Wednesday, December 21, 2011

User Friendly Medical Devices Could Alleviate Medication Non-Compliance

In my last blog post I noted that one-third to one half of all patients do not take medication as prescribed and up to a quarter never fill their prescriptions at all. This non-compliance with prescribed medication costs the US health system an estimated $290 billion annually. These costs are associated with expenditures for unnecessary hospitalizations, medical procedures, physician visits and treatments. Despite this staggering number this is just a starting point as the numbers quoted do not capture such costs as lost productivity and deterioration in quality of life. I put the blame for this non-adherence on the high, unaffordable cost of medication, the fact that people are forgetful and neglect to take their medications and the fact that often patients do not understand the reasons why following instructions about when and how to take medication is so important.

However, there is an additional  reason why people often do not take their prescribed medication properly and that is because the devices that deliver the medication are not designed in a way that makes them easy to use. In fact ,some devices are so poorly designed the patient cannot administer the medication at all.

Cambridge Consultants conducted a study that found a direct correlation between patient adherence to a drug regimen and the design of the drug delivery mechanism. The 240 diabetic patients who participated in this study indicated that they did extensive research on drug delivery devices that they would be using daily, and made their choices, not necessarily based upon their physician’s recommendation, but on their own perceptions about how the device delivered their medication. These respondents almost universally agreed that they would be willing to pay more for a device that is more user friendly and efficient.

A parallel study conducted by Cambridge Consultant of 100 health care professionals also concurred that the usability of a medical device impacts patient compliance with the medication therapy.,

The design of medical devices is regulated by the FDA , although the system is far from perfect. It has been a long road to institute regulations and standards that require manufacturers of medical devices to design in usability, design out usage errors, and provide documentation that is user friendly. By no means are we there yet.

The packaging of medication in containers that are safe and tamper secure, while at the same time enabling the average, possibly  elderly patient to easily access the medication is no easy task.

Over time this problem is going to become more complicated as the increasing numbers of individuals with chronic conditions use a variety of newly developed home monitoring devices and medication delivery systems, many of which will be based on a smart phone platform. It is important that patients have the right tools to manage their health conditions and medications. This will only happen when patients raise their  voice  and express their concerns so their health care providers  will  prescribe medications that patients completely understand and can use without a lot of challenges.

Wednesday, December 14, 2011

Did I Take My Pills Today?

One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill their prescriptions at all. According to the New England Healthcare Institute, (a health policy research organization focused on enabling innovation in health care.) medication non-adherence costs  the US health system an estimated $290 billion every year.

This non-compliance regarding medication is not a new story. In April 2007, I wrote a blog where I pointed out that not taking medication properly was the cause of more than 50% of medication- related hospital admissions. A study of 39,000 patients and 335 primary care doctors by the Consumer Reports National Research Center, published in the February 2007 in Consumer Reports, noted that doctors’ number one complaint about patients is their failure to follow advice and adhere to a treatment regimen, which results in the high numbers of people landing in the hospital or back at a doctor’s office with the same complaint that they brought to their physician days or weeks earlier.

A new study, which focuses on four chronic conditions, found that patients who regularly adhered to their prescription regimen significantly reduced their total health care spending and lowered the number of emergency room visits and the number of days spent in the hospital. Specifically, adherence reduced average annual health care spending by $7,823 for patients with congestive heart failure, $3,908 for hypertension, $3,756 for diabetes, and $1,258 in patients with high cholesterol according to the article.

There are three  reasons why people do not follow directions and take medication prescribed by their physicians:

1. Cost – many people, particularly those with chronic conditions who are on several medications come to a point where they have to make budget decisions and the pills are among the first things to go when money gets tight. The solution for these individuals lies not with changing their behavior but with the system. We have to find a way to bring down the cost of medications and co-payments to affordable levels so people can continue to take their medications . There have been several proposals that advocate paying people a financial incentive to comply with prescribed treatment such as lowering co-payments or creating incentives which reward people with cash if they comply.  To achieve a lasting solution, however, health insurers must begin to work with pharmaceutical companies and carve out plans for lowering the cost of some medications, as well as subsidizing \ individuals who cannot afford to pay.

A study funded by Aetna and the Commonwealth Fund, found that eliminating out-of-pocket costs for secondary prevention medications for patients after a myocardial infarction resulted in modest increases in adherence and improvements in some outcomes. This randomized trial showed adherence was roughly 4 to 6 percentage points higher among patients whose health insurers waived co-pays, than among those who continued to pay for prescriptions. Although these are not large percentages, it is good start toward making long term medication affordable to people with serious conditions.

