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System Administrator

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10 key insights on clinical partnering

by System Administrator - Tuesday, 27 January 2015, 2:26 PM

10 key insights on clinical partnering

This is the year we can increase the efficiencies of clinical trials through collaboration, innovation and enhancing quality. Where are the opportunities? How can we work differently with our partners? How can we embrace the changing technologies? How can we sustain effective clinical partnerships?

These are crucial questions and ones that we answer in our latest ebook – 10 key insights on clinical partnering.

  • Jo Sawyer, Head of External Partnerships, Novartis AG
  • Geno Gregory, Associate Director, Strategic Development, Global Phase 1 and Early Development Strategy, J&J
  • Mireille Zerola, Clinical Data Management Expert, Boehringer Ingelheim
  • Russell Svensen, Head Clinical Operations, Ipsen Pharma
  • Dave Walker, Senior Director, Clinical Development, Norgine
  • Olena Goloborodko, Senior Manager Global Contracts and Outsourcing Management, Astellas

Please read the attached eGuide

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11 Steps Attackers Took to Crack Target

by System Administrator - Monday, 19 October 2015, 5:05 PM

11 Steps Attackers Took to Crack Target

By Thor Olavsrud

Aorato, a specialist in Active Directory monitoring and protection, delivers a step-by-step report on how attackers used the stolen credentials of an HVAC vendor to steal the data of 70 million customers and 40 million credit cards and debit cards from the retailer.

Despite the massive scale of the theft of Personal Identifiable Information (PII) and credit card and debit card data resulting from last year's data breach of retail titanTarget, the company's PCI compliance program may have significantly reduced the scope of the damage, according to new research by security firm Aorato, which specializes in Active Directory monitoring and protection.

Leveraging all the publicly available reports on the breach, Aorato Lead Researcher Tal Be'ery and his team catalogued all the tools the attackers used to compromise Target in an effort to create a step-by-step breakdown of how the attackers infiltrated the retailer, propagated within its network and ultimately seized credit card data from a Point of Sale (PoS) system not directly connected to the Internet.

Many of the details of how the breach occurred remain obscured, but Be'ery says it is essential to understand how the attack happened because the perpetrators are still active. Just last week, the Department of Homeland Security (DHS) and United States Secret Service released an advisory that the malware used to attack Target's PoS system has compromised numerous other PoS systems over the past year.

Tracing the Attack Is Like Cyber Paleontology

While Be'ery acknowledges that some of the details in Aorato's account may be incorrect, he feels confident that the reconstruction is largely accurate.

"I like to think of it as cyber paleontology," Be'ery says. "There were many reports on the tools that were found in this incident, but they didn't explain how the attackers used these tools. It's like having bones, but not knowing what the dinosaurs looked like. But we know what other dinosaurs looked like. With our knowledge we were able to reconstruct this dinosaur."

In December 2013, in the midst of the busiest shopping season of the year, word began trickling out about a data breach at Target.

Soon the trickle was a torrent, and it would eventually become clear that attackers had gotten the Personal Identifiable Information (PII) of 70 million customers as well as data for 40 million credit cards and debit cards. CIO Beth Jacob and Chairman, President and CEO Gregg Steinhafel resigned. Target's financial damages may reach $1 billion,according to analysts.

Most who have followed the Target story know that it began with the theft of credentials of Target's HVAC contractor. But how did the attackers get from that initial point of penetration, at the boundary of Target's network, to the very heart of its operations? Be'ery believes the attackers took 11 deliberate steps.

Step 1: Install Malware that Steals Credentials

It started with stealing the credentials of Target's HVAC vendor, Fazio Mechanical Services. According to KresonSecurity, which first broke the story of the breach, the attackers infected the vendor with general purpose malware known as Citadel through an email phishing campaign.

Step 2: Connect Using Stolen Credentials

Be'ery says the attackers used the stolen credentials to gain access to Target-hosted web services dedicated to vendors. In a public statement issued after the breach, Fazio Mechanical Services President and Owner Ross Fazio said the company "does not perform remote monitoring or control of heating, cooling or refrigeration systems for Target. Our data connection with Target was exclusively for electronic billing, contract submission and project management."

This web application was very limited, Be'ery says. While the attackers now had access to a Target internal web application hosted on Target's internal network, the application did not allow for arbitrary command execution, which would be necessary to compromise the machine.

Step 3: Exploit a Web Application Vulnerability

The attackers needed to find a vulnerability they could exploit. Be'ery points to one of the attack tools listed in public reports on the list, a file named "xmlrpc.php." According to Aorato's report, while all the other known attack tool files are Windows executables, this was a PHP file, which is used for running scripts within web applications.

"This file suggests that the attackers were able to upload a PHP file by leveraging a vulnerability within the web application," The Aorato report concludes. "The reason is that it is likely the web application has an upload functionality meant to upload legitimate documents (say, invoices). But as often happens in web applications, no security checks were performed in order to ensure that executable files are not uploaded."

The malicious script was probably a "web shell," a web-based backdoor that allowed the attackers to upload files and execute arbitrary operating system commands.

Be'ery notes that the attackers likely called the file "xmlrpc.php" to make it look like a popular PHP component — in other words the attackers disguised the malicious component as a legitimate one to hide it in plain sight. This "hiding in plain sight" tactic is a hallmark of these particular attackers, Be'ery says, noting that it was repeated multiple times throughout the attack.

"They know they're going to get noticed in the end because they're stealing credit cards, and the way to monetize credit cards is to use them," he explains. "As we saw, they sold the credit card numbers on the black market and pretty soon afterward Target was notified of the breach by the credit card companies. The attackers knew that this campaign would be short-lived, a one-off. They weren't going to invest in infrastructure and becoming invisible because in a few days this campaign would be gone. It was enough for them to hide in plain sight."

Step 4: Search Relevant Targets for Propagation

At this point, Be'ery says, the attackers had to slow down and do some reconnaissance. They had the capability to run arbitrary OS commands, but proceeding further would require intelligence on the layout of Target's internal network — they needed to find the servers that held customer information and (they hoped) credit card data.

The vector was Target's Active Directory, which contains the data on all members of the Domain: users, computers and services. They were able to query Active Directory with internal Windows tools using the standard LDAP protocol. Aorato believes the attackers simply retrieved all services that contained the string "MSSQLSvc" and then inferred the purpose of each service by looking at the name of the server (e.g., MSSQLvc/billingServer). This is likely also the process the attackers would later use to find PoS-related machines, according to Aorato.

With the names of their targets, Aorato says the attackers then obtained their IP addresses by querying the DNS server.

Step 5: Steal Access Token from Domain Admins

By this point, Be'ery says the attackers had identified their targets, but they needed access privileges to affect them — preferably Domain Admin privileges.

Based on information given to journalist Brian Krebs by a former member of Target's security team, as well as recommendations made by Visa in its report on the breach, Aorato believes the attackers used a well-known attack technique called "Pass-the-Hash" to gain access to an NT hash token that would allow them to impersonate the Active Directory administrator — at least until the actual administrator changed his or her password.

As further evidence of the use of this technique, Aorato points to the use of tools, including penetration test tools, whose purpose is to logon sessions and NTLM credentials from memory, extract domain accounts NT/LM hashes and history and dump password hashes from memory.

Step 6: Create a New Domain Admin Account Using the Stolen Token

The previous step would have allowed the attackers to masquerade as a Domain Admin, but would have become invalid if the victim changed their password, or when trying to access some services (like Remote Desktop) which require the explicit use of a password. The next step, then, was to create a new Domain Admin account.

The attackers were able to use their stolen privileges to create a new account and add it to the Domain Admins group, giving the account the privileges the attackers required while also giving the attackers control of the password.

This, Be'ery says, is another example of the attackers hiding in plain sight. The new username was "best1_user," the same username used by BMC's Bladelogic Server Automation product.

"This is a highly abnormal pattern," Be'ery says, noting that the simple step of monitoring the users list and flagging new additions for sensitive accounts like administrator accounts could go a long way toward stopping attackers in their tracks. "You have to monitor access patterns."

He also notes that the reconnaissance actions taken in step four are another example of abnormal usage that activity monitoring can detect.

"It's very important to monitor for reconnaissance," Be'ery says. "Every network looks different, has a different structure. Attackers have to learn about that structure through queries. That behavior is very different from the normal patterns of users."

Step 7: Propagate to Relevant Computers Using the New Admin Credentials

With their new credentials, the attackers could now proceed to go after their targets. But Aorato notes two obstacles were in their path: bypassing firewalls and other network-based security solutions that limit direct access to relevant targets, and running remote processes on various machines in the chain toward their relevant targets.

Aorato says the attackers used "Angry IP Scanner" to detect computers that were network accessible from the current computer and then tunneled through a series of servers to bypass the security measures using a port forwarding IT tool.

As for remotely executing processes on the targeted servers, Aorato says the attackers used their credentials in conjunction with the Microsoft PSExec utility (a telnet-replacement for executing processes on other systems) and the Windows internal Remote Desktop (RDP) client.

Aorato notes that both tools use Active Directory to authenticate and authorize the user, which means Active Directory is aware of this activity if anyone is looking for it.

Once the attackers had access to the targeted systems, they used the Microsoft Orchestrator management solution to gain persistent access, which would allow them to remotely execute arbitrary code on the compromised servers.

Step 8: Steal 70 Million PII. Do Not Find Credit Cards

At this point, Aorato says the attackers used SQL query tools to assess the value of database servers and a SQL bulk copy tool to retrieve database contents. And here, Be'ery says, is where PCI compliance seems to have presented a big obstacle to the attackers — ultimately what may have kept them to stealing "only" 40 million credit cards and debit cards rather than 70 million, a 40 percent reduction of the incident's repercussions.

Section 3.2 of the PCI-DSS standard states: "Do not store sensitive authentication data after authorization (even if encrypted). If sensitive authentication data is received, render all data unrecoverable upon completion of the authorization process."

In other words, while the attackers had already managed to access the PII of 70 million Target customers, it did not have access to credit cards. The attackers would have to regroup with a new plan.

"Since Target was PCI compliant, the databases did not store any credit card specific data, so they had to switch to plan B and steal the credit cards directly from the Point of Sales themselves," Be'ery says.

Step 9: Install Malware. Steal 40 Million Credit Cards

The PoS system was probably not an initial target of the attackers, Be'ery says. It was only when they were unable to access credit card data on the servers they had accessed that they focused on the PoS machines as a contingency. Using the intel garnered during step four and the remote execution capabilities garnered during step seven, the attackers installed the Kaptoxa (pronounced "Kar-toe-sha") on the PoS machines. The malware was used to scan the memory of infected machines and save any credit cards found to a local file.

This step, Be'ery notes, is the only one in which the attackers seem to have used custom-written malware rather than common IT tools.

"Having antivirus would not help you in this case," he says. "When the stakes are so high, with profit in the tens of millions of dollars, they don't care about the cost of creating tailor-made tools."

Step 10: Send Stolen Data via Network Share

Once the malware obtained the credit card data, it created a remote file share on a remote, FTP-enabled machine using a Windows command and the Domain Admin credentials. It would periodically copy its local file to the remote share.

Again, Be'ery notes, these activities would have been authorized against Activity Directory, making it aware of the activity.

Step 11: Send Stolen Data via FTP

Finally, once the data arrived on the FTP-enabled machine, a script was used to send the file to the attackers' controlled FTP accounting using the Windows internal FTP client.

"The initial penetration point is not the story, because eventually you have to assume you're going to get breached," Be'ery says. "You cannot assume otherwise. You have to be prepared and have an incident response plan for what to do when you are breached. The real problem arises when malware is able to enable an attacker to penetrate deeper into the network."

"If you have the right visibility, that activity really stands out," he adds.

How to Protect Your Organization

Be'ery recommends that organizations take the following steps to protect themselves:

  • Harden access controls. Monitor and profile access patterns to systems to identify abnormal and rogue access patterns. Where possible, use multi-factor authentication to sensitive systems to reduce risks associated with theft of credentials. Segregate networks, limit allowed protocols usage and limit users' excessive privileges.
  • Monitor users' lists for the addition of new users, especially privileged ones.
  • Monitor for signs of reconnaissance and information gathering. Pay special attention to excessive and abnormal LDAP queries.
  • For sensitive, single-purpose servers, consider whitelisting of allowed programs.
  • Don't rely on anti-malware solutions as a primary mitigation measure since attackers mostly leverage legitimate IT tools.
  • Place security and monitoring controls around Active Directory as it is involved in nearly all stages of the attack.
  • Participate in Information Sharing and Analysis Center (ISAC) and Cyber Intelligence Sharing Center (CISC) groups to gain valuable intelligence on attackers' Tactics, Techniques and Procedures (TTPs).


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12 steps to the perfect health system

by System Administrator - Tuesday, 10 November 2015, 7:13 PM

12 steps to the perfect health system


By Ilene MacDonald

Recent FierceHealthcare coverage has highlighted the challenges hospitals and health systems face daily: high costsinfection control and patient satisfaction to name just a few.

And though organizations have made strides to transition to value-based care and better manage population health, overall the United States spends more on healthcare but ranks last in quality compared to 10 other industrialized Western nations.

It's hard to imagine or dream that a perfect health system could exist--one that would meet all patients' needs at reasonable costs.

So it was with interest that I recently started to read Mark Britnell's new book, "In Search of the Perfect Health System." Britnell, the former chief executive candidate for the National Health Service (NHS) in England, now serves as the chairman and partner of the Global Health Practice at auditing firm KPMG. He's spent the last five years working in 60 countries to help governments and public and private sector organizations with operations, strategy and policy.

His travels have allowed him to witness first-hand examples of great health and healthcare. Although he hasn't found a perfect health system, he writes that if he found one it would feature 12 components that take from the best practices from around the world. And it would look something like this:

1. Universal healthcare: The best, he says, is offered by the NHS in the United Kingdom. The NHS was the first in the world to create a universal healthcare system, one that is available to all citizens, regardless of whether they have the ability to pay for it.

2. Primary care: Britnell turns to Israel for the example of excellent primary care. Indeed, Israel has one of the highest life expectancy rates in the world (average age of 82) and one of the lowest shares of gross domestic product (GDP) spent on health. Primary care is supported by four health maintenance organizations that act as both purchaser and provider for preventive, primary and community services. Out-of-hours care is provided around the clock, he writes, and integrated with evening care centers, urgent care centers and home visit services.

3. Community services; For inspiration, he suggests we look to Brazil where community teams made up of doctors, nurses, nurse auxiliary and community health workers visit households every month, whether or not they demand or need it. These teams offer immunizations, chronic disease management and screenings.

4. Mental health and well-being: Australia has made the most progress in this area, according to Britnell's research, offering public funding to invest in crisis and home treatment, early intervention and assertive outreach.

5. Health promotion: The Nordic countries best address the social determinants of health, encouraging individual responsibility and fostering collective action, according to Britnell. The five countries have public health and illness prevention strategies that contribute to low smoking, alcohol consumption and obesity rates, he says.

6. Patient and community empowerment: Britnell says the world can learn about patient empowerment from Africa, which blends community activism, patient education, social marketing and behavior change to promote better health. One example is the maternity care program in Kenya, which encourages mothers and women to share experiences to help cut maternal and infant death.

7. Research and development: This is where the U.S. shines, he says, noting the number of high-impact drugs and medical devices we've developed. But he also called out the innovation of new business and care models, including Kaiser Permanente's health information and technology systems, Geisinger Heath Systems' population health management and Virginia Mason's lean manufacturing principals.

8. Innovation, flair and speed: Britnell has found inspiration for the adoption and adaption of new innovations in India, where several organizations have been able to create a hub-and-spoke model that focuses on cost effectiveness rather than cost-cutting. Examples included standardized care pathways, making it easier to shift tasks and do more with fewer staff; referral networks that channel patients to the correct settings and even hospitals manufacturing their own devices or implants when suppliers refused to reduce prices.

9. Information, communications and technology: Singapore offers great examples of the sharing of patient data via a national electronic health record that allows access to all hospitals, community facilities, practitioners and long-term care homes, he writes. This provides the country with the ability to fully analyze clinical, financial and operational data to better assess healthcare costs and outcomes.

10. Choice:  There are no out-of-network providers in France. Patients can go to any doctor or hospital they wish, he says. Patient satisfaction is particular high, he notes, as are the country's quality and outcomes.

11. FundingNo country does it better than Switzerland, which spends11.5 percent of GDP on health, according to Britnell. The country also boasts high patient satisfaction, good clinical outcomes and life expectancy of 82.7 years. But Britnell notes that the country can afford to spend so much because its economy is globally competitive and dynamic.

12. Aged care: Japan offers its citizens compulsory long-term care insurance, which offers social care to all those older than 65 based solely on need. The ability to pay is not part of the assessment process. Care offered under the plan includes home help, community-based services, and residential and nursing care. The country has also created dementia homes where groups of people live together in a supportive, home-like environment, he writes.

Wouldn't it be wonderful to live in a country that offered this type of healthcare system? Given the continued fight in the country to just provide affordable care to all, it does seem impossible. But I guess we can dream.-- Ilene (@FierceHealth)

Related Articles:




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12 Ways Secure Texting is Used in Healthcare

by System Administrator - Monday, 12 January 2015, 6:34 PM

12 Ways Secure Texting is Used in Healthcare

This infographic outlines how secure messaging is used within a healthcare organization as well as layout the benefits.

Please read the attached PDF

Related Resources:

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2014 Healthcare Innovation Report

by System Administrator - Tuesday, 13 January 2015, 1:07 PM

FierceHealthIT's 2014 Healthcare Innovation Report

This FierceHealthIT special report celebrates the advancements made by healthcare solutions providers to ensure healthcare is more affordable and accessible. The report also recognizes the winners of the 2014 Fierce Innovation Awards: Healthcare Edition.

Please read the attached PDF report.


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2014 Insider Threat

by System Administrator - Thursday, 14 August 2014, 9:22 PM


The 2014 Vormetric Insider Threat Report - European Edition represents the result of analysis of interviews with 537 IT and Security managers in major European enterprises around the question of insider threats. Insider threats have expanded from the traditional insiders to privileged users of systems and the compromise of internal accounts by the latest malware attacks. This report captures the key findings, focusing on comparisons critical results around organizations insecurities, concerns, technology investments as well as comparisons against their US counterpart's responses.

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2015 Annual Security Report

by System Administrator - Monday, 2 March 2015, 2:28 PM

Cisco 2015 Annual Security Report: New Threat Intelligence and Trend Analysis

Despite advances by the security industry, criminals continue to evolve their approaches to break through security defenses. Attackers are realizing that bigger and bolder is not always better. The Cisco 2015 Annual Security Report reveals shifts in attack techniques, emerging vulnerabilities, and the state of enterprise security preparedness.

Please read the attached whitepaper.

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2015 global life sciences outlook

by System Administrator - Tuesday, 30 December 2014, 9:26 PM

Infographic: 2015 global life sciences outlook

Greg Reh | DTTL Global Life Sciences Sector Leader | Greg is the DTTL Global Life Sciences Sector Leade...More

The extended nature of life sciences product development mandates that sector stakeholders adopt a long-term approach to strategic planning, portfolio management, and market expansion. However, organizations must also prepare for and react to near-term challenges and opportunities. Four major trends are expected to capture the sector’s attention in 2015: searching for innovation and growth; changing regulatory and risk environment; preserving and building shareholder value; and preparing for the “next wave.” The resulting challenges and opportunities can be both global and market-specific.

Check out top life sciences sector issues for 2015 in the inforgraphic below.

Click here to download a copy of the infographic and full report.

Please read the attached infographic file.

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2016 EHR Software Pricing Guide: How to Compare EMR Systems

by System Administrator - Monday, 19 October 2015, 6:39 PM

2016 EHR Software Pricing Guide: How to Compare EMR Systems

by Software Advice

This guide is based on extensive market research and is designed to help chiropractic professionals: 

  • Learn about relevant pricing models
  • Understand common price ranges
  • Account for additional cost factors
  • Budget by desired applications
  • Compare prices of popular systems

Please download the attached whitepaper.

Below are additional offers that might interest you:

2016 Applicant Tracking Systems Pricing Guide
Simplify your ATS software evaluation process with this free download! This guide is based on extensive market research and is designed to help chiropractic professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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5 Key Aspects to Accurate HR Software Pricing
Simplify your software evaluation process with this 2016 HR software pricing guide! This guide is based on extensive market research and is designed to help chiropractic professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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2016 Payroll Software Pricing Guide: How to Compare Systems
Simplify your payroll software evaluation process with this free download!! This guide is based on extensive market research and is designed to help chiropractic professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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5 Key Aspects of Accurate Payroll Software Pricing
Simplify your software evaluation process with this 2016 payroll software pricing guide! This guide is based on extensive market research and is designed to help chiropractic professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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5 Key Aspects of Accurate Applicant Tracking Systems Pricing
Simplify your software evaluation process with this 2016 ATS software pricing guide! This guide is based on extensive market research and is designed to help chiropractic professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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5 Key Aspects of Accurate Learning Management Systems Pricing
Simplify your software evaluation process with this 2016 LMS software pricing guide! This guide is based on extensive market research and is designed to help chiropractic professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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2016 Learning Management Systems Pricing Guide
Simplify your learning management software evaluation process with this free download! This guide is based on extensive market research and is designed to help chiropractic professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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2016 HR Software Pricing Guide: How to Compare HR Systems
Simplify your HR software evaluation process with this free download! This guide is based on extensive market research and is designed to help HR professionals: • Learn about relevant pricing models • Understand common price ranges • Account for additional cost factors • Budget by desired applications • Compare prices of popular systems
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Forrester Report: Security Risks Faced By Healthcare Providers Empowering Mobile Moments
This report will not only look at the drivers for remote system access but will show how some of the most mature hospitals and other healthcare providers have done it without compromising privacy and security.
Download This Research

Making the Switch: Replacing Your EHR for More Money and More Control
This whitepaper serves as a guide to identifying an under-performing EHR and replacing it with a solution that delivers results. It offers answers to a number of common questions about EHR adoption and replacement and demonstrates how the right EHR can help practices get more money and more control, freeing up physicians to focus on patient care.
Download This Research 


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25 Best Health Tech Infographics of 2014 - 1/3

by System Administrator - Thursday, 15 January 2015, 8:28 PM

25 Best Health Tech Infographics of 2014 - 1/3

Annual yearly recap of the best health tech infographics created in 2014

Over the past 12 months, HIT Consultant has covered some of the most in-depth and well designed healthcare technology related infographics in this industry. Infographics provide a great way to display complex information or research data in a visually appealing format. Themes this year covered the gamut of healthcare technology including trends transforming health IT (EHR, meaningful use), mobile healthcare, patient engagement, big data and much more.

For our annual recap, we’ve collected 25 of our favorite healthcare technology infographics of 2014 shown below based on the following criteria: 

    • Storytelling
    • Valuable information
    • Data Visualization & Design Creativity 
    • Data Sources
    • Insightful key takeaways
    • Popularity (number of social shares)

1. 10 Medical Innovations Transforming Healthcare in 2015

Illustrates Cleveland Clinic’s annual top 10 medical innovations that are likely to have a major impact on improving patient care in 2015.

2. How Wearable Technology Is Transforming Mobile Health

Created by Career Glider features statistics on how wearable technologies is transforming mobile health, including how they’re affecting the way Americans stay active and healthy.

3. ICD-10 Could Help Track Ebola Outbreak

Illustrates the public health impact of ICD-10 in supporting the biosurveillance of the eBola outbreak created by the Coalition for ICD-10 . If the ICD-10 delay was not announced back in spring, the U.S. would be able to use the ICD-10 code for the Ebola virus – A98.4 to assess the efficacy of treatment and outcomes.

4. Patient Portal Adoption: Baby Boomers vs. Millennials

Key findings from Xerox’s annual survey on the usage of electronic health records reveals differences between Millennials and Baby Boomers when it comes to online patient portals.

5. Meaningful Use Audits Could Return $33M in Incentive Payments

Meaningful Use audits could recover $33M in EHR incentives, according to data from the HHS published.

6. How Millennials Are Reshaping Digital Health

Key findings from “Healthcare Without Borders: How Millennials are Reshaping Health and Wellness” report by Communispace reveals that Millennials, dissatisfied with the current healthcare system, have developed unique POVs for managing, maintaining their health and what it means fordigital health.

7. Why Healthcare Is Moving to the Cloud

How health care entities are moving to the cloud for their data and mission-critical applications created by AIS Network

8. Rise of the Digital Patient

The digital patient is here. From pre-screening potential doctors to viewing their treatment information and tracking their fitness/health data, the digital patient is increasingly embracing mobile health to improve their well-being.

9. Wearable Fitness Trackers Adoption Trends

While the use of health and fitness tracking devices has more than doubled in the last two years, a new nationwide survey conducted byTechnologyAdvice shows that only 25.1 percent of adults are currently using either a fitness tracker or a smartphone app to monitor their health, weight, or exercise.

10. The Convergence of Big Data and EHR

The convergence of big data and EHR infographic created by UC Berkeley School of Information explores the how the growing relationship between health data and EHR adoption is transforming healthcare.


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by System Administrator - Thursday, 15 January 2015, 8:46 PM


Annual yearly recap of the best health tech infographics created in 2014

Over the past 12 months, HIT Consultant has covered some of the most in-depth and well designed healthcare technology related infographics in this industry. Infographics provide a great way to display complex information or research data in a visually appealing format. Themes this year covered the gamut of healthcare technology including trends transforming health IT (EHR, meaningful use), mobile healthcare, patient engagement, big data and much more.

For our annual recap, we’ve collected 25 of our favorite healthcare technology infographics of 2014 shown below based on the following criteria: 

    • Storytelling
    • Valuable information
    • Data Visualization & Design Creativity
    • Data Sources
    • Insightful key takeaways
    • Popularity (number of social shares)

11. ACO Trends to Watch

12. How Mobile Medical Apps Are Poised to Revolutionize Healthcare

Infographic created by global science, technology and product development services company Sagentiaillustrates how mobile medical apps are poised to revolutionize healthcare. 

13. Top Physician Information Sources by Mobile Device

Key findings from Wolters Kluwer Health’s 2013 Physician Outlook Survey conducted by Ipsos of more than 300 practicing primary care physicians.

14. Apple HealthKit vs. Google Fit: A Developer’s Perspective

Infographic created by True Vault, a HIPAA compliant database as a service provider illustrates how Apple HealthKit stacks up against Google’s Fit digital health platform from a developer’s perspective. It also highlights Samsung’s SAMI (Samsung Architecture Multimodal Interaction) ecosystem and their new sensor-filled watch “Simband.”

15. Embracing Cloud in Healthcare

Key findings from HIMSS Analytics inaugural Cloud Survey on embracing the cloud in healthcare.

16. How Android is Transforming the Medical Devices Market

How the Android platform is improving healthcare using new technologies and apps to enhance the quality of medical care.created by Hughes Systique Corporation

17. The Rise of HIPAA Violations

Illustration provides a picture of the regulatory landscape along with the type of complaints, breaches and fines that occur due to HIPAA violations created by TrueVault

18. Top Digital Health Consumer Activities of U.S. Households

Nearly 60% of U.S. broadband households own some kind of personal health and wellness device, such as a digital weight scale or glucometer, and new designs and form factors, such as smart watches, have generated considerable consumer interest.

19. The Average Health IT Salary is $89,879 in 2014

The average health IT salary is $89,879.43 with 30 percent also receiving an average bonus of $31,100.52, according to the new 2014 Health IT Salary report conducted by

20. The Inefficient State of Supply Chain in Healthcare


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by System Administrator - Thursday, 15 January 2015, 8:58 PM


Annual yearly recap of the best health tech infographics created in 2014

Over the past 12 months, HIT Consultant has covered some of the most in-depth and well designed healthcare technology related infographics in this industry. Infographics provide a great way to display complex information or research data in a visually appealing format. Themes this year covered the gamut of healthcare technology including trends transforming health IT (EHR, meaningful use), mobile healthcare, patient engagement, big data and much more.

For our annual recap, we’ve collected 25 of our favorite healthcare technology infographics of 2014 shown below based on the following criteria: 

    • Storytelling
    • Valuable information
    • Data Visualization & Design Creativity
    • Data Sources
    • Insightful key takeaways
    • Popularity (number of social shares)

21. The Rise of Clinical Mobility in Healthcare

Examines how clinical mobility solutions — critical to clinical workflows — are making data more readily available, improving workflow and efficiency, and enhancing the patient experience, both inside the hospital and beyond created by created by CDW Healthcare 

22. 25th Annual HIMSS Leadership Survey

Key findings from the 25th Annual 2014 HIMSS Leadership Survey, which highlights the journey of health IT over the past 25 years. The Survey examines a wide array of topics crucial to healthcare leaders including IT priorities, issues driving and challenging technology adoption and IT security.

