Last week, the Better Health Care Together coalition held a briefing at the National Press Club to unveil a new study written by economist Dr. Robert Litan.

The study, entitled Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives, found that the United States could cut $197 billion from its health care bill over the next 25 years by the widespread use of remote monitoring to track the vital signs of patients with chronic diseases such as congestive heart failure and diabetes.

But, and here’s the catch: Dr. Litan warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet the privacy, security, and reliability requirements for telemedicine applications.

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“Drugs don’t work in patients who don’t take them.” This quote, by the former Surgeon General, C. Everett Koop, M.D, appeared in a New England Journal of Medicine article on drug therapy and adherence.

There are many reasons (cost, inconvenience, forgetfulness, unpleasant side effects) why patients don’t take their medicine. Medication adherence has become an issue of great concern within the health community, especially as we get older as a nation. So in this spirit, Verizon recently launched what it refers to as the Pill Phone — a new technology that allows people to make sure they keep to their medication regimens and help family members keep to theirs.

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With more than 35 years experience within the Nursing profession, I’ve seen it all. Today, I’d like to share some of my thoughts on health care and life in general.

- Everyday you rise and ponder… Is this the day when caring for humans will override caring for houses, money, cars and the 30 seconds of fame that appear to be an American phenomenon? What do you think? I believe it can happen.

- It’s important for each of us to consider what’s at stake with this and every election. It isn’t about age or race. It’s about moving from dreams that we have held onto for a lifetime to creating the path to make the dreams come true.

- The old saying beauty is in the eye of the beholder is never truer than when you’ve worked twenty-two hours straight and someone tells you that you look great!

Last Monday, Stephanie Mensh wrote about her experience with medical homes. Dr. Pamela Mitchell, President of the American Academy of Nursing, has provided Disruptive Women with another perspective.

Guest post by Pamela H. Mitchell, RN, PhD, FAHA, FAAN

There is much talk these days in health professional, health payer, and even legislative circles about the “medical home.” This is a term coined in 1967 by the American Academy of Pediatrics. The medical home was originally meant as a single place for a child’s medical record and was particularly salient for children with special care needs. It later expanded to denote the one place that families with children with special care needs might obtain coordinated, continuous, family-centered and culturally effective care.¹ The concept of a medical home has additional roots in recognized needs for care coordination for people with chronic illness in managed care, case management, disease management and comprehensive discharge planning for complex or chronic illnesses. Most recently, a coalition of the American Association of Family Practice, American College of Physicians, American Academy of Pediatrics, and American Osteopathic Association developed and disseminated “Joint Principles of the Patient-Centered Medical Home.” This document defines the Patient-Centered Medical Home (PC-MH) as “an approach to providing comprehensive primary care for children, youth and adults. The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal physicians and, when appropriate, the patient’s family.”¹ At its best, this new movement promises quality, coordinated care for people, rather than their diseases. Further, it recognizes that care coordination and management is a complex skill that deserves payment in our current payment system. However, because of the consistent emphasis on physicians as the home “owner” and leading partner, it connotes care centered in a particular practice profession rather than care for the person or family who comes “home.”

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Guest post from Donna Barnes

Chronic disease prevention presents an obvious opportunity for health care reform. The platforms of both Senators McCain and Obama note the potential savings—in dollars and lives—that can result from preventing chronic illnesses. However, by focusing exclusively on chronic disease, we miss an opportunity for prevention of a common cause of death that takes as many lives as Alzheimer’s disease and causes ripples throughout American families and communities.

What I am talking about here is violent death—among others, homicide, suicide, child abuse, and domestic violence that takes lives. Recognizing the growing damage from violent death and recognizing that it can be prevented—just like countless medical conditions—is critical.

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Having recently received an email notice from an online health related news service, I was drawn to and intrigued by two pieces about long term care and family care giving. Within seconds I found myself clicking on link after link to see what information and materials I could find that might be applicable to our family’s current situation. I read about additional efforts to provide resources to conduct research on end of life and care giving issues. And we found organizations offering help to family caregivers.

In retrospect many of the signs and symptoms had been there for weeks maybe even months. Fatigue and weakness, weight loss, loss of appetite. “Meryl”, he said, “I am just not feeling well.” But it was more than just being 81 years old and feeling tired. It was more than mourning the loss of his wife (my mom) who had died two years earlier. Dad had been recently diagnosed with stage 4 pancreatic cancer. As he says, “the news was ominous”. For us, the news was indeed emotionally difficult as we discussed and negotiated how to help dad through the weeks and months ahead.

So began a virtual journey as I traveled the equivalent of what must be thousands of Internet miles seeking as much information as I could from dozens of web sites about home health and personal care services, hospice, family care giving, home health care, and end of life care. There in front of me were pages and pages of sites with information. So, what do we do? Hundreds of questions with no right or wrong answers.

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It’s ironic to me that while Congress was busy twisting itself into a political pretzel over privacy, which ultimately—once again—caused the defeat of a much needed piece of legislation ushering in electronic medical records, 10 brave souls volunteered to let it all hang out at Harvard, and on the Internet.

