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You Own Junk Bonds, Like it or Not - Opinion

In view of the recent events, I ran across the opinion article, written by a Venture Capitalist and just a small portion of some the content is below.  I looked to see what they currently had under management, in other words, investments and about 90% involves technology, interesting.  As everyone knows, and especially in healthcare and the biotech business, not much is getting done with the funds from the Venture Capitalists.  When receiving funds from a VC, they move in, in other words work as partners to bring the development process to where there is a a substantial gain for both sides, they want a return on their investment, which everyone does no matter where they invest, so the money is not just handed to a new upstart, there are strings, and rightly so.

We really do need intelligent people at the top, folks with at least some hands on experience as with the new move of transparency, the old methodologies just don’t work, ignorance is not bliss, and you can’t depend on what worked in the Ronald Reagan era of surrounding yourself with intelligent people and yet not have some of the “smarts” under your own cap, what if they lie?  Have we seen this?  Case rested.  image

We have seen and heard that one.

But yet, what they all seem to forget, there are a lot of very intelligent people around today, and lies and cover ups appear on the web every day. The intelligent people know how to mine data, run queries and analyze and put the transparent fact out there, duh?   Just read the news every day, and we have another “oh gosh” story. 

The folks with the data, true facts and who query and find the transparency in the world today are really the ones who have the potential to create some real inroads in all areas of our lives, but instead we keep getting figureheads that have no clue.  Just look where we are today. 

Everyone who is intelligent too is not always honest either and will work every angle for their own benefit, so how do you do battle with the ones who are not so honest?  Pretty simple answer there, make sure each side has a high level of intelligence so a real challenge takes place and not what we have today, politicians and a government trying to fight a battle with swords while the other side has machine guns to put it simply. 

Bill Gates has recently testified in front of Congress to relay this message too, but again with folks at the top not having any real hands on knowledge or experience for the most part, it all went over their heads and it easier to dismiss the technology folks as “geeks” and much of society follows that exact same path, they are just “geeks”. 

Denial is easy, but when the geeks come up with the transparent and real data, well it’s kind of hard to overlook when there’s big money involved and another “oh gosh” story appears, but we are so very distracted though too with wondering what Britney and other are doing as that is what is put in our face every day by the media, but it works for all those glued to the television and makes for water cooler discussion everywhere, every day and we keep getting fatter and just can’t figure out why our doctors are not having a bigger impression, duh?  We can’t blame it on them, and yet they are at much of the focal point here and come under scrutiny all the time on what they are doing wrong. Many people I run across don’t read much and rely on television for news and entertainment so without a varied level of sources, that is all they know, what is on TV. 

We have one Senator, a doctor too, that recently spoke out in an interview, but again he is only one person, but he makes some very good points.  Medicine is still a low tech business, a post I made recently that covers a lot of areas, including things like the FDA still using longhand paper reports among other items, well at this point it appears to me that our government is also a “Low Tech” business too. 

Like it or not the “R” word is coming back, Regulation and hopefully there might be a glimmer of hope somewhere along the line of getting some politicians engaged with fulfilling some time with learning a bit about software and business intelligence as it rules everything we do today.  The Venture Capitalists folks can tell you all about it, it’s a mainstay and priority in everything they do, so let’s get some business intelligence software knowledge involved and going in Washington for a change.

So due to the folks still running around with swords and relying on those around them to advise without some technology background and smarts themselves, we all own junk bonds.  BD

 

For many years now we've all seen the reckless use of taxpayer funds by Washington . This irresponsible and unaccountable waste of tax dollars has been particularly prominent during President Bush's tenure - from billions going to blow up bridges, roads and buildings in Iraq , only to rebuild them - to the Department of Homeland Security, which is no more than a joke. Meanwhile, America 's own infrastructure is in badly need of repair, with current estimates anywhere between $1.5 to $3 trillion and growing each day.

Has anyone asked where this money is going to come from? I guess it seems like a trivial issue given the current problems. But it's going to be a huge problem in the not-so-distant future. My guess is that Washington 's inability to pay for these repairs will ultimately lead to the privatization of the transportation department, prison system and many more services expected by taxpayer.

It's easy to forget so many of the devious and fraudulent activities of Washington , corporate America and Wall Street. When the media isn't distracting you with Britney Spears, Paris Hilton, Hannah Montana and O.J. Simpson, they are broadcasting shills and morons who lie about the real situation in the economy. Combine these smoke signals with the fact that Americans are struggling more than any time in at least the past three decades, and it's easy for people to forget the source of the abuse. I'm here to remind you.

Still, the abuse continues, from virtually every major drug company defrauding Medicare and Medicaid of billions, HMOs gauging prices and refusing coverage while employers shift higher costs to employees, CEOs destroying companies and leaving with dynasties, while the most fortunate segment of the working class continues the Bush-era trend of benefit cuts and no wage growth, while struggling to pay for food, gas and healthcare. Others have lost their jobs as corporations dump them for the cheap labor created by unfair free trade policies endorsed by Washington .

What kind of bozos are running this country? The only winners in this massive socialistic bailout will be the banks and the CEOs who will escape criminal prosecution.  My advice to those of you with children is to start looking to move to Asia, Latin America or Europe because America 's future doesn't look good. Unless you are wealthy, your children don't stand much of a chance to live the American Dream. Even I never would have predicted things to turn out this bad, and everyone was calling me a doom and gloomer and a nut two years ago when I predicted the collapse of Fannie, Freddie, the banks housing prices to decline by 30%, and the stock market to collapse.