23. State of Mobile Technologies in Healthcare Today

Key findings from HIMSS Analytics 3rd Annual Mobile Survey, which examines the mHealth landscape and examines the use of mobile devices in provider patient care improvement initiatives.

24. Intersecting Trends in HIT: Population Health Management & Business Intelligence

Illustrates how population health management and business intelligence tools are playing a bigger role in the changing HIT landscape created by CDW Healthcare

25. Rx for Doctor Disconnect

According to the U.S. Department of Health and Human Services, nearly 90% of physicians are using smartphones, but only a tenth of our hospitals are offering a secure texting solution at their facilities. Infographic highlights the doctor disconnect trend by exploring the key issues and risks contributing to poor physician engagement created by Voalte

26. HIMSS: The State of Healthcare Innovation 2014

Key findings from the 2013 Healthcare Provider Innovation Survey with select U.S. hospitals, academic medical centers, children’s and ambulatory care centers to understand the current state of innovation within provider organizations by HIMSS and AVIA.


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29% of Broadband Households Own A Connected Health Device

by System Administrator - Thursday, 18 June 2015, 7:03 PM

29% of Broadband Households Own A Connected Health Device

29% of U.S. broadband households own a connected health device and 12% of U.S. broadband households own multiple connected health devices, according to market research firm Parks Associates. The report, Digitally Fit: Products and Services for Connected Consumers examines the current adoption and usage of connected health devices with analysis of multiple nationwide surveys of U.S. broadband households. Global revenues from connected fitness trackers is also expected to increase from over $2 billion in 2014 to $5.4 billion by 2019. 

The research firm will address new partnerships between device manufacturers and health insurance providers, as well as other key issues in the growing connected health market, at the second-annual Connected Health Summit: Engaging Consumers, September 9-10, at the Omni San Diego Hotel.

“The adoption rate for fitness trackers and GPS watches has increased, while the adoption rate for other connected health devices has been more stable, said Harry Wang, Director, Health & Mobile Product Research, Parks Associates. “Fitness trackers stand out as one of the more successful product categories thanks to the release of better products and major marketing campaigns.” 

Additional Parks Associates mobile research finds: 

– 50% of U.S. broadband households use an online health tool to communicate with their doctor, access personal health data, or fill prescriptions 

– Smart watch sales will exceed 100 million units in 2019 

– Over 80% of U.S. mobile subscriptions will be 4G LTE by 2018 

– 19% of smartphone owners find a master health app that aggregates data from all health apps very appealing. 

Featured image credit: vernieman via cc 

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3 growth areas for patient engagement in healthcare

by System Administrator - Monday, 5 October 2015, 5:46 PM

3 growth areas for patient engagement in healthcare

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3 long-term healthcare changes on the horizon

by System Administrator - Monday, 27 April 2015, 11:12 PM

3 long-term healthcare changes on the horizon

Leaders share what industry will look like in 5-15 years

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3 tips for getting along with Dr. Google

by System Administrator - Wednesday, 6 May 2015, 3:22 PM

3 tips for getting along with Dr. Google

Physicians can use online health information for more productive visits

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4 factors for successful value-based care

by System Administrator - Tuesday, 10 November 2015, 7:02 PM

4 factors for successful value-based care

By Ron Shinkman

Society of Actuaries provides road map to aid transition away from fee-for-service

New research from the Society of Actuaries has identified several factors that will help ensure a provider's successful transition to value-based care.

The report, "Navigating The Transition To Value-Based Care," concluded that the payment models must include:

  • A reasonable method to determine patient costs

  • An equitable process for allocating quality incentives among participating healthcare providers 

  • A well-designed provider network aimed at fostering cost savings

  • The most efficient healthcare delivery system within the specific market  

However, the society also noted it was difficult to observe and draw conclusions from many examples of value-based care.

"The authors found that it is neither easy nor transparent to see how these organizations interact or coordinate results, even for those well-versed in U.S. healthcare," the report said. "In addition, methods of reporting results of payment reform studies were not necessarily methodologically rigorous, which made it difficult to reach definitive conclusions on whether specific reported payment reform models were successful."

The U.S. healthcare sector is struggling to make progress with value-based payment initiatives. Many providers have made little progress with their initiatives, and seem to be hesitant to ditch the time-honored fee-for-service model. And while some progress has been made in reducing the levels of "low-value care" that are being delivered, many providers have dropped out of the Pioneer Accountable Care Organization program, noting that they have struggled to meet the performance and financial goals that have been delineated by the Centers for Medicare & Medicaid Services.


To learn more:

Related Articles:


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5 Best Practices to Make Healthcare Innovation Partnerships Work

by System Administrator - Thursday, 4 September 2014, 11:30 PM

5 Best Practices to Make Healthcare Innovation Partnerships Work

Healthcare innovation partnerships can make a huge difference in the way common ailments are regarded by the medical care community. By promoting efficient distribution of data and enhancing the ability to combine resources to gain a deeper perspective into these issues, such partnerships can play a major role to in furthering medical advancements. The collaboration of Merck Medical Information and Innovation M2i2 and online research community PatientsLikeMe is a case in point.


Sachin Jain, M.D., M.B.A

Entrepreneurs and start-ups are preferred partners for Merck because they have the ‘best technology that‘s out there and they bring the Silicon Valley DNA to the thinking process…’,says Sachin Jain.

The initial agenda of the partnership was to test how information on real world health outcomes assimilated by an online evidence network could impact drug development, with the original test community being psoriasis patients. However, it was found that the partnership did not really live up to expectations as data on outcomes was very limited. This is a risk that is inherent in such partnerships. Under the leadership of Chief Medical Information and Innovation Officer Sachin Jain, M.D., M.B.A., M2i2 turned the partnership around by shifting focus to another key area of interest, sleep deprivation. The initial disappointment and subsequent success gave Dr. Jain a unique insight into the following 5 best practices on leveraging collaborations/partnerships in healthcare.

1) Sharing risk and responsibility with the partner judiciously

Risk and responsibility are both extensively involved in such partnerships and it is necessary to choose a partner organization that is trustworthy enough to be given due flexibility to work independently within its own space. The most important requirement is that your partner shares your commitment to arrive at valuable conclusion/inferences. At the same time, you have to demonstrate your reliability and adaptability to encourage your partner to reciprocate the same.

2) Transparency is priority

Stealth innovation may be the preferred path for many, but at Merck, the partnership exercise clearly indicated that complete transparency was necessary for seamless continuation of research. Despite having to contend with red tape, transparency brings all of the key players on board in both the organizations involved in the partnership. This makes data accessing easy, allows for improved collaborative efforts, and enables the pooling of a wider set of skills to make data collection and analysis easier and more accurate. Transparency necessitates the establishment of strong guidelines that help immensely when significant changes need to be made in the partnership agenda.

3) Measure progress against the objectives

Measuring the progress of the partnership against the original objectives allows you to view the success of the partnership objectively. In the case of the M2i2-PatientsLikeMe partnership, the initial lack of success prompted Dr. Jain to quickly switch over to another viable agenda instead of simply letting the partnership run its course and end up with data that was worth little to the company. Reviewing the success of the partnership and being ready to switch tracks or pull out is essential in the partnership game.

4) A skilled team at the center makes a difference

To ensure that the partnership flourishes, joint effort from both organizations is necessary. This can happen only when skilled individuals are involved in the task at both ends. Collaboration needs to be carried out effectively, such as with said partnership where a Merck team member was working with the PatientsLikeMe weekly. This helped Merck derive quality results in minimum time despite the much smaller size and completely different business structure of PatientsLikeMe.

5) Remain committed when your focus changes

With the M2i2- PatientsLikeMe partnership, both organizations quickly refocused and committed resources and support to the new agenda. A decline in enthusiasm may be inevitable when the focal point of such research and study suddenly changes, but it is up to the team leaders at both the partner organizations to keep the team motivated for the new scope and objective of the partnership.

The final word is that with such partnerships, it is necessary for each and every member involved in the task to take personal responsibility for the success of the project. Publicizing the partnerships and its perceived benefits at company-wide gatherings gives the team members involved the enthusiasm and passion necessary to derive maximum benefits.

Another very important factor behind the success of healthcare innovation partnerships is that the collaboration needs to remain agile and effective. Only then can the best resources of both partners be utilized optimally to make the partnership truly beneficial for themselves, the health care community, and the patients who are the ultimate beneficiaries of any innovation in this field.


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5 Digital Health Trends Reshaping Healthcare

by System Administrator - Wednesday, 8 July 2015, 10:06 PM

5 Digital Health Trends Reshaping Healthcare

Healthcare executives expect that, within the next three years, their industry will need to focus as much on training machines as they do on training people, according to one finding from a new report by Accenture. The Accenture 2015 Healthcare IT Vision is based on a survey of doctors, consumers and healthcare executives and] highlights emerging technology trends that will affect the health industry in the next three to five years.

84% of health executives surveyed agree or strongly agree that healthcare industry will need to focus as much on training machines – such as using algorithms, intelligent software and machine learning – as they do on training people in the next three years. In fact, most of those surveyed (83 percent) agree that provider organizations, driven by a surge in clinical data, will soon need to manage intelligent machines as well as employees.

The Accenture Healthcare IT Vision 2015 report reveals five key digital health trends reshaping the healthcare industry:

1. The Internet of Me: Your healthcare, personalized Welcome to the era of personalized healthcare defined by meaningful and convenient individual health experiences.

2. Outcome Economy: Hardware producing healthy results New intelligence is bridging the digital enterprise and the physical world. It’s about more than technology; it’s about delivering results.

3. Platform Revolution: Defining ecosystems, redefining healthcare Healthcare IT platforms capture data from disparate sources (e.g., wearables, phones, glucometers), and connect it to provide patients and caregivers a holistic and real-time view of your health.

4. Intelligent Enterprise: Huge data, smarter systems, better healthcare A data explosion, accompanied by advances in processing power, health analytics and cognitive technology, is fueling software intelligence. Medical devices and wearables can now recognize, “think” and respond accordingly.

5. Workforce Reimagined: Collaboration at the intersection of humans and healthcare As the digital revolution gains momentum, doctors and healthcare workers are now using machines to be more efficient, provide better care and take on increasingly more complex tasks.

These trends clearly prove that digital health is dramatically influencing the healthcare industry today, and it will continue to do so for decades to come. The infographic shown below illustrates these five key findings from the report (attached image).

“As the digital revolution gains momentum, doctors and clinicians will use machines to augment human labor, personalize care and manage more complex tasks,” said Kaveh Safavi J.D. M.D., who leads Accenture’s health business. “The digital revolution is also creating a data goldmine that can spark medical breakthroughs and improve individualized treatment plans.”


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5 hábitos saludables podrían reducir 80% de los infartos

by System Administrator - Thursday, 9 October 2014, 10:42 AM
Conductas de bajo riesgo

5 hábitos saludables podrían reducir 80% de los infartos

La alimentación saludable, junto con hábitos de vida de bajo riesgo y ausencia de adiposidad abdominal puede prevenir la gran mayoría de episodios de infarto de miocardio en hombres.


 Alimentación y hábitos de vida de bajo riesgo en la prevención primaria del infarto de miocardio en hombres.


El objetivo de este estudio fue analizar el beneficio de la alimentación y los hábitos de vida saludables sobre la incidencia del infarto de miocardio (IM) en hombres. Se efectuó un seguimiento de 11 años a una cohorte de 20721 hombres de 45-79 años.

Las conductas de bajo riesgo fueron:

  1. Alimentación saludable
  2. Consumo de alcohol moderado
  3. Actividad física
  4. Ausencia de tabaquismo
  5. Ausencia de adiposidad abdominal.

Durante ese tiempo se comprobaron 1361 casos nuevos de IM. La combinación de conductas saludables sólo presente en el 1% de los hombres, pudo prevenir el 79% de los episodios de IM.


La incidencia y la mortalidad de la enfermedad coronaria (EC) disminuyeron en muchas regiones del mundo, pero la carga de enfermedad aún es grande. Aunque los tratamientos farmacológicos para el descenso de los lípidos y de la hipertensión son eficaces para disminuir los episodios coronarios, la observancia de hábitos de vida saludables sigue teniendo un impacto notable. En contraste con los tratamientos farmacológicos, las estrategias no farmacológicas para contribuir a la prevención de la EC no tienen el riesgo de efectos colaterales.

Para la incidencia de EC, hasta el 77% - 82% de los episodios se atribuyeron a la falta de observancia de hábitos de vida de bajo riesgo, que para las mujeres consisten en 5 opciones saludables. En los hombres de los EEUU, el riesgo atribuible correspondiente fue del 62%, y del 57% entre los que recibían medicamentos para la hipertensión o la hipercolesterolemia.

En este trabajo se estudió el beneficio de combinar alimentación y hábitos de vida saludables sobre la incidencia del infarto de miocardio (IM) en una gran cohorte prospectiva de hombres suecos sanos.

Se estimó la carga de EC que podría haber sido evitada si todos los hombres hubieran cumplido con una dieta saludable, consumo de alcohol moderado, actividad física, supresión del tabaquismo y hubieran evitado la adiposidad abdominal. Se efectuó un análisis aparte de los hombres con hipertensión e hipercolesterolemia.


En 1997, todos los hombres nacidos entre 1918 y 1952 residentes en dos provincias de Suecia central recibieron un cuestionario que incluía 350 preguntas sobre su alimentación y otros factores de sus hábitos de vida (la tasa de respuestas fue del 49%). Esta gran cohorte es representativa de los hombres suecos de 45 a 79 años en cuanto a la distribución por edad, el nivel educativo y la prevalencia de sobrepeso.

Tras la exclusión de los que tenían antecedentes de enfermedades que podrían haber causado cambios en la alimentación y los hábitos de vida, quedaron 20721 hombres para el estudio. Se efectuó un análisis aparte de 7139 hombres con hipertensión e hipercolesterolemia.

Evaluación de los factores alimentarios de hábitos de vida

La alimentación se evaluó mediante un cuestionario semicuantitativo autoadministrado, con preguntas sobre 96 alimentos (Food Frecuency Questionnare). La alimentación saludable se identificó según la Puntuación de alimentos recomendados (PAR) (Recommended Food Score), ideada en 2000 por Kant et al. como una manera sencilla de definir la calidad de la alimentación separando los alimentos saludables de los menos saludables, sobre la base de los conocimientos actuales y las recomendaciones alimentarias.

La PAR es un excelente factor pronóstico de mortalidad e incluye los alimentos con efecto favorable sobre la salud cardiovascular, como frutas, verduras, legumbres, frutas secas, lácteos descremados, granos enteros y pescado. Se asignó una puntuación de 1 (hasta un máximo de 25) para ≥ 1 porción por semana de cualquiera de 3 productos lácteos descremados, pan crocante y pan integral, mientras que para los restantes alimentos la frecuencia de consumo fue por lo menos 1 - 3 veces por mes.

Se consideró que aquéllos con puntuación en el quintilo más alto (puntuación 23 - 25) tenían una alimentación saludable variada (alimentación de bajo riesgo). En un análisis post hoc, sólo el quintilo superior se asoció con disminución estadísticamente significativa del riesgo de IM. La puntuación de alimentos no recomendados (Non-Recommended Food Score) se basó sobre 21 alimentos, entre ellos las carnes rojas procesadas, las papas fritas, las grasas sólidas, el queso no descremado, el pan blanco y los cereales refinados y diversos alimentos dulces.

El grupo de bajo riesgo con respecto al alcohol comprendió los hombres que consumían cantidades moderadas de alcohol (10 - 30 g/día).

Se consideraron el tabaquismo, la actividad física y la adiposidad abdominal como los tres principales factores de bajo riesgo no alimentarios modificables. Se consideró que la actividad física de bajo riesgo CV incluía tanto actividad física como caminata y ciclismo diarios y un ejercicio semanal más vigoroso.

De esta manera, el grupo de bajo riesgo estuvo compuesto por hombres que no fumaban, que caminaban o practicaban ciclismo durante por lo menos 40 min/día y hacían ejercicio más vigoroso por lo menos 1 hora por semana y tenían una circunferencia abdominal <95 cm.



Durante una media de 11 años, se comprobaron 1361 casos nuevos de IM. Globalmente, fue más probable que los hombres con alimentación de bajo riesgo tuvieran mayor nivel educativo, no fumaran y no vivieran solos.

Cada factor de los hábitos de vida se asoció inversamente y, tras el ajuste mutuo, para los otros elementos del perfil de bajo riesgo, independientemente del riesgo de episodios coronarios.

Esta disminución del riesgo correspondió al 18% para la alimentación saludable, al 11% para el consumo de alcohol moderado, al 36% para la ausencia de tabaquismo, al 3% para la actividad físicay al 12% para una circunferencia abdominal normal.

En total, el 8,7% de los hombres combinaron la alimentación de bajo riesgo con el consumo moderado de alcohol. La media de su consumo diario fue de 5 porciones de verduras y frutas, 4 de granos enteros (o de salvado) y el consumo semanal de 2,2 porciones de pescado.

La mediana de consumo de alcohol en este grupo fue de 17 g/día. En relación con el grupo de alto riesgo, que no cumplió los criterios de ninguno de los 5 factores de la alimentación de bajo riesgo ni de los hábitos de vida, esta conducta alimentaria y de consumo moderado de se asoció con una reducción del riesgo de IM del 35%.

En el análisis final, los autores investigaron el efecto combinado de todas las prácticas de bajo riesgo. 

El perfil final completo de bajo riesgo, con los 5 factores, cumplido por el 1% de la población del estudio, se asoció con un 86% menos de riesgo de IM que el grupo de alto riesgo sin factores de bajo riesgo.

El riesgo atribuible poblacional estimado para el perfil completo de bajo riesgo en relación con los restantes hombres de la población del estudio fue del 79%. Esto sugiere que 4 de 5 episodios coronarios podrían haber sido evitados si todos los hombres hubieran observado conductas de bajo riesgo.

En otro análisis se evaluó la asociación entre las conductas de bajo riesgo y el riesgo de IM entre 7139 hombres con hipertensión e hipercolesterolemia al inicio del estudio con 765 nuevos casos comprobados de IM.

Las tasas de incidencia estandarizadas para la edad y los índices de riesgo descendieron al agregar cada factor de bajo riesgo. La diferencia de tasas absoluta entre ningún factor de riesgo versus 5 factores de bajo riesgo fue de 778 casos por 100000 años-persona, similar a la de hombres sin hipertensión ni hipercolesterolemia.


En este estudio de cohortes prospectivo de hombres sanos, se observó que la alimentación de bajo riesgo junto con el consumo moderado de bebidas alcohólicas se asoció con el 35% de reducción del riesgo de IM primario en relación con hombres del grupo de alto riesgo (i.e., hombres que no tenían ninguno de los 5 factores de bajo riesgo).

Los hombres que combinaron esta alimentación de bajo riesgo y el consumo moderado de alcohol con hábitos de vida de bajo riesgo (no fumar, actividad física y evitación de la adiposidad abdominal) tuvieron un riesgo 86% menor. El efecto favorable de combinar la alimentación, los hábitos de vida y un peso corporal saludable puede prevenir aproximadamente hasta 4 de 5 casos de IM en esta población sana. El descenso de los riesgos con el mayor cumplimiento de conductas de bajo riesgo se observó también en hombres con hipertensión e hipercolesterolemia.

En esta cohorte de hombres sin antecedentes de enfermedad cardiovascular (ECV), hipertensión, hipercolesterolemia o diabetes al inicio del estudio, la reducción observada en la incidencia de IM asociada con alimentación saludable junto con el consumo moderado de alcohol fue similar a la de un estudio español reciente que analizó la dieta mediterránea, complementada con aceite de oliva o frutos secos. En el 29% de pacientes sin ECV, pero con alto riesgo cardiovascular, la dieta mediterránea combinada disminuyó significativamente el riesgo de ECV en relación con una dieta control.

Al contrario de los alimentos saludables, el consumo de alcohol no se puede recomendar sin reservas para reducir la ECV. Aunque su consumo moderado puede proteger de la ECV, el abuso de alcohol es uno de los 3 factores de riesgo más importantes de la carga global de todas las enfermedades.

Riesgos atribuibles poblacionales similares se observaron en mujeres estadounidenses (82%) y suecas (77%), así como en hombres de los EEUU (62%). En el presente estudio, sólo el 1% de la población integró el grupo de bajo riesgo. Recientemente se observó muy baja frecuencia (0,1% - 2%) de “salud cardiovascular ideal,” según la definición de la American Heart Association en las muestras nacionales de ese país.

Esta definición incluyó 4 (excluyó el alcohol) de 5 opciones de hábitos de bajo riesgo junto con cifras favorables de colesterol total, glucosa en ayunas y presión arterial. Programas dirigidos a los hombres para aumentar la proporción de los que adoptan conductas de bajo riesgo podrían ser de gran impacto sobre la carga de enfermedad.

Es de gran importancia que estos hábitos de vida sean modificables y los cambios prospectivos de hábitos de alto riesgo a otros de bajo riesgo se asociaron con disminución del 27% de la incidencia de ECV. Es, sin embargo evidente que una prevención amplia sólo se podrá alcanzar inhibiendo el inicio y el establecimiento de cualquier conducta de alto riesgo y asegurándose de que las conductas de bajo riesgo ideales se introduzcan tempranamente y continúen durante toda la vida.



Este estudio indica que una alimentación saludable, junto con hábitos de vida de bajo riesgo y ausencia de adiposidad abdominal pueden prevenir la gran mayoría de episodios de infarto de miocardio en hombres.


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32. Tonelli M, Lloyd A, Clement F, et al. Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis. CMAJ 2011; 183:E1189–202.
33. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of
disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990- 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013; 380: 2224–60.
34. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation 2010;121:586–613.
35. Yang Q, Cogswell ME, Flanders WD, et al. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA 2012; 307:1273–83.
36. Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of “ideal cardiovascular health” in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation 2011; 123:850–7.
37. Capewell S, Lloyd-Jones DM. Optimal cardiovascular prevention strategies for the 21st century. JAMA 2010; 304:2057–8.
38. Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 2012; 126:1514–63.



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5 Ideas to Raise Your Patient Centricity Profile

by System Administrator - Thursday, 12 March 2015, 12:36 PM

5 Ideas to Raise Your Patient Centricity Profile

a new publication from BBK Worldwide – offers a unique look at how to apply the construct of patient centricity to recruitment and engagement at-large. This valuable guide offers quick tips, practical advice and industry insights designed to inspire you to continue to raise your organization's patient centricity profile.

Download your free copy today and gain valuable insights on how to adopt a patient-centric approach and impact:

  • Strategy & Planning
  • Patient Advocacy
  • Branding & Advertising
  • Prescreening Patients
  • mHealth & Technology

Please read the attached whitepaper.

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5 Must-Track Metrics for Practice Profitability

by System Administrator - Monday, 11 August 2014, 5:35 PM

5 Must-Track Metrics for Practice Profitability

Discover the five key data metrics that will help power your practice's financial success.
In this free whitepaper you'll learn how to:

      • Gauge the success of your revenue cycle management processes
      • Uncover factors hurting your practice's finances
      • Ensure your practice secures reimbursements in a timely manner
      • Identify missed revenue opportunities, and more.

Please read the attached whitepaper


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5 optimistic healthcare trends for 2015

by System Administrator - Friday, 30 January 2015, 4:52 PM

5 optimistic healthcare trends for 2015

Innovation, physician engagement are positive indicators, according to Aegis Health Group

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5 ways to close common medical device vulnerabilities

by System Administrator - Tuesday, 12 May 2015, 11:58 AM

5 ways to close common medical device vulnerabilities

VA CIO Stephen Warren offers tips for addressing device security threats

By Brian Eastwood

The U.S. Department of Veterans Affairs is no stranger to cyberattacks. In March, roughly 1.2 billion cyberattacks targeted the VA network, CIO Stephen Warren said at the Medical Informatics World conference in Boston. That's a sharp increase from 330 million attacks in November.

Amid all that activity, the VA saw a sharp drop in protected health information breaches in March, with 383 veterans the victim of a PHI breach in March compared to 891 in February, FierceHealthIT previously reported.

Admittedly, the VA benefits from a level of security that not all healthcare organizations have--namely, the Department of Homeland Security's control points, known as Trusted Internet Connections, as well as advanced security measures that even Warren doesn't know about.

That said, the VA has taken several steps to shore up security in a common point of vulnerability: Medical devices. With criminal attacks now the leading cause of healthcare data breaches, according to a recent Ponemon Institute report, organizations would be wise to address five key threats posed by medical devices.

Windows XP: Microsoft stopped supporting this operating system more than a year ago. Connect a device running XP to the Internet and it will be compromised within seven seconds, Warren said. Keep these devices offline.

Irreplaceability: Those devices running Windows XP remain in use because organizations believe they are too costly to replace. But the cost to mitigate a data breach can exceed $2 million, according to Ponemon, and Anthem faces damage control costs in excess of $100 million following its February cyberattack. The VA replaces medical devices regularly--as of March 5, only two devices across the 152 medical centers in the entire VA system represented a liability, Warren said.

No antivirus or antispyware software: Push the market to change this, Warren said. If you plan to replace devices regularly, it's in a manufacturer's best interest to protect those devices better. If you still have devices without software to detect vulnerabilities, meanwhile, make sure clinical staff know why these devices pose such a threat, he said.

No software updates: The VA pushes patches to its devices "multiple times a day" to ensure they remain protected against the latest threats, Warren said. Again, if devices cannot be updated regularly, they should remain offline.

Email access: Even with all of the above protections in place, medical devices remain vulnerable if people use them to check personal email--which they will do if administrative restrictions forbid them from doing so on any other computers in the building, Warren said. Give clinical staff as well as device repair contractors a place to check email, and take that opportunity to shore up email security.

Related Articles:


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56% of Americans Want Connected Health Devices to Monitor Their Health

by System Administrator - Thursday, 15 January 2015, 9:09 PM


56% of Americans Want Connected Health Devices to Monitor Their Health

  • It would keep track of my health information accurately – 30%
  • It would allow me and my doctor to see trends and patterns – 29%
  • It would give me peace of mind to know how I’m doing – 24%
  • It would allow my doctor to be “in the know” to prevent surprises during appointments – 19%
  • It would allow my doctor to monitor my health 24/7 if necessary – 18%
  • Internet of Things is the future of medicine – 11%
  • The whole world is connected so it makes sense for devices to be connected – 10%
  • It’s difficult to enter the information into an app – 3% 

Most Popular Vital Signs

The most popular vital sign Americans wanted monitored was blood pressure, with 37 percent of Americans wanting to monitor that with connected devices followed by:

  • Weight – 33%
  • Chronic conditions (hypertension, diabetes, etc.) – 25%
  • Sleep – 23%
  • Physical activity – 22%
  • Diet – 19%
  • Vision – 18%
  • Medicine – 16%

Nearly half of Americans (48 percent) are concerned about their blood pressure, with one in four Americans (25 percent) concerned about either having a stroke or developing hypertension.  Over one in five Americans (23 percent) are worried about heart attacks.

Americans Prefer Companies with Healthcare Experience

A majority of Americans (53 percent) say they would want connected health devices/apps to come from a company with healthcare experience for the following reasons:

- Medical expertise is important to me (26 percent)

- I want to know I can trust the company making the device or app (25 percent)

- Companies with medical experience will know what information will be trusted by my doctors or important to my doctors (18 percent).

Survey Methodology

This survey was conducted online within the United States by Harris Poll on behalf of A&D from December 17-19 2014 among 2,024 adults ages 18 and older. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. 

Featured image credit: 15216811@N06 via cc


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7 digital resolutions for hospitals

by System Administrator - Thursday, 8 January 2015, 2:56 PM

7 digital resolutions for hospitals


by Jenn Riggle

It's the beginning of 2015 and time for people to take a closer look at their lives and make resolutions for the coming year. It's also a good time for hospitals to take another look at their social media and digital initiatives and determine what's working and what's not.

