And technology has certainly gotten us far. So far, that nowadays we can use our own smartphones to check whether there are specialized restaurants in the area that serve the type of food that we might need (if we’re suffering from some particular disease or intolerance), what kind of foods we should evade if we or our children have allergies. Apps that help us deal with the challenges which diabetes presents and even apps that consult us what to do if we’re suffering from cardiovascular complications. Here are a number of these, in each of the above category, that you can use to prevent or cope with already existing complaints.

Find Me Gluten-Free

Find Me Gluten-Free  connects customers with gluten-free restaurants and other eating places. According to statistics, 1 in 133 people suffers from Celiac disease, an autoimmune disorder of the small intestine caused by a reaction to gliadin. The app is meant to both raise awareness and help educate people, as well as make it easier for people to eat out, without having to worry about what they will be eating. (iPhone and Android compatible)

Is That Gluten Free?

Is That Gluten Free   is another useful tool for managing one’s gluten-intolerance. Apart from also providing information about food chains, it features a large database of gluten-free menu items and ingredients which are safe to be consumed. These are sorted by category, brand or product name. It also provides users with advice on how to make their menu gluten-free. (iPhone compatible)

Cook IT Allergy Free

Cook IT Allergy Free  is quite useful for anyone who suffers from some form of allergy. It contains all major food allergen categories, such as gluten, dairy, nuts and eggs. If any of the recipes you want to cook feature a product which you are allergic to, the app can offer suggestions for an allergen safe substitution option. It also includes over 200 recipes, all of which have beautiful images attached to them. (iPhone compatible)

Foodditive

Foodditive  offers a comprehensive look at E-numbered food additives that are present in more or less all of the foods we buy at the supermarket. It is directed at people who are sensitive or allergic to one substance or another but may lack information about which foods feature such an additive. It permits for additives to be marked in different ways, so as to distinguish whether they are ok to be consumed or are to be avoided. (iPhone compatible)

dLife Diabetes Companion

dLife Diabetes Companion  is one of the best apps around, designed to help people understand and learn to live with diabetes. It features a huge database of information, answers to questions by experts, recipe and food lists. Users are also able to keep track of their blood sugar levels as well as watch educational videos from by dLifeTV. (iPhone compatible)

Glucose Buddy

Glucose Buddy  is another great tool which diabetics can use when monitoring how their blood sugar levels are doing and how they are generally coping with the illness. The app is meant mostly as a data storage utility where one can log one’s glucose numbers, food intake, insulin dosage, etc. The app can display data in graphs and also has an a1c (hemoglobin) calculator. (iPhone compatible)

Lose It!

Though  Lose It!  is not specifically designed as an app to prevent cardiovascular disease it actually does just that. The app helps users keep track of calories (a calory budget) and exercise in order for them to achieve weight-loss in an easy and balanced way. Obesity being one of the main reasons for cardiovascular complications, the app is very suitable for people who wish to avoid heart disease by simply losing the surplus pounds. (iPhone compatible)

iEat For Life: Heart Disease

iEat For Life, devised by Nutritionist Approved Inc, provides a long list of foods which are advisable in the prevention or treatment of heart disease. It features detailed information about each food and in what way it is beneficial for cardiovascular conditions. It also contains information on how to prepare foods, as well as which foods are to be avoided. Very good resource! (iPhone compatible)

Make sure to check out these apps if you’re suffering from or wanting to prevent any of the above diseases. These apps are sure to provide you with good advice and are generally meant to help you on your way to a healthy lifestyle without undue complexity.

Author:  Bianca Banova,  writing for  AIMS Education  and  Culinary Depot

Research has suggested that using cloud-based solutions can be approximately 9 times cheaper than purchasing software and hardware up front. Cloud services also remove the need to purchase additional software licenses for different users and workstations.

There is practically minimal hardware required to purchase with cloud services since the data is going to be hosted, maintained and upgraded on the vendor’s hosted servers.

You will only be required to have the basic computer that essentially runs the software so you can access, store and retrieve data whenever and wherever you like. Most, if not all vendors provide the service with free upgrades which are conducted through their personnel, leaving you satisfied and not worry about upgrading your system the next year.

The same vendors also provide the option of free maintenance which means that all maintenance done on your Electronic Medical Records are performed free of cost. Sometimes, maintenance Is also planned after the providers usual working hours so that there are no distractions and disruptions to their workflows. Another advantage of having cloud services is the fact that since data is hosted on servers maintained by the vendors, it is their responsibility to fix the servers in case there is some problem with the hardware.

The essential advantage of having a cloud based EMR is accessibility. Your EMR is practically available anytime and anywhere – you just need to have a basic system to use the software and that’s it. Since the software can practically run on any device, users will have more comparability in the sense that they will be able to access their data on desktop computers, laptops as well as smartphones.

Electronic Medical Records http://www.curemd.com/emr.htm based on web or cloud based solutions are secure. With disaster recovery plans in place, our data will never be at risk and will always be fully retrievable. In case of a rare systems failure, functionality is always resumed after a short amount of time.

Cloud based services also provide the advantages of premium support with  dedicated support team monitoring server activities 24/7.

When every member is on board about the decision, the next step is to hire a consultant who can be trusted with the hardware, software and training staff members. Ideally, the consultant should be someone who has a lot of experience in the implementation of Electronic Medical Records and knows the ins and outs of the system. It can also be helpful for the practice if they ask for references and ask them if they had a satisfactory time with the consultant.

Care practices need to take this as a project. Like any other important project, it is essential to have a time line. It is even more significant to strictly follow this timeline and work on things according to the deadlines.

When you have a reliable consultant working with you, it is now time to test how good that consultant is by working under the budget that you mutually made. The most important investment in this regard for practices is acquiring the hardware that fully supports the software provided by the vendor. Vendors sometime offer the minimum hardware and then charge to get it upgraded which adds a lot of money to the costs. Hence, the priority for the practice should be to run the software provided by vendors as efficiently as possible.

Finally, with the help of the consultant, providers should start implementing Electronic Medical Records step by step. With some help from the vendor, and dedication from staff members, this should be a piece of cake.

A few examples. The science of genomics is revolutionizing medical care in profound ways such as producing targeted cancer drugs, predicting later onset of cardiac disease, offering prognostic data to guide cancer treatment, rapidly identifying a bacteria and its antibiotic susceptibility and suggesting how our diet can actually impact our genes through the science of nutragenomics.

The pharmaceutical industry has brought us the likes of statins to reduce cholesterol, drugs to prevent blood clotting, and the targeted therapies for cancer. The device industry has created, for example, a potpourri of new approaches that have transformed cardiac care. These include angioplasty, stents, pacemakers, intracardiac defibrillators and now even the ability to insert a prosthetic aortic valve through a catheter rather than doing it via open surgery. And we can now noninvasively image organs in incredible detail and learn about physiology with molecular imaging.

So we can be appropriately awed and proud and pleased at what is available when needed for our care.

But, on the other hand, we have a dysfunctional health care delivery system.

Our current delivery system focuses on acute medical problems where it is reasonably effective. But it works poorly for most chronic medical illnesses and it costs far too much. When the famous bank robber, Willie Sutton, was asked why he robbed banks he replied “that’s where the money is.” In healthcare the money is in chronic illnesses – diabetes with complications, cardiac diseases such as heart failure, cancer and neurologic diseases. These consume about 75-85% of all dollars spent on medical care. So we need to focus there.

These chronic illnesses are increasing in frequency at a very rapid rate. They are largely (although certainly not totally) preventable. Overeating a non-nutritious diet, lack of exercise, chronic stress, and 20% still smoking are the major predisposing causes of these chronic illnesses. Obesity is now a true epidemic with one-third of us overweight and one-third of us frankly obese. The result of these adverse behaviors is high blood pressure, high cholesterol, elevated blood glucose followed by to diabetes, heart disease, stroke, chronic lung and kidney disease and cancer.

And once any of these chronic diseases develops, it usually persists for life (of course some cancers are curable but not so diabetes or heart failure). These are complex diseases to manage and expensive to treat – an expense that continues for the rest of the person’s life.

What is needed is aggressive preventive approaches and, for those with a chronic illness, a multi-disciplinary approach, one that has a committed physician coordinator. Providers (and I refer here mostly to primary care physicians), unfortunately, do not give really adequate preventive care in most cases. And they generally do not spend the time needed to coordinate the care of those with chronic illness – which is absolutely essential to assure good quality at a reasonable cost.

