Is Your Doctor’s Office Fat-Free?

By Denise Mann, MS
WebMD Guest Blogger

Oct. 27, 2009 -- You leave your house at 6:30 a.m. so you are sure to be the first person in line at the lab to have your blood work done. This way, you won’t be late for work, and with any luck, you will have the results of the tests by day’s end.

No such luck. You ended up sitting in the waiting room reading an outdated issue of People magazine and a few brochures on disease prevention for more than two hours before your name was even called, and didn’t get to the office until after lunch. Obviously, the results of your lab work were also delayed.

Sound familiar? Maybe not for long. Growing numbers of health care institutions are trimming the fat, and going lean. This doesn’t mean lay-offs, it means de-cluttering, reprioritizing, shifting resources, and striving to avoid bottlenecking in waiting rooms.

Lean can mean different things in different industries. For example, in the technology arena, lean means getting material through the factory, assembled, to the customer, installed, and ready to use faster than anybody else -- defect free, says Gary Reiner, senior vice president and chief information officer at General Electric.

Reiner spoke about the "leaning" of health care at the General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the role that technology can play in improving health care.

Fat-free health care means less frustration

In health care, getting lean means improving patient satisfaction by cutting down length of stays or wait times without sacrificing care. It also means reducing costs. It’s about the bottom line -- but that doesn’t have to mean staff lay-offs or sub-standard care.

And many hospitals and health care systems are adopting this new mode of thinking by hiring consultants to put them on diets, so to speak. Brigham and Women’s Hospital in Boston, for example, got lean and cut average waiting time from 14-17 minutes to about 4-5 minutes. They also improved the lab turnaround time, and boosted patient satisfaction by 80%.

Lean is not mean

Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J., is a believer. Going lean saved $14 million for the four health care systems that make up Virtua.

“Lean is about creating value from a customer prospective, and the customer is the patient who wants to know ‘how quick can I get home after a procedure or exam?’” he says.

In some cases, lean may involve some redesign. “Nurses and doctors walk miles and miles each day within their hospital hunting for equipment, looking for medication, charts, and supplies, but if they had the right tools in the right place at the right time, they would be able to spend more time by the bedside,” he says.

This strategy added 600 hours of doctor-patient face time -- and that is win-win.
“Patient satisfaction and employee satisfaction jumps the more time that the clinicians spend by the bed side because that is what they both want,” he says.
Lean is not mean, he says. “Many people may think lean is about job cuts, but we have not had a single layoff,” he says.

SOURCES:
Gary Reiner, senior vice president and chief information officer at General Electric.
Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J.
General Electric Healthymagination conference in New York City.

Is the Health Care System Ready for Aging Baby Boomers?

By Denise Mann, MS
WebMD Guest Blogger

Oct. 28, 2009 -- There’s a silver tsunami gaining strength, and the health care system may not be able to weather the storm.

“As the tidal wave comes, are we prepared?” asks Margaret Scott, chief investment officer of Belmont Village Senior Living in Houston. “Do we have health care providers, doctors, nurses’ aides, or systems in place to keep people at home.”

The answer is a resounding “no”, but many in the health care field are furiously working on developing innovative, multi-pronged solutions to these problems. Improved disease prevention efforts and technology are two important parts of any potential solution, but the clock is ticking.

“It’s very scary to all of us in terms of solving this,” says geriatrician Mark Leenay, MD, MS, senior vice president of medical management and physician services at UnitedHealth Group-Ovations, based in Minnetonka, Minn. Scott and Leenay took part in a sobering panel discussion on the challenges of providing quality care to the elderly and chronically ill at the General Electric Healthymagination conference in New York City.

Changing the rules of engagement

Fully 75% of today’s health care dollars are spent on treating chronic illness, Leenay says, and half of that is used to treat illnesses caused by poor diet, poor exercise, and tobacco use -- i.e. preventable causes of illness.

“The focus needs to be on preventing them from getting sick,” he says. That is easier said than done, but making risks very specific to the patient, rewarding them for positive behaviors, and motivating doctors to prevent diseases can help.

Technology and prevention can go hand in hand, he says. A diabetes pump can be programmed to monitor a person’s blood sugar and adjust insulin levels accordingly. This technology will lead to tighter control of diabetes, and a lower risk of complications and hospitalization down the road.

“Technology allows the caregiver or physician or registered nurse to do what they are there to do -- not fill out charts for four hours a day,” says John Cobb, CEO of Senior Lifestyles, a Chicago-based corporation that owns and manages 54 retirement communities across the map.

He is referring to things like electronic medical records that can put needed information at a doctor’s fingertips instead of having to sift through mounds of paper files located miles away from the patient.

