Tuesday, September 27, 2011

In Training for Health Train Express


The Enterprise Medical Center announces new EBM guidelines, questionable guidelines for outcomes and failure to meet JCAH standards.

EMC also failed to qualify for incentive payments because EMC did not meet meaningful use requirements.

Health Train Express thanks ZdoggMD for his intepretive potentially Emmy award winning video on the pitfalls of medicine in the space age.

In space, no one can hear you code. We boldly probe where no finger has probed before

Something smells bad here.

del.icio.us Tags: ,,

Monday, September 26, 2011

Social Media for Hospitals and Clinics

Mayo Clinic has established a formal Social Media Department to enhance patient care and educational needs.

Lee Aase (@LeeAase) created this slide share presentation which is also available online  There is also a presentation transcript, if one scrolls down the page.

Lee Aase is the Director, Mayo Clinic Center for Social Media. (#MCCSM) THIS IS THE EPONYM FOR TWITTER SEARCHES

For those of you who could not attend, Click Stanford Summit + Medicine 2.0 @Stanford. for the agenda.

Health Train continues to believe that social media will expand and flourish not only in the business world but also will change the game in healthcare, as much as EMR and HIE, and in a much more effective manner as it builds from the ground up.

Next Healthtrain will be  Google +, a fast moving high speed maglev vehicle with enormous potential for health institutions and clinic communication.

Saturday, September 24, 2011

Who Came First on the Health Train? The Chicken or The Egg

Caution Lights down the Track


A troubling report from the U.K.

Trouble Down the Tracks

U.K. Health Service To Dismantle Nationwide Health IT Program
Read more:

Health Secretary Andrew Lansley said that the National Programme for Health IT, which launched in 2002, "let down the NHS and wasted taxpayers' money" (Press Association, 9/22)


It is now almost ten  years since beginning their National HIE in a country much smaller than the U.S. Certainly their software designsSleeping half-moon are obsolete and not industry current.

Lansley said, "We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernized NHS" (Beckford, London Telegraph, 9/22).

Because most healthcare transactions take place in regions and not nationally it seems reasonable that the nationwide network should be built last. The interoperability standards have been set…things may evolve and what is the rush?  How many patients receive treatment in LA, Chicago, and NY?  Few travel that distance for routine treatments. The number of patiens who can afford national expeditions for treatment are limited.

So far HHS has dispensed over $ 600 million dollars in incentives, according to

The Federal Government Has Distributed $653M in EHR Incentive Pay

Read more:

The CMS data also show that:

  • $262.2 million in Medicaid incentives have been paid to 294 hospitals registered as eligible for both the Medicare and Medicaid incentive programs;
  • $226 million in Medicare incentives have been paid to 114 hospitals registered for the Medicare incentive program;
  • $93.9 million in Medicaid incentives have been paid to 4,463 physicians and eligible health care professionals;
  • $38.3 million in Medicare incentives have been paid to 2,129 physicians and eligible health care professionals; and
  • $32.9 million in incentives have been paid to 15 hospitals registered solely under state-administered Medicaid incentive
  • image

Friday, September 23, 2011

Free Riders on Health Train Express


TGIF.  Many things happened this week which may impact many of us in the world of technology and internet applications.

Hewlett Packard replaced Lou Apotheker with Meg Whitman in the wake of the discontinuance of the HP Touchpad, the announcement of HP disbanding or selling their HP consumer product line (apparently their printer division will still continue, since it is the dominant printer manufacturer, and also  produces significant  revenue for HP. 

The demise of Apotheker comes not so much from his decisions to make strategic changes, but his poor communication and people skills in dealing with his Board of Directors and the Stockholders. It must have seemed heavy-handed and the investors voted with a 50% reduction in stock price as many unloaded their shares in the weeks since the announcement was made.  This came after only 11 months of Apotheker’s  reign (apparently of terror).  Reports were that Apotheker lacked some leadership abilities critical to management of a diverse HP enterprise.


On the internet side and Web 2.0 Social media announced the expansion of SM with Google +, Google Hangouts and several new versions all within the past three months. Google + gained 45 million new users in less than three months and the growth is still exponential. While Facebook states it has over 600 million users it is 6-7 or more  years old.  Analysis shows that FBs growth has stagnated.  Users of both platforms have a diverse opinion of how G+ stacks up against. 

There is a dichotomy of opinion. Many FB fans are intensely loyal and are vocal about G+s failings while some have willingly jumped the FB ship, announcing how ‘lame’ FB has become.