When a patient is sent for extra tests, imaging or specialists visits the costs go up exponentially and the quality does not rise with the costs. Indeed it often falls. But primary care physicians are in a non-sustainable business model with today’s reimbursement systems so they find they just do no have enough time for care coordination or more than the basics of preventive care. Nor do they have the time to listen carefully or think deeply about a problem; so the response is to send the patient for a test or to a specialist.

So our paradox is that we have the providers, the science, the drugs, the diagnostics and devices that we need for patient care. But we have a new type of disease – complex, chronic illness, mostly preventable, for which we have not established good methods of prevention nor do we care for them adequately once the disease develops. And all of this is exacerbated by an insurance system that puts the incentives in the wrong places. The result is a sicker population, episodic care and expenses that are far greater than necessary.

Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and is chair of the advisory committee for Sanovas, Inc. and senior advisor to Sage Growth Partners. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery- Why It Must Change and How It Will Affect You from which this post is partially adapted.

Traditionally, providers maintain paper-based records or paper-charts, documenting everything from patient records to their treatment plans and billing.  The drawback that this method posed was the long time it took and the measures it required to keep the documentation safe from damage such as wear-and –tear, water and fire. Now consider that a natural calamity takes place such as a hurricane, an earthquake or fire spreading out inside the building; the documents would most likely be destroyed which means that invaluable patient records and information about their treatment would be destroyed.

This is one of the many reasons why having a Practice Management Software is essential for a practice. Among the many reasons, scheduling is one of the most effective ways a Practice Management Software organizes the administrative and financial workflows. Using this, providers can have their patients scheduled effortlessly, patients can be reminded of their appointments automatically, their billing activity; and the process of patients walking in, their initial checkup, examination and treatment can all be recorded.

The software can efficiently document the treatment plan of patients, which is a huge advantage in itself. It is easy to store, access and retrieve records with innovative technologies such as the Practice Management Software. Hence, it takes lesser time or rather, practically no time to retrieve a patient’s record. Latest softwares also offer the function of tracking patients with certain types of allergies or diseases. They also offer capabilities that check prescriptions for any allergic reactions since all data about patients is already embedded in the software.

Practice Management Software ensure that care providers do not worry about administrative or financial operations. They allow providers to concentrate on quality care and patient safety.

There are different types of Practice Management Systems. Some are designed for small practices with 1-4 care providers, while some are designed for larger practices comprising of 20+ care providers or multi-specialty practices.

Practice Management Solutions are majorly connected to Electronic Medical Record solutions because these two systems can work in conjunction with each other. The Electronic Medical Record handles the clinical workflows while Practice Management handles administrative and financial workflows of practices. Since the integration of Practice Management software and Electronic Medical Records is a major challenge, many providers often have different vendors for these systems. However, with the advent of technology, this challenge has been removed and vendors have created near-perfect versions of integrated solutions which provide the most quality services to thousands of care providers.

 Practice Management Software usually entail systems allowing its users to track patients after entering their information, track the appointments of patients after scheduling them, generating reports for administrative and clinical matters and keeping databases of insurance companies, providers, diagnosis, procedures and referring physicians among many other things.

When a new patient fills out information, their demographics are recorded right there and then. The demographic information includes patient’s names, addresses, contact information, insurance information, date of birth, employer, previous care providers and family and social medical history.

Scheduling of patients is automated as when the information about a patient is entered, the component of calendaring or scheduling allows users to create and then track visits of patients. There are many other options and variables involved which provide many different options to control visits of patients.

The last time I went in for my annual OBGYN checkup, my doctor and I argued about this. She had recently helped both her mother and sister through a breast cancer diagnosis, and refuted my “no family history” argument with: “We have no family history and my mom just had a double mastectomy. Don’t talk to me about family history.”

After writing about Atossa Genetics and the ForeCYTE test, I am back on board with annual screening. When I go in for this year’s exam, I will request this test, pay for it myself if necessary and search until I find a doctor who will use it.

It is not an exaggeration to say that this test could erase breast cancer by 2020, as the company founder Dr. Steven Quay predicts. It absolutely has the potential to reduce breast cancer rates just as pap smears have cut rates of cervical cancer.

The test analyzes nipple aspirate fluid for cancerous and precancerous cells. The test is everything that modern medicine should be:

• Minimal — there is no radiation
• Noninvasive — there are no needles
• Convenient — it can be added to the standard annual OBGYN exam, which means no extra trip to a mammogram clinic
• Smart — it tells you exactly what is going on in the cells of your breasts
• Targeted to the individual — women and doctors will know exactly who needs treatment and who doesn’t

It even erases the “but it hurts” objection to mammograms. Quay said that on a discomfort scale used in clinical trials, mammograms are rated 4.5, breast feeding is 2.1, and his test is 1.5. The collection process can be done in a doctor’s office and takes only a few minutes.

Atossa is also working on a new treatment for women who do have early signs of cancer. The idea is to put a chemoprevention drug in the segment of a breast undergoing precancerous changes. This is the ideal replacement for the “cut, burn, poison” approach to treating breast cancer.

We have achieved “awareness.” It’s time for Komen and every other organizations focused on breast cancer to start supporting smarter screenings and treatments like Atossa’s test, and for women of all ages to start asking their doctors to use it.

The path we’re on now in the US and Europe is to ape the experience with small molecule products by introducing generic versions as patents expire. As I’ve discussed in the past, this is a bad idea. Development costs are high, manufacturing is notoriously difficult, and the products won’t be identical anyway. That’s why the products are called “biosimilars.” As a result the products are going to be expensive –we won’t see nearly the costs savings as we do with small molecule products, and FDA will be stretched too thin monitoring the manufacturing facilities. Instead I propose to allow branded products to maintain their monopoly after patent expiration, but to regulate pricing.

Recently I’ve been thinking this through a little bit more and have become even more troubled by the idea of biosimilars. In particular I’m concerned about the ethical and practical issues of conducting clinical trials for these products.

Patient recruitment is a challenge for most clinical trials, and as a result studies are frequently delayed. A key problem is that few development-stage therapies offer significant improvements over what’s already on the market, so there is limited enthusiasm to participate in a study that has little reward but also includes risks. Doctors don’t feel comfortable recommending that patients enroll, and patients are understandably hesitant, too.

The challenge for bio-similar trials will be even harder. It’s hard for me to understand why a patient would want to join a trial just to help prove that a new therapy is very similar to an existing therapy. I suppose it’s possible that a biosimilar product could be a little better in specific instances, but mostly these trials will just attempt to prove a new drug is the same as the old.

The ethical issue is related to the practical one. If there’s no upside to joining a trial, is it reasonable to ask a patient to take on any extra risk, such as the risk that the product doesn’t work or makes them sicker? I kind of doubt it.

At the end of the day, I feel more strongly than ever that biosimilars and biogenerics  are a foolish and pricey prospect.

—-

By David E. Williams of the Health Business Group.

Share

Allowing billing teams to view consistent reports on remittances and claim payments. This essentially helps in processing payments faster and making the process of billing swift and efficient.

Accelerating the flow of information between healthcare stakeholders and eradicating the need for paper records, Practice Management Software ensures quicker remittances. Making it easier for billers to render more than a single task such as offering reports to physicians, billing by day or month and statements for insurance, practice management softwares make lives easier for care providers.

With software that streamlines your administrative and financial workflows, the practice management software reduces costs from front-end to back-end operations for every care provider. By automating workflows which usually require 3-4 staff members, the software makes the whole process easier and efficient. Bringing about the reduction in staff, the cost of paying those employees for clerical administrative work automatically reduces.

The advent of technologies has brought about an unprecedented increase in the amount and quality of features packed in today’s Practice Management Software. The best Practice Management Software provided by vendors today are top-notch in usability, functionality and quality features. Plus, many such types of software are made with the help of doctors who guarantee that the usage of this software would be convenient for other doctors and health professionals.

Furthermore, successful and highly integrated Practice Management Software offer increased functionalities such as flexible software architecture, reducing irrelevant overheads, a highly customizable and usable user interface and design, and simple point and click technology to increase the speed of transaction, quality of service and overall capacity.

