Where are we heading in “Modern” Health Services?

Although I am aware that there are significant differences between health services in different countries -and in fact within the same country-; as health worker, we all share an underlying commonality to a certain degree. I am writing this article under the assumption that, in this current era of “globalisation” and “standardisation”, there is a universal demand for the “modernisation” of health services. The health system has been forced to incorporate, within its constitution, terms such as health delivery management, strategic planning, strategic improvement, governance and quality, amongst many other fashionable words brandished around these days (the likes of which, yours truly finds confusing sometimes). However, we must accept that all of the above are part of the continuous evolution of the health service.

Before I proceed further, I would like to clarify to the readers the use of the word “modernising” in the context of this article. Here, I am referring to the involvement of numerous and diverse areas of expertise (e.g. business, aviation) within the field of health. This new approach has placed additional expectations on the clinicians, requiring them to possess reasonable knowledge in various fields. These skills include management, budgeting, cost, strategic development and other tasks which were previously left to the administration ‘to deal with’, whereas we clinicians were expected to focus on improving our clinical skills and, even more importantly, satisfying /managing our patients. I imagine that many of you will agree with me that this is a very nostalgic view, which is rarely found in this modern day and age.

I am not going to bore you with details about the health service where I work, as I do not believe it to be of significant importance; it would in fact defeat the purpose of provoking a debate relating to the key question of this article (i.e. the title). It would suffice to say that there is a pressure, as a health provider, to embrace a great deal of management, business and budgeting concepts. I am like most clinicians; work in a rapidly “modernising” health system.  Hopefully, once the reader continues scanning through the article, they will understand why I elected to use this generalization.

My guess is when we look at “modernizing” health services in different countries there appear to be a significant difference between them at first glance but once we “dig deep” and examine in depth the fundamental structure of most of the health services (wither it is private, governmental, insured, free or hybrid) I assume that the reader will find common points, at least partially.

 I, as a health provider find myself in a strange position of being instructed to be knowledgeable about “quality ” , “management”, “strategic planning” ,”updating my evidence based knowledge” , “understanding the fundamentals of accounting and budgeting”  amongst many other words, which my memory could barely remember ,let alone grasp.

The main problem is all of the above are dictated to me by different parties whose priorities (rightly or wrongly) lie within their own “primary target”.  

One could argue that all of the above could be part of one thing and by doing one; this will lead to the achievement of the others (i.e. domino effect). This is a point which I hope my article would encourage debating.

From my humble point of view, I still cannot cope with all “the priorities” I am bombarded with and I do find contradiction in many of them; especially when it comes to (if we break it down in to a simple, old fashioned targets) patients’ care versus cost which- rightly or wrongly- in my opinion, what the main issue boils up to (this is again a controversial statement and subjected to debate).

I am here not to find a solution or to offer an “ideal” way to balance a juggling act, as I am still picking up the pieces and trying again and again to be able to pull up the act efficiently in front of many anticipating audiences, each looking at me from a different angle with different expectation.

I wish that I could say that I managed but the reality is that I could not. My department and my hospital could not and more importantly my health service leaders cannot which is the most worrying concern because it is these “experts” who are suppose to guide us,  yet sometimes you feel that the blind leading the blind.

So what happened in a decade or so to lead us; and I apologies for the generalization; to be entangled in this “modernizing” health service?

I myself are nostalgic for the day when we say patient comes first and we DO mean patient comes first. Yet, I find myself focusing less on patients and looking more at statistics, strategies, missions, visions, audits, surveys etc and although (please do not get me wrong) I am all for the above, but it is becoming harder and harder to balance my already flawed juggling act.

Allow me to give an example to demonstrate what I mean. As a consultant psychiatrist, I obviously posses skills that my colleagues may lack or are not be “privileged/ technically speaking” to carry. An example for a surgeon is a type of surgical procedure, for a radiologist a special radiological technique. In my case a therapy for certain disorders that required years of supervision and learning. Again, one may argue that I should take responsibility and that this is my own fault as I should transferred my knowledge to my colleges, but here where the dilemma lie, as time, ethics are against me. Clinically I am expected to priorities my time but this raises another dilemma as my time is not entirely in my hand and the vicious cycle goes on.   

Let me give a real life example which I hope will demonstrate the above argument. When I joined my current department I started (naively) to accept undertaking therapy for patients with personality disorder (i.e. a condition which requires specific skills learned through years of supervision and practice) as the waiting list was long, and I was the only person with the expertise to manage this population. I went to my secretary and with an authoritative instruction, told her to arrange booking one hour a day every Tuesday at 11am for at least 20 weeks minimum, with the possibility of increasing the number of session. The poor secretary looked at me and did the necessary.  After two sessions of relatively positive rapport building with my client, the time for the third session approached.  As the time for the session came my secretary called and informed me that there is a “mandatory” emergency meeting for all heads of department with the human resources to discuss an extremely important issue. Dilemma again, what should I do?  I thought that our motto of “do no harm” and ethically as my patient has a real risk of feeling abandoned (which could have a catastrophic effect on therapy) and more important could lead to risk of serious self harm, I made the decision not to attend the meeting and see the patient instead.

Next day, a warning letter was delivered to me through my work email and due to my absence (even though I have sent the reason, and asked one of my colleges to attend the meeting) our department has lost in term of some administrative decision making.

That was my baptism of fire and my welcome to the modern health care. As a head of department I find myself more and more involved in writing the ideal setting to serve our clients but the time consumed in this preventing me from doing exactly what I am writing!.