You Own Junk Bonds, Like it or Not :: The Market Oracle :: Financial Markets Analysis & Forecasting Free Website

Tenet Completes Sale of Tarzana Hospital to Providence Health & Services - California

A for profit now becomes a not for profit facility, and Tenet subsidiary sells it’s interest in joint venture with HCP.  BD 

A Tenet subsidiary purchased the 245-bed Tarzana campus of Encino-Tarzana Regional Medical Center from HCP, and simultaneously sold it to Providence Health & Services -- California. These events complete the previously disclosed transaction announced on July 1, 2008. The related sale of the Encino campus closed on June 2, 2008.

Also, a Tenet subsidiary sold its interest in a joint venture with HCP. The proceeds of the sales, which were not disclosed, will be used for general corporate purposes.

     HCP, an S&P 500 company, focuses on properties serving the healthcare industry. The healthcare industry is growing and is expected to represent 16.6% of U.S. Gross Domestic Product (GDP) in 2008(1).

Established in 1985, HCP is a publicly traded company (NYSE:HCP) with $13.2 billion(2) in assets under management as of June 30, 2008. HCP’s management team, with an array of experience in real estate acquisition, portfolio management and development, actively manages our holdings. Our portfolio includes 706 properties located in 43 states and Mexico, as well as mezzanine loans and other debt instruments, distributed among distinct sectors of healthcare including: senior housing, medical office, life science, hospital and skilled nursing.

     Providence Health & Services is a not-for-profit health system committed to providing a comprehensive array of services to meet the needs of communities across five states, including Alaska, Washington, Montana, Oregon and California.  Providence continues the legacy of the Sisters of Providence and the Sisters of the Little Company of Mary in the West spanning more than 150 years.

Providence Health & Services includes 26 hospitals, more than 35 non-acute facilities, physician clinics, a health plan, a liberal arts university, a high school, approximately 45,000 employees and numerous other health, housing and educational services. The system office is located in Seattle, Washington.

Tenet Completes Sale of Tarzana Hospital to Providence Health & Services -- California - MarketWatch

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Desperate Hospitals – September 2008

An update on some hospitals financials and concerns. 

Redding, California

Hospital for sale, but not-for-profit buyer could jeopardize or break the city’s finances.

Given all that’s at stake in the sale of Shasta Regional Medical Center — a community anchor that employs hundreds and treats thousands when they are sick or injured — the fate of the downtown redevelopment district seems like a skinned knee in the emergency room.

But the city of Redding has legitimate financial concern about what kind of company buys the hospital. One-fifth of the property taxes that fund the downtown redevelopment zone could disappear overnight if a not-for-profit hospital giant such as Sutter Health or Kaiser Permanente took over Shasta Regional.

Freemont, California

Emergency room services outsourced. Other hospitals have done this as well to save money and keep budgets afloat. 

He attributed the recent increase to improved patient care from emergency care services. Earlier this year, the company was contracted to staff the emergency room, beginning in July. The group also serves Wood County Hospital and Mercy Hospital of Defiance.

Emergency care is the specialty of all the doctors and nurse practitioners who work for the company. ECS tends to hire physicians who are newly out of residency. When the patient volume rises, the Fremont staff can call in other physicians from the group to help.

Brooklyn, NY

Doctors are calling for a new board among other suggestions.

Doctors at a cash-strapped Brooklyn hospital want to sever ties with the hospital's parent company as a way of boosting revenue and saving a maternity ward that has been slated for closure.

The medical staff at Long Island College Hospital, in the Cobble Hill neighborhood, filed a plan with the state's Department of Health that would cut operating deficits by $20 million each year.

In July, the hospital's parent company, Continuum Health Partners, announced plans to shutter the obstetrics department in an attempt to stem medical malpractice costs and avoid bankruptcy.

Phillipsburg, PA

The area lacks a 24 hour emergency room and the hopes of re-opening the facility looking grim. 

During a brief hearing in U.S. Bankruptcy Court on Thursday, an attorney with the U.S. Trustee’s office said it appears that a possible agreement between the group that had run the hospital and a contractor looking into taking over the facility won’t work out.

“That doesn’t look like it’s going to come together,” said attorney Greg Lyons in response to a question from Judge Mary D. France about efforts to assign the hospital lease to another party.

Eisenhower Medical Center terminates Medi-Cal contract – California

The new California budget is finally done so hopefully money will once again begin to flow, as nothing has come from Sacramento since July 1st.  ER room patients will still be seen no matter what plan they have.image

It didn’t take even 24 hours for this statement to come out from this hospital after the budget announcement as the new budget still contains the 10% cuts for Medi-Cal which means a loss of matching federal funds potential.  So what happens when a major source of income for a hospital dries up, reduced staffing or services usually will follow. BD

Effective today, Eisenhower Medical Center is no longer accepting Medi-Cal patients that aren't part of an HMO or in need of emergency care, Chief Medical Officer Dr. Alan Williamson said.

The Rancho Mirage hospital terminated its contract with the state’s medical insurance provider for low-income, elderly and disabled patients after five months of negotiations.
“It finally became clear that they would not be able to come close to meeting what we needed in terms of covering the costs of taking care of the patients here,” Williamson said.
“It was a very difficult decision.”
Eisenhower was reimbursed $0.56 for every dollar spent on Medi-Cal patient, leading to a loss of $3.5 million every year, Williamson said.
“In today’s economy and today’s health care market, we really can’t afford to keep our doors open and provide for the rest of the patients here in our service area” with that large annual loss, he said.

http://www.mydesert.com/apps/pbcs.dll/article?AID=/20080919/NEWS01/80919027/1006/news01

Wrong Side Surgeries Again

I think every time we read about one of these stories we all just sit back and to some degree scratch our head, how did this occur again?  This hospital has had a few more than their share and has been in the news of late regarding this issue.