The good news is that U.S. hospitals have embraced social media. In fact, 99.41 percent of the 3,371 U.S. hospitals have ongoing social media initiatives, according to a recent reportfrom the Journal of Medical Internet Research. But are they using the right channels and achieving the results they want?
Here are some social media resolutions for hospital marketers for the coming year:

  • Make your website work for you: Your website is your most important digital property because it's the first place people go to learn about your organization and the services you provide. However, websites are no longer the online brochures they were in the 1990s. They need to be searchable and updated on a regular basis to remove stale and outdated content. A good resource to help you know where to focus your efforts is your site's Google Analytics, which will tell you which pages get the most views and how long site visitors spend on each page.
  • Make your content easier to find: It's not enough to create compelling content, people need to be able to find it. You may have a beautiful, informative website, but are you making the most out of Search Engine Optimization (SEO)? This is important, but can be a time-intensive task. Or have you spent a lot of time creating compelling videos and posting them on YouTube, but wonder why they may not attract viewers? A simple way to fix this is by not just posting key words, but by posting the entire videotranscript.
  • Reach the right people: Research shows that hospitals tend to post generic content or information about employee-related issues and achievements. While this approach helps build critical mass by engaging hospital employees (which is especially important when launching social media programs), it won't help turn people into patients. It's important to know your audience and know what topics interest them, which will help increase followers and stimulate engagement.
  • Give the people what they want: Not only is this the name of a great album by the Kinks, it's a good social media mantra for hospitals. Your site's Google Analytics will help you identify whether people are coming to your site to learn about your heart and vascular program or maternity services, or simply want directions to your hospital. This information will help you identify topics for future blogs and social media posts and will help ensure that you continue to provide content that interests people.
  • Focus on what works: Hospital marketing departments are stretched thin and it's often difficult for staff to find enough hours in the day to do their work and manage all of their organization's social media properties. Rather than having a mediocre presence in multiple social media channels, focus your efforts on a couple of major channels. Or create an educational social media campaign that encourages people to take control of their own health, such as getting a mammogram or having a colon cancer screening.
  • Listen to what people say: One of the most important parts of social media engagement is listening to what people say. The challenge is to keep up with the channels as they evolve. For example, Yelp is where people go to get restaurant reviews--but patients also use it to review the care they receive at their local hospital. It's important to hear what people say and respond to their concerns. It's amazing how listening to people and addressing their concerns can help turn a detractor into an advocate.
  • Be part of the bigger conversation: In addition to listening to patient comments, hospitals should listen to the issues and concerns that other organizations in their community, including other hospitals, talk about. Listening to others allows you to be more relevant and become part of the bigger conversation.

Jenn Riggle is a PR and communications consultant who lives in Dallas.


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7 ways the cloud can elevate your practice

by System Administrator - Monday, 11 August 2014, 4:37 PM


7 ways the cloud can elevate your practice

Cloud technology lets physicians build high-performance private practices capable of handling the demands of the ever-changing healthcare landscape. This technology also helps practices reduce spending on technology infrastructure and supports the trend of greater mobile usage. Cloud software helps streamline processes, improve accessibility, monitor projects more effectively, reduce staffing and training costs, and reduce capital costs.

Practices weighing the advantages of cloud software over in-house, client-server software are wise to consider not only the visible costs of the monthly subscription fee for onsite software but also the hidden costs of in-house software ownership. Additionally, cloud software provides solutions, like mobility and connectivity, once only available to large group practices and hospitals.

This guide identifies the basics of cloud software, why using the cloud is an effective solution for eliminating the hidden costs of supporting in-house software, and explores how cloud technology will benefit today’s private practices.

Please read the attached whitepaper.

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8 Ways to Stop IT Alert Fatigue

by System Administrator - Monday, 11 August 2014, 2:32 PM

eGuide: 8 Ways to Stop IT Alert Fatigue

Reacting to a never-ending stream of IT alerts takes up valuable time and resources, costs money, and prevents IT departments from playing a more strategic role in a company's success. Read the eGuide and learn what you can do right now to stop alert fatigue in 8 easy steps so you can begin to focus on addressing your real business needs.

Please read the attached whitepaper

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by System Administrator - Friday, 1 August 2014, 11:57 PM


The health care industry can potentially realize $300 billion in annual value by leveraging big data according to a 2011 McKinsey report. To successfully achieve this value, the healthcare industry must identify and establish best practices to manage big data since healthcare data is rarely standardized.

Continue reading


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91% of Physicians Practice Defensive Medicine

by System Administrator - Monday, 11 August 2014, 5:08 PM

New Study Finds 91% of Physicians Practice Defensive Medicine

Mark Crane

The fear of being sued for medical malpractice is pervasive, leading 91% of physicians across all specialty lines to practice defensive medicine — ordering more tests and procedures than necessary to protect themselves from lawsuits — a new study finds.

A survey by researchers from Mount Sinai School of Medicine, New York City, also found that the same overwhelming percentage of physicians believe that tort reform measures to provide better protections against unwarranted malpractice suits are needed before any significant decrease in the ordering of unnecessary medical tests can be achieved.

Investigators questioned 2416 physicians from a variety of practice and specialty backgrounds in a survey conducted between June 25, 2009, and October 31, 2009. Their findings were published today in the June 28 issue of the Archives of Internal Medicine.

"Physicians feel they are vulnerable to malpractice lawsuits even when they practice competently within the standard of care," said Tara Bishop, MD, associate, Division of General Internal Medicine at Mount Sinai School of Medicine, and coauthor of the study, in a news release. "The study shows that an overwhelming majority of physicians support tort reform to decrease malpractice lawsuits and that unnecessary testing, a contributor to rising healthcare costs, will not decrease without it."

Physicians were asked to rate their level of agreement to 2 statements:

  • "Doctors order more tests and procedures than patients need to protect themselves against malpractice suits," and

  • "Unnecessary use of diagnostic tests will not decrease without protections for physicians against unwarranted malpractice suits."

There were no statistically significant differences between sex, geographic location, specialty category, or type of practice. The largest difference was that 92.6% of male physicians said they practice defensive medicine vs 86.5% of female physicians.

Although physicians in relatively low-risk specialties such as general internal medicine and pediatrics are much less likely to be sued for malpractice than obstetric/gynecologic specialists and emergency physicians, their fear is just as real, Dr. Bishop asserted in an interview with Medscape Medical News. "There's just a visceral response to the word 'malpractice,' " she said. "The entire medical community worries about being pulled into a lawsuit."

Determining the true costs of defensive medicine may be impossible because so many factors go into decisions about ordering tests, Dr. Bishop noted. Malpractice fears play a large role, but so does a desire to be thorough and careful. In a fee-for-service system that often rewards overuse, it is difficult to say how large a part defensive medicine plays in the decision to order a test.

A 2003 study by the US Department of Health and Human Services estimated the cost of defensive medicine at $60 billion a year, but the American Medical Association pegs it at $200 billion. A 2008 study by PricewaterhouseCoopers' Health Research Institute calculated the cost of defensive medicine at $210 billion per year, or 10% of all healthcare spending.

The new Mt. Sinai study coincides with several earlier surveys about how prevalent defensive medicine is. Some of the findings of those studies follow here.

  • Ninety percent of physicians said they practice defensive medicine, according to a poll published in April by Jackson Healthcare, a medical staffing and information technology company. About three quarters of physicians surveyed said defensive medicine decreases patient access to healthcare and will exacerbate the growing physician shortage.

  • A 2008 study by the Massachusetts Medical Society found that 83% of its physicians practice defensive medicine at a cost of at least $1.4 billion a year in that state alone. More than 20% of x-rays, computed tomography scans, magnetic resonance images, and ultrasounds; 18% of laboratory tests; 28% of specialty referrals; and 13% of hospital admissions were ordered for defensive purposes.

  • A survey of 824 Pennsylvania physicians, published in 2005 in the Journal of the American Medical Association, found that 93% admit to risk-aversion tactics such as overordering tests, abandoning high-risk procedures, and avoiding the sickest of patients.

"We practice maximalist medicine to avoid missing any problem our clinical judgment tells us may be extremely remote," said Alan C. Woodward, MD, an emergency physician and past president of the Massachusetts Medical Society, to Medscape Medical News. Defensive medicine is rampant because "the threat of being sued is pervasive, and doctors simply don't trust the legal system."

In an invited commentary accompanying the Mt. Sinai study, Sen. Orrin G. Hatch (R-UT) acknowledged that consensus on Capitol Hill about tort reform "has been an elusive commodity" because of division and partisanship. "It is my hope that, as the American people see more evidence that they are paying for redundant and unuseful medical procedures, they will demand in larger numbers that real reforms be enacted to address this problem," Sen. Hatch writes. "That is what makes studies like the one by Bishop, et al., so important."

Arch Intern Med. 2010:170:1081-1084.


Physicians Are Talking About: The Culture of Defensive Medicine

Nancy R. Terry

The practice of defensive medicine -- the ordering of excessive tests and procedures by physicians -- is regularly targeted as a major contributor to the high costs of healthcare. But how widespread is it?

A recent posting on Medscape's Physician Connect (MPC), an all-physician discussion group, asked the question: Do you practice defensive medicine? Most physicians responded with an emphatic YES.

"Defensive medicine is practiced everywhere, everyday. And the costs have got to be simply enormous," says a radiologist.

"Here in southeastern Michigan, home of [notable] malpractice attorneys, we practice defensive medicine every day, with every patient," replies a neurologist.

Why do physicians practice defensive medicine? A second neurologist says it is to save your behind in the unlikely event of a 1:1000 outcome.

Reports from physicians suggest that defensive medicine is widespread, and recent studies appear to confirm this. The Massachusetts Medical Society found that about 83% of physicians responding to a survey reported that they practiced defensive medicine, with an average of between 18% and 28% of tests, procedures, referrals, and consultations, and 13% of hospitalizations ordered for defensive reasons.[1] An earlier study published in the Journal of the American Medical Association (JAMA) surveyed physicians in 6 specialties affected by high malpractice liability costs (ie, emergency medicine, general surgery, neurosurgery, obstetrics/gynecology, orthopaedic surgery, and radiology) and found that 93% of respondents reported practicing defensive medicine. Assurance behavior -- such as ordering tests, performing diagnostic procedures, and referring patients for consultation -- was found to be very common (92%).[2]

The JAMA study suggests that defensive medicine is more prevalent in certain settings. A health maintenance organization (HMO) medical director gives examples of what he views as routine in the emergency department and in-patient care. "A hospitalized patient with pneumonia will be seen by the primary care physician, an infectious disease physician, and even a cardiologist if his chest hurts when he coughs. Every patient in the emergency room gets a CT [computed tomography] scan and a cardiac cath." And equivocal tests frequently lead to more tests. The HMO director says that as many as 80% of imaging studies are normal or show insignificant findings that require another study.

An emergency medicine physician remarks that excessive testing has become a regrettable necessity. "In the ER [emergency room], patients often give histories that could conceivably (less than 2%) be from a life-threatening condition," says the emergency physician. "In our current system, we really can't miss these things anymore."

"Nobody wants to get sued, especially in the ER setting," comments a radiologist. "Why else would a 22-year-old with a tummy ache but no fever, no white count, and no localizing symptoms get a CT of the abdomen and a pelvic ultrasound before she leaves?"

"Most doctors would agree that the threat of a potential lawsuit significantly adds to the cost of medicine in the ER and in the hospital setting," says a radiologist. A second radiologist agrees. "The cost to the system for CYA medicine is enormous."

In fact, the actual cost of defensive medicine is open for debate, depending on whether you talk to doctors or lawyers. According to an article in The Seattle Times,[3] doctors estimate that defensive medicine and malpractice insurance accounts for up to 10% of healthcare spending. Lawyers say malpractice settlement costs amount to less than 0.5% of the $2.5 trillion spent each year on healthcare.


Defensive Medicine: Impacts Beyond Costs Summary of Findings


Between October 2009 and March 2010, Jackson Healthcare conducted a series of national physician surveys to quantify and qualify physician attitudes, perceptions and recommendations regarding healthcare reform and defensive medicine practices.
Physicians estimated that between $650 billion and $850 billion are spent each year on medically unnecessary tests and treatments in an effort to avoid lawsuits.  In addition, significant consequences surfaced beyond wasted costs, consequences negatively impacting the physician/patient relationship.

In March 2010, Jackson Healthcare conducted its third national physician online survey to quantify the impact of defensive medicine beyond cost, including the areas of access, quality and innovation.

Key Findings from Jackson Healthcare Survey

  • 76 percent of respondents reported that defensive medicine decreases patients' access to healthcare.
  • 72 percent of respondents reported that the practice of defensive medicine negatively impacts patient care.
  • 71 percent of respondents reported that defensive medicine has had a negative effect on the way they view patients.
  • 67 percent of respondents reported that defensive medicine comes between the doctor and patient.
  • 57 percent of respondents reported that defensive medicine hampers their decision-making ability.
  • 49 percent of respondents reported that defensive medicine has a negative impact on medical innovation.  Likewise, 53 percent reported delaying adoption of new techniques/procedures/treatments due to fear of a lawsuit.
  • Defensive medicine is now being taught as standard medical practice.  The survey found that 83 percent of physicians ages 25 to 34 reported being taught in medical school or residency (by an attending physician or mentor) to avoid lawsuits.
  • Patients most likely affected by defensive medicine are 1) those requiring surgery, 2) women and 3) those visiting emergency rooms.
  • Surgeons and OB/GYNs are most affected by lawsuits.
    • 83 percent of OB/GYN respondents have been named in lawsuits
    • 79 percent of surgeons and surgery subspecialists respondents have been named in a lawsuit
    • 68 percent of emergency room physician respondents have been named in a lawsuit
  • Of the physicians surveyed, 75 percent reported that defensive medicine will impact the physician shortage by decreasing the number of physicians in the U.S.

Jackson Healthcare Survey Metholodology

In March 2009, Jackson Healthcare invited 124,572 physicians to participate in a confidential online survey in an effort to quantify the costs and impact of defensive medicine.  Over 1,400 physicians spanning all states and medical specialties completed the survey, a 1.13 percent response rate.  The survey error range is at the 95% confidence level: +/-1.7 percent.


Defensive medicine practices could signal a new ‘norm’ in the climate of fear


Orthopedics Today

Defensive medicine is a hot topic about which nearly everyone has an opinion, and much like spiritual beliefs, each party feels that its view is entirely correct. The prevailing wisdom is that defensive medicine is a crisis of sorts in our health care system, contributing billions of dollars in costs that could be saved by federal intervention aimed at reassuring physicians, or immunizing them against lawsuits alleging medical negligence.

In such an environment, physicians would be free to practice medicine, exercise professional judgment, and make health care more efficient and less expensive. In reality, defensive medicine is difficult to define and there are many sides to each argument that can be taken in relation to this complex subject. We have invited a number of legal scholars and physicians to opine on this subject in this Orthopedics Today Round Table. As the responses suggest, there are many perspectives on this vexing issue that is of interest to the medical, legal and political fields, as well as the lay public.

Your comments are welcome; please add to the debate by; a website that is accessible exclusively to orthopedic surgeons, where you and your colleagues can discuss this subject freely.


B. Sonny Bal, MD, JD, MBA

University of Missouri School of Medicine Columbia, Mo.

B. Sonny Bal, MD, JD, MBA: There are several definitions of “defensive medicine;” how do you define defensive medicine?

Ramon L. Jimenez, MD: Defensive medicine is the practice of evaluating and treating a patient with the belief that certain patient is potentially litigious, and who will file a malpractice claim against you if he or she believes you have done anything wrong. This practice may entail ordering unnecessary tests or over treating to protect oneself from any untoward legal action.

Theodore J. Choma, MD: I view defensive medicine as the ordering of tests, consultations or confirmatory studies that would not necessarily be needed in addition to the current clinical impression to guide treatment. I also view defensive medicine as the refusal to offer treatment options to patients that one might deem as prone to litigation. In either circumstance, there is a barrier to full trust and disclosure between physician and patient.

Michael T. Archdeacon, MD, MSE: I would define defensive medicine as the practice of medicine where imaging studies, diagnostic tests or laboratory values are obtained primarily to protect a physician from missing a diagnosis regardless of whether the study is clinically indicated or even useful. I believe there are two situations in which defensive medicine occurs. First, defensive medicine occurs when a physician is not confident in a diagnosis and is concerned with missing a clinically significant diagnosis, such as a neoplasm or infection. The second defensive medicine scenario arises when a physician is concerned about the risk of malpractice; therefore, defensive actions are taken to theoretically reduce the risk of litigation.

David H. Sohn JD, MD: I would define defensive medicine as tests, imaging and documentation performed primarily to limit exposure to malpractice liability.

Stuart L. Weinstein, MD: Defensive medicine is defined as providing medical services that are not expected to benefit the patient but are undertaken to minimize the risk of a subsequent lawsuit. There are two types of defensive medicine – diagnostic defensive medicine has a much greater impact on costs and therapeutic defensive practices impose greater risks to patients

Robert B Leflar, JD, MPH: Defensive medicine falls into two categories: (a) indicated treatments and procedures foregone because of fear that adverse results might offer opportunities for litigation; and (b) unindicated treatments and procedures performed in part because of fear that failure to provide the treatment or procedure might open the door for litigation. This category broadly includes foregoing areas of practice perceived to be litigation-prone.

Neil Vidmar, PhD: I would define defensive medicine as practicing medicine to avoid errors. There are two types as discussed by Studdert and Mello inTexas Law Review in 2002: (a) avoiding errors that can harm the patient– e.g., errors such as not doing additional tests that would detect a condition and (b) doing unnecessary tests out of fear of a lawsuit or to collect additional fees. Studdert and Mello make the point that some defensive medicine clearly helps save lives.

Jeffrey Segal, MD, JD, FACS: Defensive medicine includes practices which are designed primarily to keep the doctor from being sued. Such practices typically, although not always, benefit the doctor by avoiding litigation rather than benefiting the patient.

Lawrence H. Brenner, JD: There is only one definition of defensive medicine – the performance of medically unnecessary procedures (usually diagnostic) for the sole benefit of the provider without any expected benefit to the patient.

David Teuscher, MD: Medical tests and procedures ordered to mitigate risk for physicians’ liability that do not commensurately and significantly contribute to the patient’s diagnosis or outcome given the costs and/or risks to the patient.

Bal: How prevalent do you believe defensive medicine is in the United States today?

Jimenez: It is my belief that the practice of defensive medicine is quite prevalent in the everyday practice of medicine today, especially in states where there is minimal tort reform or protection from malpractice liability. I practice in California where the Medical Injury California Reform Act (MICRA) was enacted in 1975. This placed a cap of $250,000 on pain and suffering awards. I believe its effect was to decrease the number of frivolous or non-meritorious malpractice lawsuits. As a practitioner, I do not look at every patient as a potential lawsuit. I try to engage and empathize with my patients and therefore gain their confidence and trust. There are a few in which I am not successful. In those cases, I am straightforward with them and I inform them why I wish to order a test and what I expect to prove or learn from it. I always ask if their permission to do so.

Choma: I suspect that defensive medicine plays a small part in the practice of almost every physician, and a substantial part in the practice of a few physicians.

Archdeacon: I would guess that defensive medicine occurs more commonly than we think. Many times our decisions are so ingrained into our daily practice, that we really don’t re-evaluate our rationale for making them.

Sohn: I believe defensive medicine is widely prevalent in the United States. Survey results indicate that more than 90% of physicians practice defensive medicine.

Weinstein: Although hard data are difficult to acquire, several studies on physician attitudes indicate that a fear of lawsuits tends to drive providers to adopt behaviors that lead to increased health care costs. One study, for example, showed that 93% of physician respondents reported engaging in some form of defensive medicine Assurance behavior, as reported by 92% of physician respondents, involves ordering tests (particularly imaging tests), performing diagnostic procedures and referring patients for consultation.

Avoidance behavior, as reported by 42% of physician respondents, includes restricting their practice, eliminating high risk procedures and procedures prone to complications, and avoiding patients with complex problems or patients perceived as litigious. A recent study in Massachusetts showed that 83% of physician respondents ordered imaging and laboratory tests or made specialist referrals defensively. Unfortunately, if these assurance behaviors continue over time, they become the standard of care. Patients also become educated through the Internet and media about this new standard and change their expectations of their care.

On the therapeutic side, defensive therapeutic measures, such as Caesarean sections or invasive procedures such as breast lump biopsies, are accompanied by significant risks to patients and increased health care expenditures.

Leflar: Unindicated treatments and procedures performed in part to avoid the possibility of litigation appear to be common, especially since they are backed up by income opportunities. For more information, see the work of Atul Gawande, MD.

Vidmar: I do not have empirical evidence on either, and thus, I am unwilling to estimate.

Segal: I believe it is extensive. A recent study suggested 91% of doctors admit to practicing defensively. One cynic suggested the other 9% are not being candid.

Brenner: I don’t know.

Teuscher: Pervasive universally, but more prevalent in pockets of perceived potential plaintiffs.

Bal: Do you support federal reform that may immunize physicians against medical malpractice lawsuits? Do you truly believe such reform will lead to noticeable cost savings by reducing the incidence of defensive medicine?

Jimenez: I do not believe that tort reform alone will result in minimizing the incidence of defensive medicine. It does offer some sense of protection, but a physician would be a fool to think that tort reform alone offers immunity from malpractice liability. On the other hand, I believe that the practice of good communication skills, thereby gaining the trust and confidence of your patient goes much further in reducing your exposure to malpractice claims. In short, I do support tort reform but I do not believe that it should be sold as an “immunity law.” If so, it may backfire and not produce any savings whatsoever.

Choma: I would support such federal reform. I believe that it would break down the barriers between physicians and patients, and on the whole, foster an environment for improved medical care. It seems to me that in this age of easy and instantaneous mass communication, and in this time of database construction on physicians’ and hospitals’ outcomes, there are many other vehicles that will serve quality control functions for health care other than the threat of lawsuit.

Archdeacon: I am not certain that federal reform, which immunizes physicians, is necessary. There are circumstances which occur where we as physicians need to be held accountable. Additionally, reform might decrease the occurrence of defensive medicine that is attributed to a fear of malpractice, but it is unlikely to reduce defensive practices related to physician indecisiveness over a diagnosis.

Sohn: I support federal reform to limit medical malpractice risk for physicians. We have more than 35 years of public policy research which clearly show that when malpractice risk is limited, at least in the form of caps on noneconomic damages, doctors utilize less medicine. With hard caps on noneconomic damages, physicians utilize 5% to 9% less medicine. With soft caps, physicians utilize between 3% to 4% less.

Weinstein: Unfortunately, the current medical liability system is ineffective; it neither effectively compensates patients injured from medical negligence nor encourages addressing system errors to improve patient safety. Currently, there is a “patchwork quilt” of laws addressing medical liability across 50 states. In addition, state liability laws are continually under attack. For these two reasons, I think we have a compelling case for a federal solution to this problem. With that said, any federal solution should not preempt effective state laws that exist in states like California and Texas.

An effective federal program must ensure that patients harmed by medical negligence are made whole and patient safety in the health care system is improved. All agree that defensive medicine exists and is costly. While the actual costs of defensive medicine are hard to calculate (range from $5 billion to $650 billion a year), they are considerable. I think that there will be definite health care savings if the medical liability question is effectively addressed at the federal level.

Leflar: I do not support such reform – unless as part of a general program to move to a non-fault-based compensation system offering wider opportunities for compensation for injured patients on an “avoidable injury” standard less stigmatizing to physicians than the negligence standard. Cost savings from such a program are questionable.

Vidmar: I do not support such legislation and indeed have testified against caps. Other evidence suggests that insurance premiums are a small part of doctor expenses. A few years ago, one of my students whose mother was an ob-gyn conducted interviews with a sample of ob-gyns in Colorado and in North Carolina. Medical malpractice premiums and lawsuits were low on their list of complaints about their medical practice issues.

Segal: Yes, in a qualified way. I’ll explain in a bit. Whether or not immunity would be the holy grail for cost savings – providing such immunity would clearly test the proposition that defensive medicine and its costs can be curtailed.

Brenner: This question demonstrates the inherent conflict of interest in surveying physicians and surgeons on defensive medicine and then publishing those surveys as if they were health science research. Any perceived linkage between defensive medicine and limiting liability will bias all responses. It is impossible to predict how immunizing physicians and surgeons from professional liability will impact their practice patterns.

Teuscher: Yes, they worked in my state, and like in California, they need to be instituted nationally. In order to realize cost savings, we need to institutionalize safe harbors to ensure the behavior ceases.

Bal: Assuming the legislative environment was conducive, what specific reforms should the federal government implement to address the allegedly high incidence of defensive medicine?

Jimenez: I strongly believe that the federal government should enact specific tort reforms, such as a cap on pain and suffering awards. Such a measure would be effective in restraining the trial lawyers from filing or taking on non-meritorious lawsuits. A testimony to that opinion is the continuous efforts by the trial lawyers lobby to overturn the MICRA law in California. On the other hand, any broader measures that would give physicians the feeling of immunity from malpractice litigation would not be good. Physicians, like other professionals who service the public, must be held accountable for their actions or lack of action. Unfortunately, we cannot rely simply on their innate integrity and responsibility.

Choma: I would suggest serious caps on jury awards for pain and suffering, and overall physician liability caps. I would also seriously consider provisions, such as those in Texas that treat academic medical centers that serve a societal safety net function in a separate and more protected category. These centers are typically relied upon to care for the most complex and sickest patients, and it seems to me that a healthy societal contract with them would account for this and shield them from the costs of frivolous lawsuits.

Archdeacon: In my opinion, reform with an emphasis on controlling or capping damage awards as well as controlling attorney fees are more reasonable measures to control costs. Health care providers’ fees are regulated at every level, so it seems reasonable that attorney fees associated with medical cases should be regulated as well.

Sohn: I would support caps on noneconomic damages as this is a form of tort reform which has consistently proven effective. A recent New England Journal of Medicine paper by Kachalia and Mello looked at various forms of tort reform from pretrial screening panels to certificate of merit requirements, and found the most consistent benefits for caps on noneconomic damages. Although various states enact different types of caps, it is safe to conclude to that caps in general lead to substantial savings in indemnity cost, modest constraint of growth of malpractice premiums, reduction in at least some defensive practices, modest improvement of physician supply and perhaps even improved quality of care.

Weinstein: While most solutions at the federal level have been modeled after California’s MICRA legislation in the 1970s or the 2003 Texas legislation, these “cap on non-economic damages” plans are essentially a “non-starter” for opponents in Congress. Achieving meaningful federal medical liability reform in any form will require a bipartisan solution. The trial bar is very well organized and 90%+ of their members support their political action committee (PAC). While the American Academy of Orthopaedic Surgeons (AAOS) is the leader in PAC support in organized medicine, including the American Medical Association, only 28% of our members recognize the importance of contributing to the PAC. If every member supported our PAC, we would be in a stronger position.

Leflar: Looking at the long term, a more promising solution may be a no-fault compensation system employing an “avoidable harm” standard rather than a negligence standard, as I mentioned earlier. However, it should probably be undertaken first on an experimental basis in one or more states rather than by the federal government.

Vidmar: Again, the issue comes back to Studdert and Mello’s study. What kind of defensive medicine?

Segal: I believe doctors who can demonstrate they followed evidence-based guidelines should be immune from litigation. Those doctors who can document why they consciously deviated from such guidelines for a specific and reasonable reason should receive qualified immunity.

Brenner: None.

Teuscher: Hard cap on non-economic damages, federal rules, and safe harbors for practicing within evidence-based guidelines.

Bal: Much of our awareness of what constitutes defensive medicine is from surveys of physicians asking if they practice defensive medicine out of fear of litigation. Recognizing the inherent bias in such surveys, how would one design a scientifically valid study that addresses whether or not U.S. physicians practice costly defensive medicine? How would you factor in the consideration of different practice environments, i.e., practices exposed to malpractice lawsuits vs. a protected environment where litigation is a non-issue?

Jimenez: It is my opinion that the best and most accurate method or survey one could utilize in determining if a physician would react or treat a patient in a defensive medicine manner is in the following manner. The test would be made up of five clinical scenarios representing patients of different gradations of potentially litigious overtones. The responses of the physicians would be recorded, not so much on the accuracy, but on the quality of the communication skills manifested. It has been shown that there is a direct correlation between effective communication skills and reduction of malpractice claims.

Choma: I suspect that given how insidious the practice of defensive medicine can be, it will be impossible to accurately quantify the scope of this issue. I don’t, however, think that this makes current survey information without value.