2. Forgetfulness There are a large number of people who simply forget to take their medications either because they are too busy or they have memory lapses. The good news is that there are new systems with alarms available that remind patients when it’s time to take their pills - some even incorporate data collection to confirm that pills were taken on a regular basis. Devices like MedSignalsVitality Glo-Caps, and Dosecast, an app for the iPhone, IPad, iPod and iTouch that thelps you to remember when to take your medicines each day are examples.  Dosecast will even let you know if you have taken your last dose and if you are due for a prescription refill.
3. Education – patients frequently walk away from their visit with their doctor and have no understanding of why a prescribed medication is important and what will happen if they do not follow the treatment. Although there are isolated examples where physicians and pharmacists have worked together to develop effective programs to help people understand the purpose, potential side effects and why, using and completing a medication treatment is the only way the patient will recover, these coooperative programs are too few. As a result most patients are not given enough information and many opt not to refill their prescriptions. or they  self diagnose and determine that a drug is ineffective for them so they stop taking it. There are also the individuals who have difficulty swallowing their pills, or difficulty opening their containers, so they get frustrated and stop using their pills.

What can the patient do to take responsibility for medication adherence?

First and foremost, patients must speak up and question their providers about all of their medications and be sure that they completely understand why they are necessary, how to take them (in what dose and when), and the potential side effects. 

Patients who are still confused about a medications should talk with their pharmacist for further clarification.

Patients who have difficulty remembering to take their medications need to find one of the many medication reminders that are inexpensive  and available at the pharmacy,or free on many smartphones.

Patients who have difficulty opening the bottles should talk with their pharmacist who can supply bottles that are easy to open.
Patients who have difficulty swallowing should talk with their physicians who can prescribe substitute medications that may come in liquid form or who can suggest easier solutions for swallowing the medications.

Empowered patients do not leave these matters to chance or ignore the potential consequences.  They seek assistance and confirmation to make sure that they stay on track..

Tuesday, December 6, 2011

Personalized Medicine and Participatory Medicine Intersect

Since the time that the Human Genome Project was completed in 2003, gene sequencing technology has moved rapidly, becoming less expensive and therefore more available. In the very near future the cost of doing a whole genome sequencing will be under $1,000 and affordable to many individuals in the mainstream. What this means is that physicians will be able to tailor medical treatment to the individual characteristics of each patient, based on their unique molecular and genetic profile that indicates whether or not they are susceptible to certain diseases.

This will help physicians determine which medical treatments will be safe and effective for each of us and which might be counter. It means that individuals will have to become even more engaged in their health care, because they will be faced with the dilemma of having to make decisions about their life and life style based on knowledge about what they might be physically dealing with, as they age. It is in the nature of humans to want knowledge and information, especially about themselves. Ultimately many individuals, who can afford to, will make the decision to do whole gene sequencing.

There are already studies where findings based on genetic variations are initiating changes in options and treatment approaches. For example, researchers, using gene sequencing,  have learned that not only does lung cancer vary in patients based on the specific genes that contribute to its onset and progression,

In cardiac disease as well, genetic tests which detect variations in the way people may be at risk of excessive bleeding, and other genetic tests that determine how people metabolize the drug Coumadin (warfarin) which is used to prevent blood clots, determine how the drug is administered to different individuals, and in what dosage.

Eventually gene sequencing will spread throughout the population. A study is underway at Inova Health Systems of 500 families whose newborns’ medical history includes a preterm whole genome sequencing to identify molecular markers and genetic differences. The goal of the study is to learn more about disease prevention and detection as the newborns mature.

While this is a tiny segment of the newborn population, there will be a time (perhaps in 25 years, or less) when all babies will have their genome sequenced and the results preserved as part of their digital health record. This genetic information will become a standard element of a person’s medical history, and will follow that individual through life. It will determine many aspects of the individual’s medical treatment.

There are many hurdles and challenges before whole genome sequencing will become ubiquitous. There are issues of bringing down the cost of whole genome sequencing so that it is affordable and perhaps even covered by medical insurance. There is a greater challenge of how to deal with the massive amounts of data that result from whole genome sequencing including who will pay for the analysis of the data, how will the data be stored and regulated and how privacy of health information will be attained.