Google + has loosened it’s ban on pseudonyms for user names, but remains a non-commercial platform.FB remains the dominant marketing SM tool. Many enterprises have just adopted SM for marketing and G+ does not as yet have a significant user base (45 million for G+ vs. 600+million for Facebook.

In the past several weeks this writer spent about six hours a day on Google +. Part of it was a learning experience. I learned much about Hangouts.. Health care has much to learn from and use in Hangouts.

I held an ophthalmology video conference based upon a user list serve for ophthalmology which is international in scope well respected and attended daily. Users who usually only communicate in writing and once or less a year at meetings were able to see and talk in real time to discuss interesting cases, display images with the restrictions in place by HIPAA.  I was able to share the HIPAA 18 never say data as a document during the conference.

What are it’s other potentials? Everyone will figure out a way to use it…patient education in small groups seems the first item, and communication of physicians in regard to operations of the practice (business) or associates and other practices. How about a section meeting of  the medical staff. Multiple concurrent Google hangouts can be run with different Gmail addresses. (You will need a high performance graphic card  or multiple display card) or separate PCs.

President Obama hold a five way Hangout (notice Harry Reid’s one finger salute to the Chief)

Google+s hangout offers a 10 way audio-video conference with the capability of sharing documents, screens, and videos. It seems to offer new functionality every day. It runs well in all the browsers. I have used it in Firefox, Chrome and even Safari (on a PC)  Interesting  that Safari which normally loads very slowly and has slower screen web page changes on my PC yields the best video performance on my laptop. Some of this may have to do with how video is rendered with the laptops meager video resources and memory sharing for video graphics.

FB countered in the past weeks with several new applications and major changes to the interface becoming much more visual with alterations in the “white space’ of their web pages. Zuckerberg announces TIMELINE.

HIPAA violations !!

And finally this news.   Neutrino found exceeding the speed limit of light.

See what I mean?  TGIF now maybe I can get back to work !!


Wednesday, September 21, 2011

Sea-change on Health Train Express

I have read that medical blogging has changed. The bloggers posting clinical cases and clinical information have declined, many (like life imitates art) are retiring, conflicted about HIPAA and privacy requirements.

Caseblog points out the 18 “never say'” items similar to the old bad 8 words of the 70s on television.

They are:

List of 18 Identifiers:   (some of these  were new to me)

1. Names;
2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
4. Phone numbers;
5. Fax numbers;
6. Electronic mail addresses;
7. Social Security numbers;
8. Medical record numbers;
9. Health plan beneficiary numbers;
10. Account numbers;
11. Certificate/license numbers;
12. Vehicle identifiers and serial numbers, including license plate numbers;
13. Device identifiers and serial numbers;
14. Web Universal Resource Locators (URLs);
15. Internet Protocol (IP) address numbers;
16. Biometric identifiers, including finger and voice prints;
17. Full face photographic images and any comparable images; and
18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep,bleep.

Count them, there are (bleep) 18 !

Are the standards different for small practices and large institutions? Reality suggests this to be true:

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Social Media in Medicine is particularly prevalent in the Emergency Department. Perhaps this is what ED physicians do during a quiet moment, between entries in the EMR.  This should not be surprising since ER medicine reflects reality. The interface of what we plan and what happens in life while we plan it. Dramatic, crises, no one goes to an  ER willingly, to wait, to see an unknown doctor unless uninsured or by other circumstance unable to make it to the doctors office during regular hours, due to transportation problems, and a simple fact that most ERs will see you no matter what to determine if it is safe to send you home. Most ERs are on a public transportation route.

Whether you are a blogger or a reader, perhaps these features will keep you focused on the never say words,  or who is blogging, why and where of it all.

Doctor Only Social Media Sites


doctors only social media sites

Kent Bottles gave a presentation at #med2 describing the  deficiencies in medical social media networks. He described them as too complicated and not easy to use.

SM sites are individuals or small groups.

Typical posts:

Do you use Social Media in your practice:?



“Angry and probably not the kind of doctor you should go see” (Kent Bottles)

On the other hand  90% of Social Media is just showing up. Here is a bit from 33charts.com  

Bryan Vartabedian  33 charts

SM is a great medium for research. Ask questions. Use #tags, Twitter is a great medium for just in time information.

Patient Advocacy:

Harry Boyle

Other Trends in Healthcare:

Electronics and Medical Monitoring:

Trends to Watch

Simulated Environments for Psychotherapy with Avatars:


More Trends to Watch:

Trends to Watch II

What do Leaders Do?