Archdeacon: A rigorous scientific study that assesses defensive medicine would be difficult to design and implement. It seems that such a study should focus on a universally agreeable negative outcome that physicians are concerned with both from a patient care standpoint as well as a litigation standpoint. Perhaps, the workup and diagnosis of infection associated with total knee or total hip arthroplasty, or deep vein thrombosis after hip fracture. Prior to engaging in such a study, an adjudication panel should come up with a set of expected clinical and diagnostic tests. This would be followed by a prospective analysis of practice patterns. This type of investigation begins to mirror evidence-based medicine approaches, which are difficult to agree upon even without the concern for litigation.

Sohn: I think the only way to see whether physicians practice defensive medicine is to compare physician behavior before and after significant tort reform. Say physicians in a litigious environment order 10 tests per patient. If the same group is then guaranteed immunity and only order six tests per patient, it is reasonable to conclude that the additional four tests were ordered solely out of defensive posture.

Such a test is obviously difficult to administer, but there are studies which look at physician behavior before and after the 1975 California MICRA laws. One study by Stanford economists Kessler and McClellan found that physicians utilized between 5% to 9% less medicine after laws which placed hard caps on noneconomic damages. I think this is good evidence that physicians do practice defensive medicine and that they practice less defensive medicine under the umbrella of tort reform.

Weinstein: This is a very complex issue. The best solution here is not related to spending time on surveys but to devote resources to developing appropriateness criteria and guidelines when possible. Unfortunately orthopedic surgery, not unlike most surgical disciplines, is not an evidence-based discipline but an expert-based discipline. It is very hard and prohibitively expensive to do randomized clinical trials on the multitude of conditions that we treat. The variables are so great and the numbers often small for the conditions we treat.

We definitely need to do good clinical research but the AAOS and our specialty societies need to be working in concert to develop appropriateness criteria which apply across all practice environments. If we don’t do this, then someone external to the profession will. With these in place, we will not only help the medical liability problem but begin to do our part in lowering health care costs and improving quality.

Leflar: Choose a limited number of expensive diagnostic procedures for which indications for their performance are clearly defined. A multicenter trial would be needed so that practice environments could be compared – low litigation risk, maybe veterans administration, vs. high litigation risk; and profit potential present, vs. no profit potential present. Obtain rates of performing each procedure at each center. Ideally, include a risk adjustment mechanism so that patient mixes could be standardized. Ideally, do an independent chart review of all or a randomized sample of cases, for an additional perspective on whether performance of the procedures was less frequently justified in some practice environments than in others.

Vidmar: In my answer above about the survey of ob-gyns, I coached the student to be neutral and not ask leading questions. In this vein, Mello conducted a survey of ob-gyns in Pennsylvania and found many saying they would leave the state because of high malpractice premiums. But she later found data that contradicted that finding — and being an honest and unbiased researcher, she reported the latter finding admitting error. I would love to conduct a much larger study along the lines of the one conducted by my student.

Segal: We already have studies which look at defensive practices in other countries. Such doctors are not even aware of what the term defensive medicine even means – as they have no such need to practice defensively. Further, doctors in more “protected” environments in the United States, such as federal employees, have been shown to practice less defensively, again because they have less need to practice defensively. I am not sure designing a study to “look for” defensive medicine would be a good use of dollars. Defensive medicine is pervasive.

Brenner: In order to validly study defensive medicine research scientists would need to have physicians and surgeons identify the charts of patients where they claim unnecessary procedures were performed to reduce liability exposure. The researchers would have to verify that the procedures were unnecessary. Finally, the researchers would have to verify the motivation for ordering medically unnecessary tests. There are many motivations for doing so including financial gain and, lack of diagnostic self confidence. It would likely be impossible to demonstrate the validity of any study of defensive medicine because the results would always be dependent on subjective factors.

Teuscher: Fear of lawsuits is not measured objectively if one practices in a litigation rich environment. How you measure that will always be biased, based upon the perceived and/or real incidence of lawsuits and the severity of damage that they cause to the practice and psyche of the participants.

Bal: In your opinion, is the ordering of otherwise unnecessary tests a worthwhile strategy to shield against medical liability or do such tests merely serve to relieve physician anxiety?

Jimenez: It is my opinion that simply ordering a test as a form of defensive medicine is not very effective. Usually the test is not necessary to provide a good diagnosis or treatment. If there is a problem associated with the test, such as an untoward side effect, or a significant copayment or cost that the patient has to pay, the patient will be unhappy.

If the patient senses or feels that the test was unnecessary, a litigious result may occur anyway. The physician needs to gain the confidence and trust of the patient by using good communication skills, such as empathy, engagement, education and enlistment. A good shared decision between physician and patient will result and the potential for a malpractice claim will be less.

Choma: I suspect, that like most practices in medicine, there is a spectrum here. At times, I truly feel that some consultations are more to address treating – physician anxiety rather than that of the patient. Again, that does not completely nullify the value of such consultations. As long as medicine is practiced by humans and not computers, it will be subject to the all of the frailties of those humans.

Archdeacon: In my opinion, unnecessary tests serve more to relieve physician anxiety than actually reduce malpractice risk. The majority of physicians are 95% comfortable with a diagnosis based on patient history and physical exam. With few exceptions, imaging studies and tests serve as confirmatory aides more that diagnostic aides.

Sohn: This is a controversial topic. There are some physicians who believe that ordering extra tests is irrational, and that physicians actually make things worse for themselves by ordering more tests. However, there are also closed claim studies which show that a commonly asserted element of plaintiffs’ complaints is failure to order tests. I think this actually would be a worthy study.

Weinstein: In the current climate of fear, defensive medicine is becoming the norm. The fear of a lawsuit drives physicians to assure themselves that they are not “missing something” and hence, they order a lot of tests, images and studies for they cannot personally afford to miss any diagnosis regardless of how rare. Instead of following a more strategic, almost algorithmic order of progression to diagnosis, physicians because of fear of liability feel the need to “cover the waterfront” to avoid missing anything regardless of how rare.

In addition, a better educated public is also more demanding of wanting expensive studies, imaging studies in particular, for diagnosis of their problem. Avoidance behavior is purely defensive on the physicians’ part; this unfortunately profoundly affects patient access to care. This inadequate specialty physician coverage is one of the main drivers for closing of emergency rooms.

Leflar: It is not a worthwhile strategy and is a significant contributor to the inefficiency of U.S. medical practice.

Vidmar: Probably the latter. Also, I am not confident that the anxiety is that high – except when it is triggered by physicians’ professional associations. The real issue is whether doctors and especially hospitals gain financially from these extra tests. I know of anecdotal evidence that the hospitals gain financially from unnecessary tests.

Segal: It is a strategy that is more likely to be effective in warding off meritless suits than hoping for the best. A more cost effective alternative might be to document the tests you would have done defensively. Then include in the documentation the literature explaining why such tests are not appropriate. Such a strategy might still land you in court.

Brenner: I am not aware of any scientifically valid studies that establish the presence or absence of defensive medicine.

Teuscher: After a reasonable informed conversation with the patient and their family, if their needs and willingness to fund are to test to make sure there is a negative result and establish peace of mind, then ordering a test with informed shared decision making with a reasonable expectation of the result is not defensive medicine.

Bal: Are you aware of any scientifically valid studies have shown the existence of high costs related to defensive medicine? Or is the evidence in support of the ubiquitous incidence of defensive medicine largely anecdotal and based on common sense (in addition to survey data)?

JimenezThe Wall Street Journal reported in September 2010 that the latest estimate was (from an analysis published in Health Affairs) $45.6 billion annually (in 2008 dollars), accounting for more than 80% of the $55.6 billion total yearly cost of the medical liability system, according to the authors — from Harvard University and the University of Melbourne.

I do not believe that the numbers are anecdotal but I must admit that they are difficult to exactly pinpoint. Some have also estimated that the costs are about 2.4% of the total health care costs. Even though these figures are difficult to document and verify, it is safe to make the assumption that a significant percentage of the health care dollar is spent trying to avoid lawsuits.

Choma: This is such an emotional issue for physicians that anecdote has a very large affect on our perception of the matter.

Archdeacon: I am not aware of any such studies.

Sohn: California realized a reduction of medical costs from 5% to 9% after enacting caps on noneconomic damages. This seems small, but studies extrapolating these savings to the nation as a whole if there were similar federal tort reform (such as H.R. 5, “The Health Act”) place savings at up to $122 billion per year. That is real savings.

Weinstein: The costs of defensive medicine vary considerably and the methodology of determining costs varied. But many credible sources and references do indeed exist. With that said, opponents will always be able to find what they determine to be critical flaws in the methodology. A 2006 study done by PricewaterhouseCoopers estimated costs upwards of $210 billion a year. The respected research firm found, “While the bulk of the premium dollar pays for medical services, those medical services include the cost of medical liability and defensive medicine … Defensive tests and treatment can pose unnecessary medical risks and add unnecessary costs to health care.”

A more recent Gallup survey of American physicians found the fear of lawsuits was the driver behind 21% of all the tests and treatments ordered by doctors, which equates to 26% of all health care dollars spent. That comes to a staggering $650 billion. According to a study of medical liability costs and the practice of medicine in Health Affairs, overuse of imaging services alone, driven by fear of lawsuits, costs as much as $170 billion a year nationally.

Looking at state data, a study by the Massachusetts Medical Society revealed that 83% of the physicians surveyed reported practicing defensive medicine and that an average of 18% to 28% of tests, procedures, referrals and consultations and 13% of hospitalizations were ordered for defensive reasons. Estimates are that assurance behavior costs Massachusetts a staggering $1.4 billion annually.

Leflar: The evidence is largely anecdotal. However, it is widespread enough to be believable.

Vidmar: I suspect there are no studies that are valid.

Segal: Studies by Kessler, McClellan and Baicker suggest that the harsher the medico-legal environment, the more expensive the practice of medicine.

Brenner: It only reduces anxieties. Most diagnostic related malpractice claims (and the court decisions that support liability) result from inaccurate histories and incomplete physicals.

Teuscher: More importantly, are there any scientifically valid studies that show that defensive medicine and our broken medical liability system are not costing us more in medical expenditures and unnecessary medical tests through defensive medical ordering practices.

Bal: To the extent that defensive medicine exists, is it not a beneficial result of our civil liability system that holds individuals accountable for their conduct? In other words, are we not better off because of defensive medicine?

Jimenez: I must respectfully disagree with your conclusion that defensive medicine is in itself good or yields a beneficial result. I believe that the feeling of accountability must be inherent in the person of the physician and not the result of society’s demands. In other words, we as physicians must hold ourselves accountable and do the best we can for each and every patient. If every physician had this mindset and practiced these principles, then there would not be any need for the practice of defensive medicine.

Choma: I’m afraid that I cannot agree with that. From my view, a large contributor to the emotion of the issue is that physicians inherently resent that there exists this barrier between doctor and patient. We know in our hearts that true confidence in this relationship can improve our quality of medicine. This is the confidence that allows us to skip the next test of dubious value when one of our patients is experiencing a suboptimal outcome. This is the confidence that allows us to skip the next diagnostic MRI when we know that it won’t change the next treatment recommendation.

In addition, patients must be brought into the daily conversation with their physicians that we are dealing in uncertainties most of the time. To the extent that the additional diagnostic maneuvers purred by defensive medicine continue to supplant that discussion with our patients, we will continue to be dissatisfied.

Archdeacon: Again, I believe most physicians are comfortable with their diagnosis and treatment plans prior to any tests or studies. A small percentage of cases probably really benefit from further investigations. However, there are obvious exceptions, like presurgical imaging studies that assist in developing the surgical plan. So, in my opinion, a small percentage of patients probably benefit from the practice of defensive medicine, but it is unlikely that the majority receive any tangible benefits.

Sohn: To some degree, there is a need for the tort system in general. Civil litigation acts as a sort of “private attorney general” that discourages negligence and improves public safety. For example, we don’t want companies making shoddy tiger cages, or cars with gas tanks placed in precarious positions. However, medicine is ill-adapted to the tort system for at least three significant reasons.

First, most medical errors are not the result of negligence. They are the result of system errors. According to the groundbreaking 1997 Institute of Medicine report, “To Err is Human,” most errors made are not negligence but unavoidable human error that can only be minimized by investment in systems of checks and verifications to catch such errors. They cannot be avoided by frightening physicians and threatening them with lawsuits.

Second, plaintiffs in medical malpractice sue due to complications, not due to negligence. One closed claim study out of Harvard found that only one in seven lawsuits filed actually contained evidence of negligence. In medicine, however, there is always the risk of complications because medicine and human biology is an inexact science. It would be nice to somehow compensate patients who are injured, but trying to assert negligence for unavoidable complications likely will have either a chilling effect on riskier services, an increase in defensive medicine, or both.

Third, using the tort system to improve the quality of medicine is no longer a luxury we can afford. We have reached a crisis in the costs of medical care, and even if there were some marginal improvement of quality due to the threat of litigation, it is not justified by the increase in defensive medicine costs. We spend $100 billion per year on radiology costs, 30% of which the radiologists estimate is not necessary. We are at a point where politicians have talked of instituting review panels for rationing of medicine, and where every year there is the threat of 10% to 20% cuts in Medicare reimbursements for physicians. The “private attorney general role,” ill-suited to begin with to the medical field, is a luxury we just cannot afford.

Weinstein: Defensive medicine is a reality. It is costly and interferes with access to care. Defensive practices will slowly become the standard of care leading to permanent costly inappropriate poor quality care. Defensive medicine does not improve patient outcomes nor make the health care delivery system safer. But the current climate of fear among physicians will lead to continued costly defensive medicine practices and lack of system transparency necessary to make the system safer.

With medical liability reform a wedge issue between Republicans and Democrats, the federal government will continue to be impotent in developing a federal solution and hence, we will continue to operate under a patchwork quilt of ineffective state programs that are continually under attack by the trial bar. Until reasonable members of both parties are willing to develop a bipartisan solution, the prognosis for ending defensive medicine practices and reforming the current medical liability system is guarded.

Leflar: No, not if one accepts my two-fold definition of defensive medicine.

Vidmar: Again I go back to the Studdert and Mello study – good or bad defensive medicine?

Segal: No. First, some defensive practices harm patients – causing worry, morbidity, sometimes mortality. Next, defensive medicine makes health care more expensive and decreases access to care for many Americans. Even if select patients benefit, patients in the aggregate do not.

Brenner: I believe that the purpose of our professional liability system is to produce fair and just results. The unending, ideological debate on whether our liability system leads to increased costs or improved patient care quality is a partisan debate unrelated to achieving fair verdicts.

This question demonstrates why the issue of defensive medicine creates an unacceptable choice for organized medicine. If you accept my definition, then performing procedures without any expected benefit to patients is unethical and potentially illegal. On the other hand, if you allow that the definition of defensive medicine includes clinical benefits to patients then you also have to allow that malpractice litigation has increased patient safety and improved patient quality.

Teuscher: Our broken civil liability system does not act swiftly nor justly, let alone predictably as promised. It fails miserably to hold anyone accountable for their misconduct. Why promote spending more money on tests defensively that do not give patients a true benefit? Litigation is not the answer, but merely a symptom of the disease that ails American medicine.

  • Michael T. Archdeacon, MD, MSE, can be reached at Department of Orthopaedic Surgery, University Hospital University of Cincinnati Academic Health Center, P.O. Box 670212, Cincinnati, OH 45267-0212; 513-558-2978; email:
  • B. Sonny Bal, MD, JD, MBA, can be reached at Missouri Orthopaedic Institute, 1100 Virginia Ave., Columbia, MO 65212; 573-882-6762;
  • Lawrence H. Brenner, JD, can be reached at P.O. Box 787, Carrboro, NC 27510; 919-929-5597; email:
  • Theodore J. Choma, MD, can be reached at Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Ave., DC 000530, Columbia, MO 65212; 573-882-1440;
  • Ramon L. Jimenez, MD, can be reached at Monterey Peninsula Orthopaedic and Sports Medicine Institute, 10 Harris Ct. Bldg. A, Suite A, Monterey, CA 93940; 831-643-9788; email:
  • Robert B Leflar, JD, MPH, can be reached at Arkansas Bar Foundation Professor of Law, University of Arkansas School of Law, 1045 W. Maple St., Fayetteville AR 72701; 479- 575-2709; email:
  • Jeffrey Segal, MD, JD, can be reached at Medical Justice, P.O. Box 49669, Greensboro, NC 27419; 336-691-1286;
  • David H. Sohn, JD, MD, can be reached at Department of Orthopaedic Surgery, Division of Sports Medicine, University of Toledo Medical Center, 3000 Arlington Ave., Toledo, OH 43614; 419- 383-3761;
  • David Teuscher, MD, can be reached at Beaumont Bone & Joint Institute, 3650 Laurel Ave., Beaumont, TX 77707; 409-838-0346;
  • Neil Vidmar, PhD, can be reached at Duke University School of Law, Room 3183, Box 90360, Durham, NC 27708-0360; 919-613-7090;
  • Stuart L. Weinstein, MD, can be reached at Department of Orthopaedic Surgery, 01026 JPP University of Iowa Hospitals and Clinics, Iowa City IA 52242; 319-356-1872; fax: 319-353-7919; email:
  • Disclosures: Archdeacon, Bal, Brenner, Choma, Jimenez, Leflar, Sohn, Teuscher, Vidmar and Weinstein have no relevant financial disclosures; Segal is a shareholder in Medical Justice.




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A Clinical Approach to Population Stratification Analytics

by System Administrator - Wednesday, 8 July 2015, 10:22 PM

White Paper: A Clinical Approach to Population Stratification Analytics

Dispelling the Myths of Traditional Risk Segmentation Models used in Population Health Management Programs

This white paper will introduce a new methodology for stratifying populations and identifying individuals for effective clinical interventions and wellness initiatives. We call this the Care Pathways framework.

Unlike the traditional risk segmentation approach—which assigns individuals into a high, moderate, or low risk category—the Care Pathways approach focuses on an individual's entire healthcare journey by segmenting the population into nine clinically-relevant stages of a condition.

In the paper we will discuss:

  1. The benefits of using Care Pathways to support a longer-term health management strategy that focuses on 100% of the population.
  2. The limitations of the traditional high-moderate-low risk stratification approach and how
    Care Pathways  points to potentially missed opportunities.
  3. A more comprehensive and accurate approach for predicting the likelihood of costly catastrophic events across a population.


Please read the attached whitepaper.

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A Guide to mHealth in Your Next Clinical Trial

by System Administrator - Tuesday, 28 April 2015, 5:37 PM

A Guide to mHealth in Your Next Clinical Trial


A series of questions and answers with industry experts from  BBK Worldwide, Oracle, the Michael J. Fox Foundation and the Institute for Aging Research that provides useful insight into the state of mHealth today, its future potential and how to overcome any perceived risk associated with innovation.

Industry Experts Weigh in on the Benefits and Risks Associated with mHealth Adoption

It is hard to dispute the fact that mHealth technology works. It is quickly becoming the new norm in healthcare and for good reason. While the clinical trial industry has traditionally been slow to adopt technology in key engagement areas, innovation in this area has quickly evolved in recent years. The industry has seen the development of apps that are working to provide anytime, anywhere access to information, whether for study patients, investigative sites or sponsors of clinical research, all critical to study success. Additionally, the development of medical-grade sensors utilized through wearables is being introduced, evolving how large data streams are aggregated and put to good use throughout the course of a study.

Much of the mHealth technology on the market today provides the same functionality that sites have been providing for years, but in a more streamlined fashion. It allows information to be aggregated through a device most people are already utilizing on a regular basis – their phone. This being said, embracing new innovation does not come without risk and mHealth is no exception.

The following pages provide useful Q&As with a variety of experts that are innovating in the areas of mHealth and putting new mobile health technologies to good use within the clinical trial setting. We hope the content inspires you to put mHealth to good use in your next clinical trial.

For more about mHealth, visit our blog:

Please read the attached whitepaper.

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A Successful Patient Engagement Strategy

by System Administrator - Wednesday, 28 January 2015, 5:10 PM

5 Elements of a Successful Patient Engagement Strategy

In recent years, there has been a great deal of discussion about how to engage patients in their care. Patient engagement has always been considered a good thing in practices and health care organizations. Today it is vital to the business of delivering care. Why the shift? Patient engagement is an essential strategy for achieving the “triple aim” of health care:

  • Improving the patient experience
  • Advancing population health
  • Reducing costs

Please read the attached whitepaper.

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Accelerated Practices (AP) Program

by System Administrator - Wednesday, 4 November 2015, 7:55 PM

Introducing the Accelerated Practices (AP) Program: An Innovative Way to Help Health Systems Accelerate and Sustain Outcomes Improvement

by Dr. Bryan Oshiro, Dr. John Haughom and Sherry Martin

We are excited to announce the launch of Health Catalyst Academy’s Accelerated Practices (AP) Program. This program has been uniquely designed by healthcare and quality improvement professionals with one goal in mind: to prepare healthcare teams to accelerate their own outcomes improvement. Such improvements are critical in an industry that faces a profound need for change with the move from fee-for-service to value-based care.

The Urgent Need for Healthcare Transformation

There is an unprecedented level of complexity overwhelming our healthcare systems and the people trying to practice within them. Far too many outcomes are inadequate. The level of harm patients experience when seeking healthcare services is not acceptable. Costs are out of control and waste is widespread.

There are many reasons for this, including competition for scarce resources; lack of permanent, integrated teams to follow through with initiatives; frustrated clinicians who don’t feel as though they have organizational support; and a lack of meaningful data-driven insights to improve care processes.

Because the current healthcare system was designed for a fee-for-service business model, it isn’t up to the task of delivering optimal care, reducing costs, and improving patient satisfaction. To move to a value-based care model, a significant transformation needs to occur. And occur quickly. It is time to accelerate outcomes improvement. Getting there requires an approach that will not only change the systems of care delivery but also change the culture.

Succesfully Tackling the Healthcare Challenges

Despite facing many challenges, some health systems have overcome the hurdles to realize significant gains in quality and cost outcomes. How? By giving caregivers the tools to gain the data-driven insights and training they need to lead change and implement quality improvement initiatives. Take, for example, Intermountain Healthcare. Back in the 1980s, the organization proved that quality improvement and change leadership principles could be used by data-driven teams to significantly improve care and reduce costs. Because the results were so successful, the organization implemented an Advanced Training Program in Healthcare Delivery Improvement (ATP) course in 1992.

Since the introduction of Intermountain’s ATP, many healthcare professionals with various backgrounds from around the world have graduated from the course. Yet because of the program’s success, there is now a lengthy waiting list to attend. As a result of the wait, other organizations have created their own ATP courses to fill the demand for this critical knowledge. But there still aren’t enough programs for everyone to attend even though change needs to happen now. That is why we’re offering an Accelerated Practices (AP) program modeled after the original ATP course—to provide more learning opportunities for those who need it.

What Is the AP Program?

The AP Program is a highly immersive, project-based learning experience that healthcare industry experts have spent a lot of time developing. The goal of the program is for participants to leave with the tools and knowledge they need to achieve significant improvements for their organizations. They will also learn how to communicate the need for change in this new value-based care environment by using data and proven leadership principles.


A course participant raises the team’s answer to a presenter’s question.

Content for the program is primarily based on the teachings of Edward Deming and Ronald Heifetz. Deming was a scholar and teacher who is known for developing quality improvement theories and principles such as the Plan-Do-Study-Act (PDSA) Cycle. Heifetz is the Founding Director of the Center for Public Leadership and is known for developing an adaptive leadership model.

Don’t expect a passive learning environment, though. Instead, participants will interact with other participants, mentors, and faculty. And because class size is limited to 40 students, participants will have many opportunities to learn from each other through discussions, interactive activities, and the assignment of a group outcomes improvement initiative.


Participants balance feathers to learn about perspective during a presentation on the fundamentals of adaptive leadership.

Key Highlights of the AP Program

The AP Program will stretch participants’ left and right brains as they progress through the course. Some examples of what they’ll experience include:

Experienced and notable faculty and coaches:

Participants will interact with and learn from many experts during each session—from Health Catalyst faculty and coaches to notable guest faculty from other organizations. Faculty members are knowledgeable and respected experts in their field and will lead discussions and presentations. Coaches attend the entire course, so participants can interact with them at any time to ask questions. Coaches are also available between sessions through phone calls or email.


A team works together to identify intervention strategies to solve the vexing problems facing their organizations.

Faculty serving as coaches will also provide guidance to a designated team of participants and facilitate small group meetings. This enables each participant to gain a deep understanding of the concepts taught. As participants work through various assignments with their coach, they will also learn how to apply their new knowledge to the real-world problems facing their organizations.

Participants will also learn from guest faculty. Examples of previous guest faculty include:


A team meets with their coach to discuss actual problems they are dealing with (e.g., reaching agreement on the best intervention or the most effective way to engage stakeholders) as they work on their improvement project.

Hands-on, experiential sessions:

Trying to learn new concepts without practice isn’t an effective way to learn. This is why our program includes many hands-on activities. Such activities are strategically place throughout each presentation and range from group discussions to team problem-solving activities to participant interaction with props to demonstrate specific principles.


A participant demonstrates the effects of focusing on physician outliers through the use of colored silly putty.

The participants themselves:

Participants come from all over the United State and have varied healthcare backgrounds. Because everyone has different experiences, the classroom becomes a lively forum for knowledge sharing.

Assignments and final project:

Some of the key advantages to attending the AP Program are the homework assignments and the completion of an outcomes improvement project. This work is done with a team, which gives particants a hands-on experience to apply what they’ve learned. For the final improvement project, teams are given tools to help them choose a problem that aligns with their senior management’s goals. This allows teams to provide a tangible return on investment to their AP Program sponsor.

Topics covered:

During the course, participants will learn about the following topics and tools:

  • Quality improvement methods and tools, such as the Plan-Do-Study-Act Cycle; problem statements; aim statements; fishbone and cause and effect diagrams; Lean methodology; and the Pareto principle
  • Adaptive leadership strategies for leading transformation and managing change
  • Quality improvement implementation strategy and how to quantify a return on investment
  • Data system design including data quality, information management, and data governance
  • Healthcare policypolitics
  • Evidence-based medicine and physician and staff engagement
  • Statistical design including variation analysis, run charts, and statistical process control charts
  • Protocol development, implementation, and testing
  • Clinical integration structure and governance models to sustain and spread improvement interventions


Graduation is a time for participants (and their sponsor) to celebrate all the work and learning that went into completion of the program. Graduation also means that participants have designed an improvement initiative they can take home to implement at their organization. Because this day represents the culmination of many months of hard work and newly gained actionable knowledge, graduates often proudly display their AP Program’s framed certificate next to, and sometimes above, other key academic achievements.

Course duration:

The AP Program includes a total of 10 in-person sessions that are spread over five months. This extended format provides teams with the time, tools, and instruction they need to generate meaningful outcomes through their own improvement initiative. The first nine sessions are dedicated to learning; the tenth session includes project presentations and a graduation ceremony and celebration.

Who Should Attend?

The course has been specifically designed for health professionals whose roles enable them to address the changes and challenges in the current healthcare environment. In specific, we recommend the following health professionals* because they’ll graduate with the knowledge of how to implement improvement initiatives at their organizion:

  • Physicians and clinicians
  • Clinical operations leaders
  • Quality improvement professionals
  • Senior leaders

We also recommend that teams come from the same organization and have a senior level sponsor. This provides the best way for organizations to realize immediate gains and a return on investment for the team’s attendance.

*This activity has been approved for AMA PRA Category 1 Credits™.


Participants present their solution to the entire class during an in-class activity.