Personalized medicine forces all of us to be more participatory in our health care because decisions about whether or not to opt for genome sequencing is one that we have to make for ourselves. We are also forced to make life altering decisions, based on the data, regarding:

  • Whether we are going to address a potential disease that may be in our genetic markers, in advance of the onset of the disease.
  • How the genetic information we receive might influence our decision to have children.
  • How to protect our children regarding what is revealed in their genetic history.

Personalized medicine is a revolutionary trend that deserves the attention of every individual who is engaged and educated about health care because the benefits are huge and the responsibilities, both on the part of the individual and society, to use this information for positive medical advancement and better personal outcomes is daunting.


Thursday, December 1, 2011

Understanding Consumer Directed Health Plans

Knowledge is the most important thing in most circumstances, but when choosing a health plan that will protect you and your family you need to know everything there is to know about your costs vs your payments. Consumer-Directed or Consumer-Driven Health Plans that include health savings accounts, (HSA) flexible spending accounts (FSA) and health reimbursement accounts (HRAs) could save you money and help you plan wisely for unexpected health expenses. 

Health savings accounts are like personal savings accounts, but the money in an HSA can only be used for health care expenses. Both employees and employers can contribute to an HSA up to an annual amount limit, set by a statutory cap: @$3,000 for a single individual and @5,000 for a family. (

Employee contributions to an HSA are made on a pre-income tax basis and some employers arrange for contributions through payroll deduction. However, individuals own and control the money in an HSA. Once deposited, this money cannot be accessed by your employer or your insurer. The money is not taxed, and you can invest it in stocks, bonds and mutual funds. . Further, you don’t have to spend the money put into the account by year end or otherwise lose whatever is left. Money can be rolled over from year to year which enables you to accumulate tax free dollars that can be withdrawn at age 65.

 To be eligible to open an HSA,  you must have a special type of health insurance called a high-deductible plan.  High-deductible plans act like a safety net if you need extensive medical care. Like any health care option, HSA’s have advantages and disadvantages. When considering an HAS, you must review your anticipated health care expenses, your financial situation and how much control you want over your health care spending. If you're generally healthy and want to save for future health care expenses, an HSA may be an attractive choice. However, if you anticipate needing expensive medical care in the next year and would find it hard to meet a high deductible, an HSA might not be your best option.

The Flexible spending account is another tax-advantaged financial account and allows you to set aside a portion of your earnings to pay for qualified expenses, most commonly for medical expense but often for dependent care as well. Money is deducted from your paycheck into an FSA and is not subject to payroll tax, resulting in a substantial payroll tax savings. FSAs are commonly offered with more traditional health plans and do not require you to enroll in a high deductible plan. Most people who have an FSA use it to pay for medical expenses not paid for by insurance, usually deductibles, copayments, and coinsurance. Prior to January 1, 2011, over-the-counter (OTC) items such as bandages, rubbing alcohol, first aid kits, and other medical expenses not distinguished as a drug or medicine were reimbursable under health care FSA plans. The Patient Protection and Affordable Care Act changed the rules, allowing reimbursement for these items only when purchased with a doctor's prescription. FSAs can also be established to pay for care for dependents who live with you and need care while you are at work. This includes child care, for children under the age of 13, or for children of any age who are physically or mentally incapable of self-care, as well as adult day care for elderly dependents. The dependent care FSA is federally capped at $5,000 per year, per household. The minimum annual amount you can elect is $250 per account. One significant disadvantage to using an FSA, unlike the HSA, is that funds not used by the end of the plan year cannot be rolled into the next year.

Health Reimbursement Accounts are medical care reimbursement plans established by employers and used by employees to pay for health care. Employers typically commit to a specific amount of money to be available in an HRA for an individual to pay premiums and other medical expenses. Unspent funds in an HRA are usually carried over to the next year; however, employees do not take their HRA balance with them if they leave the job. HRAs are initiated by the employer and serviced by a third-party administrator or plan service provider. The employer may provide in the HRA plan document that a credit balance in an employee's HRA account can be rolled over from year to year like a savings account. This is an individual employer decision.

The money set aside in health savings accounts, flexible savings accounts and health reimbursements accounts provide a cushion and a comfort against unexpected health care expenses and are worth investigating. Choosing the right iteration is an individual decision based on projecting your health needs for the coming year. It is important that you arm yourself with as much information as possible to make the best choices. 