Overall, a good Practice Management Software helps care providers in enhancing their administrative and financial workflows, but a great Practice Management Software, makes providers deliver better care quality because of the optimum efficiency achieved In their administrative and financial workflows.

Most patients are found to have lung cancer only after symptoms such as cough or shortness of breath develop. At this point, the cancer has usually progressed and spread to the regional lymph nodes or to organs outside of the lung. But recently it has been demonstrated that lung cancer can be detected with low dose CT scanning such that over 50% can be found while still stage IA or IB. This greatly improves the opportunity for curative treatment which might be by either surgery or radiation therapy. Further, it has now been amply proven that the addition of combination chemotherapy with a platinum-based compound and another drug given as adjuvant therapy with surgical resection or radiation therapy substantially improves the cure rate. These dame drugs can be used with good effect for those with advanced cancer, leading to lessened symptoms, better quality of life and lengthened survival. And there are now a series of recently introduced drugs that are targeted at the abnormal proteins produced by mutations or rearrangements of the tumor cells’ DNA. These abnormal proteins created by the DNA “driver mutations” can be inhibited leading to marked regression of the tumor until such time as the tumor develops resistance. The question than is who and where should one go to for the best possible care?

Most patients are not cured at this time although certainly more than previously. For those with advanced disease and who respond to treatment, relapses occur usually within a few months or a year so that only about 50% live more than a year and very few exceed the three year mark. But this is a great improvement over just a few years ago and it is clear that the combination of discovering this cancer earlier and being able to treat it with more effective means is making a substantive difference in not only survival but in quality of life. As a result, these are exciting days for those that treat patients with lung cancer.

The questions for the person who is at risk for lung cancer and wants to consider screening options or for the person who has been found to have lung cancer are the following. Where do I go to get screened? Or, where do I go to obtain the most advanced treatment in a setting that will be as comforting as possible?

The basic answer is to go to an institution that has the staff who are both expert and experienced. The stakes are high; there is little opportunity to reconsider and start again. Let’s consider this in some detail.

Treatment for lung cancer, as with most cancers, is best done in a multimodality or multidisciplinary fashion, i.e. with evaluation by medical oncology, thoracic surgery and radiation oncology at the time of diagnosis. At a minimum, this should be done in a tumor conference. Ideally, patients should be seen in a multidisciplinary clinic by the members of the three disciplines all at one time who then together, in appreciation of the patient’s desires and needs, recommend a joint plan of approach to treatment. This is particularly important for patients with localized or locally advanced NSCLC and those with localized (limited) small cell lung cancer, for which curative therapies are available. But it is relevant for all lung cancer patients as it improves patient and family understanding, prevents misunderstanding, assures that all providers are “on the same page” and that the patient has now met each of the physicians who will be involved in his or her care. Another team member is usually a the nurse practitioner, who will likely be the glue and the connection between the patient and the treatment team over time and who will help the patients “navigate” the medical care delivery system. Further it is always best to have the providers each come to the same clinic location rather than have the patient travel to different doctors’ offices as he or she migrates from treatment with surgery to radiation to drug therapy. This allows the patient the comfort of a familiar location and a well-known and compassionate clinic staff.
Why is this so important? First, it means that the various physicians, each with a different background and perspective, will discuss the various approaches to treatment among themselves and then with the patient. This brings out the best of all parties. But it also means that they come to a unified approach to treatment which can then be presented to the patient. This is much superior to having the patient, over time, visit each of the physicians only to learn that the course of therapy is now to be unilaterally modified. This is very upsetting to the patient and serves to tell the patient that the team is not marching “to the same drummer.” Ideally, the physicians involved will take the time to understand the patient’s and the patient’s family’s needs, concerns and issues. This must be incorporated into the plan of treatment if it is to be met with the patient’s full acceptance and enthusiasm.
This quote from the University of Maryland Greenebaum Cancer Center Thoracic Oncology Program is a good summary of the some of the key elements of multi-disciplinary care. “The team meets twice a week to evaluate patient profiles, review and discuss treatment plans and examine new innovative treatments that could be beneficial to patients. They work together throughout the treatment process to ensure that care is coordinated and duplication of services is eliminated. Patients receive the highly individualized program of care they need while undergoing complex, aggressive therapies.”
Most of the highly experienced, expert institutions also have an active palliative care team. Made up of physicians with expertise in pain management and symptom support, plus nurses, pharmacists, social workers, chaplains and others, this team greatly enhances the work of the treatment team. It has been amply demonstrated that palliative care providers, when their services are offered beginning with diagnosis, result in greater patient comfort, less anxiety and depression, less pain, greater support overall and an improved quality of life and often lengthened survival.
Lung cancer is devastating yet the chance for a cure today is much greater than in the past especially if the disease is detected early. When detected later with spread of disease, it can still be treated with good success although not cure. But the treatment options are complicated and oft times confusing making care in a setting with high levels of expertise essential. The multi-disciplinary approach is far superior and results in a higher level of quality. When combined with an expert palliative care team, the patient will be well served throughout the course of care. With the advent of early diagnosis with CT screening, more effective yet less damaging approaches to radiation therapy and now targeted drug therapy for those with driver mutations, perhaps the light is now actually to be seen at the end of the tunnel for lung cancer patients and their families

This five part series first appeared in Medical News Today athttp://bit.ly/12bCUqD  

Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and is chair of the advisory committee for Sanovas, Inc. and senior advisor to Sage Growth Partners. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery- Why It Must Change and How It Will Affect You

The reality is that only one network matters when it comes to raising capital. That network is the group of individuals who are absolutely passionate about your industry and the business opportunity. And for 99% of us, that isn’t our friends, family and former colleagues.

Overconfidence in an existing network is one of the top fatal flaws that entrepreneurs have.The entrepreneurs at the greatest risk of failure are the ones that come from a corporate environment and/or wealthy social settings. These people often have a false sense of financial support. Many times these entrepreneurs are shocked that their existing network is unwilling to support them financially to start a new company. They shouldn’t be so surprised.

In most cases, the entrepreneur’s existing network won’t provide the ideal investors for their enterprise because they don’t share the vision, the industry knowledge or the industry connections to create the motivation needed to put money into a non-­-liquid, speculative investment. That’s right, the investments of capital in the early phase of a company will not have a near-­-term payoff for investors, no matter how much potential there is. And compared with most other places investors can put their money, a new business -­- even one with an exceptional idea, is speculative. When investors are told “Invest in something you know,” that didn’t mean invest in a brother-in-law!

Instead of coercing family and friends to dive into your deal, entrepreneurs need to associate with the influencers from the industry their business is in. The people that influence decisions inside the entrepreneur’s industry are often outside of an entrepreneur’s existing network. Entrepreneurs need to find fellow passionate people that share their vision and see the potential in their business opportunity. When these people truly understand your vision and know the industry from their own experience, they will invest their capital because they are excited to participate in a real opportunity. They often will also offer other kinds of assistance that can be invaluable to a start-up, such as connections to others with expertise, capital or resources needed in the early stage.

There’s no possible way for entrepreneurs to know all of these people ahead of time. That is why entrepreneurs think it’s easier to tap into the existing network of people they know than to start fresh. It might be easier, but it’s far less productive than targeting the right investors, those most likely to help fund your business.

Entrepreneurs can waste massive amounts of time trying to reconnect the dots with past acquaintances in hopes of getting someone to invest in their company. Tracking down that long-lost college buddy who just sold his own business and now might have some loose cash is NOT the right way to target investment capital. An entrepreneur’s time is much better spent identifying and approaching the people who are influencers in their industry.

So stop reading and go connect with three people that are thought leaders in your industry! Don’t have a connection? Don’t worry. Tell them you are a passionate entrepreneur that wants to discuss industry trends. You’ll be surprised at the response rate.

Have no clues where to find thought leaders in your industry? Scour industry journals, influential blogs, and LinkedIn for contacts.

Don’t get me wrong, if your family and friends are as passionate as you are and know your industry, they are perfectly fine investors too. But if you are trying to start a pig farm, go hang out with other farmers. If you’ve got a new medical device, then hit the right local or national conferences and talk with others in the field.

And if you want to raise money for a football team, go hang out with football fans.