I am on the technology side of healthcare here, but in the midst of working I have conversations with many in health care, as it’s how I learn a lot too, so thank goodness conversation is always there.  If I never did any listening I would never have anything to talk about.

I had a conversation not too long ago with an assisting surgeon in the orthopedic area , who does this a few days a week in addition to running a family practice.  The physician was commenting on what was referenced as a particularly heavy day for knee surgeries and it was something somewhat new being done at the hospital.  From 7:00 am until 1:00 pm  there were 7 knee surgeries scheduled, all for the same surgeon and assisting surgeon.  Again, I understand that the depth and procedures of each one can and will vary from some being simplistic in nature to others being pretty complicated.

In just my thinking alone I thought 7 knees in 7 hours, well that seems like a pretty heavy workload, with the surgeon leaving and going to the next patient as soon as he was finished and leaving the assisting surgeon to finish and stitch up, which brings me to my question here, is there enough time for surgeons in between surgeries?  Each case is unique by all means, but does this allow the surgeon enough time to adequately prepare and read up before each procedure, and maybe one quick cup of coffee for good measure?  Of course there’s always the chance of complications too, but let’s say this was a normal day with nothing out of the ordinary. 

Sure there is a time out, which thank goodness is there by all means, but is there enough time out for surgeons sometimes in between surgeries to clear their head and prepare for the next case?  This I guess is more of a question of sorts as I think of every component that goes into preparation, the surgical staff, etc. and there is no doubt that the surgeon is very dependent on the accuracy of the work performed by others. 

Anyone is welcome to chime in here, but it was just something that I gave some thought, do they have time for a quick time out of their own for 5 minutes or so without a chart in front of them without disruptions before proceeding to the next patient and that could apply to the whole surgical staff for that matter.   Perhaps is this a contributing factor?  As humans we can all be physically present but our minds can be miles away.  BD

A doctor at the Miriam Hospital yesterday operated on the wrong knee of a patient undergoing elective surgery, despite the hospital’s increased focus on preventing such wrong-site surgeries.

The surgical team had apparently followed the key safety protocols, including marking the correct knee and pausing to verify the site before operating –– but somehow still made the error, according to Dr. Kathleen C. Hittner, hospital president and chief executive officer.

http://www.projo.com/health/content/WRONG_AGAIN_09-20-08_A0BLGVG_v15.17c4c47.html

Microsoft Hyper – V and Intel Virtual Technology

It has been a while since any Server related posts have been made, and this is a nice short informative video on the capabilities of Hyper –V, combined with Intel Virtual technology that is built in to the chip.  Not too long and a good brief summary so be sure and get that 64 bit server to really benefit.  Get some additional bandwidth.  BD

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http://www.youtube.com/watch?v=DAPdZ3PldKQ&sdig=1

Eclipsys to Acquire MediNotes Medical Records and Practice Management Software

It was just back in March that MediNotes purchased Bond technologies so the consolidation of technologies in the medical records business continues.  Rebranding to take place in time and this will add to the portfolio of ambulatory EHR products as I am guessing the MediNotes component might have some cost advantages over the in house Sunrise Care System, and this will give physicians at least another choice to select for integration with the Eclipsys system installed at the hospital. 

Just earlier today it was announced that a hospital in northern California has selected imageEclipsys for their hospital system.  It wouldn’t surprise me to soon possibly see Eclipsys to partner with either Google Health or Microsoft HealthVault in the near future, as the PHR is quickly becoming the tool that works to unite information together for the patient.  BD 

Eclipsys Corporation® (NASDAQ: ECLP), The Outcomes Company®, and MediNotes Corporation today announced the signing of a definitive agreement for Eclipsys to acquire MediNotes, a privately held industry leader in physician practice information solutions. 

Clinician PM includes a comprehensive and workflow-based dashboard, up-to-date information on appointments, patient and physician kiosks, current billing and accounts receivable status and more, viewed and updated in real time.

MediNotes, based in West Des Moines, IA, has practice management and electronic medical record (EMR) solutions in over 5,000 medical practices across the U.S. "Added to the clients that have chosen our Sunrise Ambulatory Care solution, this move will make Eclipsys a significant player in the clinic and physician practice market,” said R. Andrew Eckert, Eclipsys president and chief executive officer.

http://newsticker.welt.de/index.php?channel=fin&module=smarthouse&id=782694

Hershey’s Chocolate Makes an economic decision

Another economic decision, cocoa butter — the ingredient famous for giving chocolate its creamy, melt-in-your-mouth texture has been replaced with vegetable oil. image

The FDA definition of milk chocolate requires cocoa butter, so changes have appeared on the labels of the Hershey’s products that have vegetable oil and now say “chocolate candy,” “made with chocolate” or “chocolatey.”  Consumers didn’t like the new ingredient in Almond Joy, so the cocoa butter came back in that product, and there are some products that still have cocoa butter and one small bit of information is that it doesn’t raise cholesterol levels.

There are oils available which are equal to or better than cocoa butter in taste, according to the article, but I guess even our chocolate will never be the same, but the FDA said it was ok.  BD 

What’s going on here? On Friday, TODAY consumer correspondent Janice Lieberman reported that Hershey’s has switched to less expensive ingredients in several of its products. In particular, cocoa butter — the ingredient famous for giving chocolate its creamy, melt-in-your-mouth texture — has been replaced with vegetable oil.

The removal of cocoa butter violates the U.S. Food and Drug Administration’s definition of milk chocolate, so subtle changes have appeared on the labels of the Hershey’s products with altered recipes. Products once labeled “milk chocolate” now say “chocolate candy,” “made with chocolate” or “chocolatey.”