A Quick Summary of the AP Program

The bottom line: healthcare needs to change because the current system doesn’t work. There isn’t a simple fix, but with the right tools, knowledge, engagement, and organizational support, health systems will be able to see significant gains in outcomes improvement. It’s already happening at places like Intermountain Healthcare, Texas Children’s Hospital, Crystal Run Healthcare, Kaiser Permanente, Allina Health, and Stanford Health Care to name a few. This is why we’ve developed an AP Program—so other organizations can gain the knowledge and tools to survive and thrive in this new era of opportunity. Once participants finish the AP program, they’ll be able to:

  • Lead data-driven, team-based improvement initiatives
  • Improve effectiveness, efficiency, and safety outcomes
  • Improve clinical and nonclinical healthcare service delivery
  • Reduce waste and minimize inappropriate variation in processes
  • Become champions for local improvement education and change
  • Improve cost outcomes

For more information and to register for an upcoming course, visit


A sample AP Program schedule

Dr. Bryan Oshiro


Bryan Oshiro, MD joined Health Catalyst in January 2014 as the Medical Director. He received his medical degree and completed his residency in Obstetrics and Gynecology at Loma Linda University School of Medicine and completed his fellowship in Maternal-Fetal Medicine at the University of Texas in Houston before moving to Salt Lake City to join Intermountain Health Care and served as the Medical Director of the Women and Newborn Service line. He also was a member of the department of Obstetrics and Gynecology at the University of Utah. He then joined Loma Linda University where he became the division director of Maternal-Fetal Medicine and the vice-chairman for the department of Obstetrics and Gynecology. He co-chairs the American College of Obstetricians and Gynecologists Patient Safety Committee for District IX and received the Elaine Whitelaw Service Award from the March of Dimes for his work on a 5 state initiative to eliminate elective deliveries less than 39 weeks gestation.

Dr. John Haughom


John Haughom, MD is an experienced healthcare executive with proven expertise in technology-enabled innovation, developing results-oriented strategic plans, leading multifaceted organization-wide change, and directing complex operations. He has a strong record of turning vision into effective strategies and successfully implementing initiatives resulting in value including higher quality, safer care at the lowest possible cost. His broad knowledge of healthcare and emerging healthcare technologies is coupled with his recognized leadership abilities, strong communication skills, and demonstrated ability to contribute to organizational goals such as improved clinical outcomes, lower costs, improved access to care, and increased profitability. After practicing for 15 years as an internist and gastroenterologist, Dr. Haughom assumed a senior executive role with responsibilities for system-wide automation, budgeting, customer support, database administration, healthcare delivery, information technology, quality control, research, safety, and strategic planning. Dr. Haughom became President and CEO of a firm focused on health care transformation through consulting, strategic planning, mentoring inexperienced physician leaders, involvement in regional and national reform movements, membership on boards of leading edge organizations committed to improving the value of healthcare, and partnership with other like-minded organizations with similar aspirations and goals. As Senior Vice President of Clinical Quality and Patient Safety for the premiere health care system in the Northwest spanning three states (Oregon, Washington and Alaska), Dr. Haughom developed and implemented a system-wide quality improvement strategy, comprehensive patient safety plan, and comprehensive system-wide information technology strategy.

Dr. Sherry Martin


Sherry Martin, Med, MT joined Health Catalyst in 2014. Before joining Catalyst she worked as Vice President, Process Improvement from University of Texas M.D. Anderson Cancer Center, and worked to fully implement the Clinical Safety and Effectiveness Program before retiring. Sherry served as a University of Texas Fellow for Clinical Effectiveness from 2004 until 20011. Since 2011, Sherry has worked as an independent consultant with organizations to implement improvement courses. She also contracted with the National Quality Center (Health Research Inc) to provide consultative services to Ryan White funded HIV clinics in the US.


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Acceso vs Privacidad

by System Administrator - Saturday, 2 August 2014, 12:59 AM

Acceso vs Privacidad: Cuestiones de ética de la información enfrentan a los profesionales de datos


Las preguntas sobre la ética de datos se han elevado en la palestra de profesionales de primera línea a raíz de las revelaciones de recopilación de datos de la NSA y otras noticias.

Continuar leyendo


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ACHE 2015: Value-based care models heighten need for science-based measures

by System Administrator - Tuesday, 17 March 2015, 3:06 PM

ACHE 2015: Value-based care models heighten need for science-based measures

National Quality Forum CEO Christine Cassel calls for improvement of quality measures

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Alma-Ata 1978 - Atención Primaria en Salud

by System Administrator - Wednesday, 30 December 2015, 10:33 PM



A casi 4 décadas dela Declaración de Alma-Ata


Foto de la Conferencia de Alma-Ata

La Conferencia internacional de atención primaria de salud, reunida en Alma-Ata el día 12 de septiembre de 1978, expresando la necesidad de una acción urgente por parte de todos los gobiernos, de todos los profesionales sanitarios y los implicados en el desarrollo, y por parte de la comunidad mundial, para proteger y promover la salud para todas las personas del mundo, establece la siguiente Declaración:

  • I. La Conferencia reafirma con decisión, que la salud, que es un estado de completo bienestar físico, mental y social, y no sólo la ausencia de enfermedad; es un derecho humano fundamental y que la consecucióndel nivel de salud más alto posible es un objetivo social prioritario en todo el mundo, cuya realización requiere la acción de muchos otros sectores sociales y económicos, además del sector sanitario.
  • II. La existente desigualdad en el estado de salud de las personas, particularmente entre los países desarrollados y los países en vías de desarrollo, así como entre los diversos países, es inaceptable política, social y económicamente y, por tanto, implica de manera común a todos los países.
  • III. El desarrollo económico y social, basado en un nuevo orden económico internacional, es de una importancia básica para poder conseguir de manera completa la salud para todos, y para reducir la diferencia en el estado de salud existente entre los países desarrollados y los países en vías de desarrollo. La promoción y protección de la salud de la población son esenciales para mantener el desarrollo económico y social, y contribuyen a una mejor calidad de vida y a la paz en el mundo.
  • IV. Las personas tienen el derecho y el deber de participar individual y colectivamente en la planificación e implementación de su atención sanitaria.
  • V. Los gobiernos tienen la responsabilidad de la salud de sus poblaciones, que puede ser conseguida sólo mediante la provisión de unas medidas sanitarias y sociales adecuadas. Un objetivo social principal de los gobiernos, organizaciones internacionales y el total de la comunidad mundial para las próximas décadas, debería ser la promoción, para todos los habitantes del mundo, en el año 2000, de un nivel de salud que les permitiera llevar a cabo una vida productiva social y económicamente. La atención primaria de salud es la clave para conseguir este objetivo como parte del espíritu de justicia social del desarrollo.
  • VI. La atención primaria de salud es atención sanitaria esencial, basada en la práctica, en la evidencia científica y en la metodología y la tecnología socialmente aceptables, accesible universalmente a los individuos y las familias en la comunidad a través de su completa participación, y a un coste que la comunidad y el país lo pueden soportar, a fin de mantener cada nivel de su desarrollo, un espíritu de autodependencia y autodeterminación. Forma una parte integral tanto del sistema sanitario del país ( del que es el eje central y el foco principal) como del total del desarrollo social y económico de la comunidad. Es el primer nivel de contacto de los individuos, las familias y las comunidades con el sistema nacional desalud, acercando la atención sanitaria al máximo posible al lugar donde las personas viven y trabajan, constituyendo el primer elemento del proceso de atención sanitaria continuada
  • VII. La atención primaria sanitaria: (1) Refleja las condiciones económicas y socioculturales, así como las características políticas del país yde sus comunidades, desarrollándose a partir de ellas, y está basada en la aplicación de los resultados apropiados de la investigación social, biomédica y de servicios sanitarios, así como en la experiencia sobre salud pública.(2) Se dirige hacia los principales problemas sanitarios de la comunidad, y para ello, proporciona y promueve servicios preventivos, curativos y rehabilitadores.(3) Incluye como mínimo: eduación sobre los problemas sanitarios más prevalentes y los métodos para prevenirlos y controlarlos; promoción sobre el suministro de alimentación y de correcta nutrición; adecuado suministro de agua potable y saneamiento básico; asistencia maternal e infantil, incluyendo la planificación familiar; inmunización contra las principales enfermedades infecciosas; prevención y controlde las enfermedades endémicas locales; apropiando tratamiento de las enfermedades comunes y los traumatismos, y provisión de los medicamentos esenciales.(4) Implica, además del sector sanitario, a todos los sectores relacionados y a diferentes aspectos del desarrollo nacional y comunitario, en particular, la agricultura, los animales de labranza, la industria alimentaria, la educación, la vivienda, los servicios públicos, las comunicaciones y otros sectores, y solicita los esfuerzos coordinados de todos estos sectores, y solicita los esfuerzos coordinados de todosestos sectores.(5) Requiere y promociona un autodesarrollo comunitario e individual al máximo posible, conparticipación en la planificación, organización, desarrollo y control de la atención primaria sanitaria,haciendo un uso más completo de los recursos locales y nacionales y de otros recursos disponibles; ypara finalizar, desarrolla, a través de una formación apropiada, la habilidad de las comunidades paraparticipar.(6) Debería mantenerse por sistemas de interconsulta integrados, funcionales y mutuamente apoyados,con vistas a una mejora progresiva e integrada de la atención sanitaria para todos, y dando prioridad alos más necesitados.(7) Se desarrolla a niveles locales y a niveles de apoyo, mediante los profesionales sanitarios, incluyendoa los médicos, enfermeras, comadronas, auxiliares y asistentes sociales, en lo que corresponda, así comolos tradicionales y necesarios médicos de cabecera, correctamente formados social y técnicamente para ejercer como un equipo sanitario a fin de responder a las necesidades sanitarias expresadas por la comunidad.
  • VIII. Todos lo gobiernos deberían formular políticas nacionales, estrategias y planes de acción para establecery mantener la atención primaria sanitaria como parte de un sistema nacional de salud integrado y encoordinación con otros sectores. Para este fin, será necesario ejercitar voluntades políticas, a fin demovilizar los recursos del país y utilizar racionalmente los recursos externos disponibles.
  • IX. Todos los países deberían cooperar con un espíritu de fraternidad y de servicio para asegurar la atenciónprimaria sanitaria a toda la población, ya que la consecución de la salud, por parte de la población de unpaís, directamente afecta y beneficia a cualquier otro país. En este contexto, el informe conjunto OMS/UNICEF sobre atención primaria constituye una base sólida para el futuro desarrollo y establecimiento dela atención primaria sanitaria en todo el mundo.
  • X. Puede conseguirse un nivel aceptable de salud para todo el mundo en el año 2000, mediante unautilización mejor y más completa de los recursos mundiales, una considerable parte de los cuales segastan hoy día en armamento y conflictos militares. Una política genuina de independencia, paz ydesarmamento podrían ser bien empleados en objetivos pacíficos y, en particular, en la aceleración deldesarrollo social y económico, entre los que la atención primaria sanitaria, como parte esencial, deberíarecibir su parte proporcional adecuada.La Conferencia internacional sobre atención primaria de salud realiza un llamamiento urgenete y efectivopara una acción nacional e internacional a fin de desarrollar e implementar la atención primaria sanitariaen todo el mundo y, particularmente, en los países en vías de desarrollo, con un espíritu de cooperacióntécnica y en consonancia con el nuevo orden económico internacional. Urge, por parte de los gobiernos,de la OMS, de la UNICEF y de otras organizaciones internacionales, así como por parte de agenciasmultilaterales o bilaterales, organizaciones no gubernamentales, agencias de financiación, todos losprofesionales sanitarios y el total de la comunidad mundial, mantener la obligación nacional einternacional hacia la atención primaria sanitaria y canalizar un soporte técnico y financiero cada vezmayor, particularmente en los países en vías de desarrollo. La Conferencia hace un llamamiento a todos los foros mencionados para colaborar en introducir, desarrollar y mantener la atención primaria sanitaria,de acuerdo con el espíritu y contenido de esta Declaración.
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Alternative Payment Models (APMs)

by System Administrator - Wednesday, 19 July 2017, 4:19 PM

Infographic: Quick Guide to Alternative Payment Models (APMs)


Alternative Payment Models (APMs) are the most advanced options under the Medicare Access and CHIP Reauthorization Act’s (MACRA) Quality Payment Program. APMs offer the highest incentives and could be the preferred model of the future. But APM requirements are complex — and some don’t even qualify for MACRA. Where do you stand? Here’s an overview of some of the current guidelines.

Please read the attached whitepaper.

Download Related White Papers and Webcasts 
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An Expedient Strategy for Image-Enabling an EHR

by System Administrator - Wednesday, 8 April 2015, 8:12 PM

An Expedient Strategy for Image-Enabling an EHR


by MERGE Helathcare

For large scale healthcare providers including ACOs, large hospital networks, and physician groups, the fundamentals of care coordination can be daunting. Clinical images and important patient information is, in many cases, scattered across any number of locations, facilities, departments, and systems.

With Meaningful Use Stage 2 attestation requirements looming, acceleration in the shift from volume to value-based models and the need for Health Information Exchange (HIE) development, enterprise image management has now become a key mission for healthcare IT providers to connect clinicians across the continuum of care.

This white paper discusses the current state of clinical images in the context of the contemporary healthcare provider, and technologies necessary to facilitate future enterprise-level initiatives for hospitals and health systems.

Readers of this new report will:

  • Identify the inherent data exchange challenges associated with connecting imaging systems between departments (PACS, Non-PACS, informal, etc.)
  • Recognize challenges and benefits associated with launching of a Vendor Neutral Archive (VNA) driven system to create the “image-enabled” EHR
  • Diagram the concept of Universal Viewing, and the blueprint for enterprise level image management to support future initiatives

Download this free white paper to take your first steps toward an image-enabled EHR, universal image viewing across departments, and coordinating for better patient outcomes.

Please read the attached whitepaper.

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Analysis of mobile health apps, BYOD security

by System Administrator - Thursday, 18 June 2015, 6:48 PM

Analysis of mobile health apps, BYOD security

by Shaun Sutner and Kristen Lee

SearchHealthIT reporters Shaun Sutner and Kristen Lee talk about the security of mobile health apps, as well as wearable technology and telemedicine.

Just as other industries have, healthcare has embraced mobility enthusiastically.

Citing a Food and Drug Administration (FDA) report, the American Medical Association in a release this week noted that about 500 million smartphone users around the world will be using a mobile medical app this year. That number is expected to spike to 1.7 billion smartphone and tablet users by 2018.

Along with the explosive growth in mobile technology comes extensive concerns about the security of bring your own device practices, mobile health apps and even wearable health devices and connected medical devices that are part of the Internet of Things.

In this podcast, SearchHealthIT writers Shaun Sutner and Kristen Lee talk about their research into mobile health IT security, which is the focus of the upcoming issue of Pulse, SearchHealthIT's digital magazine.

A major issue Sutner discusses in his Pulse story is the lack of security of many of mobile apps, a worry explored in-depth by a recent Ponemon Institute study.

Providers have countered security vulnerabilities in mobile health apps by testing apps themselves, setting up in-house "app stores" and using containerization technology to wall off their apps from users' other apps on devices.

As Lee reports, while the mood among healthcare CIOs and CISOs is grim when it comes to mobile security, data integrity on tablets and smartphones is only a facet of larger worries about the security of healthcare data networks.

Also, such security concerns are not deterring providers from moving into the world of mobility because mHealth has so many demonstrable benefits, including patient engagement, telemedicine and value-based care.

Meanwhile, Sutner says in the podcast that the simultaneous proliferation of wearable health technology, from consumer fitness trackers and smartwatches to more sophisticated, FDA-approved Class II devices, is raising its own security and privacy issues.

As for telemedicine, Lee reports that state regulators in Texas recently bucked the trend of states giving reimbursement parity to telemedicine by making it harder for doctors to prescribe drugs remotely and for patients in Texas to receive remotely prescribed medications.

Let us know what you think about the story or the security of mobile health apps; email Shaun Sutner, news and features writeror contact @SSutner on Twitter.

Next Steps:


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Answers to Healthcare Leaders’ Cloud Questions

by System Administrator - Wednesday, 19 November 2014, 7:44 PM

iHT² Releases Answers to Healthcare Leaders’ Cloud Questions Research Report

The purposes of this paper are twofold:

1) to explain the main reasons why most healthcare organizations are not yet migrating their clinical data to the cloud; and

2) to describe how cloud vendors are addressing providers’ concerns. In addition, the paper discusses the key benefits of partnering with a cloud services provider, and explores different types of cloud structures that may suit different providers for all or part of their data storage and software maintenance needs.

Contributing Executives:

  • Jeff Pearson, MBA, CHCIO, Vice President, Chief Information Officer, Trinity Mother Frances Hospitals & Clinics
  • Chris Logan, CISO, Care New England 
  • David Reis, PhD, CGEIT, CISSP, CRISC, ScrumMaster, CISO, VP of IT Governance, PMO and Security, Lahey Health
  • Luis Taveras, PhD, SVP, CIO, Barnabas Health
  • Drew Koerner, Chief Healthcare Solutions Architect, VMware

Any questions or comments please contact the Institute for Health Technology Transformation (iHT2) directly at (561) 748-6281 or


Institute for Health Technology Transformation (iHT2)

iHT2 Research projects are a beginning point for greater stakeholder collaboration to achieve a learning health care system to improve patient outcomes and accelerate research through the effective application of technology. Click Here to Learn More

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App and Desktop Virtualization

by System Administrator - Thursday, 4 September 2014, 8:58 PM

The Rising Value and Falling Cost of App and Desktop Virtualization

When vendors compete, desktop virtualization customers win. Moore’s Law and market forces lead to better solutions at a lower cost.

The rapid increases in computing power described by Moore’s Law offer theoretical advantages for IT organizations—but it’s market competition that translates those benefits into real value. As vendors battle for market share, costs are falling for every part of the desktop virtualization architecture. Meanwhile, desktop virtualization technology itself is advancing quickly, providing new ways to enable business mobility and enabling the flexibility that people and organizations need to thrive. This trend is a double win for customers—better solutions at a lower cost—and it’s making the benefits of a service-based approach to IT available to any organization.

No longer just for early adopters and innovators, desktop virtualization has become a mainstream IT strategy for companies of all sizes. As business mobility and cloud computing transform IT, desktop virtualization enables the transition to IT. Able to meet the needs of users more effectively and securely wherever, however and on whatever device they work from, IT can better support the business while fulfilling its mission of innovation.

Please read the attached whitepaper

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Apple HealthKit

by System Administrator - Tuesday, 2 September 2014, 6:07 PM

Apple tightens health data privacy rules ahead of HealthKit launch

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Apple HealthKit vs. Google Fit

by System Administrator - Thursday, 23 October 2014, 8:18 PM

Infographic: Apple HealthKit vs. Google Fit1

Please the attached image


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Apple lanza ResearchKit para la investigación clínica

by System Administrator - Monday, 16 March 2015, 3:43 PM

Apple lanza ResearchKit para la investigación clínica

por Carlos Mateos

Apple ha anunciado una nueva plataforma de código abierto para la investigación médica llamada ResearchKit, que estará disponible el lunes próximo, y que se integrará con la ya conocida HealthKit, para el intercambio de datos de salud. La compañía de la manzana ya ha comenzado a trabajar con media docena de aplicaciones de investigación de enfermedades específicas: Parkinson, diabetes, enfermedad cardiovascular, asma, y ​​cáncer de mama.

La aplicación del Parkinson, mPower, ha sido creada por la Universidad de Rochester y Sage Bionetworks. La aplicación permite inscribirse en ensayos clínicos y es capaz de detectar los síntomas en los pacientes de Parkinson sólo al decir “ahhhh” en el teléfono. También incluye una función para golpear con el dedo que también puede detectar síntomas. Por último, la aplicación puede analizar la marcha del usuario y el equilibrio haciendo que camine 20 pasos y luego dar la vuelta y dar 20 pasos hacia atrás.

La aplicación para la diabetes se llama GlucoSuccess (glucoéxito) y ha sido creada por el Hospital General de Massachusetts.  MyHeart Counts (mi corazón cuenta) es la aplicación de cardiología, creada por las universidades de Stanford y de Oxford lo utilizaron para crear una aplicación de investigación de la enfermedad cardíaca. Share the Journey (comparte el viaje), es el sugerente título de la aplicación para supervivientes del cáncer de mama desarrollada por el Dana Farber Cancer Institute, la UCLA School of Public Health, Penn Medicine, y Sage Bionetworks. Asthma Health (salud asma) es la aplicación para el asma desarrollada por el Hospital Monte Sinaí y el Weill Cornell Medical College. El vicepresidente de Operaciones de Apple, Jeff Williams, también mencionó que el Monte Sinaí fueron equipando algunos de los ciudadanos de Nueva York con inhaladores y espirómetros conectados a su aplicación para asignar mejor sus síntomas. También están analizando varias zonas de la ciudad en busca de patógenos y síntomas relacionados geolocalizados.


Williams dijo que “es importante que todo el mundo tenga acceso” a ResearchKit, por lo que Apple está ofreciendo código abierto. Eso significa que los usuarios de Android y los que utilizan otros teléfonos inteligentes también podrían utilizar esta plataforma en el futuro.

El CEO de Apple, Tim Cook también hizo algunos anuncios sobre HealthKit y el smartwatch de Apple, que se lanzará el 24 de abril. Anunció que ahora hay más de 900 aplicaciones que comparten o extraer datos de intercambio de datos HealthKit. También dijo que el reloj de Apple podría ofrecer cerca de 18 horas de duración de la batería.

Sin duda, se trata de un gran potencial para la investigación clínica a gran escala pero también abre la puerta al autodiagnóstico,. Los profesionales sanitarios deben adaptarse a este empoderamiento de los pacientes o de sus familiares a través de las aplicaciones y poder recomendar la aplicación más adecuada.


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Apple Watch & Digital Health

by System Administrator - Friday, 12 September 2014, 12:40 AM

The Apple Watch & Digital Health: 3 Must-Ask Questions

The tech world is still digesting Apple’s big announcement. Some believe Apple’s watch is the Second Coming. Others are disappointed that it does not look cooler. Left-handed people are up in arms that the device is not designed to be worn on the right hand.

My opinion: plenty of people will buy the Apple Watch and it will dramatically improve over time. Apple’s great at getting people to desire its devices (remember what they said about the iPad?) and does a good job of tweaking its designs.

Design Critiques Aside, Are We Focusing Enough on the Bigger Picture Beyond the Device?

But, I’ve always maintained that focusing on form factor, pre-loaded 

applications and other surface features of Apple’s devices obscures the larger strategic reality. Apple is playing the long game and working to develop a device-software-data ecosystem that will keep its products relevant and necessary over the long-term. As others have noted, Apple’s foray into health illustrates how it is playing the long game quite clearly. (I’ll talk more about this in a bit.)

One need only look to the entertainment industry and the evolution of the iPhone software ecosystem to understand what Apple is trying to achieve. In music, Apple developed (for a time) a digital ecosystem that was second-to-none. In order to experience hassle-free music downloads, access the latest music on-demand and more you needed to have an iPod (and later the iPhone). Apple’s products went from nice-to-have to essential.

One of the reasons the iPhone did so well was Apple’s decision to open up the app development process to third parties. Inventive innovators developed applications that filled in the gaps in terms of functionality that many complained about when the iPhone and iPad were first introduced. Want a certain feature? There’s an app for that.

What Are the Key Health-Related Questions We Need to Answer About the Apple Watch?

Now, let’s look at what Apple is doing in health. Earlier today, I sent a somewhat breathless message to people on my email list announcing the Apple Watch. I received a number of responses to my message.

Some people wondered whether Apple would be able to solve the consumer engagement issue associated with many wearable devices. Earlier this year, Endeavour Partners put together a now-famous white paper that outlined how most people stop using wearable devices, trackers and other tools after an initial honeymoon period. So, the engagement issue is a big one.

But one of Apple’s strengths is its demonstrated ability to develop partnerships and tap into a vast and talented developer ecosystem that makes its devices more useful and relevant without the company having to invest in a large amount of R&D. In time, people will develop digital health applications that do a great job of harnessing the strengths of the Apple Watch while minimizing its drawbacks (and making it more sticky).

Other people contacted me to take aim at the digital divide — especially the fact that the Apple Watch is expensive. Well, only time will tell whether Apple will shift its pricing strategy. But, it’s done a good job of working with carriers and incentivising them to subsidize the iPhone, which has helped it reach people across economic segments. In addition, Apple is partnering with a range of health insurance firms, hospitals and others. I have to imagine that part of the reason for this activity is to encourage these powerful players to subsidize the cost of the Apple Watch and other tools — especially if they (or the software running on them) can be proven to help improve health outcomes and boost consumer engagement with their health.

The Elephant in the Room: Will Health Consumers Use a Wearable Like the Apple Watch?

The most pressing issue, however, is the adoption question. This goes beyond economics. If consumers decide the device is not very useful or adds anything to their lifestyle that will merit its long-term use, the Apple Watch is doomed. Companies like Pebble have succeeded in creating a long-term user base. Samsung and Google have already introduced watches that have gained limited traction. The jury is still out as to whether the Apple Watch will go much beyond power users.

From a digital health perspective, there’s evidence that some groups of consumers, including people with heart disease are not very interested in connected health devices, as this essay by Mark Bard of the Digital Insights Group suggests. But, it’s worth repeating that the issue of adoption may come down to a simple question: are these devices useful? Frankly, many current wearables are less then useful and require a lot of work and mental energy to optimize. (This is changing, however as this report [available via subscription] suggests.)

Yet, there is certainly a strong willingness among the most digitally active health consumers to use wearables, as our research suggests. These are ePatients or people who regularly use digital tools (i.e., Web, social media) for health.

Below is a chart illustrating some of our ePatient data.


We asked ePatients to tell us whether they would be willing to use a wearable device with the ability to track and monitor their health status. A slight majority of all ePatients said they would be very willing to use these devices. In addition, I looked at our data by socioeconomic status and found something interesting. Interest was greatest among the most affluent, but remained relatively strong across income groups. For example (as shown above) about 49% making between $31,000 and $40,000 annually were willing to use this type of device.

Related: Rise of the ePatient Movement

Now the question remains: would they be willing to use an Apple Watch? I’m not sure. But, this data does suggest that — for the company that gets wearables right — there is a significant opportunity in health.

The Bottom Line: Only Time Will Tell if the Apple Watch is a Hit, or Flop

Recent news reports make it clear that Apple is doing its best to develop a suite of indispensable products (in health and beyond), partnerships that will help it make its health data useful and relevant to medical professionals and learning the regulatory ropes. But, only time will tell whether the Apple Watch will be successful or a rare (for Apple) flop.

What’s clear is that the wearables arena is continuing to evolve, especially in health. For those willing and able to get it right, the rewards are potentially massive.

About Fard

Fard Johnmar is a digital health futurist, researcher and co-author of the #1 bestselling book, ePatient 2015: 15 Surprising Trends Changing Health Care. He is also founder of Enspektos, LLC, a globally respected innovation consultancy providing original research, strategy, analytics and more to health executives, organizations and others. 

Take your digital health knowledge to the next level by enrolling in a unique and free 5-part email course.  You’ll receive little-known, but vital insights, original research and analysis that’s critical to your success. Click here to learn more and enroll

The Apple Watch & Digital Health: 3 Must-Ask Questions by Fard Johnmar



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Apple's HealthKit

by System Administrator - Wednesday, 1 October 2014, 6:08 PM

Digital Health Companies Rush To Integrate With Apple's HealthKit

Zina Moukheiber | Contributor

Notwithstanding HealthKit’s aborted launch due to a software bug, digital health companies have jumped at the opportunity to integrate their products with Apple AAPL -1.56%’s HealthKit, a hub of personal health data that consumers can display in Apple’s new Health app in iOS 8. Many are betting that the tech giant has the clout and reach to make Health an indispensable tool for patients looking to engage with their doctors outside the clinic. “It’s going to be the biggest health release ever,” says Daniel Kivatinos, a founder of electronic health record provider drchrono.

It might take some time for doctors still struggling with electronic health records to widely accept the deluge of data HealthKit brings, but many companies don’t want to be caught flat-footed. Soon after Apple announced HealthKit in June, HealthLoop went to work to integrate its software. The start-up allows doctors to check in with their patients between visits, especially post surgery, to follow their progress. Patients who underwent joint replacement, for example, can now opt to share with their doctors who prescribe HealthLoop, the number of steps they took or their temperature from trackers and blue-tooth enabled devices uploaded through HealthKit.  A lack of activity or a spike in fever, can prompt a clinician to intervene. “HealthLoop is able to wrap these streams of biometric data with clinical context,” says Jordan Shlain, founder of HealthLoop and a practicing internist.

