With beginning of 2012, DocAsap proudly announces the launch of fully revamped website at DocAsap.com.  The new website is designed to be more users friendly while continuing to help patients get timely doctor or dentist appointments.

The streamlined site structure and navigation ensures that all information is just one or two clicks away. By enabling patients to quickly research medical practitioners and reserve appointments instantly online, DocAsap seeks to radically expedite and simplify the process of seeing a doctor or dentist.

New components of the website include:

• Differentiated UI experience with enhanced usability and navigation flow
• Enhanced search and filtering capabilities to enable finding the right doctor in the easiest way
• Comprehensive , dedicated web pages for Doctors and Practices to enable easy single point access to all required information

DocAsap.com has always focused on helping patients get timely care. Users can quickly search doctors and dentists, review provider’s bios and validated patient reviews, filter appointments that best match visit reason, insurance, schedule and location requirements and book instantly using a robust and intuitive website. DocAsap.com then manages all email and phone reminders as well.

The average wait time for core specialties in Philadelphia is 25 days surveyed by the firm Merritt Hawkins & Associates. And for some specialties such as dermatologists and obstetrician-gynecologists the wait time is around 45 days.  With DocAsap, patients are able to get timely appointments, majority of DocAsap users’ book appointment within one or two day.

For Medical practices DocAsap’s helps getting new patients. It reduces improves patient experience through 24X7 convenience of appointment scheduling. Additionally, DocAsap greatly reduces manual scheduling work done by the practitioners and their administrative assistants.

Currently, DocAsap is offering timely appointment with primary care physicians, obstetrician-gynecologists, psychiatrist, Pediatrician and dentists in Greater Philadelphia area and provides access to top doctors including University of Pennsylvania Health System.

We are super excited to begin this new year with much hope and success.

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Health care in the United States costs around $2 trillion annually, or 16 percent of GDP. So there’s a lot of concern about what will happen as those costs increase. That has led to three seismic shifts in health care; prevention, transparency and quality care.

We all know that prevention is better than cure, but are we practicing it? We all know that, to reduce health care costs, while still improving quality we need to reduce the burden of disease on the system.  Forty percent of the premature deaths in the United States are caused by obesity, inactivity, and smoking, all of which ought to be preventable. So a natural starting point is to help people stop smoking and help them lose weight.  There are many companies who don’t hire smokers; some good examples are set by Disney CEO Bob Iger who decided that there would no longer be people smoking in films made by Disney. He can easily get other producers to do the same.  As far as inactivity is concerned, people have to understand that they need to get up and move around more or their whole body will start to deteriorate…there is no other option.

Many health systems are taking initiatives to bring in transparency through patient portals as they understand that patient’s information belong to the patient and he has right to have that information. myPennMedicine was launched by Penn Medicine recently to increase patient’s accessibility. In addition to that, Penn Medicine is moving towards open access scheduling, and have already started utilizing online scheduling to offer convenience of online booking and same day appointments to its patients as well as to bring operational efficiency into the system.

Now an informed patient wants same experience from the health care provider as he gets in a restaurant or a spa.  He forms his opinions and talks to people about that experience.  And if patient volume is the concern than we think that it can be solved by addressing the aforementioned seismic shifts.

We all say that “exercise for health”, but why it is so painful?

There are many intense home fitness program such as Insanity, p90 and P90X, sometimes people get super excited and wants to get in shape overnight.  One of our friends did the same thing and instead of taking it slow, she jumped on the most intense level of p90x.  She gave her best to sustain those grueling 60 minutes for 3-4 days in a row.  Than as expected she found herself in extreme pain…generally when we subject our muscles to intense training, we tear the fibers. So what exactly happened with her?

Interestingly, there are two types of muscle soreness; one which happens during the workouts as the fibers experience more and more trauma, to prevent us from seriously damaging the tissue beyond repair the body begins to produce some serious byproducts, mainly lactic acid.

The other muscle soreness happens after working out called delayed onset muscle soreness (DOMS).  It begins 24 to 48 hours after exercise and peaks at 48 to 72 hours So what is likely happening is when you contract the muscle hard the body tells it to do so but when you stop the signal to relax is a little slow getting there. During this point in time the muscle stays contracted, cramped, and you experience the pain of a hard contraction and the burn from the waste products on the damaged fibers.