Whatchamacallit, Milk Duds, Mr. Goodbar and Krackel no longer have milk chocolate coatings, and Hershey’s Kissables are now labeled “chocolate candy” instead of “milk chocolate.”

http://www.msnbc.msn.com/id/26788143/

Hollywood Film Maker Goes to Washington

Watch this when you have time as it is over 30 minutes long, will make you stop and think a bit.  Very well done, but I wouldn’t expect less from a film maker.  Healthcare is covered here too.  Mr. Schneider goes to Washington.  BD

“Frustrated by Washington and his apathy towards it, I was finally shaken off my comfortable couch and compelled to storm to the capital of the worlds only superpower to find out what is going on with his government.”

“From education to health care, social security to taxes, foreign policy to gas prices, Americans interests repeatedly take a back seat to that of special interests.”

 image

http://www.youtube.com/MrSchneider


“A great watch. At the 32 minute mark Medicare Part D gets a mention.”


Hat Tip: Pharmagossip  (with thanks to Peter Rost.)

Things are getting tough – I had to join 2 HMOs last week stated the physician

I was speaking with a family practice physician this week on the east coast, and this is exactly what was said to me.  We were discussing some technology items as it relates to health care and about how things are evolving.  This physician has relied on both cash and PPO patients for quite a while, but again, as things get tough, income from an HMO was needed to keep things going with additional revenues.   He may not be alone out there, but as things get tough, so grows the number of patients to be seen to keep the practice open.  BD 

Also during the discussion we started talking about renting office space to other MDs, which reminded me of a couple posts done a while back.  This is a site whereby folks in the medical business can list office space they have for rent, and for those to look who are in the market for renting space.  Anyway, thought this was worth mentioning if you have space to rent or are looking, for medical office space. 

He still has the HMO issue, but he found this might be an alternative to help rent out the space he has available too.   BD

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As mentioned in previous posts:  In today’s challenging economic environment (especially for doctors, with falling reimbursement rates and rising expenses), ShareMedicalSpace.com is definitely a resource worth checking out. If you are a recent medical school graduate or a doctor who only wants to work part-time, and are not ready to invest tens of thousands of dollars in new medical space, equipment and staff, you can search for the “perfect” medical space on the website. 

For now, there is no cost to list your space on the site. So check it out while the service is still free (Dr. Weitzner expects to start charging for basic and premium listings after the summer).

http://www.sharemedicalspace.com/

Drugmakers Seek to Cut Red Tape to Speed Cancer Trials

This is probably a good move to speed this process up since many pharmaceutical companies have and are looking at moving more trials to India.

More information can be read here about the changing face of Pharma in reference to research and development. 

One more area to think about too is the use of technology with clinical trial reporting to get that on computer as much of the information is still being written and reported in longhand. 

Genomics also plays into this as well as far as the reporting functions as smaller groups can be used and information is gathered while the study is in progress, we are able to get the clinical information faster.

One other item that I mentioned this week too was the use of Personal Health Records in locating and finding participants.  This has a very promising outlook to cut down the chase and get the qualified candidates that the R and D process of the trial is looking for. 

Acurian is a service that helps find candidates, so combine some personal health records information from Microsoft HealthVault and Google Health Services to further eliminate non qualified candidates and you may have a real winner here too such as Trialx.org is working towards.  I would look for more involvement very soon with the agencies doing the qualifications and marketing for candidates real soon so perhaps a push from their direction as well for growing the personal health record too.  In the meantime I guess we shall wait and see what the committees come up with as far as any acceleration, otherwise to India and China many go.  BD

Want to start a cancer study? That could take some serious, time-consuming lawyering.

But soon academic researchers, hospitals and companies looking to collaborate on clinical tests of cancer treatments may be able to speed things along by using standardized contract language.

Earlier this week the Justice Department told the CEO Roundtable on Cancer that it didn’t see any antitrust problems in a consortium of companies working on boilerplate legalese that could save time in putting together study contracts. The National Cancer Institute is also on board.

http://blogs.wsj.com/health/2008/09/19/drugmakers-seek-to-cut-red-tape-to-speed-cancer-trials/

Allscripts Sells Marketing Subsidiary

Also, recently in the news with Allscripts due to the stock market this week there are other issues at hand not related to this sale with backing from Lehman and the merger with Misys on other technologies.   BD 

Physician software vendor Allscripts LLC will sell its Physicians Interactive "e-detailing" subsidiary for an undisclosed sum to Perseus LLC, a Washington-based merchant bank and equity investment firm. Terms of the acquisition, expected to close in early October, were not disclosed. Allscripts will have a seat on the board of directors of Perseus Acquisitions Holdings LLC.image

Allscripts Sells Marketing Subsidiary

Windows Live Services – Wave 3 – Free Download

Do you like Outlook, but don’t have MS Office, well Windows Live Services might be just the email client you may be looking for.  It installs on the desktop and looks very much like Outlook.  I use Outlook and sometimes I use the Windows Live Email Client.  Has the same familiar stack to access your calendar, contacts, etc. and it is all in synch.  I can open it on any computer and there it all is.

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I like the Live Services so well I also use Office Live as well.  More here.  To learn more about Office Live, go here for additional details.   For a small practice these services are ideal.  The Outlook connector mentioned with Office Live works and connects to your desktop applications too.  There’s a lot to say for Live Services and it keeps getting better.  BD 

 

All of this is free of course and works with Live on Line features.

New Live Photo Gallery

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Great new calendar…day, week, month views…

When you install Windows Live Mail, either for the first time or as an upgrade to an older version, go straight to Calendar.  For the first time, Windows Live has a complete, working, beautiful, and fun calendar.