Case in point: The Green Bay Packers are the only professional team in US sports that is publicly owned. They’ve only offered stock five times in heir history. In 2012, the Packers offered shares of stock for $250 apiece and fans bought it like crazy!

Why did they do this? Emotional attachment to what the stock represents is what made them buy. People want to be a part of the team, and a stock certificate is a show of proof that they support their team. And this draws on one the strongest human emotions – love. Love is typically associated with feelings of personal attachment to people, but love
can fall anywhere on the spectrum from passionate affection to mere enthusiasm.
And that includes feelings that go beyond people to teams, companies, brands and material goods.

But the real catch is that from an investment point of view, it makes no sense to purchase Green Bay Packers’ stock!

There are no investment return opportunities in Green Bay Packers stock as one would expect from owning stock in a company. There are no benefits conferred onto the owner, nor is the stock tradable in any way. In fact, there are only two benefits which come from owning this stock: receiving a stock certificate which demonstrates your support and the privilege of purchasing special Green Bay Packers memorabilia. The Packers used the money from this sale of stock to fund an expansion to their stadium.

From a die-hard fan’s point of view, it makes perfect sense because they are showing support and emotional investment into the team. We love to feel like we’re a part of something bigger than ourselves.
We want to know that we’ve done our part. Many people thrive on that warm feeling that they get when they help out a friend or give money to charity. That makes us feel connected to the world around us. That feeling of connection is what keeps us holding on to investments that are ‘worthless’ in investment terms, but full of worth in
emotional ones.

And the result? In 12 weeks the Packers sold 268,000 shares that brought in $67 million!

Go to where the PASSION is – not where the money is! Do this and the path to investment capital will reveal itself.

Patrick Donohue’s e-book, The New Fundraising Reality for Entrepreneurs, will be published this month on Amazon. The book describes how myths about fundraising are blocking the path to capital for the start-up businesses that our economy desperately needs.

Mike Dunkley

The reality, however, is that most of these new technologies fall by the wayside before they get to market. That’s because the way they are designed has not kept up with the times in order to meet the market’s demands for fast time-to-result, ease of use, and high degree of reliability.

Mark West

A researcher’s primary objective may be to advance scientific understanding or to perfect the assay performance, while engineers may be pre-occupied with automation and regulatory compliance. The knowledge-gap between the two groups may simply be too big for one group to anticipate or question the requirements of the other and the lack of alignment of goals may not steer the development effectively. In order to get scientists and engineers working towards a common objective, it is necessary to bring in a third discipline – design – to establish the vision for the ideal product early in the process.

At Continuum, we call that ideal user experience the “lighthouse” — and make it the ultimate goal when we develop a diagnostic tool for a clinical setting. It’s important to define the long-term goal so you can think through the implications of your decisions early on in the process of development of the technology—ideally after you establish ‘proof of principle’ in the lab, but before you lock in any key architectural decisions. As the scientists in the lab meet the key forks in the road where they must make decisions on how to implement their assay, they can take into account the ideal experience of users in a clinical setting.

That development requires an understanding of several key factors, including where device will be used, the skill of the users, the time necessary for results, and the cost of the test. At the same time, the ideal experience represented by the “lighthouse” must be balanced by what is technically feasible. Depending on these factors, there must be a creative give-and-take that might sacrifice accuracy, portability, or up-front cost depending on the most successful solution for usability.

For example, when we worked with Daktari to create an HIV test for use primarily in rural sub-Saharan Africa, it was clear that fluorescent detection of CD4 cells was not suitable. Sensitive optics would never be rugged enough to survive transport in a backpack to remote villages. Instead, Daktari needed a solution that could be used at point of care by a relatively inexperienced clinician in sometimes difficult environments with high heat and humidity. Daktari understood that electrical detection of CD4 cells had the inherent robustness required for its intended application. Continuum engineers and designers used this robustness “lighthouse” to make smart architectural decisions for the device early on in the development of the assay – the result was a simple hand-held instrument with a unique disposable cartridge.

A similar process took place with the OraQuick rapid HIV test, which was approved for home use last year. To create a test that could be used quickly and easily in home by unskilled users, the parent company OraSure Technologies sacrificed some technical performance. It got to market because it successfully convinced the FDA that this solution was better than the “gold standard” because it would be used by people who would ordinarily not get tested at all, therefore increasing the number of people who could be diagnosed and treated, leading to a greater benefit to public health as a whole.

On the opposite end of the spectrum, we worked with Raindance Technologies to develop the RainDrop digital PCR (polymerase chain reaction) system for use in cancer research, knowing that sensitivity at one-in-a-million levels of detection would be paramount. In this case our “lighthouse” was to produce a dramatically simpler and more reliable instrument without sacrificing performance. R&D and product development teams collaborated to simplify complex flow controls by putting more technological features into the consumable cartridge that contained the sample. This eliminated pipetting robots and tubes, creating a streamlined bench-top device that could be more accessible to cancer research labs worldwide.

As these examples show, while it may be expedient to treat R&D and product development as sequential steps, superior products can result from a collaborative approach guided by a clear view of market needs. The solutions that win are those where the technology is a good fit to the eventual application. That means establishing a “lighthouse” early in the process to guide researchers, designers and engineers toward a common vision of the ideal product.

Mark West is a principal at Continuum, a global innovation and design consultancy, where he specializes in electro-mechanical product design and development with specific expertise in robotics, precision machine design, clinical diagnostics and life-science instrumentation.

Mike Dunkley is vice president of program development for Continuum Advanced Systems, where he is responsible for building successful client engagements in the design and development of medical devices, connected health applications, clinical diagnostics and life sciences instrumentation.

Thus far in this five part series has been a general discussion of lung cancer facts and figures followed by controlled enthusiasm about early diagnosis using CT scanning. The treatment of lung cancer has also progressed dramatically and with early diagnosis as a result of CT scanning high risk individuals, it is now possible to cure a larger proportion of patients.

Today an increasing number of individuals are having their cancer detected early so curative approaches will become more common. But many if not most lung cancer patients are older and have either chronic lung disease, heart disease or both, rendering them at higher risk for surgery. At a minimum the surgeon wants to do as limited a procedure as possible, using the least invasive approach. Still, not all patients are good surgical risks.

Despite finding the cancer when it is still small and with no apparent evidence of spread, many patients still relapse in a few months or years after surgery. The addition of chemotherapy to treat microscopic but undetected disease has a resulted in improved cure rates. The same approach is being used for those treated with radiation of early stage lung cancer.

Until recently, it was assumed that only surgical resection could cure small early stage lung cancer. But many patients are poor surgical candidates due to age, chronic lung disease, heart disease or other concomitant conditions. The question thus arises, could these newer approaches to radiation therapy be as effective. Multicenter trials have now demonstrated that stereotactic body radiation treatment (SBRT) appears equivalent to surgery in terms of the local control of the tumor in small (<3cm) tumors.

It is important to understand that radiation can destroy any cancer if sufficient radiation can be applied. For many cancers, however, the risk of damage to adjacent normal tissues that are essential for life (e.g., normal lung) makes it impossible to give the desired dose. That said, radiation oncology has advanced dramatically in the past decade and the rate of progress is increasing rapidly. Innovations as a result of engineering and computer advances along with conceptual advances are making a dramatic difference. Major advances in radiation therapy mean greater effectiveness, fewer side effects and less time in treatment.

Newer devices allow stereotactic treatment not only for stationary tumors but also lung cancers– overcoming the problem of motion caused by breathing or even heartbeat and blood flow. The combination of continuous imaging, motion detection and robotic guidance combine to allow much more effective treatment than in just the very recent past.

Stereotactic body radiation treatment appears to be a very useful new approach to many otherwise difficult to treat cancers such as in the lung. It begins with the use of earlier techniques where the cancer is treated from multiple angles such that the tumor receives a large dose but the adjacent normal tissues receive much less. Stereotactic means that the tumor is imaged and the radiation adjusted to directly attack the cancer and not the normal tissue. A related innovation is to link actual delivery of radiation with the patient’s breathing parameters (gating). This is done with an infrared device that observes motion and turns the radiation beam on and off during the breathing cycle. This can be of great value in lung cancer because the target is constantly moving. This greatly reduces normal tissue damage occurring as the lungs move with respiration. It also means that the cancer gets a higher dose because the physician is less encumbered by a concern for damaging adjacent normal lung. This is a real improvement as in the past it was necessary to curtail the ideal dose with the realization that that dose would cause unacceptable side effects on adjacent normal tissue.