This paves the way for more face time between doctors and patients and can help compensate for the shortfall of doctors by allowing them more time to practice medicine.

Telemedicine can also play a role in caring for baby boomers, says Lynn Townshend, executive aide to the Commissioner of the Connecticut Department of Public Health in Hartford. Video conferencing and other technologies can allow doctors to reach out to patients in their homes, and can allow specialists to have a presence in communities that they would not otherwise have access to.

All this works to improve care and keep people home longer, she says.
Preparing for the silver tsunami is an uphill battle, Scott says. “They will not come simply, but we will find solutions.”


SOURCES:
Margaret Scott, chief investment officer of Belmont Village Senior Living in Houston.
Mark Leenay, MD, MS, senior vice president of medical management and physician services at UnitedHealth Group-Ovations.
John Cobb, CEO of Senior Lifestyles, a Chicago-based corporation.
General Electric Healthymagination conference in New York City.

View From ASPS: Plastic Surgeons Like It Hot

By Denise Mann
WebMD Guest Blogger

Oct. 29, 2009 (Seattle) -- Botox breast lifts, cleavage rejuvenation, fat injections in your butts, and breast and penis enlargement surgery.

No, this is not a rundown of hot topics discussed by the ladies of The View, it’s a mere snippet of the equally edgy -- and at times, bawdy -- subjects broached by leading plastic surgeons at the aptly titled topics “hot topics” session of the annual meeting of the American Society of Plastic Surgeons (ASPS) in Seattle.

And just like on The View, very little was off limits for this esteemed panel. Mark P. Solomon, MD, a Philadelphia-based plastic surgeon wowed the crowd by discussing a surgery that can add width and length to a man’s penis. Seeing is believing. And if before-and-after pictures can be believed, it really works. I kid you not.

And that was just the tip of the hot topics. Overall, there was less talk, and more action at this year’s ASPS meeting as new treatments moved to the breast and body. I’m talking about fat-melting injections with Lipodissolve -- a once controversial therapy that involves injecting a cocktail of chemicals into muffin tops, saddle bags, love handles, or other trouble spots to dissolve fat cells.

Several years back, V. Leroy Young, MD, a plastic surgeon in St. Louis known as a savvy clinical trialist and scion of surgical safety, began investigating this therapy. He was a skeptic at the time, but now Young is a believer. While the final results are not tallied, Lipodissolve may actually melt away fat.

What’s more, plastic surgeons have been talking about taking fat from thighs, butts, and other areas where it is plentiful and injecting it into the breast for cosmetic reasons for years. Some say it has merits, while detractors fear that it may mar mammograms, be mistaken for early breast cancer or even worse, cause cancer. But these fears are being dismissed by studies, and fat injections to the breast may be here to stay.

Plastic surgery is not all about nipping, tucking, and sucking or zapping away fat. There is another side to plastic surgery and plastic surgeons. The reconstructive side of the biz may not garner as many tabloid headlines as the sexy, celebrity-driven procedures like fat injections to the breast or cleavage rejuvenation, but reconstructive plastic surgery holds the power to save and changes lives every day.

This year’s meeting showed all of us how. An injured Iraqi citizen, a port wine stain patient, a breast reconstruction patient, and a patient who had skin cancer on her nose received the Patients of Courage: Triumph Over Adversity awards. Listening to these award winners tell their stories and talk about the doctors who treated them will forever change how you think about plastic surgery and plastic surgeons.

Design Thinking May Change Your Hospital Experience

By Denise Mann, MS
WebMD Guest Blogger

Oct. 28, 2009 – Doctor. Nurse. Physican assistant. Lab technician. Interior designer?
Yes, you read that last one correctly. Designers are increasingly becoming important members of your health care team, and they are helping to change the way that you receive medical care in some very innovative and creative ways.

It’s called “design thinking,” and it is aimed at changing your health care experience by changing the environment where you receive care. It helps take the fear and anxiety out of the hospital environment by making things friendlier, brighter, and easier to navigate.

“The health care team of the future has to involve designers,” says Nicholas F. LaRusso, MD, director of the Center for Innovation & SPARC lab at the Mayo Clinic in Rochester, Minn. The SPARC lab is working to re-create and reshape the entire patient experience with the help of a cadre of designers. LaRusso discussed his experiences at a General Electric Healthymagination conference in New York City.

In Rochester, where the Mayo Clinic is based, designers are ingratiating themselves into the community to learn what members need in terms of their health care and how they feel about their own health. Armed with this type of information, the designers seek to break down barriers by changing and softening the environment, redesigning exam rooms, simplifying the appointment check-in process, and increasing patient education.

