EPM Goes Joomla

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EPM goes Joomla (nice!), and symtym goes deeplinking:

Triangulating Health Space

Battle Between Google and Microsoft Could Trigger Revolution in Healthcare, Says Group | Government Technology | 7.10.07

Google and Microsoft, aware that a large number of Internet searches are health related, are actively attempting to build a presence in the healthcare sector.

[D]octors…are already having to come to terms with informed patients who have “Googled” their symptoms could see these same patients gaining access to their genetic profile and managing their health using an online patient record.

Google’s recent investment in the Genetic profiling company 23andMe and Microsoft’s purchase of the intelligent medical search company Medstory could lead to the emergence of services that are highly disruptive within the healthcare market.

Wireless Healthcare describes…people who both take their health seriously and have started to use Internet searches to identify early signs of disease

For the sake of discussion, the following are defined:

• Provider: broadly construed as all those that provide health services.
• Customer: broadly construed as all those that pay for health services.
• Consumer: those that receive the paid for health services.

An informed consumer, aided by such disruptive technologies, may be able to triangulate the inherent conflicts of interest amongst the customers and providers of health services.

Inadequate One, Dangerous One

To Reduce Risks, Hospitals Enlist ‘Proceduralists’ | WSJ | 7.11.07

Awaiting both kidney and liver transplants last year, Larry Pritchard suffered from fluid build-up so severe it sometimes leaked from the skin on his stomach. The condition required a procedure known as paracentesis to drain the fluid, but at the first hospital where he was treated, he says, emergency-room doctors didn’t even know about the procedure and tried to seal the leaks with medical glue. After switching to Cedars-Sinai Medical Center in Los Angeles, he found something he hadn’t heard of before: a dedicated Procedure Center, where doctors were expert at inserting a needle deep into the abdominal wall to drain fluid.

“The doctor knew exactly where to put that needle, and everyone at the procedure center was a pro at what they were doing,” says the 62-year-old retired attorney. At Cedars-Sinai’s center, experts performed the paracentesis procedure on Mr. Pritchard more than 60 times over six months, as frequently as three times a week, and inserted and removed dialyses catheters before his dual transplant last August. “They literally kept me alive,” he says.

Meanwhile, medical groups are also concluding that the traditional method of training residents — known as “see one, do one, teach one” — is dangerously inadequate.

“I vividly remember thinking I’ve never done this, and it’s almost like a dirty little secret that this patient doesn’t know that,”…”[w]e fumbled our way through it with no issues, but it just highlighted for me what an awful way it was to teach.”

To extend the old ditty:

• See One
• Do One
• Teach One
• Inadequate One
• Dangerous One

I’m shocked, another anecdote from when the giants walked the earth bites the dust…

Healthcare a Crisis

Health care crisis growing | DMN | 7.10.07

By 2020, America will be short 24,000 doctors and nearly 1 million nurses, the federal government predicts; now a major tax and consulting firm says the problem will be even worse.

The total number of nurses in the country is projected to begin decreasing after 2010.

While shortages will create difficulties, an even greater problem will arise from the unequal distributions of physicians by specialty and geography, according to the Pricewaterhouse report.

Rough times are coming.

Nursing a Crisis

Nursing Crunch May Be Hard to Fix | WSJ | 7.9.07

Fears about a shortage of nurses are fanned today by a report from PricewaterhouseCoopers. Drawing mostly on outside research – plus a survey of some 240 hospital executives – the report warns that the U.S. could fall short of needed nurses by anywhere from 400,000 to 1 million nurses by 2020.

Pay, Play and ERISA

How ERISA May Trip Up Bids to Extend Coverage | WSJ | 7.7.07

States across the country, trying to extend health coverage to the uninsured, increasingly are looking to employers to help pay the bill. But their plans could be derailed by a three-decade-old federal law.

Big states including California, Pennsylvania and Illinois are debating proposals that give employers a choice between providing insurance or paying into a fund to subsidize coverage for those who can’t afford it. Several other states are considering the approach. But business opponents and others say the strategy, known as “pay or play,” might violate a 1974 law that bars states from regulating certain health plans.

The Employee Retirement Income Security Act, or ERISA, prohibits states from imposing state rules on the health plans of multistate employers that assume the risk of their workers’ health costs. Such self-insured plans can avoid a patchwork of state regulations and offer uniform benefits, helping to keep down costs. About 70 million Americans, or half of all workers with employer-provided insurance, are covered by such plans.

Interesting table in the article:

Group	Millions	Percent
Total	308.9	100
Uninsured	46.1	14.9
Military	7.7	2.5
Direct Purchase	17.8	5.8
Medicare, Medicaid, SCHIP	77.8	25.2
Employer, Self-Funded	70	22.7
Employer, Other	89.5	29.0

Declaration of Independence

Introduction
When in the Course of human events, it becomes necessary for one people to dissolve the political bands, which have connected them with another, and to assume, among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

Preamble
We hold these truths to be self-evident, that all men are created equal, that they are endowed, by their Creator, with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.