First of all, it’s beautiful.  Clean, elegant, simple.  Even though it works in harmony with the online Windows Live Calendar, you’ll want to use the Live Mail version (and that’s the beauty of software + services!).

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AND IF YOU ARE A BLOGGER, WINDOWS LIVE WRITER…THAT’S WHAT IS USED TO POST THIS BLOG…WORKS GREAT WITH ATTENSA, MY RSS PROGRAM.

http://www.liveside.net/default.aspx?page=2

Hospital to Subsidize Doctors' EHRs - California

As I have posted in the past, hospitals today come in various shapes and forms, so doing better financially than others and those who still have the ability are moving forward to work with physicians to extend the electronic medical record to the ambulatory setting (the doctor’s office) to where the records at the physician’s office and those at the hospital will interchange and exchange data, and this is also a big plus for the physicians with the hospital being able to defray some of the cost involved for the physicians too, due to a relaxing of the “Stark” provisions that are now allowing this to happen.image

There are many ways in which this can be done, one is with a system installed at the hospital that will interchange and work with an ambulatory system and a second alternative, like the one mentioned here is an ambulatory system provided by Eclipsys, in other words a system all under one roof.  Like always, there are pros and cons to both types of systems, as some solutions may be incorporating some open source software along the line, again, a combination in order to create a fluid working system to get the job done. 

Basically what all this means, is software talking to software for the interchange and the ability of more physicians to embrace and use an EHR (electronic health record) to empower better documented healthcare.  Along with the hospital and physician side of this comes the PHR (personal health record) which also needs to have some communication levels with both the hospital and the physician.  I have written quite a bit on this blog about PHRs and a simple search here will bring up a lot of information and there are links to both Google Health and Microsoft HealthVault here all the time under resources.

PHRs will need to be linked as well, so as you can see this is a pretty massive project, no matter which way you look at it.  It also somewhat calls for a tighter and heavily involved working situation with the ambulatory vendors with the systems installed at a hospital, be it McKesson, Cerner, Microsoft Amalga, Eclipsys to name a few as the major players in the hospital technology departments.  No more is it sufficient to have a single standing operation in a physician’s practice that does not communicate with the outside world of healthcare.  This theme was very much in discussion at this years HIMMS convention in Orlando with pretty much all vendors agreeing on such.  image

Basically the call here is for everyone to get their software together to this can all come to fruition.  From the personal healthcare side of things for a simple example, Microsoft has established vendor meetings and conventions and continues to work with vendors who will, with the ok of the patient, be able to populate the chart information for us.  The PHR is somewhat in it’s infancy now, but will be a prime key element in the entire process, as with the information provided for us, as a consumer, this leaves very little effort on our part to add and change information, and we can update and correct information as we see fit though. 

Get referred to another hospital and want to take some records and information with you, not a problem with the PHR, as long as you give the OK and the facility at the other end has some basic technology that will take the data transfer.  Big problem here though is education and I find medical assistants, doctors, etc. that have no idea what a PHR is, thus perhaps time for a major education campaign as this is moving fast.

Again, good move on the part of this hospital and nice they are in a position to begin the transition however it occurs with their choices, but again this is one more calling to all software vendors to steady up those relationships and all work together.  BD 

The Community Hospital of the Monterey Peninsula will offer ambulatory electronic health records software to area physicians under relaxed provisions of the Stark Act and I.T. safe harbors to federal anti-kickback statutes. The Monterey, Calif.-based hospital will offer the Sunrise Ambulatory Care EHR from Eclipsys Corp., Atlanta. The hospital in 2002 implemented Eclipsys' Sunrise Clinical Manager suite of clinical software and Sunrise Patient Financials applications. Now, the hospital plans to integrate physicians' outpatient records with its inpatient records, providing all caregivers with an enterprise EHR, as well as clinical decision support.

Hospital to Subsidize Doctors' EHRs

Surveying Consumer Access to Rx Data

One more survey, do we really need to spend this money, I think we have a pretty good idea here that it is not many.  My personal opinion here would be to spend the money and enable and educate folks on how this can be done, rather than to see how many can’t, it’s an obvious. 

If the money were spend on an education campaign with showing consumers how to work with a personal health record, we imagewould be miles ahead to enable consumers instead of posting how many are in the dark, as a PHR process will enable this process and bring a greater awareness and continuity to the pursuit of better health care and better documentation that will favor all.  BD 

The federal Agency for Healthcare Research and Quality is seeking information on how many consumers can access their medication information online. The study is part of agency efforts to develop measures of performance of its initiatives to increase the adoption of health information technology. AHRQ also wants information available from various sources to measure the reduction in medication errors because of electronic prescribing. It also wants to measure the number of clinicians who can electronically access prevention and treatment guidelines and evidence-based clinical decision support. But secondary data isn't available to measure consumers electronically accessing their medication data, according to the agency.

AHRQ estimates the survey will cost $310,067 and is requesting Office of Management and Budget approval to conduct it.

Surveying Consumer Access to Rx Data

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Merck Outsourcing - Brings in Contract Sales Force

It appears from the article that the move is generated more towards called made on family practice physicians, as vaccines or drugs marketed to oncologists, ophthalmologists, or dermatologists will still be handled by in house sales representatives, so specialty drug representatives appear to be safe, well so far, who knows if this will grow. No doubt a cost cutting move and less employee benefits to worry about, and even Pharma has some big related expenses in the insurance department with employee insurance benefits. 

Will others follow suit, I guess that remains to be seen, but outsourcing whether it be sales, R and D, etc. seems to be the imagename of the game.  More about outsourcing clinical trials can be read here.  BD

A few months ago, Merck said it was cutting about 15% of its U.S. sales force — some 1,200 positions. Now the drugmaker says its bringing in some contract sales reps to hawk its drugs.