“Designers and design thinking are a critical component of our team,” LaRusso says. “The value of design and design thinking has been fully embraced by our institution and the demand for the designers services are exceeding capacity,” he says.
It’s a marriage made in heaven, LaRusso adds.

“Physicians are evidence-based and solution-driven thinkers and this has pluses and minuses,” he says. “We often move to solutions before considering all potential approaches, but designers slow us down and help us think more broadly about framing the question and exploring a wide array of potential approaches.”

The result of this union? Improved communication between doctors and their patients and better health care delivery, he says.

Gary Kalkut, MD, MPG, the senior vice president and chief medical officer at Montefiore Medical Center in the Bronx, agrees. The design thinking approach starts with seeing things through the patient’s eyes and going from there, he says. “At our hospital, I tell staff to physically walk patients to where they need to go as maps and directions can be confusing.” Such efforts humanize health care and help take fear and anxiety out of the hospital experience, he says.

SOURCES:
Gary Kalkut, MD, MPG, senior vice president and chief medical officer, Montefiore Medical Center, Bronx.
Nicholas F. LaRusso, MD, director, Center for Innovation & SPARC lab, Mayo Clinic, Rochester, Minn.
General Electric Healthymagination conference, New York.

Virtual Stethoscopes: Coming Soon to a Doctor’s Office Near You

By Denise Mann, MS
WebMD Guest Blogger

Oct. 27, 2009 – It’s slim, it’s slick, it’s shiny, and it’s smart. It is also about the size of a cell phone, and the Vscan may help save lives in developing nations as well as rural parts of the United States.

The Vscan, developed by General Electric, is referred to as a virtual stethoscope and can be used to quickly and accurately make a diagnosis without relying on the more traditional and cumbersome ultrasound machinery. There is no pricing information available yet, but the product was unveiled at General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the next generation of medical technology.

And that’s not the only high-tech product that may help save lives while cutting health care costs. Portable ECG machines that are about the size and weight of a laptop computer may allow doctors in small clinics and developing nations to quickly and efficiently assess the cause of heart problems. Electrocardiograms (ECGs) measure and record the electrical activity of the heart.

Former Sen. Bill Frist, R-Tenn., a former heart-lung transplant surgeon, is a fan of the Vscan. “If I had something like this, it would save what I had to do in the middle of the civil war in the Sudan when five patients showed up with abdominal masses that could have been caused by a number of things,’ says Frist, who is a member of a new advisory panel created by General Electric that aims to help use technology to provide access to affordable health care. With VScan, “instead of operating on all five, I might have only operated on one of them.”

A quick scan of the affected area with the lightweight device could have helped rule in or out causes of the pain that warrant surgery, he explains. And it’s not just the Sudan; this technology can also help doctors in rural areas of the U.S. such as Eastern Tennessee and Memphis, Frist says.

The smart ECG talks and gives feedback on the placement of the leads. While it has not received clearance from the FDA yet, some preliminary research shows that doctors dig its portability. The machine has a long-lasting battery life and allows users to transfer the information using a memory card.

Putting technology like the VScan or portable ECG into doctors’ hands will allow more people to be diagnosed sooner, says Michael J. Barber, a vice president of General Electric in Fairfield, Conn., who is head of Healthymagination.

“Health care reform is about providing access to more patients,” he says.

Sources:
Former Sen. Bill Frist, R-Tenn.
Michael J. Barber, a vice president of General Electric, Fairfield, Conn.
General Electric Healthymagination, New York.

GI Docs Talk Science, Find Time for Stress Relief

By Kathleen Doheny
WebMD Guest Blogger

Oct. 27, 2009 (San Diego) -- Mention “gastroenterologist” and some people will ask, “Which doc is that, again?” Others will literally back away, wary of their upcoming (or recent) colonoscopy.

Suffice it to say, gastroenterologists -- charged with the health of our entire digestive tract and liver --don’t have the fun-and-games image of, say, pediatricians who wear clown noses to amuse their young patients.

But another side of GI docs emerged when about 5,000 of them gathered in San Diego this week for the annual meeting of the American College of Gastroenterologists. The fun side!

In between serious research sessions, some shot hoops in the exhibit hall at the booth of PLUS Diagnostics, a diagnostic laboratory. Spokesperson Char Schraibman admitted it was a shameless (and effective) attempt to attract docs.

Over at the booth of Shire Pharmaceuticals doctors tried their hands at a video game to deliver the medicine to the little man on the screen before the bugs got him.

And at a press briefing Monday, David A. Greenwald, MD, a gastroenterologist at Montefiore Medical Center in New York, excitedly unveiled what he calls “Facebook for GI docs.” It’s a secure social network, hosted by the American College of Gastroenterologists and called the GI Circle, designed to help gastroenterologists communicate and view breaking news on research.

