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Cures for Wasteful Healthcare – some ideas by Dr. Cutler

Three Cures for Wasteful Healthcare | David Cutler | Big Think.

As a follow up to my earlier posts and links of wasteful health care administrative expenditure, this video by Dr. Cutler , Harvard based Economist makes interesting reading.

There is video and a transcript by Dr. Cutler at the link above.

 

More ideas and videos by Dr. Cutler here

AuShadha EMR Project listed at Medfloss website !

AuShadha EMR Project gets listed at Medfloss website

http://www.medfloss.org/node/806

Thanks Medfloss for the help in listing the Project !

http://www.medfloss.org/node/806
AuShadha Project is listed at Medfloss at http://www.medfloss.org/node/806

AuShadha UI is about to get a design make over – A Preview Mockup

AuShadha is undergoing a UI desgin makeover to fit into the present role. I had Open sourced my private EMR, so essentially I am stripping it of personal features and adding in the common use ones that will serve for a multiuser clinic.

Dojo 1.8 migration has already started and is currently in testing.

UI design for the pane controlling an admitted patient is as below. This is a mock up in inkscape and is likely to change.

Once the UI is finalised and Dojo 1.8 is tested locally, I will push it to github repo at http://dreaswar.github.com/AuShadha/

Please watch this space and http://facebook.com/AuShadha for further news on the project

 

AuShadha UI Mockup
AuShadha EMR project UI mock up

AuShadha Icon Pack nearing completion !

This is a preview of AuShadha Icon Pack.

AuShadha my Electronic Medical Records project will be using this.

If is nearing completion and soon will be released.

The project is hosted on Bitbucket and is private now.

I am finalising the icon licences and attributions. Hence the watermark on the Screenshot.

Most icons are derived straight / modified from NounProject.

Please keep a watch on http://facebook.com/AuShadha/

Please watch this space as I will announce it here or on Facebook

Image.

Is Medical Administration a wasteful expenditure ?

In continuation of my previous blog article: How many Administrators does it take to run a Hospital ?, the brevity and conclusion of which interested me so much that I went deeper into this subject.

A link from that article drew me to an article by Kevin MD on the subject of health care spending.

In India, as in the USA where health care spending is something worrisome, this should make very interesting reading.

It is no secret that there is no love lost between Administrators and Doctors in most institutions.

Usually the Administration claims that the doctors don’t justify the amount being spent on them by the Hospital in terms of salary and other facilities provided. This data seems to point otherwise.

As the final word on this is yet to be spoken, still every bit of more reading I do on this topic seems to affirm the feeling I always had : That I was right

See the link below for an interesting article on what the author thinks about this.

Claims are backed up with some data from US Presidents advisors…

Administration comprises one of the biggest factors for health care waste.

But does health reform do enough to streamline it? It’s doubtful.

Consider the following chart presented by David Cutler, a President Obama advisor:

Health care administration is a source of medical waste

In other words, for every one doctor there are 5 more are employed to do administrative tasks.

And, frankly, it’s ridiculous. As Dr. Cutler says, “There is a lot of money spent doing things that in no other industry do we tolerate.”

Health reformers are hopeful that the money spent for electronic health records and claims processing will cut down on the bureaucracy. But it’s doubtful. Because universal standards for health IT are fragmented and difficult to implement, it’s unlikely that digital systems are a viable answer. If anything, I can see electronic records creating more positions, such as IT support, that will further bloat the administrative side of health care.

This is compounded by the impending transition to ICD-10 — with a 10-fold increase in coding complexity.

Read More Here:

http://www.kevinmd.com/blog/2010/04/health-care-administration-source-medical-waste.html#more-43828

How Many Administrators Does It Take to Run A Hospital?

Dr. Wes: How Many Administrators Does It Take to Run A Hospital?.

I always asked myself this question…

How many administrators does it take to run a hospital smoothly.

They are apparently employed to make doctors life smooth which leads to better working environment and better patient care. .. well, at least in theory. In practice, things are a lot different.