Hypofractionation, that is giving a much higher dose of radiation per session, with the much greater accuracy of the stereotaxic approach, means many fewer sessions yet with high effectiveness. Much SBRT is now done in 3-5 fractions rather than the more typical approach of multiple, perhaps as many as 45, fractions over as many days or more. Add robotic guidance based on motion detection and the combination becomes very powerful. With robotic control of the equipment from outside the treatment room, this means less time is wasted by the staff moving back and forth to make adjustments and less time on the table for the patient.

Most radiation today is delivered by X-rays or electrons (photons). Another approach is to use protons. Proton beam therapy has the advantage that the proton gives up its energy only when it hits its intended target – in this case the tumor. It does not continue through the tumor and damage normal cells on the far side. So it allows for the delivery of very high doses of radiation to the tumor with minimal side effects. It follows that proton beam might prove very useful because one can give a much higher dose without as much fear of adjacent normal tissue damage. But it is critical to keep in mind that there are no controlled studies showing superiority of protons over photons and certainly none in lung cancer as of yet. As a result it is important that the clinical value of proton beam therapy not be over inflated. The cost of one center runs into the hundreds of millions of dollars — which would purchase 20 or more photon linear accelerators.

What is clear is there is a steady and rapid, advance in the ability to deliver radiation therapy to those with lung cancers in a more effective and more safe manner, often in much less time than in the past. The realization that radiation can actually be used to cure early stage lung cancer is a stunning advance, allowing effective treatment for those not able to undergo surgery.

In the next of this series will be a discussion of the dramatic advances in lung cancer treatment with drug therapy.

Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and is chair of the advisory committee for Sanovas, Inc. and senior adviser to Sage Growth Partners. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery- Why It Must Change and How It Will Affect You.

Most patients found to have lung cancer die within a year largely because their tumor has already spread, making treatment difficult. Now there is real reason to believe that lung cancer can be detected early and with it witness an improvement in cure. Given that 160,000 Americans die each year – more than the next four cancers combined – early diagnosis followed by curative treatment would be a major advance.

For many years it was considered useless to screen individuals for lung cancer with chest x-rays in a manner comparable to mammography for breast cancer, PAP smears for cervical cancer or colonoscopy for colon cancer because a chest X-ray only detected lung cancer when it was far advanced, which rarely meant detecting a cancer that could be cured. Over the past decade it has been postulated that CT scanning could detect lung cancer while it was still small and localized. Now as a result of careful randomized controlled studies, low dose CT (LDCT) scanning has proven effective in screening for lung cancer in high-risk populations.

The largest LDCT study, the National Lung Screening Trial or NLST, was sponsored by the National Cancer Institute. Between 2002 and 2004 some 53,454 individuals were randomly allocated to be screened annually for three years with either routine chest X-ray or with low dose CT scans with data collected through the end of 2009. The screening criteria were high-risk individuals, i.e., between the ages of 55-74, current or former smoker, 30+ pack years and still smoking until at least 15 years before. The results suggest that not only can early lung cancer be detected by LDCT but also that mortality can be reduced.

For each annual scan, about twenty of every 100 (20 percent) of individuals will be found to have a nodule. But only one patient of every 100 will have lung cancer; that is only 5 percent (one of 20) of those with a nodule will be due to cancer, the other 19 of the twenty nodules (95 percent) are benign. To establish which are cancer and which are not, the next step is to follow the nodule with repeat CT scans or to do a biopsy.

In an effort to avoid an invasive procedure to obtain the biopsy, the usual approach was to schedule repeat scans at three or six month intervals. Many individuals were given a scare before they were told all was okay many months or a year later when the repeat CT scans showed that the lesion either was stable or disappeared.

The value of screening was demonstrated by the observation that 63% of cancers detected by LDCT were Stage IA or IB, distinctly different from the norm where most are found at advanced stages. When cancer was found, surgical resection with or without adjuvant chemotherapy or radiation therapy was the usual treatment. Overall, deaths from lung cancer were reduced by about 20% by using the LDCT scanning as described compared to chest X-ray screening.

A few examples of false positives are illustrative of the dilemma:
A middle aged lady who had quit smoking ten years before was attracted by an offer at a local hospital to be scanned for only $75. She got a letter in the mail some weeks later saying she had a very small nodule that required follow-up. Naturally she was upset. Six months later she had another CT. At that screening she was told her scan was normal but that she should get screened again in six months “just to be on the safe side.” Ultimately she chose not to have any additional screening and remains fine albeit having had a tortuous path.

Another lady had a similar experience. Her nodule was larger and she had a year of every 3 months getting a CT scan and then after a year, every 6 months for two years at which point she was told that it was likely not cancer but that she should continue screening for another year. She has remained disease free.

An elderly gentleman with chronic lung disease who had been a heavy smoker for over 30 years had a lung nodule detected on CT scan. He was told it was highly suspicious for cancer. He had surgery to establish the diagnosis resulting in a collapsed lung with a difficult recovery. The pathology showed that the nodule was not cancer but rather histoplasmosis in need of no therapy.

It is this high false positive rate that raises questions of risk benefit and cost effectiveness. The opportunity for early diagnosis of lung cancer raises important issues. The NLST studied only older individuals with a long and heavy smoking history, i.e., those at highest risk. For those, over 20 percent were found to have a pulmonary lesion of which 1 in 20 were ultimately found to be cancer. And those who were screened with CT scanning ultimately had a 20% reduction in lung cancer mortality compared to those screened with regular chest X-rays. If the screening criteria were loosened to include a broader base (as in the hospital above that offered inexpensive screening for any current or former smoker), would the result still be a high lesion discovery but a proportionately much smaller number of cancers discovered? Whether or not the screening criteria are expanded, the high rate of non-cancer/benign diagnoses requires careful consideration. These are individuals who, based on their smoking history, have a high prevalence of chronic lung disease and possibly cardiac disease, together making them less amenable to invasive procedures to confirm or eliminate a cancer diagnosis. As a result, more patients in the study were followed with repeat CT scans to determine if the lesion progressed – an approach linked to high stress levels for the individual patient and for the patient’s family. Clearly, an approach capable of resolving the diagnostic dilemma that is less invasive than needle biopsy or surgical incision is required. Some new technologies may soon be forthcoming in this regard.

Taking all of this data into consideration, many professional societies such as the American Cancer Society, the American College of Chest Physicians and the American Society of Clinical Oncology have endorsed offering LDCT scanning for these high-risk individuals but only provided that there is first a thorough discussion of risks and rewards between physician and patient.

For now, those who are at high risk for lung cancer, i.e., the criteria used in the NLST, should consult with their physician and carefully weigh the pros and cons of screening. Clearly, LDCT can detect lung cancer and detect it early when treatment options are much better. But the risks including anxiety related to a positive scan which may be a false positive are real. If scanning is opted for, it should only be accomplished at an institution with high levels of expertise and experience. And should cancer be ultimately detected, it is best to be treated at an institution that not only has staff with the necessary expertise and experience but also utilizes the multi-disciplinary approach where thoracic surgeon, radiation oncologist and medical oncologist all interact with the patient together and offer a unified plan of care.

The finding that LDCT can detect lung cancer while it is still small and localized is a major advance. Study patients were 20% less likely to die of lung cancer compared to those who were screened with regular chest X-rays. It opens the opportunity for cure with a combination of surgical resection or radiation therapy plus adjuvant combination chemotherapy. It also suggests the opportunity to begin, at an earlier stage, effective treatment for those found to have some overt spread of disease. Hopefully new non or less invasive yet rapid diagnostic venues will be shortly brought to bear on differentiating which lesions are cancer and which are benign.

Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and is chair of the advisory committee for Sanovas, Inc. and senior adviser to Sage Growth Partners. He is the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery- Why It Must Change and How It Will Affect You.