Whatever your score at fun and games -- or your friend tally on Facebook -- the stress relief might be good for your GI tract, research presented at the meeting suggests. At a press briefing Tuesday, researchers warned that workplace stress can wreak havoc on your GI system.

Other research focused on improvements in colonoscopy, considered the gold standard for detecting colorectal cancer, which kills about 49,000 people annually in the U.S. High-definition colonoscopy is being phased in, with new machines replacing older ones.

A tiny camera device, called the Third Eye Retroscope or TER, gives doctors a better look at the colon as they withdraw the scope, helping them find growths hiding behind the many folds of the intestines.

There was news about old diseases, such as P. Patrick Basu, MD, of Columbia University College of Physicians and Surgeons’ report that a four-drug regimen, including antibiotics and a medicine to reduce stomach acid, works better to wipe out the ulcer-causing bacteria Helicobacter pylori than a three-drug regimen often prescribed.

It got a thumbs-up (over the phone) from Emmet Keeffe, MD, professor emeritus of medicine at Stanford University in Palo Alto, Calif., a gastroenterologist who reviewed the findings for WebMD. “This is a relatively convenient regimen and has a high success rate,” he says.

As for patients who suffer from inflammatory bowel disease or IBD, they should be extra wary of too much sun exposure, Millie Long, MD, of the University of North Carolina Chapel Hill cautioned.

In her research, she found that IBD patients were more likely to get nonmelanoma skin cancers, especially if they are on certain medications.

Her findings, she cautions, are no reason to abandon treatment, especially if IBD patients get relief. Rather, it’s a wakeup call, she says, to pay close attention to sun safety practices such as wearing sunscreen.

Despite the advances in technology, the GI doctors stressed that patients play a big role in their own GI health. Compliance with medications for IBD and other problems is always an issue, they say. And those about to undergo colonoscopy need to know preparation is crucial.

For those looking for a bowel prep alternative to that traditional pre-procedure cocktail, researchers from Wyckoff Heights Medical Center in New York reported that a pre-colonoscopy regimen of lukewarm salt water and exercise works as well as traditional measures.

Stay tuned, they’re studying the approach further before it is ready for prime time.

View from ACR: Luring Doctors With Tastykakes

By Charlene Laino
WebMD Guest Blogger

Oct. 23, 2009 -- (Philadelphia) -- It’s been a busy couple of months since Labor Day. Medical meetings are in full swing, sending me chasing infectious disease specialists in San Francisco, tracking down cancer docs in Berlin, running after neurologists in Baltimore, and ending up this week, here in Philly, immersed in the latest news in arthritis, lupus and gout at the annual meeting of the American College of Rheumatology(ACR).

I can’t stress the importance of covering medical meetings enough. Whether it’s the premier cancer meeting in Europe or ACR here at home, conferences are considered the forums to unveil new research. They are where we first hear about breakthroughs that will transform practice and, more often, about new drugs and tests that show promise. And we hear about some unique studies along the way.

At ACR, for example, there was new research, spearheaded by an elementary school student, suggesting that video games may be causing finger and wrist pain in children, and the younger the player, the greater the risk. You can’t beat this advice from the study’s leader, 11-year-old Deniz Ince: “If you’re over 7, don’t play more than an hour a day. If you’re younger than 7, give it a break until you’re older.” Indeed.

Then there are studies suggesting that milk and water may help fight painful gout attacks. When I first saw the titles, I thought, how did they even come up with the idea of studying that? Turns out there’s a scientific rationale: Dehydration is a trigger for the disease.

Lupus Drug Takes Center Stage

Another reason to attend: The written abstracts that researchers submit months before their actual presentations are often out-of-date, and sometimes downright wrong. Further analysis in the weeks leading up to these disease marathons can dilute the strength of an association that seemed so powerful based on the preliminary data. You have to be here to hear the final results and talk with other specialists about their importance.

Meetings are also where I make contacts with leaders in the field, who help me sort through the hundreds of new drugs with names like ABC123 that hold so much promise, based on early studies. Which ones are going to live up to that promise and which will die in the lab, a blip on the screen, here today, gone tomorrow? If we told you about all of those, your head would burst.

At this year’s ACR meeting, the spotlight shined on Benlysta, the first in a new class of experimental drugs that dials down the abnormal immune response that wreaks havoc on lupus patients’ joints and organs. It outperformed standard treatment in a large clinical trial, and if the findings hold up, Benlysta will become the first new drug for lupus in half a century. Everyone I spoke to said to stay tuned.