So, I started searching. I was sure I was not the only one who was having these thoughts.

This is an interesting blog article on that subject. A very short one, but serves the purpose.

How Many Administrators Does It Take to Run A Hospital?

From KevinMD:

… for every one doctor there are 5 more are employed to do administrative tasks.

And, frankly, it’s ridiculous. As Dr. Cutler says, “There is a lot of money spent doing things that in no other industry do we tolerate.”

If you want to find out how many administrators it takes to run a hospital, ask yourself how many work on the weekend.

That number should be just about right.

-Wes

 

Once you have finished that,  please see this article for more data on this and wasteful hospital expenditure

Dr.Easwar’s Spine & Scoliosis Surgery Website launched at http://spine-india.com

My spine clinic website has been launched !

Dr.Easwar's Spine Collage
Thanks to all my patients who have trusted me and helped me be part of their healing
Dr.Easwar Spine Website - Logo
Dr.Easwar Spine Website – Logo (All Rights Reserved)

Find it at http://spine-india.com

All queries regarding Spine Surgery, Scoliosis, Paediatric Deformities can be posted and I will get back to you

Thanks,

Dr. Easwar

AuShadha Open Source Public Health Management EMR System at GitHub has a official logo

Image Image

LICENSE: Image

Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License

AuShadha Project home: http://dreaswar.github.com/AuShadha/

Open Source Public Health Management EMR System in Django at GitHub is ready !

My GitHub repo for Public Health Management Electronic Medical Record is ready !

This is system that should be optimised for small Primary Care Providers especially in India and other developing countries. This is licensed as GNU GPL v3. Written in Django and Dojo

Visit http://dreaswar.github.com/AuShadha/

A discussion on Medicine, Social Injustice and Morality…

A Discussion at Research Gate on Medicine and Morality….

Historically, pivotal changes in the practice of medicine, pharmacy, dentistry, or nursing have occurred in response to the misery of the human condition. Health conditions such as the Black Plague, the polio epidemic, HIV/AIDS, and war are examples of how human suffering that affected large populations spurred advances in infection control, immunization, pharmacologic therapies, and survival after life-threatening injury.

When poverty or cruelty finally rises to the level of social awareness, political action is taken through Acts of the U.S. Congress. The 1935 Social Security Act, 1946 Mental Health Act, 1964 Civil Rights Act, 1965 Medicare Act, 1990 Americans with Disabilities Act, and the 2010 Affordable Care Act are the moments in history when human suffering rose to a level of social consciousness that there was political action. (Source: NIH Almanac Legislative Chronology http://www.nih.gov/about/almanac/historical/legislative_chronology.htm)

more here….http://www.researchgate.net/topic/Medicine/post/When_does_social_injustice_rise_high_enough_in_our_consciousness_that_we_realize_it_is_time_to_act

Patent Wars : Why The Boycott Apple Movement Matters; Why It’s Not Dumb

A new movement has started on the social networking sites it’s called BoycottApple. We noticed that even the hardcore Apple users have come out in protest of what Apple is doing against its competitors. However, at the same time we have Mike Elgan who thinks this whole movement is dumb. I, for one, don’t think so.

Mike Elgan has published a passionate article “Why the ‘Boycott Apple’ Movement is Dumb” on Cult of Mac. I agree with Mike most of the time, but this time I do not.

He cites the reasons why he thinks “the call for a boycott is misguided and futile”:

It’s based on the myth of Apple exceptionalism.

Boycott Apple advocates pretend to believe what they do not (or should not) believe, that companies don’t sue over patents because they are nice, or virtuous or believe in the free exchange of ideas. The reality is that they don’t sue because they don’t have a case, and it isn’t worth it financially.

