Posts Tagged ‘Cleveland Clinic’

The Doctor Will Tweet You Now

Monday, July 9th, 2012

Physicians are often pigeonholed as technophobes because they fear that using technology might threaten patient privacy and their own incomes.  But, an increasing number of physicians are texting health messages to patients, tracking disease trends on Twitter, and communicating with patients via email.  Kansas City pediatrician Natasha Burgert is one of this new breed, offering child-rearing advice on her blog,  Facebook and Twitter pages, and answering patients’ questions by email and text messages.  According to Burgert, she sends messages between checkups and it’s easier than calling a lot of people back at the end of the day.

These tools are embedded in my work day,” Burgert said. “It’s much easier for me to shoot you an email and show you a blog post than it is to phone you back.  That’s what old-school physicians are going to be doing, spending an hour at the end of the day” returning patients’ phone calls, she said.  Burgert doesn’t charge for virtual communication, although some physicians do.  She believes that it augments but doesn’t replace office visits or other personal contact with patients.  Colleagues “look at me and kind of shake their heads when I tell them what I do. They don’t have an understanding of the tools,” Burgert said.  “For the next generation that’s coming behind me, I think this will be much more common.”

Sarah Hartley, whose daughters are Dr. Burgert’s patients, loves having e-access to her pediatrician and says that even emails late in the evening typically are responded to quickly.  “It’s so useful,” Hartley said.  “Sometimes parents get concerned about a lot of things that maybe aren’t necessarily big deals” and getting after-hours reassurance is comforting.

Writing for the Associated Press, Lindsey Tanner says that “So far, those numbers are small.  Many doctors still cling to pen and paper, and are most comfortable using e-technology to communicate with each other — not with patients.  But from the nation’s top public health agency, to medical clinics in the heartland, some physicians realize patients want more than a 15-minute office visit and callback at the end of the day.”

Dr. Steven Nissen, who is in his 60s, is experimenting with e-technology.  A cardiologist at the Cleveland Clinic, Nissen insists that he’s not a member of “the Twitterati.”  With technical assistance from clinic staffers, he recently led a live Twitter chat about things like heart failure and cholesterol problems, and found the process “in some ways maybe a little exhilarating.  This was an opportunity to use a different communication channel to find an audience to talk about heart health,” Nissen said.  “The downside is that we dumb it down,” he said.  “It’s very challenging for physicians, primarily because the messages that we have are not conducive to 140 characters.  If you ask me a question, you’re likely to get a five-minute answer.”

Some physicians are still technology averse.  Dr. Raoul Wolf, a pediatrics professor at the University of Chicago, doesn’t use social media sites in his personal or profession life and is concerned about the permanence of online communication.  “With anything on the Internet, it’s there forever. There’s no calling it back,” Wolf said.  “Ask any politician.”

A survey of 501 randomly selected doctors found that more than 20 percent sent emails to patients over secure networks.  Another six percent communicated with patients through other social media.

The American Medical Association recognizes the benefits of using social media, but also cautions doctors to protect patient privacy and “maintain appropriate boundaries” with patients.  In a case of technology use gone bad, a Rhode island state disciplinary board last year reprimanded an emergency medicine physician for “unprofessional conduct” and fined her $500 after she posted on Facebook about a patient’s injury.  Even though she didn’t post the patients names, others figured out the identity.  Hard numbers are scarce on exactly how many of the nation’s nearly one million physician communicate virtually with their patients, but anecdotal evidence suggests the numbers are on the rise.

Drinking Coffee Can Make You Live Longer

Wednesday, May 30th, 2012

A recent study of the link between drinking coffee and mortality suggests that latte lovers have a lower risk of death. “I would say it offers some reassurance to coffee drinkers,” said Neal Freedman, a nutritional epidemiology researcher at the National Cancer Institute (NCI).  “Other studies have suggested a higher risk of mortality with coffee drinking and we didn’t see that in our study.”

Men whose coffee intake was at least six cups a day had a 10 percent lower chance of dying during the 14-year study period than those who drank none.  For women, the risk was reduced by 15 percent, according to Freedman’s work, published in the New England Journal of Medicine.  Approximately 64 percent of American adults drink coffee every day, according to Joe DeRupo, spokesman for the National Coffee Association.  At an average of 3.2 cups each, that amounts to 479 million cups a day.  Coffee lovers can take the new results seriously.  The mortality reduction is modest but solid, Freedman said.