So things that can be done to prevent muscle soreness are: adequate hydration as body lose electrolyte during intense workouts so it is important to stay hydrated.  Stretching exercises help to lengthen the muscle fibers and is especially useful for muscles which are prone to cramp up, and eating right is most important if you want to reduce muscle cramps, add milk, fresh fruits, and oats in your daily diet.

All in all, we think it is healthy and good for muscle growth to experience muscle cramps every now and then, just as long as the involuntary cramps are not ruining your workouts.  So keep on doing it, may be take slow when your body demands.

An insured patient checking out form the physician’s office paid $100 for just 10 minutes with the doctor.  What exactly this $100 covers? Why patients get shocked seeing this type of bill? Here is what that $100 is covering…

• First, doctor office schedules an appointment. It took several people to take the message, pull the medical record (paper charts), call the patient to assess the problem, determine the need for the appointment and schedule it.
• When the patient arrives, staff double checks the patient’s contact info and insurance details to make sure that it is updated on the file.  The nurse gets notification of the patient’s arrival.
• The nurse called the patient from the waiting area, measures blood pressure and weight.  And then patient goes into the exam room where nurse again takes vitals, make notes around the visit reason, medication, last visit, etc.
• The physician came in to see the patient, asked about any changes since last been seen, reviews history of present illness and examines the patient. He talks about the illness and the treatment plan and prescribed a medication. He updates patient’s medication list and makes a copy of the diagnosis form and hand it out to the patient for the records.  The patient goes to the check out desk.
• The physician refiled the medication reconciliation in the chart, finished documenting the visit, and placed the chart in the bin to be refiled.  The chart was filed, and the encounter form was sent to the billing office.
• At the billing office the charges and any payment gets posted and the claim was filed.  If there is no problem with the claim, it electronically gets processed.
• If payment was not denied, the payment arrives at the billing office and would be posted.
• If patient did not pay at the check-out desk, the patient-responsible balance is billed to the patient.  If the patient pays on the first statement, it has taken 45 to 60 days to receive complete payment.

The 10 minute office visit involved the work of the phone operator, the medical records clerk, the triage nurse, the check-in person, the nurse, the doctor, the check-out person and the biller.  It took 8 people, and at least 45 minutes of work to make that appointment happen.  In addition, that visit paid the expenses for the rent, the utilities, malpractice insurance, medical supplies, computers, phones and janitorial services.  We all want efficient and quality health care but it is not cheap.

Thanks to KevinMd for giving this useful insight.

The new survey by Wolters Kluwer Health shows that 46 percent of doctors frequently use sites like Google and Yahoo for treating, diagnosing or caring for their patients; 68 percent of doctors dig through professional journals and 60 percent of doctors seek their colleagues advice, 42 percent get their information from conferences and events,  and 42 percent say they use online health sites like the Mayo Clinic and WebMD and 46% use general browser such as Google and Yahoo as a frequent source of information.  Nearly 9 in 10 physicians feel that improved access to online medical information and resources has improved the quality of care at their practice

The survey findings also note that “63 [percent] of physicians report changing an initial diagnosis based on new information accessed via online resources/support tools,” researchers wrote in the survey report.  The survey involved responses from more than 300 doctors who are members of the American Medical Association; about half of the respondents were primary care doctors, and the other half were specialists.

In 2006, the British Medical Journal published a study showing that Google is a useful tool in doctors’ toolkits, especially when it comes to difficult-to-diagnose illnesses. In that study, doctors plugged three to five search terms into Google of 26 diseases that are notoriously hard to diagnose (including Cushing’s syndrome and Creutzfeldt-Jakob disease).

Researchers found that Google was right 58 percent of the time in diagnosing the diseases, though they acknowledged that the person doing the Googling needs to also have a wide knowledge base in order to know what to search for.  As the Wall Street Journal points out with regard to the most recent survey:  No one says Google and Yahoo don’t lead people to tons of useful info — just that it can be tough to sort the wheat from the chaff. Physicians, presumably, can assess the quality of the health information they dig up better than the average consumer.