I wish that the issue is related to me only, but even down the “chain of command” each member of my staff is finding it more and more difficult to focus on patient, and more of their work involving replaying to emails, cutting cost, achieving targets, filling endless forms, auditing, teaching, gathering educational hours, coming with initiatives, fulfilling their objectives in the appraisal and much much more.

I hope that my experience and my words echoes with similar experiences with the readers and as I have mentioned in the beginning, I am not looking for solution but I am hoping to provoke a serious debate about where are we heading in this era of so called “modernisation” and is the involvement of many parties and philosophies in the process beneficial to the end result (patients)?.

I am looking forward for a thought provoking debate and would be grateful for any of the readers from different evolving health services to share their thoughts and opinions.

 



By: Prof. Saoud Al Mualla

About the Author:

Because premiums, deductibles, copayments, and coinsurance levels for small business group health insurance policies in Texas can vary widely from plan to plan, it pays to shop around.

Have a good understanding of your employees’ healthcare needs before you start shopping. Do they require frequent medical care or do they rarely see the doctor? Are they more concerned about preventive checkups or coverage in case of emergency? Are prescription or maternity benefits important to them? This is an essential first step. You want to purchase a plan that offers the medical benefits your employees need, without a bunch of “extras” your employees won’t take advantage of. You’ll pay for these “extras” in the form of higher premiums.

When shopping for coverage, the Texas Department of Insurance recommends keeping these guidelines in mind:

- Be sure you understand the full extent of each plan’s coverage when comparing plans and rates. If you decide to go with a consumer choice health benefit plan over one with all the state-mandated benefits, the carrier or agent is required to explain in writing which coverages you don’t have.

- Plans with higher deductibles, copayments, and employee share of coinsurance generally will have lower premiums. Keep in mind, however, that your employees will also have to pay more out of pocket when they access services or benefits.

- Consider factors other than cost, such as a company’s financial strength and complaint record. These are indicators of the service you can expect. You can learn a company’s financial rating, as determined by an independent rating organization, by calling the Texas Department of Insurance (TDI) Consumer Help Line. You can also learn information about the frequency of consumer complaints filed against specific companies by calling the Consumer Help Line: 1-800-252-3439/463-5515 in Austin.

- Look into purchasing cooperatives. These are groups of small employers with similar health care needs who join together to negotiate discounted rates for shared plans. For a list of registered purchasing cooperatives in Texas, call the Consumer Help Line.

- Buy only from licensed insurance companies. Selling unlicensed coverage is illegal in Texas. If you buy from an unlicensed carrier, your employees’ claims could go unpaid and you could be held liable for the full amount of your employees’ claims and losses. Guaranty associations pay the claims of licensed carriers that become insolvent. You can learn whether a company is licensed by calling the Consumer Help Line.

- Understand that employee health coverage is different from workers’ compensation insurance, which covers only job-related injuries and illnesses. Although workers’ compensation insurance is not required in Texas, it protects you from high damage awards in the case of workplace accidents. Providing regular health coverage to your employees is not a legal alternative to providing workers’ compensation insurance.

Who Pays and How Much?

The law doesn’t require employers to contribute toward health benefit plan premiums. However, many carriers require employers to pay at least 50 percent of the plan’s premiums. Employers may choose to pay a higher percentage than the carrier requires.

The carrier must offer dependent coverage to all eligible employees. Generally, employers are not required to contribute toward the cost of dependent coverage. If the employer doesn’t contribute, employees may have to pay all of these costs themselves.

Premiums may increase at each renewal term, largely due to rising health care costs and possibly as a result of employee claims experience. Texas law caps small-employer rate increases due to health factors at 15 percent per year.

Insurers cannot require businesses to purchase additional lines of insurance, such as life insurance or disability insurance, as a condition of the sale of a health plan.

Employee Signup and Waiting Period

New employees must be given at least 31 days from their start date to enroll in a plan. After this time, they may be required to wait up to one year for the next “open enrollment period” to join. Carriers must offer a 31-day open enrollment period annually.

You can choose to require your employees who enroll in a plan to wait up to 90 days before being eligible for benefits. During this period, the carrier may not charge you or the employee a premium.

Carriers may require participants to wait a certain amount of time before covering pre-existing medical conditions. In general, plans have different rules for pre-existing conditions. Plans using the open-enrollment requirement cannot make new members wait more than one year before covering their pre-existing conditions.

New enrollees who were covered in the year prior to joining a plan also receive credit toward the waiting period on a month-for-month basis. For example, an employee who was covered under creditable coverage for the entire year before joining a new plan would receive 12 months credit toward a one-year pre-existing condition wait — and would therefore experience no wait at all. For previous coverage to be considered creditable, there may not have been more than a 63-day break between the end of the previous coverage and the start of the new coverage.

A small business employer carrier cannot refuse to provide health coverage for employees on the grounds of employee illnesses or pre-existing conditions. Nor may carriers use health-related factors — such as employees’ prior claims experience or information on conditions arising from violent family situations — to decide whether to provide coverage.

How Small Employer Plan Premiums are Calculated

The rates for any given small employer plan are not solely determined by the benefits and deductibles of the plan itself. Certain objective “case characteristics,” along with any health status-related factors of employees, may also be components in determining the premium rate for the small employer group. Case characteristics consist of age, gender, group size, industry, and geography. Carriers can use some or all of these five objective criteria:

- Age of employees: Older people can reasonably be expected to have more expensive and more frequent health-related claims. Generally, the older your workforce, the more your plan will cost.