Freedman and his team in NCI’s Division of Cancer Epidemiology and Genetics examined the coffee habits of more than 402,000 people between 1995 and 2008, including more than 52,000 who died.  They included approximately 229,000 men and 173,000 women ages 50 to 71 who participated in the NIH-AARP Diet and Health Study, which tracked comprehensive lifestyle questionnaires.  Freedman’s analysis centered on healthy people; anyone with cancer, heart disease or who had suffered a stroke was excluded from the review.  “We didn’t know what to expect,” said Freedman.  “There have been a lot of studies and the results have been mixed.”

There’s been concerns for a long time that coffee might be a risky behavior,”  said Freedman, who drinks coffee ‘here and there.’ “The results offer some reassurance that it’s not a risk factor for future disease.”

Writing in Time, Marilynn Marchione said that “No one knows why.  Coffee contains a thousand things that can affect health, from helpful antioxidants to tiny amounts of substances linked to cancer.  The most widely studied ingredient — caffeine — didn’t play a role in the new study’s results.  It’s not that earlier studies were wrong.  There is evidence that coffee can raise LDL, or bad cholesterol, and blood pressure at least short-term, and those in turn can raise the risk of heart disease.  Even in the new study, it first seemed that coffee drinkers were more likely to die at any given time.  But they also tended to smoke, drink more alcohol, eat more red meat and exercise less than non-coffee-drinkers.  Once researchers took those things into account, a clear pattern emerged: Each cup of coffee per day nudged up the chances of living longer.  Careful, though — this doesn’t prove that coffee makes people live longer, only that the two seem related.  Like most studies on diet and health, this one was based strictly on observing people’s habits and resulting health.  So it can’t prove cause and effect.  But with so many people, more than a decade of follow-up and enough deaths to compare, ‘this is probably the best evidence we have’ and are likely to get, said Dr. Frank Hu of the Harvard School of Public Health.  He had no role in this study but helped lead a previous one that also found coffee beneficial.”

The study’s findings should be viewed with caution.  “For those who do drink coffee, there’s no reason to stop.  Periodically someone will say it’s bad, but I think this strengthens the view that it’s not harmful,” said Dr. Lawrence Krakoff, a cardiologist from the Mount Sinai School of Medicine in New York, who wasn’t involved in the new research.  “Whether it’s beneficial — without knowing the cause, it’s hard to say,” he said.  “I wouldn’t encourage people to suddenly drink a lot of coffee with the expectation of benefit.”

Not so fast, according to cardiologist Steve Nissen of the Cleveland Clinic, who wasn’t involved in the study.  Asking people about their coffee consumption just one time in a 13-year timeframe can be misleading, since drinking habits change.  Nissen pointed out that the study didn’t include vital medical information that affects longevity, such as cholesterol or blood pressure levels.  “This study is not scientifically sound,” Nissen said.  “The public should ignore these findings.”

The study determined that men who drank two to three cups a day had a 14 percent lower risk of dying from heart disease, 17 percent lower risk of dying from respiratory disease, 16 percent decreased chance of dying from stroke and a 25 percent lower risk of dying from diabetes than those who drank no coffee.  Women who consumed two to three cups a day had a 15 percent lower chance of dying from heart disease, 21 percent lower risk of dying from respiratory disease, seven percent decreased chance of dying from stroke and a 23 percent lower risk of dying from diabetes.

Medicare ACOs Receive Mixed Reviews

Tuesday, August 16th, 2011

A Medicare pilot program started in 2005 chose 10 groups for an experiment in improving quality and controlling costs. This foreshadowed some of the cost-control rules in the Patient Protection and Affordable Care Act (ACA) , with groups given bonuses for meeting approximately 15 quality measures, and for spending at least two percent less than conventional Medicare.  This program is a forerunner to the Accountable Care Organization (ACO) model that is one of the prime means by which the ACA’s supporters expect it to control costs.  Now that the results are in, the quality issues were met, but the issue of cost proved to be far more difficult to achieve.