The application of biometric data in a defined clinical context, such as hypertension or diabetes, is critical in determining the success of monitoring devices with health care providers, as well as patients who are motivated to engage because of illness. “If data comes in and is not actionable, no one is going to bother,” says Michael Blum, a cardiologist at the University of California, San Francisco, and director of its Center for Digital Health Innovation, which validates tracking devices in a clinical setting.

iHealth Labs, a subsidiary of Chinese medical equipment company Andon Health, which Apple chose as a partner to pilot HealthKit, sells FDA-approved wireless blood pressure and glucose monitors, among other tracking tools. Data from blood pressure cuffs are uploaded onto mobile devices, such as the iPhone and iPad, and are currently used in clinical studies at UCSF, and the VA Medical Center in San Francisco.

iHealth’s chief marketing officer Jim Taschetta says Apple introduced the company to electronic health records vendors Epic Systems and UK-based EMIS Group, as well as Stanford University, and Duke Medicine. To test HealthKit, Duke incorporated readings from iHealth blood pressure monitors into its Epic patient portal. Epic has integrated its MyChart with HealthKit, but it is up to its customers to decide whether they want to enable sharing. Taschetta is encouraged to see a handful of health care leaders adopt HealthKit. “The odds are in our favor to see widespread adoption,” he says.

Other companies tying into HealthKit include electronic health record providers Cerner CERN -1.95%, drchrono, and athenahealth .


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Applying Automation to Healthcare

by System Administrator - Thursday, 7 August 2014, 8:50 PM

6 Big Benefits of Applying Automation to Healthcare

James Dias, Founder & CEO at Wellbe shares six big benefits that can be realized by applying automation to healthcare for overall cost reduction and efficiency.

Three out of four hospital and health systems CEOs cite overall cost reduction and efficiency as one of their top two financial priorities, HealthLeaders recently reported. With the healthcare industry continually looking to cut costs and waste and improve efficiency and throughput, automation of manual tasks can be an important part of a strategy for performance improvement.

Automation is defined as the use of control systems and information technologies to reduce the need for human work in the production of goods and services. The introduction of the assembly line at Ford Motor Company in 1913 is often cited as one of the first forms of automation. With this innovation Ford achieved a dramatic reduction in the time to produce a car from 12 hours down to 1.5 hours!

Now automation surrounds us every day in our lives, including automated teller machines (ATMs), Redbox DVD rentals, self-checkout at the grocery store, cellphone-controlled thermostats, auto park assist in vehicles, and many more routine activities managed by technology. Despite its use for years in banking, retail and other industries, healthcare has lagged behind in its use of automation. The recent pressure from healthcare reform and increased competition is driving a heightened interest to reduce costs and eliminate waste in healthcare delivery. And that has brought the adoption of automation to the spotlight.

An aging population along with more people in the healthcare system will require more care, and staffing levels in healthcare will not be able to keep up. In the July/August 2009 issue of Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s. The looming shortage of RNs demands efficiency and the elimination of redundant work and manual tasks.

John Dragovits, chief financial officer of Dallas-based Parkland Health & Hospital System, toldHealthLeaders in 2012: “If you look at an average hospital’s financial statement, 50%-60% of their expenses are salaries and benefits. By definition healthcare is an inflationary model, but it’s exacerbated by the fact that everyone wants to hire more people rather than think about how they can live with fewer people… The challenge in this industry has always been getting people excited and intrigued and rewarded for looking at things innovatively and using technology to do things quicker and cheaper.”

Once the industry transitions to population health, automation goes from a “nice to have” to a “must have.” There are not enough care providers to continuously monitor and check in with large patient populations for this new model of care. A report by the Institute for Health Technology Transformation says, “Automation makes population health management feasible, scalable and sustainable.”

Automation is often linked to a negative connotation in association with the loss of jobs in manufacturing industries. When automation and robotics were first introduced into the pharmacy, some feared it would be the end of pharmacists, with robots taking the place of human workers. However, ultimately it let them get rid of medication counting tasks that required little cognitive value, and instead let them focus on more clinically-relevant work for productive and rewarding work time.

Critics also point out that automation can’t replace doctors and nurses. And they are correct. However, automation can be blended in to their workflows to make a wide swath of care delivery processes much more efficient and to improve productivity. Patient engagement, for example, can get a big boost from automated check-ins and reminders.

Here are 6 big benefits that can be realized by applying automation to healthcare:

1. Labor Savings
Using automation to replace manually intensive tasks that are better done by machine can be a big time saver. It doesn’t have to eliminate employees, but rather elevate them into higher-functioning roles that make use of the clinical expertise they have been trained for.

2. Improved Quality and Consistency
Automation tools are not subject to human error or fatigue, so they can help provide a consistent basis of care activities. A Texas hospital study found that greater automation in the areas of medical records, order entry, and decision support appeared to result in a reduction in deaths, complications and cost.

3. Reduced Waste
Use of paper and spreadsheets and other workarounds needed for an overfull workload can lead to a lot of waste. For example, rather than playing phone tag with a discharged patient in the free minutes between hospital nursing duties, automation can help get nurses and patients connected more efficiently.

4. Increased Predictability of Outcomes
When patients follow a standardized care path supported by automation, it is more likely they will stay on track towards predicted outcomes. Additionally, automation can help detect when a patient has deviated from the recommended care plan so the care team can intervene.

5. Higher Throughput
A nurse supported by automation tools can handle a larger population of patients at one time. Instead of scaling up and down your headcount as patient volumes grow and shrink, an automated platform can scale flexibly to address groups of all sizes.

6. Data-Driven Insights
Technology used to automate processes can also deliver a wealth of data in a continuous feedback loop that can be used for performance improvement and optimization. With every cycle, automation systems can collect data on how the process is working and use that information to improve the program. This way it improves on itself over time, becoming even more efficient, more accurate and more helpful to the team’s workload.

When looking for good areas to apply automation in your healthcare environment, a standardized, repeatable process is the first thing to look for. Within hospital walls, a common procedure that is performed on a large population of patients on a routine basis, like joint replacements, is a prime area to apply automation tools. Ask yourself this question: Which program would you rather have?

Program A:

  • 3 full-time nurse navigators working the phone 10 hours a week with lots of spreadsheets to move patients through their episodes of care
  • Very little quantified feedback data
  • Patients that are highly dependent on your staff for everything in the course of their treatments and care

Program B:

  • Patients using self-service tools to manage their care from home, with alerts when they go off track
  • Two half-time nurse navigators (1 FTE) working off a risk-based, prioritized patient list
  • On-demand actionable feedback to see how your program is working in real time

Between programs A and B, automation is what makes the difference. So the next time you’re ready to tackle a new process and realize you need to hire 3 more FTEs to support it, first do a gut check and see if there’s a better way to do it through automation. 

James Dias is the Founder & CEO at Wellbe where he leads innovations program to empower people and providers with new tools to improve health. He is also the co-inventor of the Patient Guidance System.

6 Big Benefits of Applying Automation to Healthcare by Jasmine Pennic


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Are EHRs Life Savers?

by System Administrator - Thursday, 4 September 2014, 6:23 PM

Are EHRs Life Savers? Maybe So, According to Preliminary Research

by Rajiv Leventhal

Can the adoption and implementation of electronic health records (EHRs) be tied to hospital performance and lowered mortality rates? While we might be a bit of time away from being able to make that precise claim, new research does suggest a measurable beneficial relationship.

The findings were revealed by HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society (HIMSS), and Healthgrades, an online resource for comprehensive information about physicians and hospitals. The value of EHRs has long been discussed, but until now evaluations have lacked comprehensive clinical data, according to HIMSS officials.

Using HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) and mortality rate measures collected by Healthgrades across 19 unique procedure and condition based clinical cohorts, the analysis found that hospitals with advanced EHR capabilities (as reflected in high EMRAM scores) demonstrated significantly improved actual mortality rates, most notably for heart attack, respiratory failure, and small intestine surgery.

Most cohorts experienced improvement in predicted mortality rates when compared to hospitals with lower EMRAM scores. The predicted mortality rate is an indicator of the level of documentation and capture of patient risk factors that are correlated to increased risk of mortality.  In total, 4,583 facility records were selected from the HIMSS Analytics database, representing the total number of facilities with complete data from 2010 through 2012.


Collecting the Data

One such facility that participated in the study was the Charlottesville-based University of Virginia Health System, which includes a 604-bed hospital, Level I trauma center, cancer and heart centers, and primary and specialty clinics throughout central Virginia. According to UVA Health System’s CIO, Richard Skinner, who is also a board member for HIMSS Analytics, while the EMRAM model has enabled healthcare systems to see where they rank as far as EHR maturity, any kind of data that describes the impact of implementing an EHR on clinical performance has been missing until now. “The reason for this study was to describe potential benefits from the EHR, and preliminary results say there are benefits,” Skinner says.

For years, HIMSS Analytics has collected a very detailed data set from each hospital in the U.S. with the exception of some very small ones; the model has very specific criteria for which capabilities a facility needs to have for each stage (0-7) on the scale. “Every year, [HIMSS] will call someone from each hospital and ask them to renew that data set. They ask questions such as, ‘Do you have an electronic medical administration record and do you do CPOE (computerized physician order entry)’, for example. With all of that data in hand, HIMSS can then say Hospital A is at Stage 4,” says Skinner.  Then, Healthgrades takes Centers for Medicare & Medicaid Services (CMS) data and looks at people who have died in a specific facility, and CMS’ grading of if those people in the aggregate were expected to have died given their diagnoses and so forth, Skinner says.

Early Implications

According to Skinner, to date, the study has shown that those facilities that are higher on the EMRAM (in Stages 6-7) have a better ratio of actual mortality to expected mortality than do hospitals that are lower down on the scale. But Skinner does say that a deeper dive of the data is coming, and that the analysis is very preliminary. “We don’t know why that is yet, but to date that’s what the data has showed us. And you might ask about other factors—‘Are the ones higher on the EMRAM better funded, bigger, and in urban areas?’ There are a host of factors that can come into play. But again, the preliminary data shows a correlation between mortality rate and implementation of EHRs,” says Skinner.

As of today, the study hasn’t gotten down to institutional level to see what happened at a given organization, Skinner says. “And it might not, because the power of the study is the size of the sample’ and it’s the size that enables being able to discover the correlation,” he says.”If you did it at one hospital, there would be so many other variables that statistically, you couldn’t make that association.”

At UVA Health System, Skinner says he has looked at the organization’s clinical performance indicators over time and whether they are improving or not. “For some of those indicators, it’s clear there is at least an association with having better data and having that data in front of clinical decision makers. For others, it’s hard to tell, he says. “Things like urinary tract infection (UTI rates) are getting markedly better, but is that all because of EHRs? No, but you can credit the EHR with at least being able to expose the data and communicate it effectively.”

Skinner says that the reason why such evaluations have lacked comprehensive clinical data is two-fold. First of all, the EHR is a relatively new phenomenon, as most organizations have only implemented a comprehensive EHR in the last few years, and getting it to operate effectively takes some time, he says. The second factor is that the contributing factors to an improvement in clinical performance are, even in the simplest cases, “numerous and interrelated.” So analytically, Skinner says, “It’s difficult to figure out what the most causative variable happen s to be in improvement in expected mortality, or whatever it is that you’re trying to measure. I think the message to the industry is that for hospitals with EHRs, there exists great potential to get further benefits from these tools as we mature in figuring out how to use them,” he says.


Richard Skinner

Skinner adds that he feels confident in saying there is a “statistical” correlation between advanced EHR capabilities and improved mortality rates. “But again, what part of that correlation is causative awaits further analysis of the data and is not in the preliminary report. All we can say at this point is that there is a correlation. Now, intuitively, it stands to reason that further analysis will filter out those other variables to get to the real contribution to having an EHR.”

What’s more, Skinner does say that the results so far are exactly in line with what he expected. “Of course I am a biased CIO who has a stake in this business,” he says. “But organizations that have spent billions in the aggregate to implement EHRs obviously have the same expectations. While meaningful dollars play a role in that, the entire industry has the expectation that having better information better organized in front of clinical decision makers will lead better results. This study indicates that we’re starting to see that.”

Skinner says he feels that it’s important for the industry to demonstrate this not only because of the magnitude of the investment that’s already been made, but also because there is a huge amount of work left to make truly optimal use of these tools to improve performance. “That’s the hill we are climbing as an industry,” he says.

Clearly a proponent of EHRs, Skinner says that those who criticize the technology for not providing clinicians enough value might not be accurately measuring what the “value” really is. “It may be that a specific clinician hasn’t found much value to him or her, but that doesn’t mean his or her use of the EHR hasn’t proved value to the patient, to the institution as a whole, or to other parts of the institution,” he says.

Skinner notes that the case is easier to make at the organizational level than it is than it is at the individual physician level. “Providers do have a point in that they are being asked to do more and put their hands on a tool they never had to worry about. So there’s no question they have acquired added burdens. But the real question is, ‘Has the institution and its patients gotten sufficient benefit to justify that extra burden?’”


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Are providers failing to connect with consumers?

by System Administrator - Sunday, 13 September 2015, 5:49 PM

Are providers failing to connect with consumers?

by John Sharp

While patient engagement is both incentivized by Meaningful Use and touted as a solution for Accountable Care Organizations, both look to patient portals as the primary tool for patient engagement. However, patient portals vary in the features they offer, their usability and mobility. Some portals have been criticized for simply replicating features that the physicians view in the EHR. This would include lab results, prescriptions and future appointments. Without any context, these features may lack utility for most patients. For instance, is it clear that a lab result is abnormal, and if so, what does it mean – urgent action, repeat the test, see a specialist?


Second, usability may be lacking. For instance, the patient portal may require a complex process for signing up. Or once logged in, the interface is confusing to use. For instance, I am looking for my list of prescriptions and a way to request a refill. Is there a clear link to a list of current medications, or does it list all medications I have been prescribed in the past? Is the list alphabetical or by prescription date or sortable? Does the list tell me what condition or symptom the prescription was written for? 

Third, consumers expect mobility in their healthcare. Mobile apps are so pervasive, for a patient portal not to be mobile-enabled seems outdated. Along with a portal becoming a mobile app are assumptions about usability and security. What if the busy parent wants to schedule a vaccination for her child while at a soccer game? Why should this function not be available on a smartphone? Securing the data viewed on a mobile device is also assumed by consumers despite many well-publicized data breaches. Then there are those that do not have smartphones but may use texting on a regular basis. Is this an option for communicating with a provider? 

Kyra Bobinet, MD, has some helpful approaches on how providers can make consumer engagement a priority: She and other patient engagement experts will share their approaches at the HIMSS Media Patient Engagement Summit on Oct. 12-13 in San Diego. Join in on the conversation and learning at the second Patient Engagement Summit: 

How do you think patient engagement technologies can be better designed and utilized to improve health?


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by System Administrator - Tuesday, 10 March 2015, 12:26 AM


Hospitals and healthcare providers are united under one central mission: to provide exceptional care to patients while keeping costs down. Increasingly, that’s being accomplished through technology, and healthcare providers are becoming incredibly dependent on IT for their day-to-day operations.


Take applications such as electronic health record (EHR) systems. They were rare several years ago but they’re now the lifeblood in this industry and are being used by 78% of doctors, according to the National Center for Health Statistics. Doctors depend on those applications to access and share patient data in critical and often life-and-death situations.

On top of EHRs, healthcare providers are using other clinical tools, such as computerized order systems and electronic prescribing systems. Practice management and billing and coding software make sure the business side of the operation is running smoothly.

That technology brings a lot of benefits, but it also adds risk. Systems sometimes go down, and it’s happening more often as complexity rises due to cloud computing, mobile devices, growing data volumes, and other factors.

That creates a lot ofscary consequencesfor healthcare organizations, especially when it meanslosing accessto their mission-critical applications. Clinical apps help make sure the right treatments are delivered at the right time and that doctors have the information they need to make the best possible decisionsfor patients. Loss of access can get in the way of those important goals.

Application downtime can have a serious impact from a business perspective, as well. Across all industries, unplanned data center outages cost businesses $7,900 for every minute they lasted, according to a 2013 study from the Ponemon Institute and Emerson Network Power. That was up significantly from $5,600 per minute in 2010. The costs stem largely from lost business and productivity, as well as detection and recovery efforts.

In today’s data-driven landscape, even smaller performance hiccups can have a big impact on the organization’s efficiency and end users’ ability to get their jobs done. Often, the costs of lagging performance can’t even be quantified because IT doesn’t know it’s a problem.


Please read the attached whitepaper.

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As FHIR Matures, Healthcare Interoperability Comes into Focus

by System Administrator - Wednesday, 12 April 2017, 2:28 PM

Como FHIR Madura, la Interoperabilidad en Salud Entra en el Foco

As FHIR Matures, Healthcare Interoperability Comes into Focus

por Jennifer Bresnick

"FHIR is an opportunity to take data into places that we never thought possible," says HL7 CEO Charles Jaffe, but only if developers can keep on the right side of the hype.

The Fast Healthcare Interoperability Resource, better known as FHIR, has quickly seared itself into the consciousness of the health IT industry, becoming one of the most promising methodologies for open, seamless data exchange.

In just a few short years, the internet-based interoperability standard has popped up on IT developers' must-have list, capturing the attention of everyone from first-time startups to some of the heaviest hitters in the electronic health record community.

While every industry has more failed standards than successes, and only time will tell if this go-around will be any different, the excitement around FHIR seems justly deserved.

FHIR is one of the first efforts that is offering a new path forward firmly backed by both the private and public sectors without regulatory coercion. And it's one of the first approaches that truly aligns with the way technology in other sectors has been developing.

At the HL7 FHIR Value-Based Care Summit this week in Chicago, that excitement was palpable.

FHIR is making the leap from a developer-centric technical framework to one that empowers real-world implementers, said HL7 International CEO Charles Jaffe, MD, PhD, turning healthcare big data into "the change vehicle it has always promised to be."

"This is where the real change happens," he said. "Carequality and Commonwell have committed to developing a FHIR-based platform. In Silicon Valley, in the public space, and all around the world, there are companies that have committed significant investments to this."

"This is an opportunity to take data into places that we never thought possible."

What Healthcare IT Users Don't Really Need to Know About FHIR

It may be tempting to dismiss a room full of FHIR evangelists as little more than a factory for meaningless hype, but the enthusiasm was strongly tempered with a recognition that FHIR is still evolving, and will continue to do so for the foreseeable future.

"Release 3 is an important milestone that will enable a host of functionalities that weren't present in previous iterations," said Jaffe. "But like all standards, it isn't going to be useful if it doesn't change. FHIR will be evolutionary as the world of analytics blossoms."

The world of big data analytics is blooming more quickly than many healthcare providers can cope with. Big data is now a fact of life, and the ability to move information back and forth wherever it needs to go has become a clinical and financial imperative.

However, "the need for data has outpaced the industry's ability to deliver it," said Mike Baillie, Vice President of Optum Data eXchange at OptumInsight.

"We want to get to the point where we can connect once and then use that data many times," he said. "We're not there yet. If we're going to do that, we need to get the incentives in the right places, and we need to combine the assets of multiple players – that means payers, providers, and developers working together to improve this fragmented data landscape we're dealing with."

Data siloes aren't a new problem, but they aren't an intractable one, either. And they might not be the only thing going wrong with interoperability, says Shahid Shah, Entrepreneur in Residence at the AHIP Innovation Lab.

"There is no interoperability crisis," said Shah, who is also Co-founder and CEO of Netspective Communications. "There are plenty of people supplying interoperability services. The real crisis is that we're not managing and coordinating the demand for interoperability with the huge amount of available supply."

Can Application Programming Interfaces Inspire a Better EHR?

When end-users, including providers, patients, and researchers, don't have access to the data they need to make better decisions, they end up on the wrong end of the "information asymmetry" equation, said Shah.

"In the payer-provider, pharma-payer, or patient-provider relationship, there are some people who have more data than others," he explained. "When you have data inequalities, the party in power can charge more money for the things the other players don't know."

"FHIR can be a way to reduce information asymmetry. It's the developer's job to make sure that whatever they're doing with FHIR ends up balancing that unequal data access situation. You have to match development to real, existing, applicable use cases if you want to get tangible value out of your efforts."

The widespread emphasis on tying FHIR to real-world uses is one reason why the standard has thus far avoided the trap of getting too carried away by its own early successes.

"Never embark on a use case before figuring out how it's going to bring dollars back into the system or measurably improve clinical outcomes," Shah warned.

"If you have a solid business case, then you know that your management is going to have a reason to invest. The business case can highlight the priority of doing this, and that's how you grow adoption."

Why Health Data Interoperability is Setting EHR Vendors on FHIR

If FHIR can stay anchored in its utility to the ultimate end user – the patient – then every stakeholder along the way can benefit from adopting FHIR-based tools, added Baillie.

"The value-based care movement is putting some big dollars on the line for organizations that are taking on risk," he said. "There is a lot of money attached to the ability to understand data and use it to raise the quality of care."

"Small improvements can snowball into major financial gains, but we won't get there unless we figure out how to build the pipelines that can serve up patient data when and where it's needed, with all the right protections in place."

FHIR's maturity doesn't just show itself in the number of public releases or how long it has been at the forefront of the industry's thoughts. It is becoming mature because of the recognition that is perennially unfinished, which highlights both its limitless potential and the unending need to commit to making it work.

"There's a real opportunity to have these worlds come together," said Baillie. "One of the things that the payer industry has learned when trying to use claims data for value-based care is that straight and narrow data pathways just aren't going to cut it. Risk sharing requires that more people access the data, and that means we need to develop new ways to share information so that we're all speaking the same language."

"We all want to take those lessons and make something good out of them. FHIR is one way that we can do that."

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Bajar la presión arterial, ¿hay un límite?

by System Administrator - Saturday, 30 August 2014, 9:24 PM
Mortalidad y nefropatía terminal 

Bajar la presión arterial, ¿hay un límite?

El tratamiento de la hipertensión disminuye la morbimortalidad, pero aún no está definido cuál es la presión óptima que se debe alcanzar. La PAS superior o inferior a 130 - 139 mm Hg y la PAD superior o inferior a 60 - 79 mm Hg se asocian con peor evolución en pacientes hipertensos que reciben tratamiento.
Autor: Sim JJ, Shi J, Kovesdy CP et al Fuente: Journal of the American College of Cardiology vol. 6 4, no. 6, 2 0 1 4 Impact of Achieved Blood Pressures on Mortality Risk and End-Stage Renal Disease Among a Large, Diverse Hypertension Population
Fuente: IntraMed | Traducción y resumen objetivo: Dr. Ricardo Ferreira


A medida que el tratamiento y la normalización de la hipertensión arterial (HTA) continúan mejorando, los debates se centraron sobre la presión más apropiada en pacientes hipertensos tratados, específicamente en relación con el grado de intensidad con que se debe tratar su presión arterial (PA).

Se supone que hay una relación lineal entre la PA y el riesgo vascular y de mortalidad. Las PA más bajas en todos los grupos etarios se asociaron con los mayores beneficios de morbilidad y supervivencia. Estas observaciones llevaron a la conclusión de que el descenso de la PA a lo largo de ese eje lineal generará la disminución proporcional del riesgo.

La percepción es similar para el riesgo de insuficiencia renal. Se demostraron reducciones del riesgo significativas en estudios intervencionistas que lograron el descenso de la PA en pacientes con HTA grave. Sin embargo, no se han mostrado beneficios con el descenso tensional intensivo que, incluso, puede ser contraproducente. En poblaciones de alto riesgo, como aquéllas con diabetes mellitus (DM) y nefropatía crónica, las intervenciones para disminuir la PA por debajo de los niveles deseados habituales no demostraron mejoras en los resultados.

En realidad, el descenso intensivo se asoció con peores resultados, lo que sugiere una curva en forma de J. Esta curva no lineal es similar a la observada en otros factores de riesgo cardiovascular. De manera que para la población general con HTA, la relación entre el tratamiento de la HTA y la evolución del paciente no está bien definida.

Los autores estudiaron una población que recibía tratamiento médico para la HTA a fin de evaluar la PA lograda y el riesgo ulterior de mortalidad y de nefropatía terminal (NPT). 


Se efectuó un estudio de cohortes retrospectivo en pacientes del sistema de salud Kaiser Permanente Southern California, (KPSC) entre enero de 2006 y diciembre de 2010. Este sistema se compone de 14 centros médicos y más de 200 consultorios médicos. La población que se atiende es de gran diversidad étnica y socioeconómica.

Se estudió a pacientes hipertensos tratados mayores de 18 años.

Tratamiento de la HTA en Kaiser Permanente. Desde 2005, KPSC dispone de un algoritmo simplificado para el tratamiento de la HTA. La mayoría de los médicos de la institución siguen este algoritmo. Durante el período del estudio, las tasas de descenso de la HTA en la población del KPSC fueron del 65% al 80%.

Criterios de valoración. El criterio principal de valoración fue una combinación de mortalidad o NPT. 
Los criterios secundarios fueron la NPT y la mortalidad por separado como riesgos que compiten y, en los análisis estratificados de aquéllos con diabetes o sin ella, la edad < 70 o ≥ 70 años y las puntuaciones CCI (Índice de comorbilidades de Charlson).

Se emplearon los modelos de regresión de riesgos proporcionales de Cox para evaluar los riesgos (índices de riesgo) para mortalidad y NPT entre diferentes clases de PA con estratificación para diabetes mellitus y ancianidad o sin ella.

Los valores de 130 - 139 y 80 - 89 mm Hg se emplearon como referencia para la PA sistólica (PAS) y la PA diastólica (PAD), respectivamente.


Se estudiaron 398.419 pacientes hipertensos que recibían tratamiento. La PA media fue 131/73 mm Hg con desvíos estándar para la PAS (11 mm Hg) y la PAD (8 mm Hg), respectivamente.

En los pacientes que murieron, la PAS media disminuyó 7 mm Hg durante los 60 días previos a la muerte (124 vs. 131 mm Hg [p < 0,01]). Las diferencias en la PAD no fueron tan pronunciadas, con  disminución de 3 mm Hg (70 mm Hg antes y 67 mm Hg dentro de los 60 días de la mortalidad [p < 0,01]).

Se consideró que el 83% de la población con HTA había normalizado su PA (< 140 mm Hg) durante el período de observación. Se dispuso de información sobre el índice de masa corporal (IMC) en el 99% de la cohorte del estudio y se consideró obeso al 43% de los participantes.

La frecuencia de enfermedades concomitantes (comorbilidades) fue la siguiente: DM 30%; cardiopatía isquémica 19% y enfermedad cerebrovascular 8%. La media de la creatininemia y de la filtración glomerular estimada (FGe) fue 1,0 mg/dl and 74 ml/min/1,73 m2, respectivamente. En total, el 24% de la población tuvo una FGe inferior a 60 ml/min/1,73 m2.

Los medicamentos administrados fueron en general los de las recomendaciones del KPSC: diuréticos (80%), inhibidores de la enzima convertidora de angiotensina (70%), beta-bloqueantes (44%) y bloqueantes de los canales de calcio (37%).

Los grupos con PAS más baja y más alta tuvieron las mayores tasas de mortalidad

Tasas de mortalidad o NPT. Un total de 28919 personas (el 7,3%) en la cohorte alcanzaron el criterio de valoración compuesto de mortalidad o NPT. La media y la mediana de seguimiento fueron de 4,0 y 4,5 años, respectivamente.

Los grupos con PAS más baja y más alta tuvieron las mayores tasas de mortalidad/NPT (22,9% y 15,7%).

Si se toman los criterios de valoración por separado, se produjo mortalidad en 25182 (6,3%) y NPT en 4957 pacientes (1,2%). Las tasas de mortalidad también fueron mayores en los grupos de PAS más baja y más alta. Las tasas de NPT parecieron aumentar con las PAS más altas (6,9% de los pacientes ≥ 170 mm Hg). En cambio, no pareció haber un aumento desproporcionado de la NPT en los grupos con la PAS más baja (3,4% de los pacientes < 110 mm Hg).

Análisis estratificados. Los índices de riesgo (IR) para mortalidad/NPT en pacientes con DM, en relación con pacientes no diabéticos se desplazaron a las PA más bajas y tuvieron mejor evolución. Las PA más bajas en pacientes con DM fueron 131 y 69 mm Hg para la PAS y la PAD, respectivamente, mientras que en los pacientes no diabéticos fueron de 142 y 73 mm Hg.

Cuando se evaluó sólo la mortalidad, los pacientes no diabéticos tuvieron mayor supervivencia en los extremos superiores de PA que la subpoblación diabética. Para los análisis de la NPT sola, las personas con DM, en relación con los pacientes no diabéticos, tuvieron mejor evolución en los extremos inferiores de PA. Sin embargo, las personas con DM evolucionaron peor con la PA más alta que aquéllos sin DM.