Sunday, November 27, 2011

Choosing Health Care Coverage: Issues and Options

As the year concludes, many of us are tasked with electing our healthcare plan for next year. External factors, not in our control, influence what our healthcare costs are going to be. The overall economic slowdown and rising federal deficit, has placed great strain on the systems that have traditionally financed health care, including private employer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. Since 1999, family premiums for employer-sponsored health coverage have increased by 131%, while real wages are growing at a much slower pace or have even stagnated in many industries.  

This is my year to switch from the healthcare plan provided by my husband’s law firm to Medicare Part B and a Medigap program.  I am making the change because I will save several thousand dollars, now that I have reached the magic age where I qualify for this coverage. Trying to figure out how to get the best health care benefits from what is available, and understand the rules and regulations presented in the Medicare Subscriber Handbook, Medicare and You, 2012 or on the website is akin to wading through Chaucer in old English. 

So I asked my friends and colleagues which plan they were using and why.  I talked with my healthcare providers to find out if there were Medigap plans that they would not accept, to determine which plans were going to allow me to keep the same physicians and hospital that I have been using for years. I spoke with several health plans and did an extensive comparison of their benefits and payment process. I read articles on the web and looked at plan ratings.  Armed with all that information, I made a choice that I am comfortable with.   

You also need to research your options if you are to get the best plan for you and your family. Among the questions that you need to ask when choosing your health plan are the following:

  • Does the plan provide the specific benefits and services tailored to your needs? Are those services available quickly and efficiently?
  • How much is the monthly premium and what does that total for a year?
  •  What does the policy cover for specific health events?  Does it include prescription drugs, out of hospital care, rehabilitation or home care? Does it include lab fees and emergency room visits? Do you have the option to see a specialist and what are the out of pocket costs?
  • Are there limits on the number of days insurance will pay for hospital or rehab services?
  • Are there some medical conditions that are not covered by the plan?
  • Are there waiting periods involved with coverage?
  • What is the deductible?  Can you lower the monthly premiums by raising the deductible?
  • Is there a maximum that you must pay out of pocket per year?
  • Is there a lifetime maximum cap that the insurance will pay?
  • Can you go to the physicians and hospitals best situated for you?  How easy is it to see a specialist?
  • How is the plan ranked against its competitors and by its subscribers?
  • Do members get the therapy treatments they need?
  • Does the plan provide preventive/wellness services?
  • Is the plan accredited? The National Committee for Quality Assurance (NCQA, evaluates and rates plans on several quality measures as does the Joint Commission on Accreditation of Healthcare Organizations (JCAHO  A visit to the websites of either of these organizations can give you rating information at no charge.

 Additionally, you need to make sure that the policy protects you from excessive medical costs that you might face, particularly if you have ongoing medical issues. Read the fine print to make sure there are no contingencies regarding what is covered and what is not.  Understand, as an outpatient and inpatient, the benefits and co-payments you are required to make, and whether or not there is an annual deductible before the policy will start to pay. Know exactly what may be excluded from your coverage (certain diseases, therapies, procedures) and understand the added benefits such as membership in a health club or an allowance towards a weight loss program.

(These points and questions and more are discussed in my book: e-Patients Live Longer, The Complete Guide to Managing Health Care Using Technology.)

Health care is no longer a given where you sign on the bottom line and are insured for another year.  It is a major item in your annual budget, and when those forms come across your desk, take the time to do the research, ask the right questions and read the fine print for a better, more economical and healthier New Year.

Friday, November 18, 2011

Is That CT Scan Really Necessary? Benefits vs Risks

Can you imagine a 100 year old woman experiencing her first mammogram? Or a healthy 80-year-old man who was left incontinent and impotent by radiation treatments for prostate cancer, a disease that typically grows so slowly that many men die with, but not of it. Every year, like clockwork, there are thousands of women in their eighties, who still get their annual mammogram and undergo screening colonoscopies at three- or five-year intervals whether or not they have had cancerous polyps that would warrant such frequent testing.  Every year there are thousands of men in their eighties who faithfully get regular PSA tests to check for prostate cancer and routine cholesterol screenings, which can lead to the prescription of statin drugs that require regular blood tests to check liver function.  (Typically, cholesterol plaque takes years to accumulate, and statins confer only a modest benefit in the elderly.)