Writing in The Atlantic, Megan McArdle says that Donald Berwick, the head of the Centers for Medicare and Medicaid Services (CMS), says “he is optimistic about the potential of ACOs to lower costs by coordinating care, although he acknowledged that savings from the experiment ‘were unevenly distributed, and they were modest…if care is correctly coordinated, costs fall and quality rises.  To me, it’s a matter of how fast we will get there, not whether we will get there.’  He may be right; sometimes you just haven’t done a program correctly.  On the other hand, sometimes programs don’t work, were never going to work, and can’t be made to work.  Even in the latter case, you still hear the sort of thing that Berwick is saying from the proponents of said programs: we need more time, more money, more staff, more rules.  People have usually spent years, even decades, investing in their ideas; when contrary evidence comes in, their first instinct is rarely to say, ‘Well, that’s too bad–it sure seemed like it was going to work, but I guess it didn’t!’.  No, what they want to do is double down.”

Started in 2005 by the George W. Bush administration, the experiment offered “performance payments” to participants that met most of 32 measures of quality — half as many as in the proposed rule — and spent at least two percent less for Medicare patients.  Despite their spotty financial progress, all 10 medical groups in the experiment met the quality requirements.  Additionally the program promoted care innovations, according to administration officials, outside health policy experts and leaders of the groups.

The Obama administration recently announced new options for Medicare ACOs.  The new shared savings components complement the proposed rules that will be finalized this year, Dr. Berwick said.  This pioneering model has been in process for months and that the latest announcement was not in response to skepticism about the proposed rules.  “This is responsive to some of the concerns on how to get started faster,” Dr. Berwick said.  “That’s what we’re getting asked about a lot. The criticism is comment we’re welcoming.”

CMS’ announcement represents a step in the right direction, although additional changes to the shared savings program need to be included to assure physician involvement, said American Medical Association’s (AMA) Immediate Past President J. James Rohack, MD.  “The AMA is pleased that (the innovation center) is working to assist physicians at varying stages of readiness who want to participate in Medicare ACOs,” Dr. Rohack said.  “The benefits of this new care delivery model cannot be fully realized unless physicians in all practice sizes can be involved.”

The CEO of the Cleveland Clinic hates proposed federal rules for accountable care organizations, saying they create “significant barriers” and would discourage hospitals from adopting the new model of care.  Toby Cosgrove made the comments in an eight-page letter addressed to Donald Berwick, though Cosgrove stressed that the Clinic supports the concept of accountable care organizations (ACOs).

“Rather than providing a broad framework that focuses on results as the key criteria for success, the proposed rule is replete with (1) prescriptive requirements that have little to do with outcomes; and (2) many detailed governance and reporting requirements that create significant administrative burdens,” according to Cosgrove.

To be considered an ACO, organizations must agree to manage all of the health needs of a minimum of 5,000 Medicare beneficiaries for at least three years.  ACOs are appealing to hospitals because organizations that save Medicare money will be eligible to share in some of that savings themselves.  CMS is accepting public comments on its proposed ACO rules and will issue final rules later this year.  Like the Clinic, other leading hospitals have criticized the rules as being too burdensome and providing too little possibility of financial gain.

Michael Lee Stallard and Jason Pankau on Happiness in the Workplace

Monday, January 31st, 2011

“The life you live trains you for the life you’re going to lead.”  This is the opinion of Michael Lee Stallard and Jason Pankau, partners in E Pluribus Partners, the world’s leading experts on how rational and emotional connections can boost productivity, innovation and organizational performance in the workplace.

In a recent interview for the Alter+Care Inspire Podcasts, Stallard and Pankau cited a Gallup Poll that ranked 132 countries in terms of happiness.  The United States ranked 12th, which was lower than the Scandinavian nations of Denmark and Finland and even Costa Rica.  According to Stallard and Pankau, “If you look at what’s happening, people are working longer and harder days.  We spend the bulk of our waking lives in certain kinds of relational environments – this has an enormous impact on our happiness and ability to connect with others.”

Using a number of systems, including humanist psychologist Abraham Maslow’s hierarchy of needs, Stallard and Pankau have created a list of six universal human needs that people want to experience in the workplace.  They include:

  • Respect – When we are with people who are condescending, patronizing, passive-aggressive or who look down on us in some relational way, there is a negative emotional impact.  No one can thrive in that kind of environment, because humans need a basic level of respect in the workplace.
  • Recognition – We rely on the interactions of people around us to recharge our internal batteries.  Authentic, positive affirmation – not false – is the most effective.  Otherwise, employees are drained of energy.
  • Sense of belonging – Everyone needs people who have our backs and who are trustworthy.  These people help us live up to the values that we aspire to, support us and are with us through the ups and downs of life.
  • Autonomy – This gives us the freedom and flexibility to do our work free of bureaucratic red tape and without the presence of over-controlling personalities.  Autonomy allows us to master our tasks and assists with personal growth.
  • A challenging environment – When people are over challenged, they are stressed; conversely, people are bored when they are not challenged.  When work provides the right degree of challenge, people are so immersed in the task at hand that time flies and it is energizing.
  • Need for meaning – People typically derive meaning from work that is consistent with a mission that is important to them.  Additionally, they find meaning in the relational connections they have in the workplace; this provides a connection with their personal life.