Doctors aren’t the only ones Googling health info — a Pew study shows that 61 percent of Americans go online for information related to health. This new disruptive technology which is offering autonomy and access to information can help both patient and the physicians in achieving better clinical outcome. It would improve doctor-patient relationship as well as patients would get more if they show up at the doctor practice with little more planning and information.

Hospital admissions for elderly US patients with heart failure fell by nearly 30 percent over a decade, an analysis of federal Medicare data shows, a surprising finding that offers fresh evidence of progress in the battle against cardiovascular disease. The report, being published Wednesday in the Journal of the American Medical Association, is the first to document a decline in admissions in the US for the condition, an enormously costly and debilitating problem and the most common reason for hospitalization among Medicare beneficiaries.

The finding is based on data from more than 55 million patients in Medicare’s conventional fee-for-service program who were hospitalized for heart failure between 1999 and 2008. Researchers estimated there were 229,000 fewer admissions for heart failure in 2008 than would have been expected had the rate of admissions remained at 1999 levels.

As a result, the Medicare program saved $4.1 billion in hospital costs related to heart failure. Heart disease overall is still the leading cause of death in the US, and this latest research comes with caveats. For heart-failure patients who were admitted to the hospital, death rates one year after that hospitalization fell only slightly—to 29.6 percent in 2008, the last year of the decade covered by the study, from 31.7 percent in 1999.

Hospitalization rates also varied significantly by state, and the improvement for black men was smaller than that of other groups. But the gains, coming as the population ages and as obesity and diabetes—both risk factors for heart disease—are enormous public-health concerns, were a welcome surprise to some heart experts. Many attributed the improvements to better preventive measures and disease management, as well as a reduction in elderly patients’ rates of heart attack—a common cause of heart failure. About 5.8 million Americans are diagnosed with heart failure, according to the American Heart Association, which estimates that total costs for treating patients, including associated indirect costs, were $39.2 billion in 2010.

Source: Wall Street Journal, health industry

Hospital emergency departments are turning to a number of strategies to reduce wait times, amid growing concern about patients who leave without being seen.  Leaving without treatment can lead to lost revenue for hospitals and health risks for patients.  The national average of those who leave without being seen was about 2.7% in 2007-08, according to the most recent government data available. This is up from 1.7% between 1998 and 2006, according to an analysis by Johns Hopkins University researchers

“People who walk out without being seen are a measure of how we are basically failing as a health system in our ability to deliver important care in emergency departments,” says Renee Hsia, assistant professor of emergency medicine at the University of California San Francisco.

A recent study she led that was published in the Annals of Emergency Medicine shows the left-without-being-seen rate in California ranged as high as 20.3%. Visitors to hospitals serving a high proportion of low-income and poorly insured patients were far more likely to leave without being seen.

Hospitals are tackling a costly side effect of emergency-room overcrowding and long wait times by turning towards “lean” management techniques to speed patients more efficiently through the ER. Following are some effective measures:

1. Posting wait times online or in the waiting rooms at different facilities so patients can chose the shortest option. Akron General Health System in Ohio went one step further last year and began providing live streaming of wait times on highway.
2. Streamlining the traditional methods of triage and reserving beds for only the sickest patients, abandoning the longstanding rule that every patient gets a bed.
3. Staffing the ER with less-costly providers such as nurse practitioners and physician’s assistants, so more expensive ER doctors can focus on care and not on paperwork and discharge plans.
4. Allowing incoming ER patients to be quickly identified and tagged with a bar code linked to a new medical record. Rather than try to create a full medical record, patients were directed to the nearest available emergency room bed immediately after they were triaged as mentioned by Dr. Ted Chan, who works in the ED at the University of California, San Diego, Medical Center, where the average wait times for emergency patients hits two hours during peak demand periods

In addition to aforementioned measures, new protocols such as qTrack designed by department of emergency medicine at New Orleans-based Ochsner Health Systems relies more on providers like physician’s assistants for less-ill patients. Unlike traditional triage, which might take 10 minutes, qTrack has nurses giving a “quick look” evaluation to get basic information in three to five minutes.

