Monday, May 25, 2015

Medical Trash Recycled for "Green Science"

Used MRI magnets get a second chance at life in high-energy physics experiments


Hospital MRI



Re-purposed MRI Magnet


Argonne high-energy physicist Peter Winter, who recently won a DOE Early Career Award, is reusing old MRI magnets, like the one seen above, to benchmark instrumentation for new high-energy physics experiments. Credit: Mark Lopez

When it comes to magnets, a doctor's trash is a physicist's treasure.
On garbage day at a New York hospital, perfectly good medical equipment is taken away to make way for newer models. But it isn't going to the dump. Obsolescence is a key stimulus for early retirement of still useful devices
Anyone who has been to a medical facility realizes how much 'one use' devices are used. From IV tubing, catheters. gloves, and sterile fields. There are now one-use disposable surgical knives and instruments. Most of this can be sterilized and plastic recycled into re-usable items.
Along with this 'waste' are electronic instruments, containing semiconductors, rare metals, such as gold and toxic chemicals (mercury). Much of this material is from computers, display monitors.
There are also large devices such as x-ray, CT scanners (computer assisted tomography) and MRI (magnetic resonance imaging)
Most of these devices originated from laboratories focused on physics..It seems just that some of this material be returned to it's birthplace.
When it comes to magnets, a doctor's trash is a physicist's treasure.

Researchers at the U.S. Department of Energy's (DOE) Argonne National Laboratory recently acquired two decommissioned magnets from (MRI) scanners from hospitals in Minnesota and California that will find a new home as proving grounds for instruments used in high-energy and nuclear physics experiments.
The two new magnets have a strength of 4 Tesla, not as strong as the newest generation of MRI magnets but ideal for benchmarking experiments that test instruments for the g minus 2 ("g-2") muon experiment currently being assembled at the DOE's Fermi National Accelerator Laboratory. The Muon g-2 experiment will use Fermilab's powerful accelerators to explore the interactions of muons, which are short-lived particles, with a strong magnetic field in "empty" space.
The experiment relies on highly precise measurements of the strong magnetic field; the magnets will greatly aid these measurements. "As we prepare for the g-2 experiment, we have to have a suitable test magnet to very carefully calibrate our magnetic field measuring probes ahead of time," said Argonne high-energy physicist Peter Winter, who was recently awarded a $2.5 million, five-year DOE Early Career Research Program Award.
To measure and calibrate the custom-built probes, Winter and his colleagues needed a magnet that could provide not only a strong field but one that was uniform and stable. Solenoid MRI magnets like the ones Argonne has acquired are perfect for that purpose.
In addition to their strength, these repurposed magnets offer another notable advantage: originally used as a human patient MRI magnet, they have a wide bore so that large detector components can easily fit inside.
"By using these new magnets, we can fit the entire half-meter-long probe system in the magnet, which will give us a very precise measurement of the intensity of the magnetic fields," Winter said. "These MRI magnets produce a very stable, homogenous magnetic field that is ideal and crucial for getting technology ready for the larger g-2 experiment."
Because the g-2 experiment is so large and requires precise calibration, researchers need to firmly understand any potential interactions between the strong  and the equipment. "We can now validate any equipment in our test magnet, which is incredibly important because it saves time and money when the time comes to actually do the experiment," Winter said.
Because the Minnesota magnet was sitting in storage for a few years, Argonne needed only to pay the shipping costs – a few thousand dollars – to acquire it. By comparison, buying a new magnet to do the benchmarking would have cost close to $1 million.
Even the more involved transport of the second San Francisco magnet was still cost-efficient. "We're saving taxpayer money by finding new and different uses for technology that may not have been intended for physics in the first place," Winter said. "In the future, we will use this new test magnet facility to develop and test large detector prototypes that need to operate in high magnetic fields. We are open for other users across the entire lab to facilitate research that requires strong magnetic fields in a large bore magnet."
The second magnet will become a component in a new spectrometer for studying nuclear reactions that occur in supernovae. This new spectrometer is proposed for the future Facility for Rare Isotope Beams (FRIB), a DOE user facility under construction at Michigan State University. "The acquisition of this magnet would allow us to construct a state-of-the-art spectrometer that uses the radioactive beams from FRIB at minimal cost," said Argonne nuclear physicist Birger Back.
Both magnets have already been delivered to Argonne, and Winter and his team have begun to set up the magnet in the high-bay area of building 366. He expects validation experiments to begin soon.