There has been some remarkable progress in recent years in the diagnosis and treatment of lung cancer.160,000 Americans die annually from lung cancer making it second only to heart disease as a cause of death and slightly more than the next four cancers combined – breast, colon, pancreas and prostate.  This is largely because lung cancer is usually discovered only after it has spread. Now CT scanning has been shown to detect lung cancer when it is still small and localized. Further there have been major advances in treatment with radiation, with combination drug therapy and with new compounds targeted at “driver mutations”. Although cures are rare still they are growing in number. For those with extensive disease, there are useful responses to newer therapies that prolong survival and improve the quality of life. As a result, there now appears to be some light at the end of this very long tunnel. 

Facts and Figures – About 225,000 individuals will develop lung cancer in 2013. The incidence among men is higher than among women (76 and 53 per 100,000 respectively, age adjusted.) This is presumably due to the greater past use of tobacco by men over the years. The lifetime risk for men and women combined is about seven percent. That translates to one of every 14 individuals will develop lung cancer sometime during life. The incidence rises substantially with age. About one third of cases develop below the age of 65, one third between 65 and 75 and one third above age 75. The median age of onset is 70 years.

It is certainly no surprise that smoking is the leading cause of lung cancer; about 80 percent of individuals are current (20 percent) or former (60 percent) smokers. Smoking increases a person’s lifetime risk by a factor of 20 times. Other causes are radon, second hand smoke, asbestos (especially when combined with smoking) and a variety of other environmental factors including arsenic, nickel and chromium. But there are those, especially younger women, who are developing lung cancer despite no known exposures. Lung cancer among both men and women who have never smoked is the sixth leading cause of cancer deaths with about 28,000 dying annually, about the same as prostate cancer caused deaths.

The incidence of lung cancer has plateaued or even dropped slightly for men but is continuing to rise for women. This reflects the fact that a leveling off of smoking occurred sooner for men than women.

Most lung cancers are diagnosed after it has already spread past the lungs. As a result, surgery alone uncommonly leads to cure and unfortunately most patients are not even candidates for surgery due to local, regional or distant spread at diagnosis. Only about 15 percent of lung cancers are diagnosed when still localized to its pulmonary site of origin; the rest have already spread regionally (22 percent) or distantly (56 percent) with the remainder uncertain as to stage. Compare this to breast cancer or prostate cancer where about 60 percent and 80 percent respectively are localized at diagnosis. This makes for a huge difference in the ability to treat successfully. For women, it means that 73,000 die of lung cancer compared to 40,000 for breast cancer each year despite the fact the age adjusted incidence of the two diseases are 53 per 100,000 and 124 per 100,000, respectively.

Lung cancer, with its 160,000 annual deaths, accounts for nearly 30 percent of all cancer deaths and is somewhat more than the combined mortality of the next four leading causes of cancer deaths – colon (about 56,000 deaths per year), breast (40,000), pancreas (37,000) and prostate (28,000).

Survival is generally short with only about 15 percent five-year survivors (5 year survival rates are commonly used measures of successful therapy for cancer). Compare this to the rates of cure for breast cancer (about 90 percent), prostate cancer (nearly 100 percent), and colon cancer (65 percent). Given that the long phase of initiation of smoking to cancer diagnosis is many decades and given that 20 percent of Americans smoke regularly today it is reasonable to forecast that by 2030 the number of cases will increase by about 50 percent for both men and women.

Categories and Early Detection – Lung cancers are categorized as either small cell or non-small cell lung cancer (SCLC, NSCLC) and the NSCLC are further defined by both their appearance under the microscope as squamous, adeno or large cell and increasingly by genomic analysis. Lung cancer can now be detected early with low dose CT scanning. This means that more individuals are potentially amenable to having their cancer cured. The demonstration that adjuvant chemotherapy for those with possible distant microscopic disease increases the rate of cure for resected NSCLC is a major advance.  But for each cancer lesion detected early by CT scans, 19 benign lesions are also detected which are usually not easily distinguishable from cancerous ones. This results in a dilemma for the patient and the physician – to have an invasive procedure to get a definitive answer or to have regular CT follow-up to see if the lesion progresses, stays stable or regresses. Clearly, new rapid, effective yet less invasive approaches to resolving this dilemma are critical.

Treatment – The opportunity to detect the cancer early means more individuals can be cured with surgical excision or with radiation therapy. Either can be followed by adjuvant chemotherapy for those with a high likelihood of microscopic disease spread. The combination of chemotherapy with radiation therapy has curative potential in locally advanced NSCLC and in limited stage SCLC. New approaches to radiation therapy allow for much higher doses of radiation to the tumor with much less damage to surrounding normal tissues. Current chemotherapy drugs, usually used in combination with one another, have clearly improved the quality of life for patients with more advanced disease, slowed progression of the tumor and created definite a, albeit relatively short, survival advantage.

Of interest in drug therapy today is the advent of “targeted drugs,” ones that inhibit a specific abnormal protein in the tumor cell that is a “driver” of the cancer. These are the products of DNA mutations or DNA rearrangements and are uncovered by genomic analysis. Because the new drugs are quite specific, they affect the tumor but cause proportionally less side effects. Responses among patients with the DNA mutations in their cancers tend to occur rapidly and often with marked regression of the tumor. Unfortunately, relapses eventually occur as resistance develops and the drugs are quite expensive. There is an important proof of principle here that has been accomplished and improvements in targeted treatment are coming fast and furiously.

There is good evidence that the best results with early diagnosis and with effective treatment lies in organizations that have high levels of expertise and utilize a multi-disciplinary approach to care wherein the patients is seen concurrently by surgeon, radiation therapist and medical oncologist to devise the most appropriate approach to care. Added to this, palliative care begun at the time of diagnosis adds to patient comfort, lessens anxiety, and reduces overall costs while improving satisfaction with caregivers and therapies.

With the advent of early diagnosis with CT screening, more effective yet less damaging approaches to radiation therapy, effective chemotherapy, targeted drug therapy for those with driver mutations, all initiated in experienced hands with a multi-disciplinary approach and early institution of palliative care, perhaps the light is now actually beginning to glow at the end of the tunnel for lung cancer patients and their families.

Four follow-on articles will discuss in more depth early diagnosis, treatment options of surgery, radiation and drugs, the use of multi-disciplinary team care and the value of palliative care teams.

1. More patients in less time

EMRs automate processes that were once performed manually at your practice. Patient registration for example, no longer requires filling in forms and manual data entry. With patient portals a patient can either provide this information himself or your staff can retrieve it through scanning driving licenses and insurance cards.

At the clinical end, there is no need for nurses to sit in front of computers entering patient’s vitals, as device integration allows reliable and quick transmission of information into the patient’s chart.

On the financial side, you need not create super-bills manually. The system does this on its own and guides you to the next patient. Thus, EMRs enable you to utilize your time more effectively. Saving time is a luxury for most in the care delivery profession.

2. Less paper, less cost

A significant decrease in the use of paper does not only save trees but considerable cost to your practice. Your hard earned money is not spent on items that add little value, such as office stationary, paper storage cost, courier service for communication and staff for maintaining and upgrading patient records.

EMRs do all that and much more with a simple click of a button. Communication and collaboration with patients and other care providers or organizations is done through emails, electronic faxing and SMS transmission, so you can dedicate your staff to enhance the patient experience, a small change that does wonders for patient satisfaction and ultimately your practice ratings!

3. Disease specific Templates

These templates help you in two ways. They reduce your workload by identifying and automatically populating disease specific information in a patient’s chart. Furthermore, they increase the chances that you will be paid fairly for your services.

Consider for example that there’s a flu going around, so every patient walking in is complaining of the same problem. A template driven EMR can help you document faster with more efficiency, because half your work is already done. All you need to do is to make patient-specific changes in the template and end up with a well documented visit note for the patient. Not only does this reduce your workload but also increases your chances of getting a higher return. More detailed diagnoses lead to a higher E&M code with complete supporting documentation reducing chances of rejections.

4.  Bonuses are good

Can you imagine being paid for buying a product? With EMRs you do.

Government and non-governmental organizations offer monetary incentives to that can cover a substantial chunk of your EMR investment. The Meaningful Use program gives physicians up to $ 44,000 in reimbursement over five years for Medicare and $ 64,000 under Medicaid. More importantly, you get an initial payment of $ 21,500 under Medicaid for just signing up with a certified EMR vendor.  As electronic medical records reduce risk of medical errors, malpractice insurers have also started to provide incentives for medical practices to transition to EMR.