The New England Journal of Medicine reported in March, 2010, that too many angiograms were administered to patients who do not really need them. Angiograms which are invasive imaging tests for heart disease carry a slight risk for stroke or heart attack during the procedure. (

The Journal   also reported in an article in September, 2010, Lessons from the Mammography Wars, © 2010 Massachusetts Medical Society, that there is a disagreement among physicians regarding the age at which to begin, and end as well as how often administer mammograms.  It had been assumed that for all women over the age of 40, breast cancer screening with mammography should be a once a year routine. The discussion continues to this day..
One has to wonder about these routine screenings for cancer and other ailments for people in their 70s, 80s and 90s, even at 100!. Many medical experts say there is little evidence of benefit, and considerable risk, from common tests for colon, breast and prostate cancer, because these tests often trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments leaving patients worse off.

What is the cause of perpetual over-testing that has little benefit to the health of patients and increases the cost of healthcare by an order of magnitude for all of us? Are these tests ordered by doctors who are trying to be cautious and avoid malpractice lawsuits? Or are they demanded by patients who are becoming more educated about what is available, and fueled by an attitude among US patients that,if a screening is available, it should be done whether or not it is needed?  A 2010 study in the Journal of the American Medical Association of more than 87,000 Medicare patients found that a "sizeable proportion" with advanced cancers continued to be screened for other malignancies. We have to ask whether this is good medical practice.

The New York Times reported in June 2011, that long after research indicated that CT Scans can expose people to dangerous radiation levels if done too frequently, Medicare was making payment for scores of elderly patients in hospitals throughout the country who were given two scans in succession on the same day – one using contrast to check blood flow and one that did not. This practice has been stopped, but many forms of over testing still occur every day.
.Why do doctors continue to screen elderly, ill patients?  What can patients do about it?
he Foundation for Informed Medical Decision Making offers some guidelines for e-patients who want to control their own destiny, avoid unnecessary, often painful tests, and be mindful of the cost of their care as follows:

1.  For all tests, ask two questions. What is this test for? And, what do you expect to find?
2.    For tests the doctor runs in the office (blood work, EKGs, MRIs), ask the questions above, and then ask what that test will answer that another test, already ordered, may not. Or, ask if there is a less expensive test, available that will supply enough information but not more than is needed.
3.    For all tests, ask when the results will be available, and ask that copies of tthe test results and records be supplied to you directly as well as to your doctor.
4.    Finally, ask the doctor about scheduling a time, whether by phone, email, an e-visit or in person, to discuss test results and treatment options before you agree to further tests and procedures.
Only you can assure that for every test or procedure you undergo, the benefit outweighs the risk.



Friday, November 11, 2011

Personalized Medicine Raises Issues of Cost and Efficacy

The seventh annual Personalized Medicine Conference was held this week at Harvard Medical School in Boston, hosted by the Partners Center for Personalized Genetic Medicine. Personalized medicine is founded on the principle of providing customized tailored health care to individuals based on their genetic makeup. This is achieved by sequencing the genome. This conference focused on the state of personalized medicine and the challenges and obstacles ahead concerning whole human genome sequencing. 

Everyone agrees that whole genome sequencing could potentially solve many complex medical issues, particularly in the field of oncology, and in many other areas as well. As one would guess, the main obstacle to whole human genome sequencing is cost. Keynote speaker Ezekiel Emanuel, Chair of the department of Medical Ethics and Health Policy at the University of Pennsylvania, lead with a spirited discussion on whether the cost of gene sequencing will ever be affordable and justified.

 Certainly, everything we do today in health care must be mindful of the cost of care. The very first Human Genome Project took 10 years and cost $3 billion USD (US Dollars). The next project took two years and cost just $300 million USD. Both projects were concluded by 2000 or 2001. Gene sequencing costs have dropped exponentially since then, to the point where today we are discussing the $1,000 genome.  Many predict the cost will, within several years, drop to a level of a few hundred dollars. That will make it totally affordable for many, particularly those individuals faced with a disease for which there is no known cure.

The second challenge to whole human genome sequencing is the issue of data analysis. The cost of sequencing pales in comparison to the cost of establishing the infrastructure and crunching the massive volumes of data needed to make sense of all of the variants in a genome profile.

A third issue is  what to do with this information.  Extensive physician education will be required to help providers make intelligent medical decisions using this information. And finally, there is the question of what consumers will do with their personal genetic data once it is available.

Although the naysayers may place obstacles and objections along the path, the train is out of the station and personalized medicine is moving forward. In my book, e-Patients Live Longer I project that in Health Care 2050 a digital health record will be issued for every newborn that will follow that individual throughout his or her life. After listening to the speakers at this conference, I contend, as well, that whole human genome sequencing by 2050 will become as standard for newborns as the PKU test is today and that it will benefit all of us.