- Gender: Females generally incur higher medical costs than males at younger ages, particularly during childbearing years. The variance diminishes with age until medical costs for males begin to exceed those for females as they near ages 50 and 60. If you have a younger, proportionately more female workforce, or one that is older and proportionately more male, expect to pay higher premiums.

- Number of plan participants: Carriers often base rates on group size for two reasons. As size increases, administrative costs per insured decrease. Also, smaller groups tend to buy health coverage based on the targeted needs of participants, increasing the likelihood of claims for the benefits provided. As group size increases, this “custom-tailoring” becomes more difficult and premiums tend to decrease. However, the highest group size factor may not exceed the lowest group size factor by more than 20 percent.

- Industry: Some industries have higher medical claims costs than others because of working conditions and the prevalence of accidents. High employee turnover in some industries can also result in higher administrative costs for the carrier. However, the highest industry factor a carrier charges may not exceed the lowest factor by more than 15 percent.

- Geographic area: Health care costs vary by region due to differences in cost of living and medical practices, as well as the amount of medical competition in the area. Most plans vary rates by either county or ZIP code, using the employer’s business address to set rates.

The rating process for a small-employer group can be described as a two-step process. First, a carrier determines a premium rate based on case characteristics and plan design, without regard to health status-related factors. This produces the baseline price of the policy. Second, the carrier may adjust the rate to reflect health status-related factors of the group. This adjustment must apply uniformly to all members of the group and may not exceed 67 percent of the baseline price of the policy.

Group health insurance can be not affordable for many small businesses, not to mention an administrative headache. Another alternative to group health insurance plans is to offer individual health insurance options to your employees. By law, an employer is not allowed to contribute to these plans, or that would be treated as group insurance under Texas state law. But you can still help your employees become insured in a good plan and improve their health and well-being and also improve employee retention in the process. If you’re a small business owner who would like to offer affordable health insurance plans to your employees, but can’t afford group health insurance, you should consider offering your employees the revolutionary, comprehensive individual health insurance solutions created by companies specifically for young, healthy individuals.



By: Pat Carpenter

About the Author:

Medical Office Administration is comprised of various job fields and specialties. From Medical receptionists, to medical coding specialists; medical office administration encompasses a wide spectrum of specific clerical and administrative functions that keep medical offices and facilities running accurately and smoothly.

Medical office administration fields are not only necessary, but are clearly becoming one of the fastest growing job fields in the workforce today. As more and more patients continue to utilize insurance programs and government assistance to fund health care, medical office administration is a vital element for quality management of health care.

Medical office administration duties include medical reception, scheduling appointments, patient admissions, medical transcription, billing, filing, coding, processing insurance claims, and general office duties. Medical office administration can be found in physician’s offices, insurance companies, pharmacies, private medical laboratories, medical billing services, long-term care facilitates, clinics, health agencies, and hospitals.

To learn more about a career in medical office administration, please feel free to browse our vocational schools’ directory for schools that offer course studies in medical office administration today at HolisticJunction.com.

Find your dream job! Let education within fast-growing industries like massage therapy, cosmetology, acupuncture, healthcare, personal training, and others get you started! Explore career school programs near you.

Medical Office Administration

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By: Steven Parbach

About the Author:

There is a lot of prospect in community-based mental health careers both in the state of Maryland and all over the country. This is because for years now, there has been a lot of emphasis on prevention and reduction of inpatient hospitalization for all illnesses, including mental illness. This might primarily have been intended for cost control, it has also facilitated quality and access. The second reason why career prospects in community mental health are many is that there is currently a severe shortage of mental health workers in all sectors. The 2007 Maryland Mental Health Workforce White Paper revealed that the number and complexity of mental health problems experienced by children and their families have increased over the past decade. It further said, “At least one in five children and youth, or 20%, experience a mental health disorder. The crisis of mental health in the United States is such that 75-80% of youth with mental health diagnoses receive no services, and services received are often inadequate”. Thirdly, there is inadequate diversity among the few mental health workforce. For example, 28% of Maryland population is of ethnic minority but only 12% of mental workforce is of ethnic minorities. Furthermore, there is an acute shortage of African American males in mental health workforce.

 1. Outpatient Mental Health Clinics (OMHC)

Outpatient mental health clinics provide therapy, counseling, medication management, social skills teaching, and case management services to individuals with severe and chronic mental health problems. Career prospects available in OMHC include:

Therapists and Counselors: New regulations require therapists and counselors in OMHC to have a minimum of a Masters degree and a license (such as LGSW, LCSW, LCSW-C, LGPC, LCPC, RNC, APRN/PMHN) in nursing, social work, psychology, counseling, or psychiatric rehabilitation. Also, an RN without a Masters degree but with an RNC from ANCC can be employed as a therapist. Salaries are very attractive.

2. Psychiatric Rehabilitation Programs (PRP)

PRP programs are an extension of the services provided to the patient in the OMHC. A PRP may stand alone or be an additional service to an OMHC. The purpose of PRP is to promote the rehabilitation, integration and improved quality of life for the patient at home, school, work and community. It aims at helping the patient to function at his or her optimum best in life. The counseling can be done at the Program office (onsite) or at the patient’s home (offsite). PRP counseling could be about a wide range of topics, including anger management skills, social skills, assertiveness skills, medication compliance, coping with symptoms, managing peer pressure, taking a bus, determining bus route, drug and alcohol, gang prevention, sex education, STD education, accessing community resources such as food stamps, affordable housing, bus pass, ID card, driver’s license, job search, preparing for job interview, keeping a job, improving attention in school, completing homework and school projects, respect of authority, etc.     