There was also a great deal of enthusiasm for a large, head-to-head study showing that for many people with rheumatoid arthritis, the traditional, and much cheaper, disease-modifying antirheumatic drugs appear to work just as well as newer TNF blockers that target the underlying disease process. Importantly, the trial also suggested that for many patients, methotrexate alone may do the trick, at least for a while. A footnote echoed by all, however: The findings are based on symptoms. X-ray images, taken during the study but not available yet, may show one strategy is better at halting disease progression.

Speaking of TNF blockers, other new research links the immune-disease drugs to an increased risk of skin cancer. But please, do not read this and panic if you are on the drugs: For most, the benefits far outweigh the risks. Do, however, check your body regularly for any abnormal growths that can signal skin cancer.

While you’re in front of the bathroom mirror, checking your back for moles, why not multitask and brush and floss? A new study shows gum disease may raise your risk of developing rheumatoid arthritis (RA). Now, there’s a simple intervention to modify your risk of a disabling disease.

Actually, here’s another. Other research shows spraying your home and garden with insecticides may increase the risk of both RA and lupus. Maybe you’ll think twice next time you see a bug? They’re not that bad.

Attracting Doctors With … Tastykakes?

There was some disappointing news this year, too. Using a more sensitive measure of joint damage than in the past, researchers have found that the popular supplement glucosamine does not appear to slow the progression of knee osteoarthritis.

Maybe you’d be better off exercising and eating a healthy diet than spending money on supplements? That’s my personal view, one I must admit many of my friends take issue with. But this brings me to my latest concern: I’m a little worried we are going to end up with a nation of overweight doctors, at risk for everything from arthritis to heart disease.

Why? For years, in the enormous exhibits areas at every meeting, doctors stuffed their conference bags with “gifts” from pharmaceuticals companies -- everything from personalized ballpoint pens to the latest computer gadgets, all emblazoned with the company’s logo.

Rules that went into effect in the U.S. earlier this year frown upon inscribed giveaways. So how are the companies attracting doctors to their booths to hear about -- and hopefully then prescribe -- their drugs and diagnostics? With food, usually junk food no less. I kid you not. One booth had soft pretzels with mustard, another homemade chocolate cake. I’ve even had crepes, cooked to order. There are always cookies, candies, colas, and coffees. Philly’s hometown treat, Tastykakes, were a big hit at ACR. Talk about empty, but devilishly fun, calories.

More than one attendee admitted having to let his belt out a notch by the end of the week. I just hope they go home and work it off.

I know I have to.

New Image Mapping Takes the Guess Work Out of Cancer Treatment

By Denise Mann, MS
WebMD Guest Blogger

Oct. 23, 2009 -- New image mapping technology that allows doctors to take a closer look inside cancer cells is helping usher in the era of personalized medicine.

Researchers can now map out more than 25 proteins in prostate and colon cancer cells and tell which signaling pathways are activated within these tumors -- a level of detail not possible with existing technologies. These findings will pave the way toward the development of more targeted therapies and allow doctors to more accurately match drugs with cancer patients, improving care and eliminating a lot of trial and error.

“We didn’t realize the heterogeneity within cancer cells,” says Richard J. Gaynor, MD, vice president of clinical investigation at Lilly Research Laboratories in Indianapolis. Calling the new technology a “huge coup,” Gaynor says that it “will potentially extend to all cancers and other disease where there is a molecular component, such as Alzheimer’s disease.” Eli Lilly developed the new technology with General Electric.

So far, the technology has been tested in colon and prostate cancer tissue, and preliminary studies on these and other cancers are slated to begin within a year, Gaynor tells WebMD. He envisions the technology being used in the diagnosis of disease and as a way to monitor treatment.

“If we can see what is going on at the cellular level, basically, our hope is that we can develop drugs that target specific proteins and signaling pathways and that can make a big difference,” says Mark Little, PhD, the senior vice present and director of GE Global Research in Fairfield, Conn. “So far, the results have exceeded our expectations.”

Personalized medicine is the wave of the future, says Marisa Weiss, MD, the president and founder of advocacy group Breastcancer.org and the author of several books, including Taking Care of Your Girls: A Breast Health Guide for Girls, Teens, and In-Betweens.

For example, “breast cancer is as unique as each woman who might one day receive a diagnosis [and] because no two cancers are identical, there is no one-size-fits-all treatment, says Weiss, who is also the director of breast radiation oncology and breast health outreach at Lankenau Hospital in Wynnewood, Pa.

The future of breast cancer diagnosis and treatment is to first conduct an intensive internal investigation into the unique extent and nature of the cancer, followed by a customized treatment plan that’s perfectly tailored to each woman’s individual situation,” she tells WebMD. “The promise of personalized medicine requires the development of a customized solution to precisely target the unique nature of each person’s cancer. Only then will the greatest benefits with the fewest side effects be achieved for each person facing a potentially life-threatening diagnosis of breast cancer.”