Edad. Las PA más bajas estimadas para mortalidad/ NPT en personas  ≥ 70 años fueron 140 y 70 mm Hg para la PAS y la PAD, respectivamente, mientras que en pacientes más jóvenes las PA más bajas fueron 133 y 76 mm Hg. Para el riesgo de NPT sola, el grupo < 70 años evolucionó mejor con valores más bajos de PA en relación con aquéllos de ≥ 70 años, pero fueron más susceptibles con la PA más alta.

Enfermedad cardiovascular previa. Las interacciones entre cardiopatía isquémica y PA fueron significativas para la mortalidad (p < 0,001) y la combinación de mortalidad/ NPT (p < 0,001). Las interacciones entre enfermedad cerebrovascular y PA fueron significativas sólo para mortalidad/ NPT ESRD (p = 0,02). Se efectuaron IR para los criterios de valoración mortalidad/ NPT en aquéllos con cardiopatía isquémica previa y sin ella y también en aquéllos con enfermedad cerebrovascular y sin ella. En relación con los pacientes sin enfermedad cardiovascular y PAS 130 - 139 mm Hg, los IR para mortalidad/ NPT fueron:

    • en los pacientes con cardiopatía isquémica previa: 4,19, 2,21, 1,43, 1,36, 2,03, 3,73, 4,38y 7,69; 
    • en los pacientes con enfermedad cerebrovascular previa: 6,18, 2,33, 1,63, 1,44, 2,06, 2,74, 4,05 y 4,77 para PAS <110, 110 - 119, 120 - 129, 130 - 139, 140 - 149, 150 - 159, 160 – 169 y >169 mm Hg, respectivamente.

Nefropatía crónica. Cada disminución de 10 ml/min/1,73 m2 en la FGe se asoció con un IR de mortalidad/ NPT de 1,08 (IC del 95%: 1,07 – 1,09).

¿Cuál es el nivel óptimo de presión arterial?



Este estudio de observación de una cohorte grande y diversa de personas con HTA tratada médicamente demuestra que la PA lograda tanto en los límites superiores como en los inferiores se asocia con aumento del riesgo de mortalidad y de NPT.

Se observó una curva en U para el criterio de valoración compuesto de mortalidad/ NPT con PAS >139 y <130 mm Hg. Hubo aumentos graduales del riesgo en ambas direcciones. Las PAD < 60 y > 79 mm Hg también tuvieron mayor riesgo. Las PA más bajas asociadas con los mejores resultados fueron 137 mm Hg para la PAS y 71 mm Hg para la PAD. Las PAS y el riesgo de NPT solo mostraron una curva un poco en forma de J con menor riesgo con PAS de 110 - 139 mm Hg.

La población del estudio incluyó gran cantidad de pacientes diabéticos y de pacientes ≥ 70 años. Los análisis estratificados, tanto en la población con DM como en la de ≥70 años demostraron una curva de riesgo en U. En este estudio, los pacientes con DM tuvieron mejor evolución con PA más baja que los no diabéticos, pero su PAS óptima siguió en la gama de 130 - 139 mm Hg.

Históricamente la PA más baja se asoció con mejor supervivencia de la enfermedad vascular y con menor mortalidad. Estudios intervencionistas que lograron el descenso de la PA en poblaciones con HTA extrema demostraron mejoría significativa de la morbimortalidad en pacientes tanto con DM como sin ella. Esto generó iniciativas para aumentar la conciencia sobre la HTA y la implementación de estrategias para su descenso. Se hizo hincapié en que cuanto más baja la presión mejor sería la evolución del paciente. Esto no necesariamente se aplica a la población con HTA que recibe tratamiento.

La PA ideal en la población hipertensa no ha sido estudiada satisfactoriamente. Si bien la hipertensión es perjudicial, los beneficios del tratamiento se mostraron sobre todo cuando se logró una PAS >130 mm Hg. El tratamiento intensivo de la HTA para lograr presiones muy bajas puede tener consecuencias negativas. Varios estudios sugirieron peores resultados con el tratamiento para lograr un PA relativamente más baja, mientras que otros sugirieron que quizás no haya beneficios demostrados del tratamiento de los pacientes con HTA leve salvo que tengan evidencia de daño orgánico. Las recomendaciones recientes de 2014 basadas en la evidencia para el tratamiento de la HTA sugieren PA y umbral para el tratamiento más altos en los pacientes con DM, nefropatía crónica y edad ≥60 años. 

Limitaciones del estudio. La PA lograda quizás no necesariamente refleje la PA que se deseaba con el tratamiento, sino que puede representar un biomarcador para una población más enferma. Un ejemplo de esta limitación es la frecuencia desproporcionada de cardiopatía isquémica a través de todos los valores de PA.

Las interacciones estudiadas entre la cardiopatía isquémica y la PA demostraron significación, lo que denota que la enfermedad cardiovascular prexistente puede afectar el IR. Sin embargo, en análisis separados de las poblaciones con enfermedad cardiovascular y sin ella, el IR a través de todos los valores de la PA continuó demostrando una curva en U.

La obesidad también fue muy frecuente en la población estudiada: el 43% tuvo un IMC ≥30 kg/m2. Esta cohorte también demostró una paradoja de la obesidad similar a la mencionada en el pasado en otras poblaciones de alto riesgo. La obesidad tuvo efecto protector y los que eran obesos tuvieron un IR de mortalidad/NPT de 0,85 (IC del 95%: 0,83 – 0,88).

Debido a que la PA disminuye hacia el final de la vida, la PA media durante el período de observación puede tener efectos de confusión, ya que quizás refleje los procesos que conducen a la NPT o a la muerte más que la PA actual tratada.

Otro factor de confusión es el efecto del tratamiento medicamentoso sobre la evolución. Las diferentes clases de medicamentos y la cantidad de los mismos pueden tener efectos pleiotrópicos además del efecto hipotensor. 
El sesgo de los médicos puede haber sido otra limitación, ya que los pacientes que ellos identificaron como más enfermos quizás hayan sido vistos con mayor frecuencia y tratados de manera más intensiva. 
A pesar de estas limitaciones, las fortalezas de este estudio son la gran población con HTA, con diversidad étnica y gran número de pacientes diabéticos y ancianos.


Los autores hallaron que los pacientes hipertensos tratados, con PAS de 130 - 139 mm Hg y PAD de 60 - 79 mm Hg son los que tuvieron el riesgo más bajo de sufrir el criterio de valoración compuesto de mortalidad y NPT. Los pacientes con PA superior o inferior tuvieron mayor riesgode sufrir estos parámetros.

Mientras que las recomendaciones de los EEUU hacen hincapié en los límites superiores de los objetivos terapéuticos, es necesario tener en cuenta los posibles riesgos del tratamiento excesivo. Tanto el aumento como la suspensión de los medicamentos pueden ser apropiados para tener resultados óptimos en la población con HTA.


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Best Free Apps to Recommend to Patients

by System Administrator - Tuesday, 14 October 2014, 11:36 AM

Best Free Apps to Recommend to Patients

By Keith L. Martin

Alive ECG
• iTunes
• Google Play

Pill Reminder
• Google Play

iHealth BPM
• iTunes

• iTunes
• Google Play

• iTunes
• Google Play

Lose It!
• iTunes
• Google Play

• iTunes
• Google Play


• Google Play

Fit Brains Trainer
• iTunes
• Google Play

To view the slides in PDF format, click here.


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Best Practices for Managing Archive Migrations

by System Administrator - Friday, 15 August 2014, 7:25 PM


This white paper discusses a variety of challenges around migrating legacy archives and also offers a selection of choices and recommendations for improving the archive migration process.

Please read the attached whitepaper.

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Best Practices in Revenue Cycle: Preparing for Value-Based Care with Analytics

by System Administrator - Wednesday, 23 September 2015, 4:18 PM

Best Practices in Revenue Cycle: Preparing for Value-Based Care with Analytics

The purpose of this guide is to shine a light on the current hospital revenue cycle management trends that have made an impact already and those that will play a role in the years to come. Hospitals and practices that are aware of these trends have a better chance of success by remaining ahead of the competition.

This guide comprises important insights from industry insiders and subject matter experts with ample experience navigating the healthcare revenue cycle efficiently and effectively.

Please read the attached whitepaper.

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Better Data Means Better Quality Healthcare

by System Administrator - Sunday, 5 July 2015, 8:09 PM

Infographic: Better Data Means Better Quality Healthcare


Envision a future where everyone has access to affordable, personalized quality healthcare through sophisticated sensing technologies that put you in charge of your own health. Where sensors and devices recognize and measure your personal health information, provide insights and recommendations relevant to you and communicate that information to your physician.

The following infographic highlights the aim of the Nokia Sensing XChallenge: a whole new level of personalized, digital health information.

The Nokia Sensing XCHALLENGE is a $2.25 million global competition to accelerate the availability of hardware sensors and software sensing technology that individuals use to access, understand, and improve their health and well-being. Innovation in sensing is an important component to creating a means for appealing, usable, smarter digital health solutions.


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Beyond Games: Why VR Will Soon Be Vitally Important to Healthcare

by System Administrator - Monday, 24 August 2015, 10:56 PM

Beyond Games: Why VR Will Soon Be Vitally Important to Healthcare

By Michael Aratow

Virtual reality (VR) is the new [old] buzzword [again], capturing the imagination of a new generation of early adopters, technologists and gamers. With its early roots in the 1950s simulation community, there have been decades of research, dedicated journals and conferences that have built a substantial VR knowledge base.

You can imagine how the current VR hype cycle must appear like a true déjà vu event for many VR veterans. But what’s different this time is that the technology is now within reach of the consumer…and almost out of reach of motion sickness.

And, there is a new benefactor: the gaming and entertainment market. The majority of recently created VR content is, therefore, made solely for the user’s enjoyment. However, though the global entertainment and media market is substantial (~$2 trillion), VR applications in other sectors are poised to have a much larger impact on our daily lives.

Consider the healthcare sector, which is a target rich environment for VR. Due to the variety and complexity of operational workflows in the medical field—only to be surpassed by the variety and complexity of human pathology—there are several opportunities for VR to create a significant impact: Education, simulation, diagnosis, treatment and behavior modification are major entry points.

Physical Therapy in Immersive Virtual Worlds

Physical therapy can be challenging, uncomfortable and boring. Compliance rates for home regimens can be extremely poor. Virtual reality will help enliven the process. My company, VRecover, is developing engaging, gamified, immersive environments with accurate motion tracking to help physical therapy patients keep up with treatment regimens and improve outcomes.

Much research has been conducted using motion capture devices to record a patient’s movements and map those movements onto a virtual avatar displayed on large screen monitors. Compared to traditional physical therapy, results have shown significant promise using this technique in patients with stroke, Parkinson’s disease and musculoskeletal injuries—but much less research has been performed in these settings using immersive VR with head-mounted displays (HMDs).

VRecover is betting that full immersion with presence will have an even more dramatic and beneficial effect on their recovery and become a critical modality for use by physical therapists.

Understanding Disease: A VR Experience Is Worth a Million Words

Patients have a varying understanding of their disease processes, and it is well known that after an encounter with a provider, patients can forget more than half of what they were discussing. While a picture is worth a thousand words, an immersive VR experience is worth a million.

Using immersive experiences to visualize their disease, patients can gain a significantly better understanding of the illness, allowing them to feel more empowered and therefore more willing to follow through with their treatment.

Understanding their condition is also critical for “informed consent.”

The process of educating a patient to the details of a treatment or procedure and its risks, benefits and alternatives, is required by law in all 50 states. It has been recognized as a critical and highly effective patient safety practice by the Agency for Healthcare Research and Quality and the National Quality Forum, both highly respected organizations which are influential in healthcare policy and practices.

Patients who are properly informed are more satisfied and willing to work with providers and less likely to file a malpractice claim. Informed consent is taken to a new level when the patient can actually see a simulated surgical procedure using 3D visualizations of their body from CT, MRI or PET scans.  When it is your body that you are looking at, rather than an impersonal 3D rendering or animation, you pay attention to every visual detail and hear every word of explanation. This is personalized medicine for imaging!

Again, the immersive experience is worth a million words—or the equivalent of a really long informed consent session!

Making Guided Imagery With VR

Guided imagery is a technique that can be used in many aspects of medicine, including medical conditions such as hypertension, treatments such as chemotherapy and radiation therapy for cancer, and psychological conditions such as anxiety and chronic pain. This technique directs a patient to imagine images that can promote healing and well being.  

The experience is obviously user dependent, with individuals realizing different levels of effectiveness based on their ability to concentrate on the visualization task. VR can not only accelerate the training for this mental exercise, but the experience now becomes more vivid, with content that can not only be personalized for the patient’s unique medical condition, but dynamically changed based on feedback.

Learning Anatomy With a Guided 3D Tour of the Body

Human anatomy is not an easy subject to master. Organic shapes arranged in complex and unintuitive configurations are difficult to comprehend, especially for those who have a hard time thinking in 3D.

Students won’t have to mentally struggle so much to reconstruct the spatial relationships of internal human anatomy in their mind using immersive VR.

Now, they will be able to view these relationships by freely moving to anywhere inside a virtual body and viewing from any angle. This will benefit not only the future surgeons of the world, but all providers, who will have better diagnostic and procedural competency through their improved understanding.

Surgeons Can Better Explore, Plan, and Practice Operations

No two people are alike, inside or out. Regardless of the experience of a surgeon, anatomic variability can at times be an interesting anomaly or a potential cause of complications.

The ability to understand an individual’s unique anatomic configuration from skin to bone can be a significant benefit to a surgeon, especially prior to a complex operation. Immersive VR will enable surgeons to explore their patient’s virtual body—reconstructed from their CT or MRI data—and plan or even practice difficult surgeries prior to the actual procedure.

This will lead to better outcomes through fewer complications, optimized surgical approaches and shorter operating times.

Powerful Ideas Finally Made Viable

While these use cases have been proposed or attempted in the past, they have been difficult to operationalize. But now with consumer access to quality VR, they can become viable solutions.

It is an exciting time to be involved in the VR renaissance. With almost monthly advances in displays, input devices, the software production pipeline or delivery platforms (VR can even be experienced through a web browser...check out WebVR)—there is much to learn and build upon the path blazed by the VR pioneers of the past. VR is not likely to return to the technology hibernation cave again!

Michael Aratow is CEO and co-Founder of VRecover, Chief Medical Information Officer at San Mateo Medical Center in San Mateo, CA, Board Certified in Emergency Medicine and Clinical Informatics and still practices Emergency Medicine.  He also is an angel investor and sits on the Board of two digital health startups and the Web3D Consortium, a nonprofit trade organization that maintains an open, royalty free, ISO ratified 3D standard for the web. 

To get updates on Future of Virtual Reality posts, sign up here.


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Big Data in Healthcare: The Five Most Enticing Insights

by System Administrator - Monday, 31 August 2015, 1:18 PM

Big Data in Healthcare: The Five Most Enticing Insights

With a tangled web of disparate legacy systems, significant site-by-site customization, and growing regulatory scrutiny, healthcare organizations face unenviable data challenges. However, along with challenge comes opportunity. A recent study focused on analytics in the healthcare space highlighted some of the performance implications of delivering timely insights to key decision makers.

Please read the attached PDF.

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Big Data: The Godzilla of Healthcare

by System Administrator - Thursday, 7 August 2014, 4:13 PM

Big Data: The Godzilla of Healthcare


by Jenn Riggle

If you grew up watching Creature Double Feature movies, you know that Godzilla is a giant dinosaur-like monster that destroys Japan (and most recently San Francisco), and battles other monstrous creatures like Mothra and Destoroyah. In the early movies, Godzilla was the villain, but in the later movies he became a giant, albeit destructive, anti-hero. By the same token, big data can be a hero and save the day, or it can be a big, scary monster.

In its most basic form, big data is digital health information that comes from a variety of sources, including electronic health records, clinical trials, insurance claims, mobile apps like Fitbit and social media, where people post information about their health issues.

The power of big data is indisputable, but is it a force for good or evil?

Healthcare Hero?

A recent PwC study reported that 95 percent of healthcare CEOs said they were exploring better ways to harness and manage big data. Why are they so committed to exploring new ways to do this?

Experts predict that big data could improve everything from the drug-discovery process to predictions about patients' disease risks. In fact, a McKinsey and Co. report estimated that big data could help reduce U.S. healthcare expenses by as much as $450 billion.

Here are some ways big data can transform healthcare:

  • Population health: Big data could allow physicians to study larger populations and analyze the data to cost-effectively implement treatment changes quickly to improve people's lives.
  • Preventive care: Carolinas HealthCare System, an integrated delivery network with 900 service locations in North Carolina and South Carolina, purchased consumer spending data to analyze purchases and anticipate patients' future healthcare needs. For example, if a patient buys a lot of alcohol or eats a lot of fast food, he or she could be at a risk for depression or diabetes.
  • Reduce healthcare costs: The July issue of Health Affairsidentified six ways that big data can help reduce healthcare costs, including improving treatment for high-cost patients; reducing readmissions; improving patient triage; treating patients with deteriorating health conditions; decreasing adverse events; and treating people with diseases that affect multiple systems.
  • Organ transplant matching: Hospitals can also use big data to find matching organ donors. Economic professors developed an algorithm to find organs for previously incompatible pairs that takes into account blood type, antibody information of the candidate and the antigen information of the donor. A Carnegie Mellon professor created an advanced algorithm to create a kidney exchange network featuring donor chains. The result: people can get the organs they need to lead healthy lives.

Scary Monster?

However, even with these promising outcomes, big data is still a giant, destructive monster. The problem facing big data is that no one has answered two very important questions:

  • What is the right way to collect this information?
  • Who should be allowed access to this data?


Federal Trade Commissioner Julie Brill expressed concernsabout the way smartphone apps and mobile devices are collecting health information and sharing it with third parties. In addition, a recent FTC study reported that health app developers have collected consumer health data and shared it with third-parties, including marketers.

The fact that mobile companies share people's health data with third-parties, without notifying people, raises some major legal and ethical concerns. There aren't any accepted standards for how patients agree to have their information used and shared.

One terrifying scenario would be if this data is collected and shared with the wrong people. Imagine if the number of steps people walk a day, the number of hours they sleep per night, their blood pressure scores and whether they buy alcohol on a regular basis is shared with insurance companies. Independently, these facts might not mean anything, but together, they might indicate that people are at higher risk for diabetes or heart disease and insurance companies could raise their insurance rates.

There are also concerns about whether the data used in predictive analysis is clean. While the data from the patient’s medical record may be accurate, the data from external sources may not be. Combining data from different sources could impact the accuracy of the conclusions and ultimately, lead to prescribing the wrong treatment.

Time will tell whether big data will save the day or destroy the world. But either way, the healthcare landscape will change dramatically. Let's just hope we won't have giant monsters battling in U.S. cities, smashing buildings, squashing cars and making a giant mess of things. Healthcare reform is one thing, but giant monsters that breathe radioactive steam is something completely different.

Jenn Riggle is a vice president at Weber Shandwick Worldwide based in Washington, District of Columbia and member of its healthcare practice.


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Bill Gates: The next outbreak? We’re not ready

by System Administrator - Friday, 3 April 2015, 5:51 PM

Bill Gates: The next outbreak? We’re not ready

In 2014, the world avoided a horrific global outbreak of Ebola, thanks to thousands of selfless health workers -- plus, frankly, thanks to some very good luck. In hindsight, we know what we should have done better. So, now's the time, Bill Gates suggests, to put all our good ideas into practice, from scenario planning to vaccine research to health worker training. As he says, "There's no need to panic ... but we need to get going."



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Biotechnology Accessible to All

by System Administrator - Friday, 28 November 2014, 9:37 PM

Two Crowdfunded Machines Make Biotechnology Accessible to All


“I predict that the domestication of biotechnology will dominate our lives during the next fifty years at least as much as the domestication of computers has dominated our lives during the previous fifty years.”

Freeman Dyson wrote these words in a piece called “Our Biotech Future” in The New York Times Book Reviewin 2007. By ‘domestication’, he means, quite literally, getting the tools and technology traditionally reserved for high-tech labs and universities “into the hands of housewives and children.”

Seven years later, we have a thriving group of scientists, entrepreneurs, and enthusiastic amateurs bringing us technology to do just that.

A recent Kickstarter campaign called Open qPCR offers a sleek touch screen PCR thermocycler, with a price tag of $1500 (most commercial PCR machines cost upwards of $20,000). The machine not only copies DNA but also converts it to easily understandable data, made by the same team who brought us the original OpenPCR, which was successfully funded in 2010.

Open qPCR is a real-time diagnostic tool able to detect foodborne contaminants like E. coli and Listeria and help track the spread of infections like HIV, malaria and Ebola. It offers a web interface for visually designing experiments, powerful functionality for experimentation, and presents clear positive/negative results to end user. It’s accessible enough that a tech-savvy mother can determine if the tomatoes from the store are truly GMO free or whether her dog truly is true bred.

With under a week to go, the campaign has tripled it’s original goal of $50k and new stretch goals have been announced to help in the fight against Ebola.

A concurrently running Kickstarter, called OpenTrons, offers a $2000 “liquid-handling” robot which automates manual micropipetting work, accounting for much of the tedious and error-prone human labor necessary to carry out an experiment.

OpenTrons allows users to design protocols in software called MixBio, a modular drag and drop interface, and to run the experiment on OpenTrons, which handles the micropipetting work. The software allows you to receive feedback on your protocols from the community, rapidly increasing innovation, collaboration, and progress.

The campaign is down to it’s last few days, but recently hit it’s $100k goal.

Truth is, biohacking is harder and way less glamorous than it sounds. So far, scientists and researchers who don’t have access to high cost robotic equipment to automate these processes spend most of their time moving tiny amounts of liquid around by hand. True progress takes a very long time when you’re running experiments manually and in the vacuum of an isolated lab.

This is precisely what makes OpenTrons and Open qPCR powerful – not only are they are accessible and affordable but they both offer software which makes data analysis and collaboration much easier.

As Dyson stated in his essay, building the tools necessary to carry out valuable scientific experiments while making them widely available and user friendly is the next step towards the domestication of biotech. But he also asked whether the domestication of biotechnology could be and ought to be stopped?

Projects like OpenTrons and Open qPCR make it hard to argue the fact that we are indeed moving swiftly into an age of domesticated biotechnology. In fact, the movement is a diverse decentralized global network. Stanford recently opened up a state-of-the-art bioengineering building on their campus and teenagers from Brooklyn to Paris are taking ‘biohacking’ classes for fun.

There’s no ‘off’ switch to hit to shut momentum like this down, but there’s also no compelling reason to do so as the potential value greatly outweighs the risk.

Ellen Jorgensen makes a good case for this point in her TED talk, saying “[The United Nations] concluded the power of this technology for positive was much greater than the risk for negative, and they even looked specifically at the DIYbio community, and they noted, not surprisingly, that the press had a tendency to consistently overestimate our capabilities and underestimate our ethics.”

In terms of regulation, so far, the community is doing a solid job imposing limits and regulating itself. Jorgensen goes on to say that the global community got together in 2011 and wrote out a common code of ethics, adding “that’s a lot more than conventional science has done.” Of course, this process of setting and regulating limitations will evolve over time, and will be adopted into legislation eventually, but for the time-being it’s happening in a very self-driven, organic way. Groups like Jorgensen’s GenSpace in Brooklyn are working directly with the FBI to educate law-enforcement officials on the work and culture of the movement and identify potentially dangerous situations.

Today, we’ve not even begun to imagine the possible value this technology can bring once in the home of individuals.

Thomas Watson of IBM now-famously said, “I think there is a world market for maybe five computers” in 1943. Of course, the thing he called a computer took up an entire room. We don’t yet know what the personal computer version of biotech and synthetic biology is yet, but we can guess that OpenqPCR and OpenTrons are the forefathers of whatever it turns out to be.

The hope is that coming generations build the beautifully vibrant future that Dyson imagines, where designing genomes becomes a new personal art, as creative as painting or sculpture, and “a new generation of artists will be writing genomes as fluently as Blake and Byron wrote verses.”

[image credit: pipettes courtesy of Shutterstock]

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by System Administrator - Tuesday, 25 November 2014, 10:21 PM


Doctors, like the healthcare organizations they work with, are under increasing pressure to do more with less. One of these pressures applies to time – the need to do more in the same amount of time. Here are three strategies to help your clinicians achieve time savings by increasing communication workflow efficiencies.

Please download the attached whitepaper.

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Boost patient experience at first point of contact: The call center

by System Administrator - Friday, 29 August 2014, 9:42 PM

Boost patient experience at first point of contact: The call center


by Andrea J. Simon

I recently worked with a hospital improve its cancer program. It had wonderful doctors and an up-to-date facility. Nurses were very patient-focused and the staff smiled a lot. What could be better?

Yet new patient volumes were sluggish and growth elusive. The hospital found the highly competitive local market very challenging, especially because differentiation--a meaningful point of difference--was pretty much non-existent. In truth, the area hospitals were all pretty much the same. How could it compete? Most of the ideas focused on the patient experience inside the hospital.

So instead, we decided to see what it was like as an outsider trying to find out more about the hospital options if we were diagnosed with cancer. We began our inquiry, with observational research and shopping the experience. We called hospitals in the region, as well as some nationally recognized leaders in cancer care, hoping to learn something of value.

We contacted 20 hospitals and quickly realized something was clearly missing: The basics of a good (let alone great) customer experience. I invite you to call your own call center and see how it presents your excellent services to your consumer.

The typical call experience went something like this:

  • After waiting multiple rings, an operator finally answered the call. We said: "My father has just had a positive diagnosis for prostate (or lung) cancer and we are evaluating his options. Could you please connect me with someone who could tell me more about how you treat prostate cancer?"
  • The responses:
    "What is the name of the patient?"
    (us) "No, my father is not at (name of hospital). I would like to learn more about your hospital's cancer services and how you would evaluate his prostate cancer."
    "What is his doctor's name?"
    (us) "He doesn't see one of your doctors."
    "Where did he get his diagnosis? He should go back there."
    Hang up!
  • We got passed along to another call center for oncology physicians and had to go through its prompts, none of which would connect us to anyone who could answer questions.
  • They referred us to their website.
  • They referred us to surgery department, which then referred us to a surgeon's office, but we had to call the office back directly at another number.

We experienced 18 of these types of encounters.

Then we called Cancer Treatment Centers of America, Dana Farber Cancer Institute, Johns Hopkins Medicine and Massachusetts General Hospital. While each was different, they at least had an approach to cancer inquiries and cancer care that demonstrated they might actually care about a caller requesting information.

Of these national brands, Cancer Treatment Centers of America, was clearly in another space. The operator was immediately engaged, showed empathy towards me and expressed concern for my "father." She knew whom to connect me with--their cancer advocate, who introduced herself, expressed her concern for my father and explained how the Centers deliver care for cancer patients. Their well-thought-out call center process was all about making both the patient and the family feel important, cared about and listened to. The process was also easy to understand and made sense.

What startled us, was the sorry state of the rest of the call centers. The basic caring of the other healthcare organizations was totally missing in action at the first point of contact. Any effort to understand the needs of a cancer patient at that crucial point was back in the dark ages. The operators, supposedly, are there to answer a call in three rings and direct the caller to where he/she needs to go. For us, we would have been happy if they had, at the very least, answered the phone in less than 10 rings and greeted us with kindness.

True, most calls to a hospital's central number are from people wanting to be connected to a patient, seeking a physician or looking for an administrative department--billing or admissions. We clearly threw them a curve ball asking for information about their cancer protocols. But was that enough of an excuse not to:

    1. Answer the call promptly?
    2. Reflect the brand of the hospital in their voice?
    3. Utilize their communication skills?
    4. Demonstrate a willingness to try and find a solution to our inquiry?

Which led us to wonder: Why? With all the innovative work going on these days to respond to healthcare reform, almost everyone, it seems, forgets the telephone center--a necessary evil.

From our perspective, the call center seems an easy point of differentiation. How can a healthcare institution make a person's overall experience satisfyingly patient-focused and person-centered if they can’t even answer the phones well? And conversely, if they could create an amazing experience at that first touch point, maybe they could do the same throughout the entire patient and family experience.

Overwhelmingly, this whole experience felt like a time to pause and focus on the basics. While not innovative or sexy, the call center is essential. It must reflect well on you and add value to your organization, not dysfunction.

Remember: you don't get a second chance to make a first impression. Your call center is the first contact someone has with you. You certainly don't want to go to a hospital that cannot even get the phones answered satisfactorily nor provide an operator who can genuinely engage with you with emotion and empathy. It may seem small, but really, it is huge. And healthcare organizations better start paying attention, soon.