Leading hospitals across the country recognize the need to create connections between management, physicians, nurses, staff, patients and – importantly – their families, because it positively impacts the quality of care and medical outcomes.  A primary proponent of fostering connections in healthcare environments is Herb Pardes, M.D., a psychiatrist who is president and CEO of New York-Presbyterian Hospital and New York-Presbyterian Healthcare System.  Other hospitals that are proactively creating workplace connections are the Yale New Haven Health System and the Cleveland Clinic.  To sign up for Michael Lee Stallard’s and Jason Pankau’s newsletter and receive a free digital download of their book, click here.

To listen to Michael Lee Stallard’s and Jason Pankau’s full interview on happiness in the workplace, click here.

Cleveland Clinic Moves Towards More Personalized Healthcare

Thursday, January 27th, 2011

The renowned Cleveland Clinic has launched a Center for Personal Healthcare “for the identification, analysis, adoption and integration of select new services and technologies that will allow for personalized care of patients,” according to the clinic.   One goal of the program is moving information on the patient’s family medical history – which is currently available via the Clinic’s electronic health-record system – and developing clinical decision support tools to transmit pertinent information to physicians as quickly as possible.

Kathryn Teng, M.D., a primary-care physician at the Cleveland Clinic, is heading the new center.  She said “In the first year, we plan to create awareness of, and supply physicians with, additional resources that allow collection and analysis of family medical history.  Ultimately, our goal is to help clinicians offer a wider range of considerations and options for patients, while also providing patients with resources that encourage proactive behavior and empower them to be active partners in their health plan.  This new center will build on our efforts to create evidence-based personalized health plans for our patients by incorporating new technologies and innovations which will allow us to truly focus upon each individual,” said Dr. Teng.  “There will be a greater emphasis on the physician-patient relationship as we team together to develop more accurate and personalized care plans.  Our ultimate goal is to empower our patients and our community towards greater health.”

Teng is an assistant professor at the Cleveland Clinic Lerner College of Medicine and Case Western Reserve University.  Additionally, she has been the Clinic’s director of general medicine since 2007 and the patient experience officer since 2008.  Additionally, she founded the Voice of the Patient Advisory Council for the Medicine Institute.

We All Need a Chief Wellness Officer

Thursday, September 17th, 2009

The prestigious Cleveland Clinic has taken a proactive stance on preventative healthcare by creating a Chief Wellness Officer position and putting Dr. Michael Roizen in the job.  Dr. Roizen is well known for his appearances on the “Oprah” show and as the co-author of health and lifestyle books with Dr. Mehmet Oz.  His impressive resume lists the position as the past chair of the Food and Drug Administration’s advisory committee.

small_clevelandmag_docsDr. Roizen has taken on the cause of preventive wellness through the Cleveland Clinic’s Lifestyle 180 program. Lifestyle 180 provides patients with chronic diseases with a proactive approach to improving their health.  Patients are closely monitored and coached to improve their health and well-being through diet, exercise and stress management.  Interestingly, the program has a dedicated space in an old corporate headquarters building  in Lyndhurst, OH.

By all indications, Lifestyle 180 appears to be an excellent approach to educating patients so they can attain improved health.  This raises a question.  Once patients complete the program, where do they go to maintain and continue to put into action the valuable information and lifestyle tools they have received?  Although patients are encouraged to come in for follow-up appointments – which are important – where do they go?

This is exactly where a medically based wellness and fitness center fills this void.  Patients need a comfortable, unintimidating medically directed facility that provides them with the information, tools and resources they need to continue their journey to improved health.

We all could use a chief wellness officer to pave the way to improved health, no question.  We also need a medically directed facility to put into action and maintain the life lessons that we have learned.  Kudos to the Cleveland Clinic for recognizing the need to improve health through comprehensive wellness strategies.  Now, let’s take it a step further and apply this proactive strategy to a comprehensive medically directed wellness and fitness center so we can live this healthy lifestyle forever.