SOURCES:
Richard J. Gaynor, MD vice president of clinical investigation at Lilly Research Laboratories in Indianapolis.
Mark Little, PhD, senior vice present and director of GE Global Research in Fairfield, Conn.
General Electric Healthymagination conference in New York City.

It’s Not a CT Scan, It’s a Spaceship!

By Denise Mann
WebMD Guest Blogger

Oct. 23, 2009 -- Your 3-year-old falls and hits his head so hard that he throws up. Does he have a concussion? Sometimes the only way to tell is with a CT scan.

Now just try to lure your son into one of those cold, metal – and frankly, terrifying machines. As many a parent or doctor can attest: it’s not easy. As a result, 70% to 80% of kids aged 3 to 8 who need diagnostic imaging such as a CT scan to rule out a concussion, for example, must be sedated, which increases the risks as well as parents’ fears about a diagnostic test that could save their lives.

But what if your son was dressed as a superhero replete with a cape and mask and asked to crawl through a tunnel to attempt a daring rescue? It might be an easier sell, and such medical play is becoming a reality in many hospitals across the United States where CT scanners are routinely being turned into space ships, jungle adventures, and more.

Preliminary data shows that there is 90% decrease in the need for sedation when children are presented such cleverly disguised scanners, says Bob Schwartz, general manger of global design for General Electric Healthcare, a company that is helping to spearhead such efforts. Schwartz made his comments at the General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the next generation of medical technology. Clinical trials looking at the benefits of such disguised devices are slated to begin.

Such CT scanners are part of a new movement called “design thinking” that aims to take the cold, clinical, and scary out of medical equipment for kids, parents, and really patients of all ages.

The new CT scanners create illusions that change the environment. Instead of a diagnostic test, it’s an adventure that the child can be part of and this tale usually involves a scenario that calls for the child to lie very still, which allows the scanner to capture needed images.

“This softens the cold, metal traditional look of scanners, and makes it less intimidating because it is inherently fear-provoking,” says Gary Kalkut, MD, MPG, the senior vice president and chief medical officer at Montefiore Medical Center in the Bronx. Montefiore offers several such machines to pediatric patients.
Patients have a lot of anxiety about going to a hospital, and doctors and other health care professionals need to start seeing things through patient’s eyes, he says.

“Design thinking addresses the vulnerability and fear that are part of the hospital experience,” he tells WebMD.

“From the bedside to the hallways and all through the hospital environment, we need to address these issues with decorations on the wall, soft surface toys, sleeper sofas in kids rooms for parents, laptops, and/or flat screen TVs,” he says. “It’s important because you are no longer creating fear by walking into a sterile, harsh and unknown environment.”

It’s not just hospital equipment either. Some designers are working on child-friendly inhalers that work by inflating and deflating a balloon and medications that can be delivered by writing on your skin, says Paola Antonelli, the senior curator for architecture and design at the Museum of Modern Art in New York City.
Design thinking is the missing link, says Nicholas F. LaRusso, MD, director of the Center for Innovation & SPARC lab at the Mayo Clinic in Rochester, Minn. The SPARC lab is working to recreate and re-shape the entire patient experience with design thinking.

“We are diagnosing and treating disease more effectively than we ever have. There is no question about that,” he says. “What’s lacking is the delivery model, so the idea of bringing design thinking and innovation to the process of health care delivery is essential.”

Sources:
Gary Kalkut, MD, MPG, senior vice president and chief medical officer at Montefiore Medical Center in the Bronx, N.Y.
Nicholas F. LaRusso, MD, director of the Center for Innovation & SPARC lab at the Mayo Clinic in Rochester, Minn.
Paola Antonelli, senior curator for architecture and design at the Museum of Modern Art in New York City.
General Electric Healthymagination conference in New York City.

Virtual Care Eases Pressure on Sandwich Generation

By Denise Mann
WebMD Guest Blogger

Oct. 22, 2009 -- Members of the so-called “sandwich generation” are often juggling their jobs and home responsibilities with those of caring for aging parents -- many of whom want to grow old at home. It’s not easy, but new technologies that allow caregivers to virtually monitor family members and doctors to conduct virtual visits may lighten the load of all involved.

By and large, such virtual care and care giving are quickly becoming a reality.
One such virtual check-up system allows patients to chat with their doctor at scheduled times, as well as type in health information and vital statistics so that their condition can be remotely monitored. Some insurers even foot the bills for the technology.