5. Reduced “No Shows”

Patients who fail to show up for appointments are the bane of any practice. No-shows reduce revenues, waste staff time and create artificial access problems. With integrated EMR and Practice Management software: automatic email, SMS and telephone alerts notify patients of upcoming appointments, thereby reducing the chances of a no show. In cases where patients want to reschedule, a simple drag and drop allows the user to change the appointment date and time without.

6. Satisfied Patients. Better reviews!

A satisfied patient is the best form of marketing for your practice. With the right EMR, your patients have access to their medical records at all times. Patient portals not only allow for patients to request appointments, refills or access their health clinical records, patients can also receive disease specific alerts. Built-in patient education material helps better understanding and management of their clinical condition. Staff is more actively engaged with patients rather than file work making patients feel important.

In conclusion, as more practices experience the benefits of EMRs they find that the initial investment is affordable and the longer-term return increasingly compelling.

Selecting outstanding sites is the key in running a well-controlled clinical trial. Failure to identify outstanding sites could result in added costs and could lead to delays in bringing much needed products to the bedside. Investing upfront time in the selection process could yield a positive return. Today’s clinical research landscape typically allows for minimal resources under tight timelines, requiring sponsors to quickly, yet effectively, decide which sites are the right fit for the job. Selecting sites is the responsibility of the sponsor as outlined in ICH-GCP 5.6.1, 21 CFR 812.43, 21 CFR 312.50, and ISO 14155:2011(E). There is not a great deal of detail in these regulations to provide further guidance to sponsors. It is truly the sponsor’s responsibility to take the time at the start of the study to carefully examine potential sites and ask important questions during the review process.

• What does the sponsor need to look at to determine if a site is outstanding?
• What are some important questions to ask in relation to the sponsor’s study?
• Is there an easy way to weed out sites that are not efficient or effective?

IMARC’s most recent whitepaper dives into these questions and takes an in-depth look at what sets sites apart and allows them to shine as OUTSTANDING! Use and learn what being an OUTSTANDING site means and how to use OUTSTANDING to select high performing, compliant sites.

O-Organized
U-Unified study team
T-Trained study staff/Therapeutic Expertise
S-Sufficient amount of staff
T-Time and costs
A-Adequate facticity
N-New to research or well experienced
D-Data! Timely, accurate, and complete
I-IRB status
N-Number of potential research patients
G-Good reputation of the PI and Co-Is

Please take time to download IMARC’s newest whitepaper: “Selecting OUTSTANDING Sites” to learn more about the importance of site selection.

Electronic Health Records usually encompass the element of medical billing. There are many advantages a provider can avail by outsourcing its medical billing to a certified and successful vendor. Just as the provider has to analyze and compare the different versions offered for Electronic Medical Records EMR in the market, it has to do the same for billing.

Therefore, before choosing a vendor for the purpose of medical billing, providers should look at some of the following factors before making a contractual purchasing decision with the vendor.

Providers should look at the level of services that the potential vendor is providing. It is all the more helpful if the vendor is providing full and complete practice workflows starting from the initial patient visit to the electronic medical billing. Sometimes, the billing too is confined to just a couple of options such as submission of claims and follow up, but can lack some of the necessary steps required to finish the whole billing operation such as finalizing the claims.

Providers should also be able to compare the different models of billing provided by different vendors and decide which one best suits the need of the practice. Sometimes the billing has a direct and aggressive approach and sometimes it can be passive and defensive. Sometimes only a couple of functions are rendered electronically and sometimes only a couple of errors are taken care of at the initial encountered level.

One of the most important aspects for providers to see in any vendor providing Electronic Medical Billing service is its ability to compile and prepare operational reports which consistently show the total claims submitted, paid for, and failed etc. This is important because it consistently informs and guides providers about where they are (for any patient) in the overall billing process and what they need to do to make the process streamlined and efficient.

This vital question for the future of health care worldwide will be asked during the premier life sciences meeting in North America, the DIA 2013 49th Annual Meeting.

DIA 2013 49th Annual Meeting will be held in Boston, Mass. from June 23-27, and will feature a session titled “Defining Clinical Trial Innovation: Challenges and Opportunities for 2013” under the Communities Showcase track. The forum, developed by the DIA’s Clinical Research Community, will give participants the chance to discuss the challenges and opportunities for innovation to improve global health and fulfill unmet medical needs.

Panelists will give their views on whether the regulated and increasingly resource-constrained R&D environment will have opportunities for innovation to ensure a sustainable future. The panelists will include Craig H. Lipset, Head of Clinical Innovation, Worldwide Research and Development, Pfizer Inc; Andreas Koester, MD, PhD, Vice President, Clinical Trial Innovation, External Alliances, Janssen Pharmaceutical Companies of J&J; and Jeffrey S. Kasher, PhD, Vice President, Global Clinical Development, Eli Lilly and Company.

The session will be chaired by Susan K. Nunchuck, PhD, MSN, Senior Clinical Research Associate, Actelion Clinical Research.

Participants in the session, to be held on June 24 from 2:30 to 4:00 p.m., will learn to define clinical trial innovation in 2013; identify key challenges and opportunities for innovation in clinical trials; and define funding resources in a constrained, highly regulated environment.

The DIA 2013 49th Annual Meeting: Advancing Therapeutic Innovation and Regulatory Science is the largest multidisciplinary event that brings together a global community of life sciences professionals at all levels and across all disciplines in the discovery, development, and life cycle management of medical products, all with a common goal to foster innovation that will lead to the development of safe and effective medical products and therapies for patients.

Returning to Boston, one of the strongest life sciences regions in the United States, this year’s program will feature 250+ educational offerings over 22 tracks on hot topics from key thought leaders from the life sciences industry.

The DIA Annual Meeting provides participants with a valuable opportunity to meet professionals from around the world, share knowledge and experience, network, and build new relationships.

Find out more about DIA 2013 49th Annual Meeting at www.diahome.org/DIA2013.

Register by May 17 to reserve your spot on the Advance Attendee List.

Last week the Box.com healthcare team invited me to participate in their “Secure Cloud Collaboration in Healthcare” webinar. The full event, audio, and screencast is available on their BrightTalk.com channel.

My point to the audience was that healthcare professionals are very resourceful and if IT doesn’t provide them the proper solutions they will not just wait for progress, they’ll take matters into their hands — creating a growing “Shadow IT” problem. In the webinar I talked about “Shadow IT” and how solutions like Box.com can reduce the problems of end users choosing consumer-grade cloud solutions that are not HIPAA compliant or secure enough for enterprise use.

We hear that hospitals are going broke. They can’t make ends meet. The uninsured are breaking the hospitals’ backs from emergency room over-utilization. Hospitals won’t survive unless Medicaid is expanded. (This is the most interesting claim, as hospitals simultaneously complain that underpayment by Medicaid justifies their cost-shifting to others!)

These are the lies that are primarily responsible for bringing us ObamaCare.

But if we look around us, what do we see?

Hospitals are building everywhere. They sponsor sports franchises. They buy advertising in high-priced media outlets. They are ceaselessly buying physician practices—and also buying rural hospitals they destroyed by having bought all of the small-town physician practices and diverting their referrals. They are expanding their emergency rooms—and even building free-standing emergency rooms, so-called loss leaders for their institutions. They make multi-million-dollar “logo” changes. Their administrative staffs are huge and extremely well paid.

Why are patients terrified of becoming uninsured, or driven into bankruptcy by medical bills? It is not because of doctor bills. How many doctors have extracted such huge payments from patients as to cause them to lose their homes? It is hospitals that do that. Routinely.

After reading the recent article in Time magazine about abusive hospital billing practices, in which Oklahoma City’s own Mercy Hospital was named, one of my partners remarked that the rotating cross on top of their hospital should be replaced with a dollar symbol! My father recently asked me if any of the hospital administrators whose billing practices have bankrupted countless patients ever had face-to-face contact with those whose lives had been ruined by their greed. Or, he asked, were they like drone operators, destroying people’s lives in a remote, impersonal way, while they themselves remain safe in their office?

The truth is that, economically, hospitals are not unlike utility companies in that they have high fixed costs. As Thomas DiLorenzo explains in his brilliant book Organized Crime: the Unvarnished Truth about Government, once the plant is built and the power lines are present, the cost of adding another utility customer approaches zero. Once the emergency room is built and staffed, the actual cost of an additional patient approaches zero, other than the actual supply costs. As a physician who owns and operates a medical facility, I can tell you that the supply costs are not that high, even in a surgical environment.