Even though a mere one-year work experience in a mental health setting or having an AA degree qualifies one to be a PRP counselor, PRP programs prefer to employ persons with a BS degree in any health or mental health related field such as nursing, social work, counseling, psychology and rehabilitation. PRP counselors are usually paid $14 or more per counseling session. Each client receives 2 to 8 counseling sessions per month.

3. Expanded School-Based Mental Health (ESBMH)

In addition to the school clinic, some schools also have an ESBMH clinic. A therapist assigned from an OMHC manages each of such clinics. Apart from providing therapy to troubled kids sent to the therapist’s office from the class or principal’s office, the therapist also serve as a resource person to the school staff regarding particular children, issues or topics related to mental health. 

4. Crisis Response Programs (BCRI, BCARS)

Mental health professionals are also needed in crisis centers where services are provided for anyone in mental health crisis. The two main centers in Baltimore are Baltimore Crisis Response, Inc. (BCRI) and Baltimore Child and Adolescent Response System (BCARS). For employment inquiries, please call 410-433-5255. There are positions that do not need a Masters degree.

BCARS website provides the following information about what they do: 

BCARS is a mobile crisis response service that provides emergency contact with mental health professionals throughout the city. Dedicated crisis clinicians staff the program as part of a continuum of clinical care provided by the Catholic Charities.  The Johns Hopkins Division of Child and Adolescent Psychiatry provide psychiatric consultations to the program.  BCARS assists children and families facing psychiatric and psychosocial crises by providing hospital diversion and immediate intervention and respite. For information or assistance, please call the BCARS hotline (410) 752-2272. It is available 24-7. 

BCRI web site provided the following information: about what they do:

HOTLINE: The telephone crisis “hotline” (410-752-2272) is available 24 hours a day and is staffed by trained counselors who have the ability to provide information and referral to the network of human services in the Baltimore metropolitan area. The counselors also provide supportive counseling, dispatch emergency assistance and link callers with more intensive BCRI services.  In FY 2004 – 34,852 and FY 2005 – 30,257 calls were received on the Hotline.

MOBILE CRISIS TEAMS: Mobile crisis teams are comprised of mental health professionals including psychiatrists, social workers and nurses who can be dispatched to community locations to provide immediate assessment, intervention and treatment. Teams operate from 7:00am till midnight seven days per week. Currently the teams average over 2000 responses per year.

IN HOME SUPPORT: Persons experiencing a mental health crisis can often be maintained in the community through regular visits from the BCRI mobile crisis teams. An average of 350 people a year is cared for in this manner.

RESIDENTIAL CRISIS BEDS: Baltimore Crisis Response, Inc. operates 18 psychiatric crisis beds. Crisis beds are not new to Maryland. However, since its inception, BCRI has operated with an average length of stay of 4.5 days compared with the historical statewide average of 16.5 days.

PUBLIC EDUCATION AND TRAINING: BCRI provide public and professional education and training on a wide range of mental health related topics including: suicide prevention, crisis intervention, mental illness, and stigma.  Training has also been provided to members of the Baltimore City Police Negotiation Team, over 3,000 patrol officers, Housing Police and Sheriff’s officers. Through special grants and contracts, BCRI has provided training to Baltimore City Public School teachers and guidance counselors, clergy, 911 operators, shelter care staff and others.  Public education is also provided via a cable television program called “Mental Health Matters”.  This program provides practical information regarding mental health issues and community resources.  BCRI has also offered professional training conferences, workshops and symposia.

ADDICTIONS SERVICES: In response to the growing need for addictions treatment services BCRI has expanded and now provides a 10-day residential detoxification program for chemically addicted and dually diagnosed persons.  There are currently 16 beds operated for this purpose.

5. Group Homes

Direct care staff and counselors are needed in group homes to manage, care and support the residents in the areas of activities of daily living, behavior management, life progress, and community living. Employment preference is usually given to individuals who have a degree related to health or mental health. Salary rates are very attractive. New regulations now mandate each group home especially for children to be managed by a Program Administrator (PA) who must possess at least a BS degree in any field but preferably in a health or mental health related field. Program Administrators are very well paid, depending on their education and experience and the size and intensity of the group home. 

6. Private Practice

There are a lot of prospects for licensed mental health professionals with at least a Masters degree to establish their own private practice. The practice could be in the area of clinical, research, educational, or consultancy.



By: Samson Omotosho, PhD, APRN/PMHN

About the Author:

The explosion in the popularity of online degrees is making news these days, with health care degrees online near the top of the list of popular courses. It’s important to keep in mind, however, that not every kind of health care degree is appropriate for online study while others are particularly well suited to this type of program.

A bachelor’s degree in nursing would be difficult, if not impossible, to pursue at an online university simply because there are so many hands-on courses that are required to become proficient. Programs in health care management, health care reimbursement and health information systems can all be studied online with excellent results. Most of these health care degrees online focus more on the management, procurement or organizational aspects of health care services rather than direct patient contact. They offer the ideal combination of a satisfying health care and business-oriented career.