The painful, costly investments that we must make now for digital health IT and for radical advances in diagnostics brought about the sequencing of the human genome will ultimately bring down the cost of healthcare and radically improve our opportunity to address a whole array of difficult health issues. We just have to have the foresight to see beyond the present and think long term.

Thursday, November 10, 2011

Cybercitizen 2011, American Consumers Managing their Healthcare Online

A study released last month  from Manhattan Research, “Cybercitizen Health ® U.S. 2001,”  which explores digital health trends among U.S. consumers, reaffirms that American consumers are managing their personal health using a variety of online health resources. The study is based on a randomized poll, conducted on the telephone and online, of 8,745 adults age 18 and over. Findings reveal that millions of consumers of all ages are now using the Internet to research health and medical information, many as their first option for health information, even before talking with their physicians. 

 Important to note in the findings is the marked increase in the number of individuals using wireless devices to access health information. This year Cybercitizen health ® U.S. 2011 revealed that 26 percent of U.S. adults use their mobile phones for health information and health aids. This compares with 12% in 2010 and 9% in 2009, and indicates that wireless devices are a major tool for finding and using health resources. As more mobile health solutions are developed to help people, not only access information, but manage and monitor health issues, these numbers will markedly increase.  For example, the study revealed that 8% of consumers used prescription drug refill or reminder services on their mobile phones in 2011, up from 3% in 2010.

Cybercitizen Health® U.S. 2011 also found that 56 million consumers accessed their medical information on an electronic health record maintained by their physician and 41 million expressed interest in doing so in the future. There are still a large number of people who are ambivalent toward electronic health records - 140 million consumers, according to this study, have not used and are not interested in accessing medical information on an electronic record.  However,  the growing numbers of people who are now interested in this access to their electronic record, along with an increased interest and usage among physicians, indicates a sea change in care delivery and patient engagement. Reinforcing the cyber health movement is the fact that increasing numbers of caregivers are using online health information and tools as well.

This significant and comprehensive annual study by Manhattan Research demonstrates the importance of online technology and wireless devices in helping American healthcare consumers become empowered and engaged in their health care and more personally involved in the day to day tasks that will keep them healthy.

Thursday, November 3, 2011

Smartphone Health Care Apps, An e-Patient's Most Valued Tool

The Pew Internet & American Life Project conducted a national telephone survey of 2,277 adults in May 2011 and found that 83% own some kind of cell phone. One-third of these cell phone users (35%) own a smartphone (iPhone, Android, Blackberry, Palm). These smartphone users utilize their mobile devices in new ways, incorporating them into their lives, accessing the Internet, sending photos and videos to others, going to twitter and engaging in video calls and chats.

Many of these smartphone owners have also downloaded one or more of the 17,000 health care apps currently available. Twenty-five percent of these apps are free. Research2Guidance, a consulting firm predicts that as many as 500 million people will be using healthcare mobile apps by 2015. Assuming that this prediction is correct, it means that people resonate to owning smartphones and empowering themselves as healthcare consumers with these interactive apps. Among the individuals polled for this research, 33% indicated that they want to manage their health records online and 32 percent said they want to have telehealth visits with their doctors.
Another study, by the consumer electronics Association, polled patients on their willingness to communicate with their providers using a smartphone or smartpad. In The New Role of Technology in Consumer Health and Wellness study, 36% of consumers say they want to be able to send information to their doctor wirelessly; 33% want to manage their health records online; and 32% want to have telehealth visits with their doctors for remotely based procedures and surgeries such as angiograms, head scans, CT scans, and skin cancer examinations.

Right now, consumers indicate that their favorite smartphone applications include:  body weight scales, vital sign meters and gauges, devices that record and track fitness programs and nutrition. Some of the newest popular apps are mobile for the iPhone, iPad and iPod Touch which patients can use to manage their cancer treatments. (This app covers 120 cancer types);  Asthma which is used to record asthma attacks, track medications and note triggers;  pocket first aid which provides education and instructions on CPR, chocking, burns, diabetic emergencies. It can also track family medical information, and emergency contacts. There are apps for testing visibility; apps that provide clinical data and check medication interactions, and apps that provide explanations of medical terms. 