Sunday, May 24, 2015

A New Generation of Innovators





Young physicians have much to teach their more mature colleagues.

Peer collaboration has increased since the internet developed, resulting in formerly impossible international networking. 

One remarkable thing which distinguishes the new generation of student innovators from their elders is that they are changing the competition paradigm; rather than working secretly and erecting barriers against competitors, they are sharing experiences and learning from one another what works and what doesn't.

The Five Characteristics of Successful Innovators

Scanning this list, my natural inclination was to think of larger-than-life innovators like Steve Jobs and Mark Zuckerberg -- but since that time I've come to realize that there are students on campuses across the country with these very characteristics.

Physician innovators share several key character traits with other innovators.  A Harvard Business Review article by Tomas Chamorro-Premuzic 

A professor of Business Psychology at University College London (UCL) and Columbia University, he distilled the research evidence and proposed five key characteristics of innovators (in addition to creativity):

  1. An opportunistic mindset that helps them notice gaps in a market, and a craving for new and complex experiences.
  2. Formal education or training that is essential for understanding what is relevant and what is not (even though this may be contrary to conventional wisdom).
  3. Pro activity and a high degree of persistence.
  4. A keen sense of when to proceed with caution.
  5. Social capital that enables them to use connections and networks to mobilize resources and build alliances.


A young man named Nicholas (Niko) Kurtzman is symbolic of this new wave of student-led innovation. Niko is a 27-year-old second-year medical student at the Sidney Kimmel Medical College who is studying for exams; he is also a co-founder of two companies:

  • EtherHealth, a company that offers a mobile app for physicians to "crowd source" informal, cross-specialty consultations on complex patient issues.
  • MedX, a free, massive online course for medical students that addresses 30 topics that are essential to physician practice but not taught in medical school (e.g., pay-for-performance, work-life balance)as determined by early-career healthcare professionals and taught by the nation’s experts in health care delivery science and management.
Not surprisingly, Niko describes himself as a very high-energy "people person" who thrives on multitasking and complex problem-solving.
When asked, "Why medical school?" he posits that knowledge of business, product design, and development -- in addition to medicine -- will enable him to help patients on a broader scale.
Unlike his father, a physician-innovator who ultimately opted to work full-time in a successful business he founded, Niko plans a career that encompasses both innovation and emergency medicine.
One remarkable thing that distinguishes the new generation of student innovators from their elders is that they are changing the competition paradigm; rather than working secretly and erecting barriers against competitors, they are sharing experiences and learning from one another what works and what doesn't.
Today, student-led innovation centers are beginning to crop up on campuses across the country, from the University of Central Florida (Center for Entrepreneurial Leadership) to Stanford University in California to Massachusetts General Hospital to the University of Pennsylvania.
One example is the Jefferson Accelerator Zone 
JAZ will serve as "command central" for innovation activities at Jefferson, including events related to the Innovation Engagement Speaker Series, Healthy Hackathons, and other programs under development. We welcome all members of the Jefferson chapter of the National Academy of Inventors with unlimited access to JAZ to foster mentoring of new ideas and commercialization prospects within the Jefferson community. JAZ will serve as a platform to engage and unleash creative, entrepreneurial talent.  
This only one of several university affiliated innovation centers across the United States. These centers are often partnered with local entrepreneurial minded individuals or established business in the fields of engineering, technology, and computer science.



The most apparent advantage of University affiliated innovation centers is that they are located in centers of learning, a fertile ground for creativity, and adjacent to an academic center where students can easily access a center. The innovation center serves as a center and platform for visiting entrepreneurs, and lecturers.





Plant the seed, fertilize it, nurture it












More.......

Friday, May 22, 2015

Meaningful Use People don't work that way


Not only physicians and hospitals apopolectic over the 3 stages of meaningful use.  The software developers and algorithmers are weighing in with their own opinions on meaningful 
use.