The Proper Coursework for Getting a Health Care Degree Online

Courses that are typically part of the curriculum for health care degrees online will include some introductory biology courses such as anatomy (which anyone dealing in any aspect of healthcare services must understand) and a wide range of management and business courses that are geared to the health industry. Some courses you should look for if you are considering pursuing your health care degree online include:

Accounting

Physical anatomy

Health care legal issues

Health care management

Financial management and/or Clinical management

Human Resources management

Health care administrative practices

Online Degrees Will be Increasingly Popular

Some people mistakenly think that a health care services degree of any type is somewhat limiting. This couldn’t be further from the truth, as every type of health care provider in the United States requires a variety of management personnel, and many other industries outside of healthcare itself hire them as well. One example is a health administration or health services management degree; individuals with this type of degree can be encouraged by these statistics, which illustrate the diversity of opportunities available:

30 percent are employed by hospitals or large clinics

16 percent are employed by private facilities, small clinics or doctors’ offices

20 percent are staff at home health care, ambulatory and nursing facilities

The remainder work for insurance companies and the government in some capacity

In the next three decades the need for increasing expertise in managing the day-to-day operations and budgeting of health care services will become crucial as the population ages and increases. More and more people who are currently working in some capacity in health care services now will move up to management level positions by pursuing an advanced health care degree online, combining education and experience.

With such a vital need and online colleges and universities tailoring coursework to meet the need, it seems likely that the best way for anyone who would like to move from a receptionist or medical secretary to a management level position is to keep working and pursue a specialized health care degree online.



By: Andy West

About the Author:

Established in 1979, American Women’s Services is proud to lead the way in setting a standard for women’s healthcare. We are fully committed to providing proficient, excellence women’s reproductive health services in a very professional, caring, and compassionate manner within USA in these locations – New Jersey, Pennsylvania, Maryland, Virginia Beach. We are competent to provide the best care available because of the extensive knowledge and experience in women’s reproductive health care that our doctors, health care teams and administration bring to their work. Our services are provided in private practice office settings to assure confidentiality and individual support for each woman.

Here are few services of ours:

Abortion Services

Gynecological Services

Emergency Contraception

STD and HIV Testing

We provide the most current and safest abortion services – specialized in non-surgical and surgical abortion. Also, we have full range of Gynecology Services including emergency contraception, prescriptions for contraception, diaphragm fittings, IUD/IUS placement and tubal occlusion. American Women’s Services- is an expert, service-oriented women’s healthcare organization that understands what women want and need at every stage of their lives.

American Women’s Services – is like a family unit, and we truthfully consider that our best team of staff members, experts and medical professionals offers excellent women’s care because they themselves are treated in a manner that shows respect and caring. Our physicians are experienced Healthcare Providers who are devoted to providing quality reproductive health care services for women. Our health care teams work in collaboration with the doctors in each office to ensure that every woman receives the information and counseling necessary to make important reproductive health care decisions. We strive to make every patient’s experience as personalized, smooth and streamlined as possible.

For more information on our services or to schedule an appointment, please call us toll-free, at 1-888-ABORTION , 24 hours a day to speak with one of our professionals who can answer your questions and make an appointment for you or visit http://www.americanwomensservices.com/ .



By: Seo Expert

About the Author:

Several significant events have driven public and industry interest in personal health records. In 2004, President George W. Bush outlined a plan for the implementation of an electronic health record that could be accessed by all Americans. Although numerous companies had been in this market for several years, the announcement provided impetus for growth in this area. In 2007 and early 2008, computer giants Google and Microsoft announced their intentions to enter into this market, Google with Google Health and Microsoft with Microsoft HealthVault.

In March of 2008, laboratory industry leader Quest Diagnostics announced a partnership with Google Health to provide uploading of laboratory testing to Google’s version of a personal health record (PHR).

The U.S. Department of Health and Human Services cites six positive outcomes with the implementation of widespread personal and/or electronic health records.

1. Improved healthcare quality

2. Prevention of medical errors

3. Reduction of healthcare costs

4. Increased administrative efficiencies

5. Decreased paperwork

6. Expanded access to affordable healthcare

Although there are a number of potential barriers to widespread implementation of personal health records, three are the most significant. They are:

1. Interoperability. The various systems need to be able to interact with each other and various computer systems.

2. Privacy and Security. The systems need to provide HIPAA-like compliance, but also have security measures similar to the banking industry and in compliance with a variety of industry standards.

3. Data Modification. In order for physicians to be able to act on medical information, they will need to be confident of the veracity of the medical data. This will at least partly require that they be able to determine the sources and modifications that have occurred to the information in personal health records.

Although there are a number of companies currently in the marketplace offering personal health records, they fall into four broad categories.

1. Standalones. These companies are primarily personal health record companies, such as LifeOnKey or FollowMe. In some cases these companies also specialize or have specialty subcategories, such as MiVia, which was designed for the migrant farmworker population, or LifeOnKey’s Diabetes focus or Women’s Health focus.

2. Spin-Offs of Information Technology or Software Companies. Most notable in this category are Google Health and Microsoft HealthVault.

3. Healthcare Providers. Examples of this are Partners HealthCare’s Patient Gateway and the Group Health Cooperative’s MyGroupHealth.

4. Platform Providers. In some cases, the companies are focused less on being the patient/consumer’s personal health record, than in providing the platform and/or technology for personal health records. MedCommons is an example of this. Microsoft HealthVault may also fall into this category. FollowMe also is willing to customize their product for other companies, which then provide their own branding.

There are five ways personal health record providers are generating revenue.

1. Subscriptions. Typically, standalone PHR providers charge nominal annual subscription rates ranging from about $25 to $50.

2. Advertising. Google Health and Microsoft HealthVault indicate they will generate income via advertising. It’s not yet clear how Microsoft intends to do this, but Google Health has indicated that their product itself will not contain advertising, but will have search boxes that connect to the traditional Google page, which does have targeted advertising.