A similar program, Door to Doc, which includes a model hospitals can use to match staffing levels to peak-demand periods, was developed by Banner Health, which cut the rate of patients who left before being seen to 0.5% from 8% in 2007.

A new form of E.coli (Escherichia coli-STEC) is causing lot of trouble in Germany, so far 17 people have died and several got infected.   It is causing bloody diarrhea and affecting Kidneys and considered to be “highly infectious and toxic”

As recorded by BBC, Dr Dilys Morgan from the Health Protection Agency says the E. coli outbreak is “alarming, it mainly affects young children and older adults, but what we’ve seen is predominantly young females getting this condition. It’s a very rare organism that’s causing this and it’s thought it has particular properties where the toxin it produces is particularly virulent and therefore is affecting this population more than we would normally expect.”

Professor Hugh Pennington, a microbiologist from the University of Aberdeen, said: “This outbreak is unusual in that it doesn’t seem to be targeting young children, usually children under five have had a very hard time with this kind of bug in the past, they seem to be escaping it, maybe just due to the nature of the food that’s causing the problem.”

According to the Centers for Disease Control and Prevention, to prevent Shiga toxin-producing E. coli (STEC) infection, you should just follow these simple things:

• Wash your hands thoroughly after going to the bathroom or changing diapers
• Wash your hands thoroughly after handling animals, animal bedding, or any material contaminated with animal fecal matter
• Eat only thoroughly cooked ground beef, pork, sheep meat, or sausage.
• Cook ground meat products to an internal temperature of 160ºF
• Avoid drinking unpasteurized milk and juices
• Wash fresh fruits and vegetables thoroughly before eating raw
• Prevent cross contamination in food preparation areas by washing hands, counters, cutting boards, and utensils after they touch raw meat.
• Keep raw meat separate from ready-to-eat foods

As long as you are doing aforementioned, you shouldn’t worry too much.  Ask your physician if you have any more concerns around this.  Just remember prevention is the key to a good health!

Use DocAsap for timely appointments. 

The Government’s vision to create a Health Information Exchange (HIE) has the potential to provide a comprehensive patient history at the point of care. In addition to this data exchange, Internet and “meaningful use” of electronic health records will have a positive and significant impact on the delivery of healthcare and its associated costs. This new arrangement will improve the collaboration among providers and health facilities.  The integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, and University of Pittsburgh Medical Center are extensively utilizing technology to improve access.  These big groups are combining doctors, clinics, hospitals and often some insurance and capturing the financial savings from electronic health records.

However, despite all the benefits, adoption of technology is slow in most of the small practices.  It is surely a change in “status-quo”, and as such small practices do not get financial incentives to use computerized medical records and for some practices it is very time consuming process to convert paper records into electronic records.

“And there are privacy and patient centered concerns as well” said Dr. Donald Tavakoli; a Philadelphia based Psychiatrist. “Obviously for psychiatrists, mental health issues and therapy notes raise a major concern of “discoverability” and differ from the rest of medicine (at least in some people’s minds).  Not to mention, typing with a patient in front of you, which happens a lot with electronic systems, takes away from the doctor patient relationship.  On the other hand, legibility, access to records, and streamlining for billing purposes can increase efficiency and decrease redundancy in testing etc.”

Dr. Tavakoli said “technology being incorporated into practice is a good thing as it increases access (as DocAsap proves), increases efficiency, and decreases risk of errors.  And at the end of the day, it is inevitability.  Increasingly, I’m hearing about things like Ipad’s being considered as notepads for clinicians, which could offer simply touch screen checklist items to mark off during evaluations, this not only reduces medical error but healthcare costs as well.  And it is possible increased technology and Electronic record systems dovetails with increased “checklist” medicine.  The big concern is that in healthcare, sometimes the art of medicine can have immeasurable value, and the doctor patient relationship is crucial (and mental healthcare tops that list, especially with psychotherapy, but it is true in all of medicine).”

Please check Dr. Tavakoli’s profile at DocAsap