past 25 years with 200 hospitalizations under my belt, I first think of Health Care Social Media and the various Patient Technology Tools that are derived from “Health Technology.”   That said, however, I think the medium of HCSM will evolve into “THE” Game-Changer of Health Technology by bringing “Efficiencies” back to both the business of Health-care and to the Practice of Medicine.  The almost instantaneous database-like availability of Patient information and experiences created through HCSM allows Patients around the Globe to access what they need, when they need it, directly from other Patients in similar circumstances.  Thus, HCSM could become a Behavior-Changing medium much the same way the creation of Amazon.com changed the way we purchase Books after first reading about them in The Sunday New York Times.

In the “old days,” we’d jot down the Book Title and eventually make it to the Bookstore to purchase the book but now we spark up the Computer and with just a few clicks the book is on its way to our homes.  Audio-books have even improved upon that “Purchasing Experience Efficiency.” This type of impact would be extraordinary with HCSM and I think it is entirely possible since no one but Patients can participate in HCSM in any meaningful way for fear of Ethical, Legal and Licensure Constraints no matter how well-intended they are or how up-to-date their respective Professional Licensing Boards are with respect to the possible perils of Social Media and Health Technology.  HCSM, and some aspects of Patient-driven Health Technology “Patient Tools,” are simply moving too fast for Medical Professionals to be adequately protected from the perils of a Global Patient Population seeking medical advice 24/7.  So, if Patients take their HCSM  “Credibility” responsibilities seriously, Health Technology will have created an Amazon.com-like Clearing House of Information and Experiences which Patients can utilize to more efficiently manage their Health-care issues which in turn will assist Physicians and Hospitals in treating a much better informed and prepared Patient Population.

By way of example, I use “Health Technology” every day when I Tweet about HCSM, or seek input about the side effects I am having to Crohn’s Disease medications or ask for  recommendations about Doctors.  This use of Health Technology often leads me to Niche Health-care Facebook Pages where I learn even more detailed information.   As a Patient, I also “Subscribe” to Disease-specific email Yahoo or Google Groups which bring individual Patient stories and queries to my email in-box every day.  I try to participate in the dialogue so that I don’t “take” more than I “receive.”   I also do this with Medical “Key-Word” searches on Yahoo and Google so that at the end of each day I am up-to-speed on the latest research on Crohn’s Disease.  I also Subscribe to several Medical Podcasts and even Host my own which focuses on Living with Chronic Illness.  This helps me stay current with the latest issues I may be faced with either regarding my illness or regarding Health-care in general.  I also participate in a variety of “Tweet Chats” which are medical-related and usually comprised of such a diversified audience of folks involved with Health-care that I come away ALWAYS learning something new or at least made aware of a different perspective.  It is also fascinating to converse with people in Australia, for example, about how Health-care is faring in their country.   I also read certain Blogs and maintain one myself (Voila!) and this gives me the opportunity to share with others what I’ve learned from the above and/or it offers me the chance to share information and experience that might help others.

When I think about “Health Technology” from a Medical Professional’s point of view, I think about an exchange I had last evening with a Physician who wondered how Patients can get the best Health-care without having a Smart-phone!!  Perhaps I am narrowing the point she was making but I am trying to illustrate that we are talking about Two Completely Different Worlds when we try to explain “Health Technology” and what it means to Patients as opposed to its purpose in the day-to-day lives of Doctors, Nurses, Technicians, Medical School Professors/Students, etc.  I happen to think that is a GOOD THING because HCSM seems to be a Patient-Driven Medium whereas the Mobile Phone (and many other Technology Gadgets) seem to be efficient and effective Health Technology Tools for Physicians and Hospitals.  I do think a Smart-phone can be a GREAT aid to Physicians who are always pressed for time and thus anything which provides them with more clarity is betterment to Health-care and that is good for Patients.  Electronic Medical Records (“EMRs”) also come to mind in this side of the “Health Technology” discussion as it is an Eventuality because we must break away from the Inefficiencies seemingly favored by behemoth Health Insurance Companies and other Payors who utilize Oil Cartel-like business practices hoping that Health-care is never made Efficient such that it becomes more affordable, more effective and therefore more accessible to more people.  There is much debate about the adoption of EMRs and at this point in time I think ANY argument against them is ridiculous because if we are routinely doing Banking on the Web, and with no problems, then there is no longer a viable excuse not to use EMRs.

Other than that, I think of “Health Technology” for Medical Professionals as any Gadget or Tool which enables them to Diagnose/Treat faster and more accurately and which generally enables them to do their jobs in the most safe, effective and efficient manner.