What Leaders do

Shameless Shout out for Kent Bottles, MD

Quantified Self

Some typical professional “Social Medical Networks:

Doctor’s Hangout         MomMD          Doctors Lounge     DocGreet



Facebook, Twitter, and Google + each have their own way of developing lists, groups and circles for groups, however none of them are secured by passwords for healthcare providers. It should also be noted that although the doctor only social networks are not HIPAA compliant….private and confidential patient matters should be de-identified.

Thursday, September 15, 2011

Health IT Confusion and Clarification


This is National Health IT week, if you did not know that already. It runs from September 12th-16th. President Obama declared it in an official Proclamation and a Senate Resolution (at least they agree on something).

Official Press Release:

ONCHIT is celebrating by announcing a new website for providers and professionals. It’s a bit more readable for both groups.

Health Information Technology and ONCHIT are becoming synonymous as Federal incentives drive electronic medical record adoption by providers..

Anyone reading a government website knows they do not use smart graphics design.  Even HHS admits this since they have started a new website, more oriented to reader understanding.

The old website is still available.

Two Websites, One Message

ONC’s existing website will remain housed at healthIT.hhs.gov. The HHS site will become more policy and program-focused, and HealthIT.gov will serve as a primary resource for providers and patients who are interested in learning more about how health IT can help improve their health and health care. The new website provides access for patients as well as providers .


Wednesday, September 14, 2011

ICD 10 Craziness


Next time you go to see your MD don’t worry about the seemingly inane questions he / she will ask you. If he doesn’t he will be in violation of a new ICD coding initiative installed by HHS in the next two years.

And for you astronauts you are covered  for spacecraft incidents, except for re-entering the atmosphere without a space-ship.

ICD 10 Search

Turtle Injuries


ICD 10 Codes:  Search

My favorites are:

Bitten by Shark, Bitten by Shark, Second Encounter

Whale encounter cannot be found

Injury or Death from encounter with sting ray….could not be found, nor a code for second encounter…..What would the late “crocodile hunter’ say, may he rest in peace.

Jelly Fish are included, however, only show up if you search for Jelly and do not if you search for Jelly Fish.

Try it yourself, it’s a bit of a game show….probably good for an evening of after dinner socializing.

Wait one, my spouse is calling me to dinner:  She got my attention with an ICD Code:  W274XXA, followed by a W274XXD with a  modifier Y92010.

In trying to escape I further was injured by a: W541XXS at which point, I W134XXA.


I just hope I don’t get: W2111XA.

Did you get all of that? Don’t ask me to repeat it..

Tuesday, September 13, 2011

Federal HIT final Strategic Plan Released

Like it or not, the feds have released their ‘edict’ for adopting the digital age for EMR, and HIEs.(Office of the National Coordinator for Health Information Technology).

Anyone reading my blog knows that I am not a luddite,, and I  tend to err on the side of caution.  Like most surgeons my first thoughts are ‘primum non nocere’.  (first do no harm).

For all physicians and leaders this is a must read, It was developed after a 90 day period of public comment, and the document states it is still subject to revision(s).

The document includes the following information:

“Request for More Information on Outreach and Education to Providers and Consumers
In order to achieve the highest participation possible in the Medicare and Medicaid EHR Incentive Programs, ONC and CMS are working together on a coordinated outreach and education campaign directed at providers and hospitals. Our approach is two-pronged and involves distributing critical information and materials nationally, while focusing on local communities to engage audiences where they live and work.  We’ve already started collaborating with stakeholders and the media to distribute materials and established a strong online presence through social media.

In addition, ONC and the Office for Civil Rights are gearing up to launch a national campaign this month, designed to increase consumers’ awareness about:

  • The transition to health IT;
  • How to access their health information;
  • The benefits of leveraging health IT tools to better manage their health; and
  • Privacy rights to access and protect their health information.

Does this mean HIT is now a ‘civil right’?  Will it be subject to enforcement if a provider does NOT provide an EMR, or is this the way our bloated government deals with publicizing items for public consumption? Perhaps I am over-reacting here…I will have to call Glenn Beck and get his opinion.

BTW Glenn now has his own Internet TV network at  GBTV.com (Unashamed promotional material given without financial compensation (my charitable donation to freedom )

The revised Plan is available

Read the Federal Health IT Strategic Plan [PDF - 1 MB]

Your tax dollars at work….

Comments are welcome here. HealthTrain posts are announced on Twitter, Facebook and Google +. Readers may also comment on my blog @glevin1.