3. Data mining. Although often mentioned as a possible source of revenue, few companies indicate they are currently selling non-user-identified health data to researchers or pharmaceutical companies.

4. Increased Service. Healthcare providers, in general, acknowledge that their personal health record systems are just part of the service and a happy client will remain with the system. Google Health indicates they aren’t in the healthcare business and part of their mission is to drive users to Google.

5. Subcontracting and licensing. MedCommons is focusing on providing their services and platform technology for other users and companies that might want to deliver personal health records. It’s not clear if Microsoft HealthVault plans to enter the market in this fashion, but many industry sources suggest it’s likely.

Ultimately, what is clear from looking at a cross-section of PHR providers is that there are a number of approaches to dealing with laboratory results depending on the nature of the PHR. Google Health has recently announced a partnership with Quest Diagnostics.

This is likely to be the first in a number of similar relationships with other laboratory corporations. The real question, one that remains unaddressed yet, is whether competing labs will create partnerships with Google Health and other PHRs or whether it will become an exclusive and competitive marketplace, where some PHRs will find their services locked out of the market.

Another potential question is whether or not a laboratory, independent or affiliated with a particular healthcare provider, is going to be able to provide data uploads to a myriad of different PHRs. Although largely a technical issue, it’s hard to see how a laboratory needing to provide results to twenty or thirty different PHRs in addition to requesting physicians and patients, is going to make laboratory medicine more efficient or cost-effective.

PHRs Gain Momentum

In his January 20, 2004, State of the Union Address, President George W. Bush outlined a plan for the implementation of an electronic health record that could be accessed by all Americans. The system was to be in place by 2015. According to the White House Web site, patient participation would be voluntarily, and “these electronic health records will be designed to share information privately and securely among and between health care providers when authorized by the patient.”

To achieve that goal, the following steps were taken:

1. Health Information Standards were adopted. Under the direction of the Department of Health and Human Services, in cooperation with other Federal agencies and the private sector, voluntary standards were to be identified and endorsed.

2. Health Care Information Technology Demonstration Project funding was increased to $100 million.

3. Federal agencies were encouraged to adopt Health Information Technology.

4. A sub-cabinet level position of National Health Information Technology Coordinator was created. This falls under the Office of the National Coordinator for Health Information Technology, part of the Department of Health and Human Services.

It’s important to note that the Bush Administration’s proposal did not break new ground. Numerous companies providing personal health records (PHR), medical health records, and electronic health records or some way of storing and delivering medical information electronically were in existence for several years prior to the Bush Administration’s efforts.

The announcement of launches into the health information technology (HIT) arena by Google and Microsoft has renewed media interest in the area, and may signal a renewed velocity and vigor to the market.



By: Mark Terry

About the Author:

From child welfare to outreach social work, personal care to vocational rehabilitation, the human services industry is more meaningful to our world now than it has ever been. Find out why this career option earns high marks from new graduates and mid-career changers alike.

Human Services Career Profile

The human services industry encompasses a wide range of professional titles that focus on improving the quality of life for the population in general. Workers in this field plan, organize, and coordinate the activities of social service programs or community outreach organizations. Common job titles may include Program Director, Personal Care Attendant, Director of Child Welfare Services, Vocational Rehabilitation Administrator, and Director of Social Services.

A Challenging Career

One of the solid benefits of a career in human services is the sheer demand for the position. A challenging overall job market should prove profitable for human services professionals. Job cuts and higher costs of living are placing a strain on the average American, prompting the need for social services to help ease the difficult transition.

Of course, the social conscience of the position is another big plus. If you want your career to mean more than the figure on your paycheck, human services can give you the opportunity to strengthen your own community. For counselors, rehabilitators, and service providers, job satisfaction should be a major draw.

Human Services in the Numbers

According to the Bureau of Labor Statistics, social and human service assistants held about 339,000 jobs in 2006 with over 60 percent employed in the health care and social assistance industries. Not surprisingly, employment of professionals in this industry is expected to increase by nearly 34 percent through 2016. All sectors considered, human services should add about 114,000 new jobs in the coming decade.

Depending on the specialty, salaries vary throughout the field of human services. In 2007, these occupations earned the following median annual salaries:

• Social and human services assistant: $26,630

• Child, family, and school social workers: $38,620

• Mental health and substance abuse social workers: $36,640

The Human Services Career Path

Perhaps the most attractive feature of this profession is that it traditionally relies on life experiences as much as academic training. A variety of positions in human services usually don’t require the advanced degrees that you may find elsewhere in the healthcare industry, for example. The basis for success should be a genuine interest in the well-being of others. And while formal training can make you more competitive in the job market, an extensive educational resume is certainly not a prerequisite for career satisfaction.

If you plan on advancing to leadership positions, advanced degrees are certainly recommended. A bachelor’s degree in sociology, psychology, or a related humanity is a good place to start. Postgraduate work in business administration or counseling can help you garner the experience needed to manage non-profits or government organizations. Certification with such agencies as the National Institutes of Health, the Food and Drug Administration, and the Centers for Disease Control and Prevention typically carry a lot of weight.



