How many of us actually understand the meaning of “Board Certification” and how many of us actually care whether our doctor is board certified or not.

Board certified officially means that the physician is an exceptional expert in a particular specialty and/or subspecialty of medical practice and has gone through the required training to practice medicine.  It also means that the physician is committed and is consistently achieving superior clinical outcomes in patient-focused setting.

It is believed that for patient like us the board certification is the best measure of a physician’s knowledge, experience and skills to provide quality healthcare within a given specialty. Is it really true?

Does this board certification actually make any difference in patient outcome? May be it does but nobody is sure. We believe that general public never cared where their doctor went for medical school.  People care for quality health outcomes and timeliness. Most of us even don’t know the difference between Doctors of Osteopathic Medicine (DOs) and Doctors of Medicine (MDs). They both go by Primary Care Physician (PCP); the DO is an Osteopathic physician, while MD is Allopathic physicians.  Many don’t even care if they get timely care from a Physician Assistant (PA) or a Nurse practitioner.

So we tried to dig little more into this at American Board of Medical Specialties (ABMS); a nationally recognized organization certifying doctors. After a tedious search process, we got something very interesting

“The physician certification information in the ABMS database is updated periodically with data provided by its Member Boards. Due to the possibility of reporting and processing delays, the accuracy and completeness of records cannot be guaranteed. ABMS shall not be liable to you or others for any decision made or action taken by you in reliance on the information obtained from this service.  It is the user’s responsibility to determine that the physician record obtained is that of the physician whose information is sought”

So… what now…ABMS is telling us that it’s OUR responsibility to determine… so guess we are left with our gut feel while choosing a doctor.

We are not saying that board certification or doctor credential doesn’t mean anything, Doing a background check into your doctor’s credentials is important to be sure they are appropriate and current. But there are other things in addition to credentials that patient needs to think about before choosing the right doctor, such as does the doctor communicate well and believe in building relationship? What is his methodology; prevention or just treatment? Whether he listens to his patient’s concern or just jump on the prescription?  Can doctor relate with the patient?

One’s health is his own and his doctor’s business, nobody wants to disclose health issues to public.  So please take time and research, ask your friends and family when it comes to making right choice for your right doctor…advocate of YOUR health.  We have tried to compile doctor information including reviews from the real patients on DocAsap.com for your convenience, our doctors would love to hear your concerns and they are all Board Certified…J

Eating Right and Staying Active is no rocket science

So here we are in 2012…hopefully you are beginning this New Year with lot of resolutions such as more partying, working hard, letting go, more adventures etc.  Don’t forget that nothing is possible without health.  We believe that staying healthy and fit is the greatest achievement of one’s life.  Frankly speaking, it’s not a rocket science; just eating right and staying active would do the job for you. Don’t need to spend hours in the gym, just dance, jump, go up and down the stairs anything for 15-20 minutes each day will do magic.

As a New Year resolution, some of our friends are doing extremes by quitting sweets (in any form) or grains or dairy. Being committed is good, but healthy eating is not about strict nutrition philosophies, staying unrealistically thin, or depriving yourself of the foods you love. Rather, it’s about feeling great, having more energy, and keeping yourself as healthy as possible– all of which can be achieved by learning some nutrition basics and using them in a way that works for you.

Healthy eating begins with learning how to “eat smart”—it’s not just what you eat, but how you eat. Your food choices can reduce your risk of illnesses such as heart disease, cancer, and diabetes, as well as defend against depression. Additionally, learning the habits of healthy eating can boost your energy, sharpen your memory and stabilize your mood. You can expand your range of healthy food choices and learn how to plan ahead to create and maintain a satisfying, healthy diet.

Trust us…your body deserves the best.  If you have any concerns please visit one of our doctors to find out what is best for your health.

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 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

We recently came across an interesting article that discusses the challenges of locating the right information to help select a primary care physician.  Some interesting points:

• Determine if your insurance is compatible with the doctor’s practice.
• What is the doctor’s hospital affiliation? Is the doctor affiliated with a reputable, nearby hospital?
• How convenient is the doctor’s office to your home?

In the coming weeks, DocAsap will be launching with primary care, allowing you to find this information, and more, with ease.

We are excited to announce that DocAsap has officially launched today, and that you can now use our service to find and book online dental appointments in Philadelphia!

On DocAsap, patients can instantly find and book available appointments 24 / 7 from local doctors and dentists who take their insurance, and can research providers based on their backgrounds.  Our rationale for starting in Philadelphia is not only because we commenced the venture while Wharton students, but also because Philadelphia, which has the second longest doctor appointment wait time of any U.S. city, could use a service that helps its residents get more timely care in a quick and convenient manner.

Right now, DocAsap only provides online appointment booking for Philadelphia dentists.  But in coming months, we will launch more specialties, add more content on our doctors and dentists, and roll out other features to improve the efficiency of finding and visiting a doctor.  In addition to providing us with any feedback, we would love for you to tell your friends in Philadelphia to book their next dentist appointment through DocAsap, join our Facebook group to get future updates, and spread the word to those you think might be interested in our service.

Anyways, thanks again for your help along the way, and we look forward to hearing from you.

The DocAsap Team

I recently met with directors of the Camden Coalition, which is seeking to radically change the way residents of Camden, New Jersey seek and receive care.  To provide context, Camden, New Jersey was America’s poorest city as of 2006 (pdf article) and one of its most violent.  Furthermore, over 50% of Camden residents visit the ER room in a year, which is over double the national average in the U.S.

This over-usage of ER rooms led a group of New Jersey physicians and public health officials to undertake the ambitious effort of tracking ER “super user” characteristics over time in order to make Camden residents healthier while lowering overall medical costs.  According to Dr. Anthony Mazzarelli of Cooper Health, who directs Cooper’s ER room and has been named one of ten Outstanding Young Americans and hosts a radio show, the ER over-usage results not only from many Camden residents lacking insurance, but also many insured residents lacking physician relationships.

In a program led by Dr. Jeffrey Brenner, the Camden Coalition is now hyper-targeting those ER super-users with an all-encompassing care management program by having physicians and public health workers promote preventative care and healthier lifestyles among these patients.  Furthermore, the Coalition has a broader goal to reach out to all Camden residents to increase access to preventative care through open access scheduling (see our previous post about open access scheduling).

A key lynchpin of their effort is effectively utilizing electronic medical record information, as a patient health record helps physicians better track and serve patients.  DocAsap also believes that online technology can help patients find appointments or interact with doctors remotely.  While internet usage in poorer areas typically trails that of wealthier communities, Camden’s young population, many of whom have cell phones and use the internet regularly, could benefit from having online tools such as DocAsap to more easily get doctor appointments.  DocAsap believes that providing intuitive doctor appointment search tools to all Americans that it can decrease over-usage of ER rooms, reduce overall healthcare cost, and create a healthier U.S. population.