That’s not true; most companies don’t sue because they believe in capturing the market via innovation instead of litigation. They don’t acquire stupid patents like ’rounded’ rectangular devices. If that was the case there would be only one TV manufacturer in the world which could make rectangular TV sets with rounded corners. The rest of the TV makers would be making triangular or circular TVs……

read more here… http://www.muktware.com/3871/why-boycott-apple-movement-matters-why-its-not-dumb

Plone based Open Source Intranet Solution for Hospitals

As discussed in my previous post I have implemented an Open Source Intranet Solution in my Hospital, Ortho One Orthopaedic Speciality Centre, Coimbatore, India.

This is based on Plone. Customisation have been done to suit and hospital work flow. Necessary add-ons have been added to achieve the desired functionality along with custom scripts. Basic styling has been done to keep it simple and presentable.

Plone is served from an Ubuntu Server 12.04, 4GB Ram and 500 GB HDD. The processor is Core2Duo. This is a staging server. We may be shifting out once we have fitted the gaps and are ready to go live. That said the existing hardware serves well.

Here are a few screenshots:

Intranet Wall
Intranet wall for file dumping, discussions, chats, announcements.. even secret meetings !
Chat on Intranet.. Too lazy to create events, pages ? Chat away…
Staff Leave Calendar
Staff Leave Calendar
Intranet Login Page
The Login page…
Intranet Discussion Board
Discussion Board for the Intranet.

 

What stops Open Source Imlpementation in Hospitals ? – A Poll

Guide to Successful Open Source Software Implementation in Hospitals – Some Difficulties That Needs to be Crossed..

      Its the age of Great Leap Forward..

People are happy, work goes on.. life is kind of strange with no BSOD but people are still carrying on.

One thing they are unhappy about.. They have to work. Gone or the days when their trusted OS used to giveway under then leaving them staring at a BSOD so that they could make a quick call to the IT in charge and go out for a coffee.

Excuses for work delay have come down.

So how did we get ourselves in this mess ?

We had to struggle.

What follows is a first hand account and a general guide for all Doctors who wish to implement Open Source Solutions / Software or Linux based systems at their workplace but are afraid to take the plunge.

For the technically minded Mr. Kumaran (http://kums.in) is preparing a more technically heavy note full of implementation details. Please watch that space.

 

Essential Reading

1) How we moved to Open Source at our hospital

2) Intranet &PACS

3) My Open Source EMR

4) EMR Implementation

Planning ::
==========

– Sit down and think what we want our computers to do for us and define a budget.

– This will dictate what software & hardware you need to get that
job done.

– Make the right Hardware and Software Investments. It is very easy to
get convinced by the vendor to invest more in features you may never
use / need.

– You need to choose you FOSS projects carefully.

http://www.ohloh.net/

http://www.sourceforge.net

gives you indices that help you decide the popularity of the software.

– Look Before you Buy: Always check the Linux Compatibility of the
hardware you are going to purchase after you have installed Linux.
While many will work out of the box, some will work after tweaking,
some may not work.

– Get the right persons for the job. There will be an element of luck
here. If you are, then you will find somebody passionate abt this. Consult them.FOSS enthusiasts and ready to help.

– Do your Homework: I worked for 5 years trying out one solution after another before settling on the ones I wanted. Since I know the work flow of my hospital, I naturally know what suits it the best.

– Keep it cheap. It can be done. Cost is important, even if you are willing to pay
more. Bargain hard. Buy only what you want. Dont by what you are
sold.

– Interoperability within and without your office. This is important.
When going down the not-so-beaten-before track. Detractors are many.
Complaints will be raised. It will be irritating. Don’t expect users
to share your idealistic vision. Every complaint needs to be
listened to and most of them can be safely ignored. Some of them
will give an idea of the gap that needs to be bridged.

– After-installation-service – accessibility, response time, ?365X24X7.
This needs support. If you have an in house reponse team that knows
FOSS solutions, then thats good, otherwise you may need to buy
support. My Open Source friends tell me that Red Hat support is good
and is value for the money paid. Decide on support. Lord Murphy is
always watching. Depending on the level of in house support there may be some investment here.