More than any other single device or tool, the smartphone with its audio, video, built in cameras and access to the Internet right at your fingertips, has the capability to help patients take charge of health issues, engage more effectively with providers, and become  educated, empowered, and interactive in healthcare. So Power Up. Doing so could save your life.

Saturday, October 22, 2011

Health Information Exchange Enables Continuity of Care

George resides in Seattle Washington.  He suffers from asthma and high blood pressure, but these conditions are usually controlled with medication prescribed by his primary care physician.  George goes on a business trip across the country to Boston, Massachusetts.  He develops a pain in his chest and shows up in the emergency room at one of Boston’s major medical centers in the middle of the night.  He has never before been hospitalized and does not have a personal health record, his health history or a list of his medications with him.  He does not even remember the phone number for his PCP.  The ER physicians immediately do a cardiogram and see no indication of a heart attack.  They are puzzled and have no idea how to treat George without access to his medical information, medications, allergies, etc.

With extensive specialization in medicine, and continual changes in healthcare insurance coverage, most Americans receive their medical care from a number of different providers. In our current healthcare system, these consumers are encouraged to seek the advice of specialists and obtain second opinions. The different providers, all keep their own health record. Although those records may be digital, they typically cannot talk to one another. As a result an individual’s health information becomes stored in many silos. The solution is to establish networks of health information exchanges to enable mobilization of healthcare information electronically across organizations, within a region or community, and ultimately across the country. HIEs aggregate a patient’s record in a single data file that can be viewed by many primary care physicians, specialists, therapists and staff at diverse doctor’s offices, hospitals, pharmacies and  labs. The advantage to the patient is that there is continuity of care. The number of redundant tests is reduced, along with opportunities for medical error and misinterpretation of data.

Most Health Information Exchanges began as Regional Heath Information Organizations (RHIOs) that received their initial funding from grants to states. When the funds ran out, many of the RHIOs failed. Now, most RHIOS are being consolidated into state-wide networks. The ultimate goal is to create a national health information network NwHIN.  The technology is available, but funding issues and confidentiality of patient information hamper attempts to get this done.  The NwHIN represents a giant step forward in insuring that patient data is available at the point of care.  It also makes it possible to aggregate data to improve population health. 

For a more detailed commentary on health information exchange, see the recent article posted in the Journal of Participatory Medicine.

Monday, October 10, 2011

Brave New world of iPad Computing

After all of the discussion  and political debate about EHRs; the pros and cons, the deadlines, the training, the difficulty that so many doctors seem to have adapting their practice to a model that incorporates an electronic health record, and use of the computer during the patient visit, the world has changed once again. Enter the iPad.

In many physicians’ offices, patients arrive to find an iPad waiting for them where they can fill in current problems, allergies, symptoms, and medications with the touch of a finger. When the nurse takes the patient to an examining room to check vitals, that information is also recorded on an iPad. All of this data is instantaneously transferred to the doctor’s iPad and is available during the office visit. When the office visit is over, the doctor dictates notes directly into an iPad. The full set of patient data is then automatically stored in the patient’s electronic health record. Annoying issues of eye contact and personal communication with doctors who use desktop systems that can become a barrier to communication go away. The 1.3 pound iPad sits between the provider and the patient, can be seen by both individuals and does not become a diversion. 

iPads are also easy to use and maintain and do not require the learning curve or the overhead of larger computer systems that doctors have resisted for so long. Implementing an iPad-based electronic health record qualifies doctors for the stimulus money allocated by the 2009 Stimulus Package as long as they adhere to the meaningful use definitions. The Electronic Health Record software for the iPad is supplied by the familiar players:  Allscripts, Prima, Meditouch and Eclipse and other vendors who have been developing EHR software for years and have hopefully worked the bugs out of their systems.

In the brave new world of using IPads, physicians and hospitalists also take them right to the patient’s bedside where they can view the patient’s chart together and determine next steps. Doctors who make house calls to home-bound patients are using iPads loaded up with the patients’ electronic health records, x-rays, lab tests, and procedures, that they can share and discuss. IPads are even used today in emergency departments to track movement of patients and staff and record orders.

There is a downside to using an iPad that contains extensive patient data and can be carried in a pocket. Privacy of health information is serious. It is important that the data is encrypted, and that iPad users are diligent about insuring that their iPad is with them at all times, so it cannot be stolen. 

Did Steve Jobs ever envision that the iPad would become an important device in the delivery of healthcare? One can only wonder.

