As you look ahead, what do you envision? If you’re like most people, you are probably eager to stay healthy and enjoy your life in the most vibrant, vigorous way possible. No magic pill or secret potion can deliver a long, healthy life. To some extent, your genes are responsible however, abundant research shows that the actions you take today matter the most. Simple lifestyle choices — what you eat, how active you are, whether you smoke — have an enormous impact on your longevity and quality of life.

A 2007 study in the American Journal of Medicine focused on adults who adopted a healthier lifestyle during middle age. The researchers followed ~15,000 adults (ages 45+) for a decade and noted that 970(~9%) of these people embraced a healthier lifestyle by the sixth year of the study. These individuals ate five or more daily servings of fruits and vegetables, worked out at least two and a half hours per week, didn’t smoke, and avoided obesity. Benefits appeared quickly. Just four years later, the group of individuals who made these four changes had a 40% lower rate of death for any reason and 35% fewer cases of heart disease compared with the participants who made fewer of these changes. No matter what your age or stage of life, you have the power to change many of the variables.  Actions you can take to increase your odds of a longer and more satisfying life span are really quite simple:

1. Don’t smoke.
2. Enjoy physical and mental activities every day.
3. Eat a healthy diet rich in whole grains, vegetables, and fruits, and substitute healthier monounsaturated and polyunsaturated fats for unhealthy saturated fats and Trans fats.
4. Take a daily multivitamin, and be sure to get enough calcium and vitamin D.
5. Maintain a healthy weight and body shape.
6. Challenge your mind. Keep learning and trying new activities.
7. Build a strong social network.
8. Follow preventive care and screening guidelines.
9. Floss, brush, and see a dentist regularly.
10. Ask your doctor if medication can help you control the potential long-term side effects of chronic conditions such as high blood pressure, osteoporosis, or high cholesterol.

“Out of the box thinking” by an e-patient.

A patient receives a diagnosis of a close to serious illness; the response is one of fear. How does he will move from a place of fear and uncertainly to a place of empowerment? Isn’t it difficult to get involved in your own care when you don’t feel well?

However, our empowered, engaged, equipped and enabled patient a.k.a “e-patient” digs into pipeline to information.  His approach includes …

• Connect with other e-patient community to learn about others’ experiences, advice…
• Learn about the disease to be knowledgeable about his condition
• Assess treatment options by different providers so as to know what to expect when medical bills knock at the door…would be tough to handle financial/mental stress  with his ongoing illness

But to find the right information, right care is not easy….and on top of that complicated payment   options make things worse. He doesn’t stop there, he thinks out of the box and actually issues Request for Proposal (RFP) to choose the best/most appropriate medical provider to partner with, just like any other purchase, hoping to find a really good fit for his needs i.e. right medical provider who would provide quality care and who is in his budget…

However, doctors don’t like to be called “service providers for consumers”, but this is exactly what they do…isn’t it?  And as a consumer, everybody should evaluate his/her criteria for which/whom he/she wants to get treatment and build the partnership.

We think that, RFP is a great process for patients to define what they want and relative priorities – even though getting clarity about the charges is more challenging than getting quality care…as cost vary depending on the doctor and the condition. But we hope to see future iterations of this as an RFP “checklist” for patients.

Here is the RFP for your reference.  We hope this e-patient gets quality care within his means….

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

May’09 was a hectic month for DocAsap and for us. We graduated from Wharton and DocAsap product entered active beta testing. We grew our team, built new partnerships, formulated new processes, and are more and more close to our goal. Few more weeks and we would be live helping people get doctor appointments easily.

While we worked on finding ways to increase access to care, we found many amazing people who are successfully solving healthcare access problem.  One person clearly worth mentioning in Mr. Don Parker, CEO Atlanticare health services. Of many other things, Don is also a pioneer in creating urgent care model in the southern New Jersey area. The AtlantiCare Urgent Care Centers, located in Egg Harbor Township, Marmora, Little Egg Harbor and Hammonton, offer fast, quality care for non-life-threatening illnesses and injuries that occur after hours and on weekends and holidays. When doctors are not available as is many times the case, people can go to these urgent care centers and get needed care. Kudos to Mr. Parker. He has guided us in many ways over the last few months and we hope to get more insights on increasing healthcare access from him in the coming future.