The company has formed a “strategic partnership” with inVentiv Health, a shop that does lots of sales and marketing work for Big Pharma.

Merck spokeswoman Amy Rose told Dow Jones Newswires that “rather than recruit, hire or keep full-time representatives on the books, we’re creating a more flexible approach so as the market demands, we can expand and contract the number of reps we have at our disposal.”

http://blogs.wsj.com/health/2008/09/19/after-cutting-us-sales-reps-merck-brings-in-contract-sales-force/ 

Amgen defends Enbrel after J&J wins trial – Pharma Wars

The battle of the “heartbreak of psoriasis”, my trial is better than yours!  BD 

A new Johnson & Johnson drug trial has put Amgen on the defensive. According to the 903-patient study, J&J's experimental drug ustekinumab (Stelara) proved more effective at treating psoriasis than Amgen's blockbuster Enbrel was. "We've never really seen clearance [of psoriasis] along the lines of what we've seen with ustekinumab," one of the trial's lead investigators told the Wall Street Journal. Amgen fired back, saying that the J&J trial only lasted 12 weeks, and so it didn't address the new drug's long-term safety. Enbrel has a "consistent safety profile," an Amgen spokeswoman said, and 16 years of clinical experience. It's true that the FDA is digging into links between the fungal infection histoplasmosis and TNF-alfa meds, but only 17 of the 240 cases occurred among Enbrel patients. Stelara works via a different mode of action than Enbrel does: It's an interleukin inhibitor, rather than a TNF blocker.

Amgen defends Enbrel after J&J wins trial - FiercePharma

Mission Hospital to Provide Concierge Services as a Patient Benefit - California

Mission is a part of the St. Joseph hospital system and from looking at the Best Upon Request website, they are not the fist hospital who has enabled the concierge service.  The best part of the service is that is complimentary.  I can see this evolving fast as family members are rushed today with schedules to keep and other family demands. 

I wonder how far the personal errands can go with this?  Let’s see can I have my dry cleaning picked up too?  Overall this sounds like a nice service though and something that should prove to be helpful as being a patient today in the hospital is not without it’s level of stress with everything you need to remember.  BD  image

MISSION VIEJO, Calif., Sep 18, 2008 (BUSINESS WIRE) -- Mission Hospital patients and their families now have access to an on-site concierge service provided by Cincinnati-based Best Upon Request to help reduce the stress associated with being a hospital guest. The complimentary concierge service is available to assist with making special arrangements for visitors, food requests, personal errand-running and more. "Imagine being admitted to the hospital unexpectedly and not having time to make arrangements for your time away," said Peter F. Bastone, president and chief executive officer of Mission Hospital. "Through our partnership with Best Upon Request, patients and their families have the benefit of a personal concierge to take care of the little things that make a patient's stay more comfortable.

Mission Hospital Contracts with Best Upon Request to Provide Concierge Services as a Patient Benefit - MarketWatch

Healthy Tanning Beds? Experts Say No

Well this may not go down well for the tanning business wanting to grow.   They say more studies should be done.  I did learn something here though, I had no idea there an International Tanning Association.  The American Cancer Society feels that indoor tanning is not safe either, and that patients should seek information from their physicians relative to Vitamin D.  image

Maybe John McCain, since he has battled skin cancer can help Sarah Palin out here a bit as this article states she installed a tanning bed at her own expense in the Governor’s Mansion when she took office, but I know they go months without sun up there. 

"It was done shortly after she took office [in early 2007] and moved into the mansion," Wetherell told the Narco News.”

The experts seem to feel that sun exposure, natural or tanning bed increases the danger of contracting skin cancer.  BD

Sept. 18, 2008 -- Health experts are fighting back against an aggressive campaign by the tanning industry to portray sunbathing and the use of indoor tanning beds as not only safe, but good for you. In a series of papers published today, leading researchers in the fields of melanoma research, dermatology, and cell biology call for greater regulation of the indoor tanning industry. Arguing that there may be no such thing as a safe tan, Society of Melanoma Research President David E. Fisher, MD, PhD, and colleagues accuse the industry of trying to confuse the public about the health benefits of tanning.

International Tanning Association Executive Director John Overstreet accuses the authors of the newly published reviews of making "irresponsible assertions without providing any concrete link between indoor tanning and melanoma."

Healthy Tanning Beds? Experts Say No

Microsoft Aims to Redefine ‘I’m a PC’

Preview of new Microsoft ads, and guess what “I am a Tablet PC” 

They are not dead by any means and everyone who reads this site knows I use mine daily, in the office, away from the office and for taking notes in meetings.  Check out the Tablet PC Section of this site to find out more.  BD 

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http://www.nytimes.com/2008/09/18/business/media/18adco.html?pagewanted=1&_r=2&partner=rssnyt&emc=rss

When Pay for Performance and $4.00 Generic Prescriptions Hit the Wall –Reuters

Medical Quack on Reuters. 

Now this is a sad state of affairs to be the prudent consumer, and yet you are potentially taking money out of your doctor's pocket by doing so when it comes to pay for performance for them, so what's up with this when purchasing $4.00 Generic Drugs.  BD

 

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Investing Blog Posts

Google Health adds the “Free” E-Prescribing Program from Allscripts to the Health Record

It is interesting in the last few weeks, since the 2% increase in payments for those physicians who use e-prescribing is getting close about the number of inquiries I have received about “how do I do this”. I have had the link for NEPSI on this site under resources for over 2 years, but now that there is a little money involved, the questions come.

This is a free service to any physician that signs up and there is a mandatory online training session, and that’s where I have seen this hang up, those not willing to take a few minutes out for training, they sign up, and that’s the end of it.