By: Kelli Smith

About the Author:

SOCIAL JUSTICE THROUGH HEALTH CARE

We hardly come across a person who may be fully satisfied with the health care delivery system run by either the government or the private sector. This is true not only for developing but for all the developed countries as well. Every law abiding, contributing individual has some legitimate expectations from the state. Disenchantment with present dispensation of health care compels people to seek better options across the borders. Even the present flow rate of patients from developed to developing countries has assumed the proportions of Medical tourism. Medical tourism is not a one-way traffic. Poor from India are known to visit Rashid Hospital at Lahore for kidney transplants. Medical tourism will definitely bring in world class equipment and services in our corporate hospitals. These corporate tertiary care hospitals can act as excellent referral hospitals. Lack of enough clinical material, as the patients are often referred to in medical parleyences is prompting the doctors from developed world into medical adventurism. Very recently two NGO’s headed by renowned plastic surgeons of Indian origin were in India, claiming to their credit hundreds of cleft lip and palate surgeries conducted in one week. During my brief interaction when I asked them one basic question that how do you justify single step surgery by a single specialist for a clinical entity that require 3-5 set up surgeries by 10 specialists over a period of 20 years, there was no answer. On record local doctors conduct all these surgeries. These NGO’s bring in a battery of trainee resident doctors for hands on training. Dumping of questionable services and drugs continues unabated in the absence of stringent regulations. Clear-cut up to date guidelines by health authorities have yet to be issued to safe guard the health interests of this nation. Most of the drugs banned in developed countries are still being dumped in the Indian market. Commerce alone dictates the policies of multinational companies in health sector of developing countries. State and national medical councils, the watch dogs of our national health interests are controlled by elected representatives from among the doctors. Competitive populism for being elected to these high offices takes away the very sting off these regulators. In this ‘market forces’ driven health sector, apart from other factors, size of the population, economic prosperity and literacy levels dictate the out look of key players. Subjective as well as objective assessments of the health care operations leave people confused with huge piles of data and endless interpretations. At the tail end of govt. health care delivery system is the rural dispensary or the slum revamping center, and the end user an illiterate or semi literate villager or a slum dweller. Dispensary is the humane face, the welfare state can present to its people. In yesteryears the service providers were from among the same social class they used to serve. Doctor can be a friend, philosopher and guide to the locals. Unfortunately the economic and social disparity between the service providing doctors and the service user population has grown enormously. Ad-hocism in health care delivery should be done away with immediate effect. Doctors and paramedical staff appointed on yearly contract basis are not showing any interest in the national programmes. Established private health care providers also have not shown any meaningful commitment for national programmes. Middle class itself has fragmented. Now it is fashionable to assign economic values to any issue like gender, but for social responsibility and justice. In this era of fast paced growth, the unorganized, silently suffering millions can not be wished away. Once reading on biodiversity I stumbled upon a very interesting quote, “only the species with economic importance will survive”. In our active pursuit for magnetizing economy, we assigned economic values to any thing except for morals. Commercialization of education has produced a new breed of professionals who have scant regard for professional ethics. Privatization is the buzzword with governments, because it takes away government responsibility. Private sector players are eyeing many ‘viable’ health institutions. There are no takers for commercially non-viable rural institutions. Rural health institutions dispense social medicine. Very recently one of the key players from private sector health care quoted the cost of developing one bed in corporate hospital at Rs. 30-60 lacs. These corporate health services are definitely out of each of the common man. These type of hospitals are definitely required for a nation with the present rate of growth but ‘bharat’ definitely needs different kind of hospitals. There are very strong social under currents against the exploitive private healthcare, inadequate government sector health care resources and the indifferent approach of welfare state. Health for all is a very lofty but expensive proposition. There are ways and means to reduce the pressure from government institutions. Private-public partnership, health insurance, monitoring and regulation of private sector health care can all make the things bit easy. Preventive health care education can go a long way in improving the public health. Community participation in health care has produced few but wonderful examples. Complementary community participation can make up for minor but critical deficiencies in the government run health care system. Setting up of health system corporations with World Bank assistance has already improved the working of govt. sector health care institutions considerably. Community participation through NGO’s can still improve the system, but most of the meaningful NGO’s turn their back on govt. run health care institutions because of their doubts on the integrity of government officers. Government health care institution are increasingly seen not as caring hospitals but like police stations, where medico legal reports are written and postmortems conducted. Most of the government doctors’ time is spent in courts appearing as medico legal experts witnesses. Emergency, post mortem, and then the VIP duties in addition hardly leave the doctors free for any meaningful job at government hospitals. There is an urgent need to have separate curative, preventive, legal, administrate and health intelligence wings. Government hospitals attract the poorest of the poor, mostly people from the unorganized sector. Their contribution to national GDP is by no means small. With the present growth rate, upward social mobility is seen in every strata of society. Many segments of this unorganized sector can be organised so that they also enjoy the patronage of welfare state in the form of health insurance policies. Apart from direct benefit to these segments of society, the state will benefit from the ‘off loading’ of burden from government run health care system and loading it on insurance driven private sector health care institutions. Poorest of the poor will repose faith in welfare state. Sanjivini, health insurance policy with the Punjab Milkmen Cooperative Societies is already a big success. ECHS (Ex servicemen Contributory Health Scheme) is an other success story. These success stories can be replicated with countless groups like, panwallas, dhabewallas, autorikshaw drivers etc. Simply organize the unorganized sector. There is no dearth of role models from among government doctors also. Their inclusion rather than drift after dissent from the present dispensation of health care will immensely improve the system. Stability of tenure is an excellent incentive government can give to its doctors without costing anything to exchequer. Yet tenure beyond decades should be discouraged as it leads to development of vested interests of the old incumbents and denial of chance to the youngsters. Resource mismatching is a major problem in the govt. run health care system. There are dispensaries where specialists are posted and still many more civil hospitals where non-specialist are posted. These mismatching result in defective and inefficient health care. Nodal Hospitals can be created for round the clock emergency services by cannibalizing defunct and sick institutions where equipment worth crores is lying unused and salary bills are bleeding the exchequer white. Most of the medical officers retire in the same administrate rank. This undue stagnation has forced many a brilliant doctors out of service. By simply seeking options for place of posting, honestly implementing with minimum displacement on merit can also revitalize the govt. doctors’ cadres. Private sector health care delivery system is a totally market driven commercial enterprise. So called ‘market forces’ have least respect for ethical and moral value systems. Multi level marketing chains have evolved in the name of referral systems. End result is exploitation of the unsuspecting common man, who still regards his healer a holy person. This ‘incentive’ system is strengthening the hold of unqualified, unscrupulous and unregistered medical practitioners on illiterate masses. Not many qualified doctors are unscrupulous. A large section of private health care providers feel genuinely threatened by blackmailers of all sorts. Consumer protection act is a very convenient beating stick in the hands of their tormentors.