A separate system in use at some nursing homes and assisted living facilities uses inconspicuous motion sensors to detect a person’s activity and establish patterns and trends. If there is a deviation in a pattern, the system picks it up. Say your loved one goes to the bathroom more frequently than usual at night? It could be a urinary tract infection. This high-tech system can also tell if a person slipped in the shower, took their pills, and ate three meals a day.

It may one day help family members keep a virtual eye on aging parents or loved ones -- from across the map or across the street -- easing their worry and allowing their loved ones to remain independent longer.

These new video monitoring systems were among many new technologies showcased at General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the next generation of medical technology.

Research shows that patients and doctors like virtual visits. One such study in a recent issue of the Journal of Telemedicine and Telecare showed that evaluations done through videoconferencing were similar to face-to-face visits in terms of time spent with the doctor, ease of interaction, and personal aspects of the interaction. What’s more, diagnosis and treatments were the same whether a person was examined virtually or in the office.

“This is the wave of the future – no doubt about it,” says study researcher Ronald F. Dixon, MD, an internist at Massachusetts General Hospital in Boston. “You get to see and do a visual exam, which is helpful in diagnosing many conditions such as rashes and joint pain; you can gather the same data that you would in a ‘real’ visit, ask questions, and have all the information from the patient’s medical record in front of you,” he says. Dixon did not attend the conference.

There are other benefits too, he says. “Technologies that allow for continuous or regular monitoring of blood pressure and other vital signs such as pulse oxygenation are much better than the snapshot you would get in just one office visit,” he says.
Such technology will also one day help friends and family members keep track of their loved ones who are ill or homebound. “Anyone in your health social network could be alerted if there is an issue,” he says.

Dixon is not sure the technology is here yet, “but we are getting there.”

Such video monitoring and virtual doctor visits will also help reduce health care costs and improve care, says Former Republican Sen. Bill Frist of Tennessee, a former heart-lung transplant surgeon. Frist is a member of a new advisory panel created by General Electric that aims to help use technology to provide access to affordable health care. “Eighteen percent of people on Medicare are back in the hospital in 30 days,” he says. Why? The reasons are manifold. Maybe their doctors’ orders are a bit unclear or maybe they fail to pick up their medications, he says.

“Home monitoring can connect patients at home with nurses, with social workers, and with doctors so they don’t bounce back into the hospital,” he says. Keeping patients out of the hospitals and emergency rooms -- whenever possible -- can drastically reduce costs of care.

SOURCES:
Former Republican Sen. Bill Frist of Tennessee.
General Electric Healthymagination conference in New York City.
Ronald F. Dixon, MD, an internist at Massachusetts General Hospital in Boston.
Dixon R, et al. Journal of Telemedicine and Telecare. May 2009.

Health Reform Sparks Doubts About Cost of Coverage

By Andy Miller
WebMD Guest Blogger

Affordability.

It’s the latest buzzword in the health care reform debate.

We're going to look at one angle -- the one for a family of four, making an annual income of $60,000 but lacking health insurance.

The new reform law would require the family to purchase coverage. If no employer coverage was available, the family would go to a new health insurance exchange and get federal subsidies to offset the cost of policy. Still, the price tag for the family, with a household head of age 50, would exceed $6,000 a year under the Finance Committee plan (using the Kaiser Family Foundation subsidy calculator at www.kff.org). And that cost doesn’t include the inevitable co-pays and deductibles.

The penalty for not getting insurance? It may be zero under the Baucus bill coming out of the Senate Finance Committee.

Will that family buy coverage or pay the (non) penalty and remain uninsured? Is the coverage truly affordable? “How many [families] have $6,000 of room in their budget?’’ says Bob Laszewski, who writes the blog Health Care Policy and Marketplace Review.

One major element in the debate involves the level of subsidies to help the uninsured buy coverage. The reform proposals give subsidies to people making up to four times the poverty level, or about $88,000 for a family of four.

The subsidies in the Baucus plan, at $461 billion over 10 years, is a large chunk of its price.

The subsidy carrot is accompanied by a stick – penalties for not getting coverage. And the recent weakening of penalties that has riled the insurance industry.

All along, insurers had been banking on a major tradeoff in supporting the drive for reform. The industry agreed to jettison their discriminatory practices against people with pre-existing conditions in exchange for a federal requirement that everyone obtain coverage. A mandate for people to buy insurance would bring millions of new customers to their health plans.

But the Finance Committee has reduced and delayed the penalties it originally proposed for people who don’t purchase coverage. Under an amendment, families would face no penalty the first year up to a maximum of $1,500 in 2017. And individuals and families would not face a penalty if coverage cost more than 8% of their income. In the previous version, the exemption started at 10%.