You also have another option to consider a full on medical records system at this point, which will bring everything under one digital program, so now might be a good time to give this some thought, in view of the Google Health Record update today. Microsoft HealthVault is moving in the exact same direction, so look at one of them at least.

Put very simply, the records from the e-prescribing program can now go in to the patient Google Health account, so your patients will have a record of their medications and allergies, in their files, so soon patients who have a personal health record will want this so they can have the information available to access. Time to bone up a bit here. Here’s the information and link in case you can’t locate it on the blog.

Also, in case you missed it, Quest Labs can do the same with lab results with Google Health, so now we have labs, meds and allergies that can auto populate the personal health records for patients. BD

Allscripts LLC has completed integrating its ePrescribe electronic prescription software with Google Health from Mountain View, Calif.-based Google Inc. That means physicians using the software can enable patients to import their medication history, allergies and medical conditions into their Google Health personal health records. Swedish Covenant Hospital in Chicago is enabling patients with Google Health PHRs to import their medication data.

Free Script App Tied to Google Health

As personalized, genomic medicine takes off, four developing countries show the way for others

No we do hold the monopoly on this technology in the US, and this article brings to light that genomics is a global concern and effort.  BD

Developing countries that want the benefits of cutting-edge health care possibilities based on the genetic variation of individual citizens and sub-populations need to foster the new science at home, says a major new Canadian study published today by Nature Publishing Group. In a special six-paper supplement of the journal Nature Reviews Genetics (NRG), researchers from the McLaughlin-Rotman Centre for Global Health (MRC), Toronto, say four countries with emerging economies -- Mexico, India, Thailand and South Africa -- are showing the way for others in similar economic circumstances.

As personalized, genomic medicine takes off, four developing countries show the way for others

Despite Regulatory Changes, Hospitals Cautious in Helping Physicians Purchase Electronic Medical Records

Well I think a few words might sum up this entire report, “Show me the money” might be some word echoed by hospitals.  I visited a hospital this week and they are keeping the lights and basics going only, why, because we have no budget for the State of California and nursing homes and other businesses are closing as a result.  No budget means no money for Medicaid compensation and it has been a long draught and folks are running out of money, no possibilities for extended lines of credit and it is possible the governor is going to veto the bill? 

I think this is one huge reason why hospitals are not subsidizing physicians, same old story.  About 50% of the hospitals border on insolvency now and you can catch up and read my series on “Desperate Hospitals” for more facts and information.  There’s also the new Medicare rules coming in to play on October 1st about the “never-never” rules they are concerned with, so I think all in all they might have some other pressing issues at hand before considering the medical records issue.

If you look here, even the folks at Harvard are looking to Venture Capitalists for funds, and thank goodness those folks are around so advances can take place, so again there’s this big issue called money and this group is  very pro active in working on this solution for the physicians in their area, so again we can analyze all we want, but “Show me the money” is the big issue. It folks can do wonders if the funds are there for them to work with.  BD 

While hospitals are evaluating strategies to help physicians purchase electronic medical records (EMRs) following recent federal regulatory changes, they are proceeding cautiously, according to findings from the Center for Studying Health System Change’s (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Hospital strategies to aid physician EMR adoption include offering direct financial subsidies, extending the hospital’s ambulatory EMR vendor discounts and providing technical support. Two key factors driving hospital interest in supporting physician EMR adoption are improving the quality and efficiency of care and aligning physicians more closely with the hospital. A few hospitals have begun small-scale, phased rollouts of subsidized EMRs, but the burden of other hospital information technology projects, budget limitations and lack of physician interest are among the factors impeding hospital action. While it is too early to assess whether the regulatory changes will spur greater physician EMR adoption, the outcome will depend both on hospitals’ willingness to provide support and physicians’ acceptance of hospital assistance.

http://www.hschange.org/CONTENT/1015/?PRINT=1

CCHIT Offers PHR Web Site – Personal Health Records

This might be of interest if you want to learn about the certification process of Personal Health Records, also known as a PHR.  Medical record software used by physicians and hospitals have gone through the process for a number of years, in other words a committee to certify that the software one is purchasing will have the capabilities and options as advertised.

There are both free and personal health records that you pay for.  In my travels, it is amazing to me in the fact that even medical practices are not familiar with Personal Health Records.  I publish a lot of information in that respect on this blog, so you can do a search to find out more, and there are permanent links to both Google Health and the Microsoft HealthVault on this page as well.image 

The one large benefit coming to a PHR is the efforts of having most of the information pre-populated for the patient, as none of us have time today to sit down and create a record, much less have the accuracy of files that are imported into the file.

Personal Health Records will also have the ability to exchange data with those records kept by a physician, lab, etc.  Recently in the news Kaiser and Microsoft have entered into an agreement to have the medical records imported to the Microsoft HealthVault.  The vendor list for both Microsoft and Google Health is growing as more and more vendors are coming online.  The HealthVault recently signed on a new vendor that will enable consumers to opt in if they are interested in participating in clinical trials, so this makes it easy for the consumer to be alerted to any potential trials they might be interested in without a long time consuming search of the internet.  The certification process for the consumer side of healthcare software is just in the beginning phase.  BD 

The Certification Commission for Healthcare Information Technology will launch a new Web site and blog on Sept 29 focused on issues involved in personal health records.  CCHIT will host a “town hall” teleconference on Oct. 10 to enable consumers and consumer representatives to gain a better understanding of PHR certification and how they can get involved. To participate in the meeting, to be held at 3 p.m. Central, call 1-877-313-5342 and use ID number 65204557.