Also, while the hospital spokesmen claim that they have to take everyone regardless of ability to pay, hospitals get paid even when they don’t get paid through the uncompensated care scam. As hospitals wave the charity flag with one hand, they are fleecing the taxpayers through this scam with the other.

When Jim Epstein of Reason magazine was writing an article about our facility, Surgery Center of Oklahoma, he discovered that the amount Medicaid paid local hospitals exceeded the prices we post publicly at surgerycenterok.com. Hospitals claim that these “horrible reimbursements” by Medicaid are one of the primary excuses used to justify the “hidden tax” they impose on uninsured (self-pay) and privately insured patients.

Think about this: if the costs for the indigent are shifted to others who do pay, or to taxpayers, how is it that the hospitals are providing “uncompensated” care? One way or the other, the hospital gets paid for everyone who comes through its doors.

We make a profit at the prices we have listed online. These prices are one-sixth to one-tenth of the prices charged for the same procedures at most “not for profit” hospitals. This is what you can see for yourself. What you now hear if you listen closely is a quiet panic engulfing those in the medical-industrial complex, as this free-market, transparent pricing model is getting noticed and gaining ground.

This movement, if allowed to grow, will reduce the cost of care and raise the quality bar, just like competition does in every other sector of the economy.
Why expand the bureaucratically encrusted waste and corruption-ridden Medicaid model that is bankrupting government, when freedom works so much better?

After a seven-year investigation, Dr. Natale was indicted for Medicare fraud. Unlike the majority of federal defendants, who feel compelled to cave in by signing a plea bargain even when innocent, Dr. Natale courageously exercised his constitutional right to have a public trial. That is in itself considered an “obstruction of justice” by our government. The conviction rate is more than 95 percent, and sentences may be much longer than those meted out to “cooperative” defendants.

The jury found Dr. Natale not guilty on all of the fraud charges. But he was convicted on two counts of making “false statements” in his operative reports. Over his objection, prejudicial diagrams were sent to the jury room, supposedly representing the operation described in the operative report as well as the operation that was actually done. As anyone can see, a Y-shaped graft (mentioned in the operative report) is different from a tube-shaped graft (placed in the patient, by the doctor’s own admission). The government had thereby emphasized a false statement by Defendant.

The term “false statement” suggests a deliberate lie, but it could be, as Dr. Natale said, a simple mistake, made while a tired and overworked surgeon dictated a pile of reports weeks after the surgery. The jury was not instructed that a false statement is a crime only if made in a deliberate attempt to commit fraud—and, as the jury determined, there was no fraud.

The fraud charges concerned whether Dr. Natale had billed for an operation more complex than the one he did, and were related to the upper end of the graft, not the lower end. All the patients had an abdominal aortic aneurysm that involved the renal arteries, so that the aorta had to be clamped above the branches supplying the kidneys. Dr. Natale did a reconstructive procedure to strengthen the aorta, so he did not have to cut the renal arteries off the aorta and sew them into the graft. There is no precise AMA-copyrighted code for this, so Dr. Natale used the closest one, which is not for a more complex procedure and which did not increase his payment.

After seven years of searching, the government was able to come up with only five cases to include in the indictment, all of them frail, elderly patients who would have died of rupture of their weakened abdominal aorta without surgery, or of kidney failure from inadequate surgery. All the patients survived and did well after surgery. The key patient survived for nearly a year after Dr. Natale’s operation. Later, after two very aggressive, likely unnecessary re-operations done by Dr. Natale’s main accuser, the patient died.

At the appeal, the main argument was not about justice, but rather about what the defense attorney did or did not say during the trial. Did he “waive” or “forfeit” grounds for appeal by not objecting to the jury instructions?

One judge referred to the need to apply the law that was in effect in 2002-2004. Under more recent law, the government’s burden of proof has been lightened. The mens rea or criminal intent requirement is virtually gone. The prosecutor does not need to prove that a doctor “knowingly and willfully” lied in order to pad his fee, only to show that an incorrect AMA code was used and the doctor intended to get paid for his work.

The implications of the case are profound, the judge noted: Any error in any medical record related to a health program could be a federal crime.

But if the rules change about defense attorneys’ waiving their client’s rights by being insufficiently assertive, the floodgates for appeals might be opened.

Let us hope that justice is done for Dr. Natale. But to this observer who attended the appellate proceeding, it looks as though the laws are increasingly designed to deter expensive care of the elderly, and that the judicial system focuses more on procedural rules than on substantive justice.

Doctors need to know that anything in the medical record can be used against them — as can errors by their own million-dollar attorney.

Electronic medical record (EMR) software can reduce care costs and improve patient safety, making implementing the software an arguably good investment – but physician practices are often hesitant to spend money on technology that might not deliver a sufficient return on their investment. After all, while doctors are in the business of savings lives, doing so would be impossible if high overhead costs and low returns were to force them out of business.

The problem with calculating EMR savings, however, is that it isn’t always easy to do. In fact, despite having implemented the very same piece of software, the return on investment (ROI) for one practice could be drastically different than for another. After all, using an EMR can be cost effective, but setting it up takes work.

A practice that decides to use its EMR’s integrated billing module, for example, is likely to spend less on implementation than one that needs an interface built to connect their current software to the EMR. Meanwhile, a practice that has to hire a temporary worker to scan paper records into the EMR will end up spending more than one with the resources to handle the task in-house.

More importantly, the time it takes to recoup money invested in an EMR can vary greatly, and physicians looking for a quick return are often disillusioned by the time it takes to notice decreased costs. With patience, though, and careful planning the savings do materialize. Here’s how:

1. Reduce office supply expenses.

One of the things that EMR companies tend to advertise most is that implementing their software will allow practices to go paperless. Doctors relish the thought of all the money they can save by eliminating paper – and they’re sold.

The truth is EMRs don’t eliminate paper use altogether, and truly paperless practices don’t exist. But an EMR can significantly reduce the need for paper, driving monthly hard costs down and leaving money in the budget for other expenses. In fact, a single-provider practice that sees a modest 30 patients a day can save as little as $400 to $500 dollars a month in paper-based fees alone.

To calculate potential savings for a particular practice, physicians can use an EMR ROI calculator. This tool allows the input of specific data, such as how many new patient charts are created on average, how many superbills are printed and how many papers are faxed each day, and it estimates monthly savings.

2. Increase productivity.

Learning to use an EMR– not to mention redesigning workflow to adapt to electronic charting – can be overwhelming and will almost certainly slow physicians down at first. As learning takes place, however, particularly for practices that focus on the training aspect of implementation, productivity will slowly increase, translating into big savings over time.

Once physicians and staff get the hang of using an EMR, for example, documenting patient visits and carrying out billing processes will take less time. This allows physicians to spend more time with patients or to schedule more appointments to bring in extra revenue for the practice.

3. Gain office space.

A benefit that practices often fail to consider is the storage space that is inevitably freed up by going digital. After all, once paper files have been scanned and are safely stored within the EMR, it becomes unnecessary to continue storing them on-site. But what to do with an empty chart room?

The obvious answer is to turn the space into an exam room so that it becomes an extra source of revenue. This provides practices with the possibility for growth – whether to take on a new associate or for existing physicians to treat more patients – without incurring any additional costs.

Of course, the extra office space can also be used to generate revenue in other ways. For example, rooms with more square feet can be used to offer yoga or Zumba classes to patients for a fee. The space can also be used to hold support group meetings for patients who are trying to stop smoking or for those struggling with weight loss. The possibilities are endless.

4. Allocate staff resources more efficiently.

The most obvious example of how an EMR system allows practices to save money when it comes to staff is that it eliminates the need for a full-time medical records clerk. That’s savings of more than $2,000 a month, which for many practices is even greater.

Another alternative to cutting overhead without letting a staff member go is to use them in a more efficient way. For example, a file clerk can be trained to perform front desk duties, reducing workload for other employees and eliminating overtime. This can allow practices to grow their operation by making use of a newly-converted exam room, without necessarily having to take on an additional employee.

The important thing to remember about implementing an EMR solution is that savings will be noticed not immediately, but over time.