"We have all watched HHS and CMS blunder their way through Healthcare.Gov and just heard some wild stuff out of the mouths of data mechanics novices (and recently we heard it at the SEC too with Mary Jo White with markets not rigged) so it’s everywhere around in government.  So now here’s the AMA with a good list of ideas on how to fix some of this and it’s not bad at all as obviously you want to see doctors convert to electronic medical records but some of the folks out there today live too much in virtual values and lose track of the real world, which I call “The Grays”.  The AMA is trying to give forth some suggestions that focus more in the real world versus what has become pretty virtual as Meaningful Use is now and again all models don’t work in the real world as they do virtually.  It’s easy to get side tracked though when you work with data and forget the “real” world exists.  Doctors know it though as they deal with the real world every day and there’s a name for that and it’s called “patients”."
[Medical Quack] 

We have all watched HHS and CMS blunder their way through Healthcare.Gov and just heard some wild stuff out of the mouths of data mechanics novices (and recently we heard it at the SEC too with Mary Jo White with markets not rigged) so it’s everywhere around in government.  So now here’s the AMA with a good list of ideas on how to fix some of this and it’s not bad at all as obviously you want to see doctors convert to electronic medical records but some of the folks out there today live too much in virtual values and lose track of the real world, which I call “The Grays”. 


The AMA is trying to give forth some suggestions that focus more in the real world versus what has become pretty virtual as Meaningful Use is now and again all models don’t work in the real world as they do virtually.  It’s easy to get side tracked though when you work with data and forget the “real” world exists.  Doctors know it though as they deal with the real world every day and there’s a name for that and it’s called “patients”. 

HOW I LEARNED TO LOVE MY EHR, OR AT LEAST LIVE WITH (HIM--HER)

Health Care Professionals are not the only ones who live to learn how to love their software "at the office"

Developers are not inexpensive. They must develop platforms that are flexible enough to be used in many different businesses, one size fits all....suitable for none.

It would be a breakthrough to have true artificial intelligence (AI) as the gateway to business or medical applications.


The correct software can even change your personality and love-life. (at home, or in the office) Two different versions could be offered. Ver.M  and Ver F each for the appropriate gender. Voices can be age adjusted according to the user's preference.

Don't look for this very soon. The challenges of Interoperability makes this look easy. Not only one developer can write code for an entire program. There are specialists for portals, mHealth, differing OSs amd more..

Monday, May 18, 2015

Trending ICD Controversy ONC Interoperability

On Friday, the Office of the National Coordinator for Health ITpublished nearly 250 comments that it received on its draft nationwide interoperability roadmap, Politico's "Morning eHealth" reports (Pittman, "Morning eHealth," Politico, 5/18).

Background

The draft roadmap, titled "Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0," aims to achieve basic electronic health data interoperability by 2017.
It outlines short- and long-term goals for the next 10 years, with 2017 set as the deadline by which "a majority of individuals and providers across the care continuum" should be able "to send, receive, find and use a common set of electronic clinical information."

Interoperability Roadmap Public Comments

ONC requested public commentary on it's program for health information interoperability.
ONC accepted public comments on Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0. The comment period ended on April 3, 2015.
The draft Roadmap proposes critical actions that need to be taken by both private and public stakeholders to advance the nation towards a more connected, interoperable health IT infrastructure and was drafted by ONC based on input from private and public stakeholders. The draft Roadmap outlines the critical actions for different stakeholder groups necessary to help achieve an interoperable health IT ecosystem.
Selected commentary:
I am very opposed to this. It proposes to repeal federal law that allows state legislatures to enact true medical privacy laws for citizens. It views patient data as public property rather than personal property. It has uses of data that many patients will not accept.

Sunday, May 17, 2015

Teladoc plans to file for IPO, sues to stop Texas Medical Board rule

Fast-growing Teladoc, a Dallas-based telehealth company, has taken a step toward filing for an initial public offering despite a recent Texas Medical Board ruling that went against the company’s business model.




Telehealth’s time has come,' as Teladoc nabs $50M to amp up growth

Teladoc also today filed an antitrust lawsuit in the U.S. District Court for the Western District of Texas against the medical board and its members to prevent a new rule from taking effect that would restrict the practice of telehealth.
Jason Gorevich, President and CEO of Teladoc

Teladoc filed a confidential Form S-1 with theSecurities and Exchange Commission and expressed an intention to file an IPO after the SEC’s review process, according to a statement from the company. The number of shares of common stock to be sold and the price range for the proposed offering have not yet been determined, the statement said.