CCHIT Offers PHR Web Site, Blog

Colonoscopy Without the Scope – Study States CT Scan is Effective

The debate over Medicare paying for this procedures has been up in the air for years, but now I believe the cost as well as convenience issue is starting to come together.

imageCT Scanners have had this service available for years and it certainly is much easier for the patient, hands down.  There is a time and place for both.  So what does it look like and what is involved?  One of my clients, Advanced Body Scan of Newport Beach has a page on their website that answers many questions and even has a video of what the procedure looks like in 3D and a page with some frequently imageasked questions.  

Visit the website to watch a video of how it looks from the camera side of things.   BD

“Although this test does not require a physician referral, it is recommended that you consult with your physician to discuss your personal recommendations for a colon examination.”

ATLANTA - A long-awaited federal study of an X-ray alternative to the dreaded colonoscopy confirms its effectiveness at spotting most cancers, although it was far from perfect.  Medicare is already considering paying for this cheaper, less intrusive option that could persuade more people to get screened for colon cancer. And some experts believe the new method may boost the 50 percent screening rate for a cancer that is the country's second biggest killer.

Colon X-ray seen as effective at spotting cancer - Yahoo! News

USB 2 Digital High Resolution Microscope – ProScope HR

I ran across this and immediately I could definitely see healthcare applications written all over it, labs, or anything you might normally put under a microscope and at 249.00, such a deal.  

imageThere are several videos at the site and it’s not going to break the bank.  I think of how many times a imagephysicians has looked at either a cut, scrape or a mole that I questioned and thought boy this could really help in seeing much more.

It can be used and not have to touch the surface at all, or you can use the touch portion or use a tri-pod to mount.

   The software works on both Apple and Window operating systems. 

The unit is used at universities and has several lens attachments.  Again, this item could be used at any practice or office.  Being hand held gives it a lot of flexibility and forensic investigators use the product at crime scenes as well.  BD 

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http://www.bodelin.com/

Group Posts E-Mail Hacked From Palin Yahoo Account

 Ho- hum, another technologically challenged candidate, it keeps getting better, although I don’t wish this on anyone by any means and hope they find the violator, but good grief, perhaps the FBI or some other government agency might help folks in limelight understand what “encryption” means, and explain where and how you can get a secure email account, lots of them out there and the FBI and many other government agencies use encryptionimage Security breach story of the week. 

If one is in the public eye, it might not be a good idea to rely on a free web email account to send some of your most sensitive information as one is almost a walking target, so and “F” for technology knowledge here and shoot, how many others do this.  If you have a personal account, keep it that way and refrain from doing business from a non-encrypted email account.

Any doctors reading here?  If you do any email correspondence with patients and there is any matters that fall under privacy, better not be using a free non-encrypted email account.  GMail has a free secure service as a simple example and you can upgrade your Yahoo account for secure services, think about it.  You may not be as big of a moving target as Palin, but you don’t want to gamble, plus there’s HIPAA to think about.  BD 

Vice-presidential candidate Sarah Palin's private Yahoo e-mail account was hacked, and some of its contents posted on the internet Wednesday. The internet griefers known as Anonymous took credit for the intrusion, and screenshots of e-mail messages and photos belonging to the Alaska governor have been published by WikiLeaks. Threat Level has confirmed the authenticity of at least one of the e-mails.

Group Posts E-Mail Hacked From Palin Account -- Update | Threat Level from Wired.com

Ranbaxy Finds Rudy Giuliani is for hire..

The story keeps getting stranger by the day.  A little recent history can be found here.  The US is only 2-3% of their entire market so most pharmacies have already found other supplies, such as Walgreens did a few months ago when things started brewing.  Will this soon be a Japanese owned business?  The proposed purchase as stated below is not affected by the recent activities taking place in the US.  BD 

“Japan's Daiichi Sankyo Co., which is awaiting Indian government approval for its $4.6 billion bid for Ranbaxy, said the move won't affect the proposed deal. "We are implementing the [takeover] procedure as planned," a spokesman said.”

The Indian generic drugmaker, which is under investigation for allegedly falsifying records that resulted in the production and sale of generic meds that didn’t meet FDA standards, has hired Rudy Giuliani “to provide advice and review compliance issues,” according to a statement this evening.

This is the second time the former New York City mayor has acted as a paid consultant to a troubled drugmaker. He also worked for Purdue Pharma, which was fined for its Oxycontin marketing, and he helped negotiate a deal with federal prosecutors that kept company execs out of jail. Ironically, when he was a US Attorney in Manhattan, Rudy didn’t hesitate to send junk bond dealers to jail because they preyed on the system. Of course, Rudy is a private consultant now and paid to serve his clients.

http://www.pharmalot.com/2008/09/ranbaxy-hires-rudy-giuliani-to-fend-off-feds/

Medicare rules ban cold-calling by insurers and will use “secret shoppers”

There is a potential fine for violators and they cannot initiate the call, the consumer has to initiate, but once that is done then it is pretty much up to the consumer once more to make that bone crushing decision, as it’s not getting any easier or imagesimpler to choose.  It’s shame this has to be such a daunting process that is not only confusing, but it so fragmented and nobody really knows what they are getting until they need service.  Let’s hope the “I Spy” program helps to at least keep things from getting as far out of hand as they have in the past. BD  

The regulations will go into effect Oct. 1, which is when insurers can begin marketing their plans for 2009. Among the changes mandated by Congress are:

_No unsolicited contacts with beneficiaries, such as visiting their home or calling them. The prospective customer must initiate the contact.

_No selling of other insurance products, such as annuities or life insurance, to beneficiaries.

_No free meals at promotional or sales events.

_New requirements for training or testing of agents.

Medicare rules ban cold-calling by insurers