I’m talking, of course, about the groundbreaking new venture known as the Personal Genome Project, led by Harvard genetics professor Dr. George Church. The project, which launched this week with 10 volunteers calling themselves the PGP-10 (including technology VC extraordinaire, Esther Dyson), is looking to speed medical research by doing away with traditional privacy precautions.

For the participants, the quid pro quo of having their DNA decoded involves putting their information on the project’s website—for all the world to see.

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A Medical Home may be coming to your neighborhood soon—and it’s a welcome first step to help consumers and caregivers coordinate complex medical services for family members suffering from chronic, debilitating diseases. CMS will be hosting a public telephone “Open Door Forum” on October 28 describing Medicare’s new Medical Home Demonstration Program, set up by 2006 Medicare legislation, aimed at recruiting primary care physicians and local health clinics to sign up when the program begins next year. (more…)

Don’t neglect your ovaries during Breast Cancer Awareness Month.

Earlier this week, the Ovarian Cancer National Alliance (OCNA) released both a 30 second public service announcement (that ran in New York taxi cabs in late September) and a more personal, in-depth interview with Kathy Bates—about her experience with ovarian cancer.

I wanted to share this information with as many people as possible—men and women.

Please help educate others about ovarian cancer.

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If you don’t, you may want to seriously think about creating one. I am. I’ll admit it, at first I was skeptical, but the more I see the benefits of virtual worlds, the greater the value and potential I can see for health care.

An Avatar, as Wikipedia notes, is “a computer user’s representation of himself/herself or alter ego.” (Hmmm, wonder what Joe the Plumber’s avatar might look like)…

Avatars are used in virtual worlds like Second Life and Whyville. (more…)

When asked if she had a choice, if she would rather be deaf or blind, Helen Keller chose blindness. She answered “blindness separates you from things but deafness separates you from people”. Communication is the foundation of all human interactions. 30 million Americans, or 1 in 10 suffer from hearing loss yet only about 20% of those who could benefit from amplification choose to wear hearing aids. It is a statistic that has stymied me for many years. Most adults have hearing loss that occurs gradually over time. They don’t typically wake up one day and suddenly say “I don’t hear too well anymore”. In fact, the process occurs slowly over years. Many people aren’t even aware; family, co-workers or friends may be the first to realize what is happening. The TV may be a little louder, the person asks for repetitions, struggles in a crowd. The problem is, once made aware; resistance has historically been truly amazing. My grandmother, until nearly the age of 90 stated, “I don’t need a hearing aid…they are for old people”.

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Regulate–deregulate. Can we really solve the crises in the economy and health care by doing one or the other? Is it really so simple?

I’m not an economist, but I am a nurse and journalist who can tell you that regulations in health care serve to protect the public. They can also get in the way of better care.

Consider the story of Dr. Meridean Maas, RN, and Dr. Janet Specht, RN, two advanced practice geriatric nurse specialists who had extensive expertise in long-term care of people with dementia. Based in Iowa, they realized that the facilities where they had worked were not places in which they would put their own parents. They believed they could provide a better model of care and decided to prove it. They took out a loan for $350,000 and a received a grant from the Iowa Development Corporation to purchase a ranch-style home with acreage that they called Liberty Country Living. They created a home-like atmosphere for people with dementia who dressed in their own clothes and could walk the fenced-in property without fear of becoming lost. Staff ate with the residents and got to know their interests and backgrounds, often encouraging the residents to engage in activities that held meaning for them. Family were told to come any time and supported in being with their loved ones as much as possible. (more…)

Ornery Facts

As we work to cover the uninsured, a goal all Americans share, it is key to understand who they are.  Otherwise we will change the law but not achieve the goal. Let’s accurately identify who really needs a new program to provide coverage.

20% are eligible for government programs but are not enrolled. That is almost 10 million people who don’t need a new program; what they need is better outreach by existing programs. Add to that the 19%, or 9 million, that earn more than $75,000. (close to 400% of the FPL for a family of 4) and the 13%, or 6 million, that are eligible for employer coverage (only 5% of whom go uninsured). They don’t really need a new program either. Then there are the 22% who are ineligible because they are here illegally or are in their first five years of legal residence.  That’s 12 million who DO need some type of coverage. So you get some idea of the impossibility of measuring success by “47 million”. (more…)

As working professionals with decades of experience in health care, we face several workplace challenges, including co-workers from different (often younger) generations and retirement plans crumbling in this era of economic downturn. As mothers we face the dynamics of child birth and the hair pulling dilemmas of child raising. But it is as baby boomers who are part of the sandwich generation, that I think we are experiencing hurdles more difficult than contemplated. For me, front and center has been the need to confront care planning and end of life decisions for family members living hundreds of miles away. (more…)

Will pharmacist prescribing be good for physicians? Yes.

The practice of medicine has never been more complex or demanding. It’s a perfect storm, especially in primary care. The number of primary care providers is dwindling as older physicians retire, those not at retirement age leave the profession and younger people do not replace them. Even those who do choose primary care are less likely to work long hours. And why should they? They’ll not be paid commensurate with their value and the love of their work is not something they can use to negotiate a mortgage or pay the kids’ tuition. (more…)