Texas Medical Board voted April 10 to adopt new rules limiting physicians who treat patients over the phone, video or online. The ruling could have severe implications for Teladoc, which conducts a substantial amount of its business in its home state.
The rules, which take effect this summer,require a face-to-face visit or an in-person evaluation to establish the doctor-patient relationship before the physician can diagnose or prescribe drugs to a patient. The new rules have been the subject of four years of debate and lawsuits.
State Medical Boards are entrenched in protecting regulations in each state. Telemedicine offers great potential for rural areas where there are great distances to physicians and hospitals.   Regulatory agencies must shift gears to accomodate new technology to maximize gains promised by the affordable care act.
What is the difference between a patient calling their insurance company hotline for recommendations (offered by a nurse or physician assistant, and a teleconference with a real physicians. (None).  The first is legal and has  never been challenged.

An issue with Teladoc is that it's service is linked to 'Freshbenies, a web site that promotes Rx Discount Cards as well as other partner sites. (erratum)
Texas is a large state with great distances between cities, patients and hospitals. 
Access to physicians and/or hospitals is very different in states such as Connecticut, Rhode  Island, New York, or New Jersey and the Washington D.C. metor area.
If the rule change takes effect this summer, it will represent a huge step backward for Texas," a statement from Teladoc says. "California, Colorado, North Carolina, Kentucky, Virginia and dozens of other states have found solutions that embrace telehealth, and all of its benefits, while ensuring patient safety. 

Thursday, May 14, 2015

What are the differences between ICD-9 and ICD-10

The biggest challenge to clinics, hospitals and physicians is the complexity of adopting ICD capable software while at the same time adding other functions to satisfy Meaningful Use  Stage III.

Most physicians are not quibbling about adopting this much more objective classification of disease, or normality.  The issue has been the steep timetable for adoption, with a looming deadline of October 1, 2015.  While many large institutions are already using ICD-10 the majority of small practices have not. The additional expense is considerable, and competing regulatory requirements compete with available capital to acquire new technology.

It's Simple, Really

CMS offers 10 ICD-10 facts


Now we have a list of 10 ICD-10 facts to focus on:
  1. The ICD-10 transition date is October 1, 2015.
    The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.
  2. You don’t have to use 68,000 codes.
    Your practice does not use all 13,000 diagnosis codes available in ICD-9, nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.
  3. You will use a similar process to look up ICD-10 codes that you use with ICD-9.
    Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.
  4. Outpatient and office procedure codes aren’t changing.
    The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of Current Procedural Terminology (CPT) for outpatient and office coding. Your practice will continue to use CPT.
  5. All Medicare Fee-For-Service providers have the opportunity to conduct testing with CMS before the ICD-10 transition.
    Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure that you can submit claims with ICD-10 codes. During a special acknowledgement testing week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.
  6. If you cannot submit ICD-10 claims electronically, Medicare offers several options.
    CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:
    • Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
    • In about ½ of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
    • Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met
    • If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.
  7. Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015.
    Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.
  8. Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes.
    Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
  9. Costs could be substantially lower than projected earlier.
    Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.
  10. It’s time to transition to ICD-10.
    ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:
    • Improve coordination of a patient’s care across providers over time
    • Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
    • Support innovative payment models that drive quality of care
    • Enhance fraud detection efforts.

Five Facts to Know Before the ICD-10 Transition Deadline


Dual Coding ICD-10 and ICD-9: When and How

QualiTest ICD-10 Survey Results

What I found interesting:
  • 28 percent of responding hospitals have  conducted ICD-10 revenue impact testing with healthcare payers.
  • 67 percent of responding hospitals have conducted ICD-10 testing with clearinghouses.

ICD-10 Gap Analysis Points to Revenue Neutral Transition

United Audit Systems, Inc. (UASI) has been conducting ICD-10 gap analysis for three years and concluded that the Centers for Medicare and Medicaid Services (CMS) will deliver on its revenue-neutral projections. (Journal of AHIMA)


  
 Ease your path to ICD-10!