– Staff training had to be spot on so that there is no excuses
to put up your hand and say `open office is too tough`. This is the
most important. Implementation will fail otherwise. Management will
be inundated by complaints of `non-working’ computers. In our
Hospital. Mr. Kumaran cleverly themed Cent-OS to look list Win7.
Most users tech-savviness ends are very `iconic`, so thats all that
will require.

What did we do ::
=================

– Even when we had the WinSystems I stood firm and never let the management invest in MS office. It was unnecessary. Complaints were many ranging from inability to open external files to difficult UI.

Some of the complaints, especially UI related were somewhat relevent, but I decided not to pay heed. These have settled down.

– Avoiding repeated investments to tide over a initial improper investment: The Pros kept telling us to invest in Teminal Server License but we stood firm. I kept telling the management that that takes away the advantage of cost and that I could run it better without any further investment by installing Linux. There needs to be a strong FOSS enthusiast in whom the management has trust. Otherwise the Corporate win.

– Kept to a budget: When we cut off all the frills like antivirus, firewall, terminal license we cut off all the recurring expenses.

Know what you want and buy only that. They will try to sell you more; thats their job. Let them do theirs, and you do yours.

– Choose your FOSS projects you wnt to implement: Now that you have got the courage to implement, use only well maintained and mature FOSS projects. We have Cent OS , Ubuntu, Zope & Plone, mysql, postgresql, dcm4che,JBoss – all mature and well maintained. For EMR you can use Open EMR, Open MRS, GnuMed, GNU-Health. There are several DICOM viewers you can use depending on the data you want : Oviyam, Mayam, Osirix(Mac), Aeskulap, GingkoCADx, inVesalius and many more. ImageJ is useful with its Java plugins for image analysis.

-Use the LTS version of the OS if possible. Install it on the staging system first. Train all the staff, get them to use it everyday and stress the system. This will give you an idea as to what kind of server you need now and when you expand in future.

– Training. It is important to train the staff. This is paramount. Our Admin Officer (AO) who also looks after IT complaints goes around doing all the minor trouble shooting and doubts. Once the staff realise work has to be done with this, they keep quiet and try to learn. We do Plone/Zope training many times a week. The software vendor and our AO do the Hospital Software training. The basic use of a Linux thin client interface has been taught. The theming is very handy for bridging the gap.

– Firewall. Set up a linux firewall and set up basic access rights to prevent unauthorised access to internet. Setup a secure Wireless. This will help access to Intranet, PACS, EMR over mobile and touch devices and also allow remote access.

Accept the Sore Areas:

===============

Medical Presentations: Right now its only MS office. Even Mac guys have trouble presenting many times; atleast in India. This will need users to use their personal MS office products to prepare their presentations. Sadly Libreoffice Presenter leaves much to be desired. It can do the basic .ppt export, but cannot be relied upon

Printer Support: This will need you to look before you buy. If you have expensive existing systems please evaluate. We could not use two network printers (Sharp)after switching over. They are both aged, so replacement is an alternative.

External DICOM applications: Many patients come with CDs with bundled DICOM viewer software. This may not work in Linux ; even under wine. Depending on the type of practice this may be a problem. In our current practice most patients come with printed films so it is ok. Some of the DICOM viewers open / the CDs can be opened with Aeskulap, but GE PACS cd usually dont.

.docx files: People send you MS Office files of all kinds. You cannot expect them to save it in a legacy format. Ubiquity of MS Office and Win make them expect a reply when the files are received. MS office 2007 – 2010 files are an issue. Simple ones open. Extensive use of animation, graphics causes improper rendering. Usually Office communications are bland letters which open without an issue. For academic presentation use, we suggest you rely on a personal copy of MS Office in you laptop.

Hopefully these basic guidelines will help people to switch. This is first hand account. That should be encouragement enough.

We have made it happen at our Hospital. It is comfortable. Transition has been very smooth with most users not even knowing the OS has changed. They only feel the computer is faster.

Please feel free to leave comments in case of any implementation queries.
As I said before watch http://kums.in for technical updates.