Under the constant threat of being blackmailed, the private health care providers are becoming more defensive in attitude. More patients are being referred to tertiary care institutions for this reason only, thereby flooding the referral institutions. People have a common feeling that sickness is an invitation for exploitation at the hands of private health care providers. Even the charitable hospitals are charging as heavily as fully private hospitals. Medical profession is fully responsible and capable of self-correction. Medical councils and associations can jointly evolve a fail-safe mechanism to keep their black sheep under check even without government help, but the buck stops with the government. Welfare state is duty bound not only in providing health care delivery system but also proper health care administration and social justice through its health care delivery mechanism.

Name : Dr. Pardeep Kumar Sharma

Email-ID : omfspardeep@yahoo.com.

(M) : 0988456296

Date of Birth : 12.02.1962

Education Qualifications : BDS (Bachelor of Dental Surgery)

MDS (Master of Dental Surgery in Oral and Maxillofacial Surgery)

Educational Institutes Attended

Govt. High School Bargari : Matriculation (1969-1977)

Distt. Faridkot, Punjab, India

DAV College Chandigarh : Pre-University (1973-79)

(Punjab University)

Barjindra College Faridkot : Pre-Medical (1980)

Dental Wing, Medical College : BDS (1981-1986)

Patiala

Dental College and Hospital : MDS (2003-2006)

Amritsar

Professional Experience

House Officer, Christian : 1987-1988

Medical College & Hospital,

Ludhiana

Research Officer, All India : Jan. 1989 to June 1989

Institute of Medical Science

AIIIMS, New Delhi

Dental Officer, Indian Armed : July 1989 to August 1994.

Forces in the Rank of Capt.

3

Medical Officer (Dental) : w.e.f. Nov. 1995 till date

in Punjab Civil Medical Service

(PCMS)

Research papers Published

“Role of Programmed cell death in dental anomalies associated with cleft lip and Palate”. “Medical Hypotheses” Churchil Living Stone Publishers London-1991

Post traumatic polatoglossal adhesion, a case report stomatologica India (1990).

Research Project Undertakes

“Malocclusion and associated Factors among Delhi Children” a study sponsored by Indian Council of Medical Research (ICMR).

Areas of Interest : Environment, Health, Defence, International Affairs and Rationalism



By: Pardeep Kumar Sharma

About the Author:

The new Administration is taking over facing an unprecedented economic crisis. The country is already deep in debt and proposes to spend billions more to help prevent a long-lasting recession. Looking overseas, the war in Iraq still has eighteen months to run and there is no end to the war in Afghanistan in sight. So some would argue this is not a good time to start proposing major changes to the health care system. The last time this was tried under the Clinton Administration, the economy was doing well and the momentum for change was lost. Trying it again now is inviting a battle over the legislation when the country would be better served if its leader was focussed on the economic problems. Well, the nay-sayers would be wrong. This is the right time to talk about it again.

According to the latest figures, it is estimated that out of a population of about 305 million, some 45 million people in the US do not have health care cover. They are entirely dependent on the emergency rooms and the public hospital system subsidized by local, state and federal bodies. Why are so many people without insurance? The answer is, as everyone is all too painfully aware, that the premiums have been rising faster than inflation for the last five years and more. Now that unemployment is rising at a fast rate, more people will be unable to afford the instalment payments. The Administration’s own estimate is that someone is driven into bankruptcy every thirty seconds (for the record, it is also predicted that approximately 1.5 million will be driven out of their homes in 2009 for non-payment of mortgage or rent). If fewer people pay their health plan premiums, the premiums must rise for everyone else. Treatments remain expensive and have to be paid for. If the hospitals cannot collect any money from their uninsured patients, the costs for all the insured must rise. Businesses are now passing on these increased costs to the members of their health plans. In effect, this is a pay cut. That is why this Administration wants to see a more fair system with affordable care and cover for everyone.

This means a halfway house. The current Administration would probably prefer to move to a single payer system of health insurance immediately, but there is too much invested in the current private insurance market. So the government is proposing a state-based system for all those without private insurance, allowing those with insurance policies to change over if they wish. Health care coverage for children is already here. The budget has $634 billion earmarked for preventative medicine and the provision of more affordable services. This is going to put a lot of pressure on private health insurance companies to respond with their own cost-cutting measures. Failure to stay competitive with a growing efficiency in public provision could lead down the slippery slope into a single payer system. That this is the standard model in most of the rest of the world, does not make it right for the US. Or does it? We can only wait and see what happens.



By: David Mayer

About the Author: