Is the computer intrusive or welcomed?

The board of trustees of the AMA (American Medical Association) has just released a report named “Exam Room Computing & Patient-Physician Interactions” regarding these computers and the relationship between patient satisfaction and doctor communication with the patient and computer.  The issue will be discussed at the AMA House of Delegates’ June meeting which will take place in Chicago.

According to the 2005 study by the board, patients were “satisfied with the physician’s level of familiarity, communication about medical issues and the degree of comprehension with decisions made during the visit all improved significantly” after their physician began using a computer in the exam room.”

But as computers are taking a more visible and stronger role in the exam rooms with patients and physicians, do patients still feel satisfied?

An article published in the Family Practice Management journal advises doctors using computers to:

A report from the Pew Internet and American Life Project illustrated the desire of the American public to use mobile technology:

• 42% of 18-29 year olds seek health data
• 39% use it in the 30-49 year old range
• 9% of seniors over 65 use it

Yet have American doctors embraced this technology as eagerly?

Deloitte Touche Tohmatsu Limited, commonly called Deloitte is one of the biggest professional services firms.  Their study, published 5/14 about mobile health tools, asked doctors about their use of mobile health technologies.

Results of their report showed 57% of doctors do not use mobile health technologies.  The reason given for this:

• (26%)  mobile applications and programs are not suited to their needs
• (29%)  concerns about patient privacy
• (44%)their workplace does not provide mobile tools and that they are unwilling to use their personal devices;

 The research firm Klas studied the issue of security and found encryption was used by 46% of healthcare organizations to protect patient data on clinician mobile devices and 35% said they used mobile device management software. Twelve percent of surveyed health care organizations say they put limits on the use of mobile devices, 11% said they use an internal cloud, 6% said they put limits on mobile operating systems and 5% said they use an external cloud to protect patient data. (Source: KLAS, “Mobile Applications: Can Enterprise Vendors Keep Up?”)

Health Information Texting

Texting for health information by the public at large does not seem as popular. “Only 9% of 2,581 mobile phone users surveyed used text messaging to retrieve health or medical information”.  The breakdown showed African Americans,women and those between the ages of 30 and 49 the most likely to receive health information by text.

No longer is medicine doled out in a patriarchal fashion where the doctor dictates which treatments will be undertaken.  Now, patients are informed which options are feasible and it is the patient who decides the course of action, and takes on more responsibility.  Healthcare delivery has transitioned a step beyond to formulate functional medicine.

How does Functional Medicine differ?

Rather than just treating symptoms, functional medicine seeks to not only treat the underlying cause of chronic illness, but focus on prevention of  health problems.

Key features of functional medicine include:

• Integration of previous medical history, clinical findings and lifestyle is attempted with a view to meshing mind, body and spirit.
• Health is promoted as a positive energy, not just the lack of medical problems.  Exercises, diet, and nutrition are tailored to each individual.
• Nutritional supplements, herbs, detoxification programs, meditation and stress-management techniques are considered.

 Core Principles

According to the Institute of Medicine. “Crossing the Quality Chasm: A New Health System for the 21st Century” , there are 6 primary principles of functional medicine:

1. Seek a balance between the internal and external body, mind and spirit
2. Practice a patient-centered approach to treatment, rather than a disease-centered outlook
3. View health as a positive vitality
4. View and connect physiological factors throughout the body
5. Treat people individually, taking both genetic and environmental conditions into consideration
6. Promotion of organ reserve for increase to health span

The article further states:

“A patient-centered approach refers to health care that is respectful of and responsive to individual patient preferences, needs, and values, and that ensures that patient values guide all clinical decisions.1 At IFM, patient-centered care is at the center of what we call the therapeutic partnership, the relationship that forms between a patient and clinician that empowers the patient to take ownership of their own healing. The power of the therapeutic partnership comes from the idea that patients who are active participants in the development of their therapeutic plan feel more in control of their own well-being and are more likely to make sustained lifestyle changes to improve their health.”

Of the 66% of Americans looking for health information on the web, as many as 40% will use doctor review websites.  Healthgrades.com alone receives seven million hits each month. The glitch is when a site gets only 1-2 reviews for a doctor.  This will obviously be skewed, especially if a patient has a vendetta.

Word of mouth from patients, family members and friends, still seems to be the most popular way to find new doctors but a trend is slowly changing this.

A study from PricewaterhouseCoopers’ Health Research Institute, shows that 13% of the American consumers are now choosing to write reviews about their doctors and other healthcare providers and 31% have read these reviews.

See below:

For What Types of Health Care Services Have Consumers Read or Written Online Reviews?

The report found that 28% of U.S. consumers have read online reviews of hospitals and 14% have written such reviews, while 16% of U.S. consumers have read online reviews of insurers and 5% have written such reviews. Twelve percent of U.S. consumers have read online reviews of pharmacies and 5% have written such reviews, the report found.

The report is based on a November 2012 survey of 1,000 consumers who represent the U.S. demographic population.

Source: PricewaterhouseCoopers’ Health Research Institute, “Scoring Healthcare: Navigating Customer Experience Ratings”

Have you used a doctor review site to rate a doctor or to find a doctor in your area.  Share your experiences and comment below.  

• I never knew how much love my heart could hold until someone called me “mommy”

  - Unknown
  • • A baby asked God, “They tell me you are sending me to earth tomorrow, but how am I going to live there being so small and helpless?”

”Your angel will be waiting for you and will take care of you.”

The child further inquired, “But tell me, here in heaven I don’t have to do anything but sing and smile to be happy.”

God said, “Your angel will sing for you and will also smile for you. And you will feel your angel’s love and be very happy.”

Again the child asked, “And how am I going to be able to understand when people talk to me if I don’t know the language?”

God said, “Your angel will tell you the most beautiful and sweet words you will ever hear, and with much patience and care, your angel will teach you how to speak.”

”And what am I going to do when I want to talk to you?”

God said, “Your angel will place your hands together and will teach you how to pray.”

”Who will protect me?”

God said, “Your angel will defend you even if it means risking it’s life.”

”But I will always be sad because I will not see you anymore.”

God said, “Your angel will always talk to you about Me and will teach you the way to come back to Me, even though I will always be next to you.”

At that moment there was much peace in Heaven, but voices from Earth could be heard and the child hurriedly asked, “God, if I am to leave now, please tell me my angel’s name.”

”You will simply call her, ‘Mom.’” 
- Unknown

  ◦                      

Hello Operator, does Heaven have a phone number? Mommy went to Heaven, but I need her here today, My tummy hurts and I fell down, I need her right away, Operator can you tell me how to find her in this book. Is heaven in the yellow part, I don’t know where to look. I think my daddy needs her too, at night I hear him cry. I hear him call her name sometimes, but I really don’t know why. Maybe if I call her, she will hurry home to me. Is Heaven very far away, is it across the sea? She’s been gone a long, long time she needs to come home now! I really need to reach her, but I simply don’t know how. Help me find the number please, is it listed under “Heaven”? I can’t read these big big words, I am only seven. I’m sorry operator, I didn’t mean to make you cry, Is your tummy hurting too, or is there something in your eye? If I call my church maybe they will know Mommy said when we need help that’s where we should go. I found the number to my church tacked up on the wall. Thank you operator, I’ll give them a call 
- Unknown 







  • Mothers hold their children’s hands for a short while, but their hearts forever. 
- Unknown

  Have a happy Mother’s Day.  Celebrate the nurturing side in all of us.

Not only does CMS (Centers for Medicare and Medicaid Services) reimburse for telemedicine,(starting from the use for remote locations)  the private payers are coming on board to save money in an area that has been rife with escalating costs.  Payers are seeing that it is cheaper to keep patients healthy with home monitoring and online conferencing, than repeat hospitalizations.

A spokesman for Aetna, Ethan Slavin states:

“We believe telemedicine can play a critical role in improving health and managing chronic disease, while increasing member satisfaction. Telemedicine can also significantly reduce costs by reducing non-medically necessary ER visits and readmissions as members use virtual options for after-hours care and provider instruction.”

Telemedicine is being viewed as an adjunct to the total health plain as pointed out by Randy Parker, the President and CEO of MDLive:

 “What we’re doing is taking telehealth into the health plan design, making it a part of the product rather than a stand-alone product.”

Still, a corroborating comment from Jason Gorevic, the CEO of Teladoc stated:

“Access to primary care is one of the fundamental problems with our healthcare system today, and as we move toward 2014 and a massive expansion of coverage, this problem is going to become a crisis.  Teladoc helps ease the access issue via its national network of care providers, available to anyone who has signed up for the service.”

Supporting Insurance Companies

There are several insurance companies that have jumped into the fray of support for telemedicine:  Aetna (with RelayHealth since 2006), WellPoint (with American WEll), Highmark (with Teledoc) and Cigna (with MDLive)

The Problem/Objection

While it would seem to be a “no-brainer” to have telemedicine (and payment to entice people to utilize the system), many state health boards object to having patients receive medical care or advice from out-of-state since they wouldn’t have a specific state license.

The American Telemedicine Association is trying to address this problem.  While private insurers reimburse tele health services in only 19 states currently, ten more states are considering legislation to support it.

According to a recent survey conducted by Cisco Systems and released in February, 70 percent of consumers are comfortable communicating with doctors via electronic means, versus seeing them in person.

“As we move forward in the telehealth journey, 87 percent said they were willing to give up anything – cost, convenience or travel – to be treated at a perceived leading healthcare provider, to gain access to trusted care and expertise,” said Kathy English, Cisco’s senior director of public sector and healthcare marketing. “So it looks like our patients are craving access to care as a top of mind, regardless of how that happens.”

Healthcare Finance News stresses “As the fee-for-service model expands, the mix of managed care, accountable care organizations, medical homes and more will call for proper use of telemedicine to cut costs and increase efficiency”

Telemedicine has already proven to be a cost saver and increases access to healthcare though some doctor groups feel that it can potentially compromise the doctor-patient relationship.  Unfortunately, people are already seeing a compromise to this relationship, not with telemedicine but with doctors staring at the computer screen of their new electronic medical systems in the office instead of the eye-to-eye contact that we used to enjoy.

What is your take on this issue?  Comment below.

Today, we will do an in-depth discussion regarding what telemedicine is, its value and how it can play a pivotal role in the medicine of this 21st century.  Tomorrow, we will get into how we can incorporate it into practice and how it will be reimbursed.

What is telemedicine?

In this technological age of the apps and smart devices that everyone uses in everyday life, medicine has travelled along for the ride.  Using a myriad of applications including smart phones, tablets, email and other telecommunication systems, telemedicine was born.  Simply, it is the exchange of medical data from one site to another by electronic communications for the purpose of bettering a patient’s health.  Originally it was devised to reach patients in remote areas where health providers or doctors were not very accessible.  Now it has been woven into the fabric of daily hospital operations, home health, doctor’s practices, home care  givers and even health in the workplace.

If so, you are not alone.  Two surveys done for the AMA prove this point.  Telephone surveys were done by Global Strategy group in 2008 and Baselice & Associates in 2010 polling 850 adults throughout the country.

Results of the study showed only 46% in 2008 and slightly more than half in 2010 concurred with the following:

“It is easy to identify who is a licensed [medical doctor] and who is not by reading what services they offer, their title and other licensing credentials in advertising or other marketing materials.”

With holistic practitioners opening their doors along with alternative therapists and nurse practitioners with Ph.D’s introducing themselves as doctors (and taking on the role of doctors), it is easy to see how the confusion will become even more widespread.

Truth in Healthcare Marketing 2013 Bill

This bill cosponsored by Rep. David Scott from Georgia and Rep. Larry Bucshon from Maryland hope to clear up any confusion so that consumers have a more educated choice for their healthcare services, and know the credentials of those professionals who are advertising their services.  The bill was sent to the Energy and Commerce committee .

For those making innuendoes, or stretching the truth…You are On Notice

The Healthcare Marketing Bill specifically makes it illegal for a healthcare provider to make false claims or incorrect statements in marketing materials regarding their degree, license, clinical background and training.   Any licenses that are held must be clearly mentioned.

If you are “stretching the truth” a bit or inferring information that may be misconstrued, you are on notice.  The Federal Trade Commission will charge you with violations for the deceptive services or false claims.

Be an Informed Consumer

Deputy director of government relations for the American Psychiatric Association (APA),Matt Sturm  feels t this bill is necessary to make sure health providers, including physicians, are fully informing consumers of their credentials. He pointed out that acronyms used for degrees and affiliations with various professional organizations may not be recognized or understood.  Further, he states:

“There is clear data that patients are confused about the level of training for health professionals. We simply think proper display of credentials in marketing and advertising, making licensure misrepresentation clearly illegal, and beefing up enforcement makes logical sense. If you were looking for mental health treatment for yourself or a family member, services that are potentially sensitive and need to be carefully managed, wouldn’t you like to know a provider’s qualifications?”

Not only does this protect the consumer, it actually helps the bona fide physicians as well.  The doctor that has clinical experience, training, and active licenses will get the acclaim deserved and the patients, rather than having to compete with the “quack” down the road.

For more news as it breaks, sign up for the blog (box at the top left corner of this page).

See you at the next posting!

Unlike the family physician of yesteryear, our doctors don’t always coordinate our care among all the specialists that have examined us.  It seems that doctors are in a hurry and shove us out the door.  Only when we get home do we think of all the questions that we need to ask.  When confused, don’t understand the medication or instructions you have been given or need someone to connect the dots, a patient advocate can be a godsend.  This person will research the treatment options or differential diagnosis that you need and may open doors to specialists that you may not have had access to on your own.

Private advocates work directly for you, not the hospital or insurance company (although they have their own and allegiance to their employers). Although insurance coverages and Medicare do not pay for the services of a patient/health advocate, it is definitely worth your while.  After all, not taking the medicine you have been prescribed through lack of understanding and overdosing on it or getting untoward side effects is much more costly in the long run.

Though it may not be easy to find an advocate in your area, there are two sites with directories that you can check out:

• Advoconnection- which has a list of the types of advocates, the services they render and the location as well as contact information
• NAHAC- National ASsociation of Health Advocacy Consultants- use of this site for referrals is free

Prepare a list of questions for interviewing the advocate that you are considering:

• What is your training or background?
• Have you performed these services before?
• What will the charge be?
• Are you available now or is there a waiting list?
• How long do you anticipate I will need your services?

Knowing what to expect and getting the help you need will help you promote your health and give you peace of mind at the same time.

Sign up for the blog and we’ll keep you posted as this story develops further.

Having a patient advocate on your side can make all the difference between understanding your healthcare options and having doors opened to specialists that might not have been accessible to without the advocate.

According to the director of Health Advocacy Program at Sarah Lawrence College in N.Y., Laura Weil, “now everyone seems to agree that you need help navigating a fragmented and technical health care system that is not always friendly”.

Even the government is recognizing the pivotal role that advocates play.  Health care legislation is being bandied about in Washington to improve the coordination of care for medical care improvement, decreasing unneeded tests, treatments and procedures.U.S. News & World Report recently listed patient advocates as one of the hottest growing careers. They are even being added to benefit packages by employers.

Hewitt Associates, a benefits consulting firm offers a clinical patient advocate program so that employees can call a hotline manned by doctors and nurses giving advice for medical care.  Michelle Olef, an advocate for Hewitt sates “every single participant who contacts us is angry and stressed out after having tried to deal with the health care system.  More and more we were hearing confusion about clinical issues, as well as standard claim issues.”

“A hospital advocate can facilitate the flow of information,” said Ms. Weil, who worked as an advocate in New York area hospitals for 20 years. “They can be the point person who can access anyone in the institution for you.”

Whether the patient advocate is hired by the patient, hospital or insurance company does make a difference however in terms of allegiance. If hired by the hospital, a patient is not going to get referrals by the advocate to services outside the hospital. “Know the agenda of the person who is helping you,” she said. A hospital’s own advocate, for instance, may not be allowed to suggest another institution or physician where you might find better expertise for your particular medical condition.

Depending on the location and type of service that you enlist, care and advice from an advocate may be done in person, by phone or even online. Just make sure that the advocate has the experience and knowledge required for your services.

You will be seeing more  of patient advocacy in the future.

Sign up for news as it breaks on this issue in the opt-in box at the top left of the screen.