Those Finance Committee penalties and exemptions are not a big enough stick, according to America’s Health Insurance Plans, a major trade group. People will ignore the penalty or wait till they get a serious illness before they obtain coverage, the group said.

“Fewer people participating will lead to higher premiums for everyone else,’’ said Robert Zirkelbach, an AHIP spokesman. “Unless everybody participates in the system the market reforms aren’t sustainable.’’

Meanwhile, many experts insist the subsidies in the Baucus bill are not high enough, especially for the uninsured middle class.

And Laszewski says that under the plan, people “can wait till someone in their family has brain cancer to buy insurance.”

The subsidies for people under 250% of the poverty level are adequate, he says. But those at the upper end of the income range have trouble with affording a policy that could cost a family $6,000 to $10,000 a year, says Laszewski, who recommends raising both the subsidies and the penalties. “Where [the legislation] is now is political expediency that destroys the insurance market,’’ he says.

Finance Committee members are attuned to the affordability issue. Baucus last month said, “We want to make sure that if Americans have to buy insurance, it’s affordable.’’

Yet Ed Haislmaier, an insurance expert at the Heritage Foundation, says the insurance products under reform would attract a larger percentage of the sick but leave the young and healthy outside the system. “If someone is in reasonably good health, they’ll be more likely to pay the fine,” he says.

Congress is insisting on comprehensive coverage in the health insurance exchange, Haislmaier adds. “You’re selling something to people 25 and healthy that they don’t need and can’t afford. Young people are healthier and don’t earn as much.”

In 2006 Massachusetts reformed health care law to require individuals to buy insurance, but Boston-based consumer advocacy group Community Catalyst said the state’s subsidies for the uninsured were more generous.

“The reason people don’t have health insurance is that they can’t afford it.’’ says Michael Miller, the group’s director of strategic policy. “They have a mortgage to pay, kids with school expenses, a car payment.

“You have to make it affordable for individuals and families, not just the federal government,” Miller says.

The $900 billion cost barrier will have to be broken to make it more affordable for the middle class, says John Holahan, director of the Urban Institute’s Health Policy Center. “If we want health reform, you’ve got to put a little more money into it.”

Still, the current reform legislation would represent a vast improvement over the current individual insurance market, which is riddled with cost and coverage problems, says Families USA, another consumer group.

The price of insurance for those at the 400% poverty level “is a lot of money,” acknowledges Kathleen Stoll, director of health policy for the group. “But it’s a lot better than paying full freight. Is it absolutely a free ride? No way.”

Yet Stoll also notes that reform legislation would protect people against high out-of-pocket costs and annual and lifetime medical spending limits. “I would like to see subsidies higher, as an advocate for consumers. Do I think they’re a wonderful start? Yes.”

The affordability issue is difficult to project, both in the ultimate fate of legislation – if it’s passed – and in the marketplace. Dean Smith, a health care expert at the University of Michigan, says of the penalty vs. coverage dilemma: “It’s really hard to gauge the public sentiment on this.”

But if people remain uninsured, Smith notes, they will often get care in emergency rooms. “And someone is going to pay for it – that’s the taxpayers.”

SOURCES:

Associated Press.
Kaiser Health News.
New York Times.
Wall Street Journal.
John Holahan, director, Urban Institute Health Policy Center.
Bob Laszewski, Health Care Policy and Marketplace Review.
Dean Smith, professor, senior associate dean for administration, School of Public Health, University of Michigan.
Kathleen Stoll, health policy director, Families USA.
Michael Miller, director of strategic policy, Community Catalyst.
Kaiser Family Foundation Reform Subsidy Calculator.
America’s Health Insurance Plans.

WebMD & CDC Team Up to Focus on Flu

As fall rolls around each year, you probably don't think much about the flu until the fever, muscle aches, and fatigue wipe you out for a week. But this year is different.

That's why WebMD is collaborating with the CDC to bring the latest flu developments right to you.

Nervous about the flu vaccine? Wondering if you should get the swine flu vaccine? Do you need antiviral drugs if you think you have the flu? How can you help prevent spread of pandemic H1N1 (swine) flu?

WebMD and CDC experts are here to ease your mind and answer your questions about swine flu and seasonal flu.

Along with WebMD Chief Medical Editor Dr. Michael Smith, WebMD experts Rod Moser and Dr. Matthew Hoffman and CDC expert Dr. Anthony Fiore will be answering questions and sharing the latest information.

We want to hear from you. No matter the question, we want to know what's on your mind. We'll do our best to help you and your family stay safe this unusual flu season.

Go to our new "Focus on Flu" page to join the conversation or get your questions answered.

Sean Swint
WebMD, Execuitve Editor