Monday, September 26, 2011

Talking to your Doctors, Getting What you Need

There has been a lot of discussion about patient/provider communication, partially driven by the move to electronic health records and the question of who has access to the contents of that record, and partly driven by a heightened awareness among patients that they must control their health destiny because basically no one else will. 

Some even contend that patients should have access to their lab reports. But let’s face it, most patients do not know how to read these reports, nor do they want to. To resolve this dilemma, and help patients become more empowered and engaged, they need   easy tools such as lists of questions to ask, when they are in front of their physicians and other healthcare providers, and a notebook to jot down answers. Some even need an advocate with them to help them understand and remember the physician’s instructions.

In Chapter one of  my book, e-Patients Live Longer, The Complete Guide to Managing Healthcare  Using Technology,, I provide  suggestions for the reader to think about regarding what outcome they want from a visit with the doctor; what characteristics make a good patient and key questions to ask during an annual checkup.

Just last week, the Agency for Healthcare Research and Quality announced that they had a Question Builder Tool on its website that outlines the kinds of questions patients should ask when seeing a doctor. Question Builder is a great tool for patients who know where to find it. Unfortunately not many people will search it out or take the time to go through all of the links and choose the questions that are relevant to their care.

 If providers really want to help empower their patients, and make their time with patients more efficient, they have to suggest these resources to their patient population.

Will this format for communication save time and money. You bet it will. The patient will experience fewer redundant tests, medication side-effects will be reduced and fewer errors will occur. Patients will be more compliant about following treatment plans and more educated about their health issues. This has long enough been discussed. Now is the time for action.

Tuesday, September 20, 2011

E-Patients Need to Strike Out against Hospital Acquired Infections

Empowered patients not only have to be good communicators, who know how to use the Internet for research and networking,  you have to be aware of what is going on around you and savvy enough to take appropriate action in situations where there are no specific  rules. That is what keeps you  empowered and in charge of your health. One example of that is to understand the dangers you face as a patient in the hospital, and   what you can do to address those dangers.  

Hospital-acquired infections (HAIs) are among the top five leading causes of death in the United States, striking 4.5 of every 100 patients admitted to a hospital. As an e-patient you do not want to be one of those statistics. A recent study released by the American Journal of Infection Control, (Sept., 2011, Vol. 39, Issue 7, p. 555-559)   reports that many of these acquired infections could be caused by bacteria and pathogens that linger on hospital staff uniforms .and other clothing worn by doctors, nurses and hospital workers.

 A team of researchers, led by Yonit Wiener-Weil, MD from the Shaare Zedek Medical Center in Jerusalem, Israel, collected swabs samples from the uniforms of nurses and doctors and found that fifty percent carried pathogens on their pockets, sleeves and waists of their clothing, particularly the scrubs and lab coats that they wore when they were in direct contact with patients. Other studies have found that hospital bed handsets, TV remote controls, cell phones of hospital staff were also found to contain biologic material that could be contaminated with disease-causing microbes.

It would seem obvious that hospitals need to go back to the practice of several years ago when they laundered the scrubs and lab coats used by doctors and other workers.   They also need to make sure that hospital issued clothing does not leave the hospital and come back in the next day,  and that street clothing worn by individuals who have direct patient contact need somehow to be sanitized each day. Additionally hospitals need to adopt programs to sanitize equipment such as bedside remotes, cell phones, and other electronic devices that patients and workers use, so they will not carry these pathogens around the hospital and spread the incidence of HIAs.  

There is also the issue of hand hygiene. Following the H1N1 scare, hospitals, doctor’s offices and other institutions, instituted stricter hand washing policies and installed hand sanitizer dispensers in key locations. They launched a major campaign encouraging people to be more diligent about hand washing, especially healthcare professionals who were in contact with patients or with lab equipment. 

There are steps that e-patients can take to avoid exposure, including:

1.    In your bag that you take to the hospital pack a large bottle of hand sanitizer and a disinfectant or wipes that you can use to clean the equipment around your bed. If you are too ill to do this, ask your advocate (family members or friends) to oversee this task.

2.    Be diligent about cleansing your hands and ask your doctors and nurses directly if they washed their hands  before examining you

3.    Check out the hospital where you are planning to stay. There are websites for that purpose such as: or

4.    Take direct action. Send messages to you hospital officials to advocate for safer hospital practices; Volunteer to work with hospital officials on initiatives that address this problem. Solicit other patients to get behind this effort.