That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or abolish it, and to institute new Government, laying its foundation on such principles, and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object, evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.

Indictment
Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let the Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.

He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their Public Records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved Representative Houses repeatedly, for opposing with manly firmness of his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected, whereby the Legislative Powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.

He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice by refusing his Assent to Laws for establishing Judiciary Powers.

He has made Judges dependent on his Will alone for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people and eat out their substance.

He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.

He has affected to render the Military independent of and superior to the Civil Power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:

For quartering large bodies of armed troops among us:

For protecting them, by a mock Trial from punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all parts of the world:

For imposing Taxes on us without our Consent:

For depriving us in many cases, of the benefit of Trial by Jury:

For transporting us beyond Seas to be tried for pretended offences:

For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies

For taking away our Charters, abolishing our most valuable Laws and altering fundamentally the Forms of our Governments:

For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our seas, ravaged our coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation, and tyranny, already begun with circumstances of Cruelty & Perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.

He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.

He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Denunciation
Nor have We been wanting in attentions to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

Conclusion
We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States; that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.

Signatures
New Hampshire: Josiah Bartlett, William Whipple, Matthew Thornton

Massachusetts: Samuel Adams, John Adams, John Hancock, Robert Treat Paine, Elbridge Gerry

Rhode Island: Stephen Hopkins, William Ellery

Connecticut: Roger Sherman, Samuel Huntington, William Williams, Oliver Wolcott

New York: William Floyd, Philip Livingston, Francis Lewis, Lewis Morris

New Jersey: Richard Stockton, John Witherspoon, Francis Hopkinson, John Hart, Abraham Clark

Pennsylvania: Robert Morris, Benjamin Rush, Benjamin Franklin, John Morton, George Clymer, James Smith, George Taylor, James Wilson, George Ross

Delaware: George Read, Caesar Rodney, Thomas McKean

Maryland: Samuel Chase, William Paca, Thomas Stone, Charles Carroll of Carrollton

Virginia: George Wythe, Richard Henry Lee, Thomas Jefferson, Benjamin Harrison, Thomas Nelson, Jr., Francis Lightfoot Lee, Carter Braxton

North Carolina: William Hooper, Joseph Hewes, John Penn

South Carolina: Edward Rutledge, Thomas Heyward, Jr., Thomas Lynch, Jr., Arthur Middleton

Georgia: Button Gwinnett, Lyman Hall, George Walton

Unintended Path

Keeping Patients’ Details Private, Even From Kin | NYT | 7.3.07

HIPAA was designed to allow Americans to take their health insurance coverage with them when they changed jobs, with provisions to keep medical information confidential. But new studies have found that some health care providers apply HIPAA regulations overzealously, leaving family members, caretakers, public health and law enforcement authorities stymied in their efforts to get information.

Experts say many providers do not understand the law, have not trained their staff members to apply it judiciously, or are fearful of the threat of fines and jail terms — although no penalty has been levied in four years.

Medical professionals can talk freely to family and friends, unless the patient objects. No signed authorization is necessary and the person receiving the information need not have the legal standing of, say, a health care proxy or power of attorney. As for public health authorities or those investigating crimes like child abuse, HIPAA defers to state laws, which often, though not always, require such disclosure. Medical workers may not reveal confidential information about a patient or case to reporters, but they can discuss general health issues.

It should come as no surprise that HIPAA has followed its fellow–beast, EMTALA, down the unintended path.

Identity Management

Calling In Pros to Refine Your Google Image | WP | 7.2.07

Google’s ubiquity as a research tool has given rise to a new industry: online identity management. The proliferation of blogs and Web sites can allow angry clients, jealous lovers or ruthless competitors to define a person’s identity. Whether true or not, their words can have far-reaching effects.

Conflict Registration

Is Your Doctor Tied to Drug Makers? | NYT | 7.2.07

It’s no surprise that the pharmaceutical industry is appalled at proposals to set up a national registry of its gifts and payments to doctors. Too much information might lead patients to suspect that their doctors are choosing costly medicines out of gratitude to the manufacturers rather than for the best medical or economic interests of their patients.

The drug companies ply doctors with a wide range of gifts, everything from free lunches for busy doctors and their staffs while sales representatives extol the virtues of their latest drugs to subsidized trips to vacation spots for conferences billed as educational events. The companies also pay large sums to doctors for consulting or for conducting research. These payments, which can mount into the hundreds of thousands of dollars over a period of years, look suspiciously like inducements to promote or prescribe the companies’ drugs.

Time for the medical profession to put up and register their conflicts or shut their doors to the pharmaceutical industry.