Andrea J. Simon, Ph.D., is a former marketing, branding and culture change senior vice president at Hurley Medical Center in Flint, Michigan. She also is president and CEO of Simon Associates Management Consultants.


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BPM for Dummies

by System Administrator - Friday, 12 September 2014, 4:17 PM

BPM for Dummies

Hace unos cuantos años nadie había oído hablar de Business Process Management (BPM), pero ha irrumpido en la escena global hasta convertirse en la tendencia de gestión empresarial y tecnológica más popular de la década. Si se encuentra en alguna empresa o sector industrial, ya sea público o privado, es casi seguro que habrá oído hablar del movimiento hacia el proceso, o de cuestiones como gestión de procesos o mejora de los procesos. Puede que sepa acerca de métodos de mejora de los procesos como Six Sigma o acerca de nuevas tecnologías como Business Activity Monitoring (BAM), supervisión de la actividad de negocio, o Service-Oriented Architecture (SOA), la arquitectura orientada a servicios. BPM representa la culminación de la experiencia, pensamiento y desarrollo profesional de todo un colectivo en la gestión empresarial durante las pasadas décadas. Coloca al cliente en primer lugar. Se centra en el negocio. Faculta a los individuos de cualquier rincón de una empresa para alcanzar un mayor éxito. Reúne a personas y sistemas. BPM es donde se condensan todas las elevadas ambiciones y mejores estrategias. Junte todo esto y obtendrá una mezcla que puede parecerle bastante confusa. Pero en realidad, BPM es un concepto muy sencillo. Es un conjunto de métodos, herramientas y tecnologías utilizados para diseñar, representar, analizar y controlar procesos de negocio operacionales; un enfoque centrado en los procesos para mejorar el rendimiento que combina las tecnologías de la información con metodologías de proceso y gobierno.

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Breakthrough Technologies in Surgery

by System Administrator - Sunday, 24 August 2014, 2:14 PM

Breakthroughs Technologies in Surgery

Dr. Catherine Mohr, VP of Medical Research at Intuitive Surgical, speaking about breakthrough technologies in surgery.

View Catherine Mohr’s full talk here.


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Building smarter wearables for healthcare - Part 1

by System Administrator - Friday, 8 January 2016, 3:55 PM

Building smarter wearables for healthcare, Part 1: Examining how healthcare can benefit from wearables and cognitive computing

by Robi Sen

In this article, I examine the current trends in wearable computing in healthcare. Also, I explore the gaps between what can be done with current hardware offerings and their analytic capabilities. You'll learn how cognitive computing platforms like Watson can accelerate time to market for wearable device makers and also how Watson can fill the gap between the potential of wearables and their current rather weak offerings.

Wearables and healthcare

One of the hottest trends among hardware developers is the development of small wearable sensors, orwearables, specifically for collecting health and lifestyle data. This trend includes everything from simple devices such as the Fitbit to more sophisticated Lab-on-a-Chip devices that measure everything from blood sugar and hormone levels to complex proteins.

Unfortunately, most of these devices generate data that is underutilized. Either the user cannot derive anything but simple metrics from the devices, such as step count, or the data to is just not accessible to users. This underutilization often occurs because many hardware developers cannot afford to develop either the big data capabilities that are needed to manage all that data or the analytic capabilities that are needed to derive useful information from the wearables.

Services like the IBM Watson API, however, provide developers with the ability to offer valuable information to their users who use wearables, without having to build their own PaaS offerings. With the help of Watson, developers can create solutions that combine and compare data, find patterns and look for trends in that data, and even learn about the patients who are using the wearables.

For this article, I define wearables as a device with central processing capability and sensors that are designed to provide services to the user with the least amount of user interaction as possible for a specific task or need. So, while a smartphone can be worn on your arm as a wearable fitness sensor, it's not designed to do that. So it requires a lot of interaction to do tasks such as downloading an application, enabling the application, and then strapping the setup to your arm in an often cumbersome manner. As such, a smartphone can be worn, but it is not a wearable. A good example is something like a Fitbit device, which is designed to help a user track their steps or activity with the idea of promoting healthy behaviors. Keeping this definition in mind, wearables offer a plethora of potential capabilities within healthcare if the information and data created by these devices can be turned into actionable intelligence and insights.


The analytics gap

The Mi Band, Fitbit, and other wearables can collect a lot of data on a user. However, data such as how many steps you take in a day, no matter the frequency or accuracy, has little actual correlation between fitness and health without being able to contextualize that data. By contextualizing we mean comparing your activity to your age, sex, weight, and overall health. For example, if you're 20 years old and in good health, taking 700 steps a day is not particularly active for your demographic. But, if you're 80 and recovering from knee surgery, it's an impressive amount of activity. Most activity sensors in wearables are not useful: the accelerometers and magnetometers are not accurate, they can't differentiate between activity like walking or strength training, and they are often terrible at counting calories. Yet, with enough computational power and data, you can make data from something like these wearables far more relevant as a personal health and fitness monitoring tool.

Taking advantage of Watson APIs

IBM's Watson offers developers of wearables a sophisticated super computer and cognitive computational system as a service. This service allows savvy developers to rapidly design and develop applications that can fuse data that a user provides on weight, diet, health, and much more. For example, data can be collected from your activity sensors and potentially from other data sources, such as sleep monitors, glucose monitors, an Internet connected scale, and even your electronic medical records. Watson APIs can even help intelligently fuse this data together, but more importantly, they can derive meaningful information from your data. For example, a Fitbit offers data visualization like that shown in Figure 1, which isn't that useful.

Figure 1. Example of the sort of visual analytics from Fitbit


Fusing data from wearables with personal health data

To make data from wearables more useful, you need to not only analyze a user's data from their wearable, but also fuse it with their personal health data. You can contextualize this fused data further with similar data from other individuals with similar metrics, thus providing you with a meaningful statistical analysis.

For example, in Figure 2 you can see an example of Watson combining a patient's wearable data with their electronic medical records and then comparing it to patients with similar criteria. In this case, the goal is to get a sense of the patient's risk of heart disease by following the Framingham Criteria, which is a methodology that is used by physicians to evaluate the risk of cardiac failure. Read the full paper, "Interactive Intervention Analysis," presented by David Gotz and Krist Wongsuphasawat at the American Medical Informatics Association Annual Symposium in 2012. (SeeResources for more information.)

Figure 2. An example of Watson-generated visualization of patient data compared to similar patients. This image is excerpted from this report: "Interactive Intervention Analysis." by David Gotz and Krist Wongsuphasawat. American Medical Informatics Association Annual Symposium (AMIA), Chicago, IL (2012).


Because Watson has an open design as a platform with simple RESTful APIs, developers can pull data from popular sensors and from sites that store a user's DNA analysis. They can access sites where the user enters their diet information, or their medical records, and even get data from the National Institute of Health's updated data sets. Comparing that data based on what times users are active, the type of their activity, where they live, and changes in their weight, opens the door to more advanced statistical analysis beyond simple regression.

Developers can create applications that help users understand their basic wellness and diagnose medical problems. These apps can also potentially predict future medical problems based on early indicators of illness. The apps might even recommend that they see a specialist and have specific tests done based on the analysis. Policy makers and public health officials might also benefit from apps like this, since the apps might recognize disease outbreaks and even potential spikes in illness, before a major problem arises. Cognitive computing platforms, like Watson, can help developers bridge the analytic gap and allow wearables to move from simple devices that collect simple data, to potentially revolutionary platforms for understanding fitness and overall wellness.

The "Quantified Self" movement and cognitive computing

Wearables have in large part been driven by the Quantified Self movement, which focuses on individuals who use technology to monitor their own self to have a greater understanding of their personal health and well-being. Unfortunately, few users have been able to truly benefit from current hardware tools and software offerings due to the previously mentioned analytical gap. This gap caused the Quantified Self movement to be almost completely dominated by a small group of highly technical individuals who have the resources and abilities to extract useful personal information from their wearables. Tools need to be able to help users who are not trained data scientists or physicians to find outliers and trends that are specific to their individual health. Users also need tools that can understand or "learn" about themselves, and guide them to their health and fitness goals.

Currently, a platform like this isn't available to users, partly because it requires a level of intelligence that is hard to develop into software tools. However, IBM Watson is a cognitive computing platform that offers the foundations to help create this new breed of tools. For example, the Question and Answer service coupled with the Text to Speech and Natural Language services can enable individuals to manage, explore, and better understand their own well-being without having to have a sophisticated understanding of statistics, biology, physiology, and technology. With Watson, you can create cognitive applications for wearables that would truly transform the Quantified Self movement into something from a domain of the technology elite to a major fitness and health movement for the masses.

Wearables and cognitive computing applications will help deliver on two key benefits of the Quantified Self movement: patient-centered care and a more efficient and effective healthcare system.

Patient-centered care

Information about your health and wellness from even the most sophisticated of computer platforms cannot replace dedicated physicians or healthcare specialists anytime soon. Wearable developers need to consider how their devices and associated software platforms can help individuals engage with their healthcare providers to develop a more open and collaborative form of healthcare, which is commonly referred to as patient-centered care.

In patient-centered care, healthcare providers collaborate with patients to help them make not just informed choices, but choices that are best for their particular circumstance and situation. With this new model of collaborative care, developers of healthcare wearables can provide a critical role by making their devices and tools securely accessible to a patient's healthcare providers in formats that healthcare providers regularly use. Furthermore, wearable developers can create interfaces and services that are specifically designed to allow both patient and physician to explore the patient's data, and drill down into it. These services might provide the main user an important tool for monitoring their health. Also, they might provide their caregivers a method to more efficiently monitor their patients' health and collaborate with their patients and other caregivers.

In this patient-centered environment, patients might come in and sit down with their healthcare providers and talk to them about their issues. Then, along with their physician, they might review their medical records alongside of their wearable's data. The system might summarize the patients' medical records along with recent data, pointing out potential outliers to the physician that might require greater analysis. The physician might then walk through those outliers with their patient, calling up past medical tests or records. The physician might even compare recent wearable data to past data to help patients understand the physician's analysis or prognosis.

Even more exciting, wearable platform developers might add predictive modeling capabilities for the physician to show their patient likely outcomes of various treatments, therapies, or regimens. For example, a physician might have the system show a patient the outcome of what a modest exercise and diet change would have on their health, based on their specific medical case and aggregates of other medical cases like them. Wearable devices might help healthcare providers make better decisions faster, allowing them to provide better service for more patients.

A more efficient and effective healthcare system

Currently, the medical community is overwhelmed by both patients and data. Many physicians are spending only 15-30 minutes with new patients, where they must rapidly assess their medical history, often provided orally, and make a diagnosis. The result, according to some studies, is 12 million misdiagnoses a year just in the United States. This issue is exacerbated by poor medical records and often low fidelity and low frequency lab tests that are often not even digitized, resulting in physicians often making informed guesses. Wearable devices and cognitive applications might fundamentally change how physicians diagnose patients, by providing better quality analytics, by helping recommend treatments, and also by providing higher quality and very high frequency data.

With this cognitive computing solution, physicians might review patient records, tapping into sensor data streams to get clearer views of what's really going on with a patient. And, the physician would benefit greatly from the analytic and decision support capabilities from a cognitive computing platform like Watson.

The next generation of wearable device providers might even create notifications for healthcare providers that can allow physicians to create rules to notify them when certain conditions are met. The physicians can follow up remotely by looking directly at a patient's data without having to meet with the patient at all. This enhancement would be extremely powerful, allowing healthcare providers to test various hypotheses and validate them in real time outside of a lab. This scenario is something that is currently only possible and practical under medical or scientific studies. But with wearables and cognitive computing, physicians might manage larger numbers of patients, with clearer visibility into their health, while using better data, and while reducing the potential for tragic mistakes and misdiagnosis.


In this article, we briefly looked at how cognitive computing platforms like IBM Watson can help usher in a new generation of wearables that allow developers to enable better analysis, user interaction, and patient-centered care. We have also looked at how taking advantage of wearables to mix big data, historical user data, and sensor data can be used to more accurately diagnose illness and also predict illness. Finally, we looked at how cognitive applications combined with wearable sensors can help physicians in managing their workloads, reducing misdiagnoses, and providing them with an important tool in understanding their patients' health in real time.

In the next article in this series, "Designing cognitive applications that take advantage of the Watson services," I look at how you might design a cognitive application that uses IBM Watson for wearable sensors.




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Building smarter wearables for healthcare - Part 2

by System Administrator - Friday, 8 January 2016, 4:48 PM

Building smarter wearables for healthcare, Part 2: Designing cognitive applications that take advantage of the Watson services

by Robi Sen

In this article, I explain why you want to use IBM Watson, a robust cognitive computing platform, for your wearables project. I also describe how you can integrate Watson into your wearables project.

Why Watson?

Traditionally, to build the sort of sophisticated applications that were discussed in Part 1 of this series ("Examining how healthcare can benefit from wearables and cognitive computing"), wearable developers would have to build their own machine learning and data analysis services. This task is no small feat without experienced software engineers and specialized machine learning specialists and data scientists. After they create these expert services, developers would have to develop their application and system architectures, and test them over time, to make sure that they meet the needs of their users. For these reasons, few wearable vendors have provided anything more than the most basic of tools.

IBM Watson and the Watson services available on the IBM Bluemix platform offer wearable developers numerous benefits. Some of these benefits include time to market, minimizing investment, meeting regulatory requirements, built-in security, and of course the cognitive feature set. By using the Watson APIs, you can potentially save companies several man-years of effort. More importantly, though, wearable vendors and service providers can deliver paradigm-changing capabilities without having to hire their own machine learning developers or data scientists. With Watson services, wearable developers can now focus on their sensors and their product visions without being distracted by developing the complex services and infrastructure that are required to make them truly useful.

You can mix these Watson services with your own application code and other services, including those services that are offered by IBM as part of its Bluemix platform. The Watson APIs are RESTful services, which means you can create much more complex applications or systems that are driven by them than you might able to do on your own. You can also use the parts of the Watson APIs that best complement your efforts, while you develop and build out your system that satisfies the needs of your business and application. Or, you can simply use the whole IBM ecosystem and platform within Bluemix to create your applications.

Watson Services RESTful APIs

To get a sense of how Watson services can be used within your wearable offering, you need to understand how Watson services work, how they fit into a larger developer ecosystem, and what benefits you can derive from them. Currently, Watson has a small set of APIs, which you can find in the Watson Services API catalog, that take advantage of its cognitive computing capabilities.

Currently, the Waston Services catalog includes the following services, in various release states (GA, Beta, Experimental):

  • Concept Expansion
  • Concept Insights
  • Language Identification
  • Machine Translation
  • Message Resonance
  • Natural Language Classifier
  • Personality Insights
  • Question and Answer
  • Relationship Extraction
  • Speech to Text and Text to Speech
  • Tradeoff Analytics
  • Visual Recognition
  • Visualization Rendering

Designing a wearable offering: A Watson API example

Let's examine a detailed example to more fully understand the benefits of developing wearable offerings with the Watson APIs. Figure 1 shows a diagram of an application that takes data from a wearable sensor and sends it to a smartphone. That smartphone communicates with an application that stores relevant user data and sensor data, but also pulls data from a large healthcare data set for doing statistical comparison.

Figure 1. Simple cognitive application using the Watson APIs that gathers data from wearables


In this simple example, the application uses several of the Watson services. Most notably, it uses the Question and Answer service, which helps users ask natural language questions, such as "How does my data compare others like me?" or "What does it mean to have a prolonged, high resting-heart-rate after I go for a run?" This application also uses the Watson Trade Off Analytics service, which lets users compare their diet, type of activity, weight, caloric burn, and sleeping patterns. Overtime, this comparison can help them visualize what changes to make to their daily regime.

This health app might take many months to build from scratch. For a company that already has a wearable analytic application, however, it can easily be done using the Watson RESTful APIs without making major changes to the existing application. Indeed, developers have used the Watson APIs to make similar cognitive applications in as little as 48 hours without having much more than a basic web programming and development background. For developers who create a new application or service, everything can be done in their cloud of choice, with their programming language of choice, or it can be done directly in Bluemix.

While the Watson APIs are certainly easy to use and integrate into applications, successful applications still require good up-front designs. Because the power of Watson comes from the system's ability to learn, learning from good content and feedback from users and domain experts, you need to carefully consider and decide on the data that Watson will use to learn from and to provide responses back to users.

Guiding users through your application is often key to making a successful cognitive application. Watson has powerful machine learning capabilities that are best exercised in clear information domains, by using clear queries, and that result in clear responses. For example, let's say we have a system that pulls wearable sensor data from a user and compares that data, along with their specific diet, exercise, and demographics, to national healthcare data. We then use the Watson Question and Answer API to let users ask the system a variety of specific health and fitness questions. A good question for the Watson QA API might be "Is my blood pressure too high?" This question is a good question if we designed the application to contextualize the question. For example, if we designed a screen that shows recent blood pressure data, and the system looks at that data and compares it to aggregated data. The system then might respond that the user's blood pressure and other collected metrics are well within national trends for their specific demographics. However, the same question might be a bad question to ask the system if it was not contextualized through good application design. Another major consideration when you design applications for Watson is making sure that you have good content for the system to work with.

Data is still key

Because Watson uses machine learning to derive relationships and find relevant information, having good data that is related to your problem domain is critical to using Watson services. Watson services can pull data from a large variety of data sources, both structured and unstructured. In many cases, you need to prepare your data before you ingest it into a Watson Content Store by acquiring, cleansing, aggregating, and validating that data.

After you have selected and prepared the content that you want to use, you need to look at tuning Watson to use that data more effectively, by using Watson to enrich the data. IBM offers a set of tools that essentially focus on having a human domain expert work with Watson to help develop question and answer pairs and also to train the system on its responses. This tuning of the data helps Watson get better at finding the best response to a user's questions from its knowledge base. Watson can be further trained by its users, who can vote or rank responses by how useful they are. Watson takes this data and further tunes its responses based on all of this information. You can easily accomplish this fine-tuning of your content by ensuring that your Alpha and Beta releases of your applications allow users to respond, thereby tuning the system with real users.


In this article, I presented some reasons why you should use Watson in your wearable offering. I also explored the process of designing a Watson cognitive application.


In the next article in this series, I will look at how to start building a Watson application for a hypothetical wearable offering. I'll explain in greater detail how to integrate Watson into a real world application.


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Business Analytics and the Data Complexity Matrix

by System Administrator - Thursday, 30 March 2017, 12:09 PM

Business Analytics and the Data Complexity Matrix


Data environments are growing exponentially. IDC reports that compound annual growth in data through 2020 will be almost 50% per year. Not only is there more data, but there are more data sources. According to Ventana Research, 70% of organizations need to integrate more than 6 disparate data sources.  When considering a Business Analytics program, different approaches are better suited for each data state.

Please read the attached whitepaper.

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BYOD on the decline in healthcare organizations, survey finds

by System Administrator - Monday, 10 August 2015, 10:44 PM

BYOD on the decline in healthcare organizations, survey finds

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Can FHIR Spark Health Information Exchange, Interoperability?

by System Administrator - Wednesday, 12 April 2017, 2:05 PM

¿Puede FHIR Spark soportar el intercambio de información en salud, es decir, la interoperabilidad?

Can FHIR Spark Health Information Exchange, Interoperability?

by Jennifer Bresnick

Health information exchange in the United Sates may suffer from chronic fragmentation, data duplication, misinterpretation, ambiguity, and disunity, but there’s one thing nearly all providers can come together to agree upon: data interoperability could be much, much easier if health IT infrastructures all spoke the same language.


But deciding what language that should be, not to mention implementing it across tens of thousands of systems, has been a lengthy process fraught with difficulty.  From vendor mistrust to reluctance from providers to invest even more in their technologies without seeing measurable return, private industry and government organizations alike have stumbled time and again over bumps in the road to truly interoperable data exchange.

Enter FHIR, the Fast Healthcare Interoperability Resources standard from HL7 International that has rekindled hope of a simple, accessible way to use common internet protocols that change the way healthcare views data exchange.

While this wunderkind of the data standards world may not be the magical solution to every health information exchange problem ever identified, it has been lauded as a huge step forward for interoperability by the Office of the National Coordinator, the JASON Taskforce, and private consortiums including the CommonWell Health Alliance, and the Argonaut Project – not to mention experts such as Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and Chair of the eHI Interoperability Workgroup.

“To me, FHIR is currently the best candidate for the next step forward in health information exchange technology,” Tripathi told  “We want to move away from where we are now, which is document-based exchange. Right now, interoperability in healthcare is basically just the exchange of Consolidated Clinical Document Architecture (C-CDAs).”

“The exchange of these XML documents has a certain value, because unlike in banking, where I just need raw data, whole documents are really important in clinical care,” he continued.  “For banking, you can just tell how many dollars there are, or tell me how many units there are. Give me an account number, and I’m good to go.  I don’t need a document.  I don’t need as much context around the data in that transaction.”

But in clinical care, context is everything.  “If you just send me some lab results or a list of allergies, that’s great,” said Tripathi.  “I need those things, but you haven’t told me the story of the patient, and that’s really important for a clinician to understand.  Document exchange is important, but so is that data-level exchange.  Health information exchange based entirely on C-CDA XML documents doesn’t allow you to access information at a data level as well.”

That’s one place where the healthcare system has stalled, especially when it comes to clinical analytics and liberating big data from confines that limit its usefulness.  C-CDAs provide a tidy way to bundle all the patient information required for meaningful use, but even the ONC admits that developing a truly standardized, simplified framework for C-CDA exchange is beyond the capabilities of the EHR Incentive Programs at this time.

In its proposal for updating the 2015 Certified EHR Technology (CEHRT) criteria, the ONC explains that there are two release versions of the C-CDA, and many health IT systems cannot read one or the other.  Instead of requiring health IT module vendors to develop a single document that can be read by all systems, 2015 certified products will need to send two separate C-CDAs, one in each version, and vendors are allowed to accomplish the accompanying error tracking and data validation in any manner they choose.

Transmitting duplicate documents may get the job done, but it isn’t really what many stakeholders have in mind when they hear the word “interoperability.”  C-CDA data is not easy to extract to use for clinical analytics and taking the next step in population health management, and it’s not something the majority of providers are equipped to do.

“You can get data out of C-CDAs,” Tripathi acknowledges.  “My company does a very large business in data warehousing, where we get over 500,000 C-CDA records a month.  We parse those and deliver data-level healthcare analytics back to our customers.  You can do it. It’s just very inefficient.”

Healthcare must move beyond temporary patches and short-term fixes that enable a certain level of health information exchange, but don’t allow health IT systems access to deeper, richer analytics and integration functionalities.  FHIR is one of the protocols that present a new way of thinking about moving clinical information around.


“The next step in health information exchange is what almost every other industry has already started to do, which is developing more open APIs that allow data-level access,” states Tripathi. “These have to be based on internet conventions like the Representational State Transfer (REST), which is a much easier way to exchange information securely between two different entities.  You already use it every day.”

“When you order something on Amazon, for example, look at your browser line,” he added.  “If you’re logged in and you click on something, what you’ll see is a URL that says “https” and then this huge string of nonsense.   That’s a query-retrieve system that’s generated in your browser and sent to Amazon, and then Amazon immediately returns the results securely.  That’s essentially a single line command that can be received by all through browser technology, so I don’t need complicated interfaces.  I can do it through any internet browser I want.”

“That’s really the next step forward in healthcare.  We need to start taking that kind of approach as we think about interoperability instead of building these complicated interfaces that take too much time and too much money.”

But FHIR “isn’t a magic bullet solution,” Tripathi says, and it comes with its own set of challenges that dovetail with the ongoing, contentious debate over EHR usability.  Regardless of which protocols are functioning behind the scenes, EHRs and data analytics interfaces must be user-friendly, and must enhance the provider workflow instead of reducing productivity, sapping time, and wasting energy.

FHIR works so well because it is based on the use of discrete data elements, or resources, that are sufficiently standardized.  The resources require data to be entered into the system in an expected and specific manner.  “FHIR tells people, in fairly specific terms, that if you want this data resource to be interoperable, you’ve got to enter the information in this standardized way,” explains Tripathi.  “That means you’re left without a whole lot of options for how the data is entered by the user, but that’s a way of driving standardization.”

Drop-down menus and check boxes are an excellent way to jumpstart data standardization, but these limited input fields have long been the bane of providers complaining about poorly designed EHR interfaces and a complete lack of intuitive design among available products.  But that doesn’t mean FHIR is going to make EHR usability worse.  Instead, bringing more vendors into the FHIR community and making interoperability a standard feature may drive competition and innovation among the vendor community, which will have to distinguish themselves on something other than their ability to participate in health information exchange.

“Once you have those expectations for a particular set of things you want to do in FHIR, that’s where the EHR vendor comes in and competes with other vendors in terms of usability,” Tripathi believes.  “Some may say, ‘Well, I’m going to force the user to enter everything according to a set of pull down menus.  And I’m going to lock it all down so that they won’t enter any bad data.’”

“Others might say, ‘I’m going to allow the user some flexibility, and then underneath the covers I’ll do the mapping.  I’ll allow a user to enter an ICD-9 code for a problem and then I’ll map it behind the scenes so the user doesn’t have to worry about that.’ The vendors will figure out which is the right balance for the right users, because we have to remember that healthcare is just like any other market when it comes to segmentation.”

“There are a lot of providers who want standardized buttons and drop-down menus.  I hear them say, ‘How come my vendor hasn’t locked down the way that I do this so that the data is normalized?’  Others get tremors when they think about an interface that restricts how they enter data, and they want to have a lot of flexibility.  I think you’ll see vendors who take different approaches for different types of users, and eventually they’ll develop products that will meet enough expectations and enough needs.”



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Can Google Glass Transform Medical Education?

by System Administrator - Thursday, 7 August 2014, 6:23 PM

Can Google Glass Transform Medical Education?

Google Glass looks exciting for the medical world, and presents a particularly powerful opportunity for medical education(for examples, see Forbes article here or here). A white paper by the Department of Emergency Medicine, Singapore General Hospital says, “simulation-based training has opened up a new educational application in medicine. It can develop health professionals’ knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks”. Google Glass is taking simulation to the next level and making it more real, as the patients treated are real.

Yet the underlying concept of simulation-based-learning in medicine isn’t new. Neither are the individual components of Google Glass (such as the video recording feature and the possibility of sharing procedures online with any number of students). The biggest innovation might be having all this in one device. As Aristotle said, the whole is more than the sum of its parts.

Medical education is often a two stage process. In stage one, doctors in training need to study voluminous tomes and pass exams; stage one is the collection and storing of knowledge – perhaps too much knowledge. Richard Barker says in his book 2030, the future of medicine, that “as our bio-medical insights continue to fragment traditional diseases into multiple molecular disorders, keeping pace with advances gets tougher and tougher; … ‘head knowledge’ needs to be complemented by online decision support, distilling the wisdom and experience of the best specialist and putting it at the fingertips of the practitioner”. In other words, clinicians are starting to need real-time knowledge on tap.

Stage two focuses on learning through direct patient contact under the guidance of seniors, and Barker’s position suggests that stage two may never really end. Google Glass would support this stage of the curriculum, helping to simulate the practice of medicine, teach decision making, and then allow collaboration long after qualification. With a teacher demonstrating on patients (or that earlier revolution: a mannequin) with a headset camera, the learner is brought straight into the operating theater.

Google Glass is similar to a standard pair of glasses. It has an optical head-mounted display, sitting just above the right eye. Features include a built-in GPS, microphone and Bluetooth, and a camera which can record and live-stream videos to a Google hangout. Particularly useful is voice activation which would allow surgeons to, for example, do a web search for latest research or access EMRs or even real-time patient metrics without “breaking scrub” (compromising operating room sterility). As well as improving the provision of care, this ought to give students a more holistic understanding of each case.

Related: EHR Vendor Develops EH​R App for Google Glass to Improve Clinician-Patient Interaction

Dr. Rafael J. Grossmann, Surgeon, mHealth Innovator and Google Glass Explorer was the first to perform a Google Glass-aided surgery, including remote teaching contexts and offering clinical advice remotely via Google hang-out. Orthopaedic surgeon Dr. Selene Parekh followed with a demo of foot and ankle surgery, and then plastic surgeon Dr. Anil Shah used the device while carrying out a rhinoplasty. Recently, Medical News Today wrote about a surgeon who live-streamed a procedureusing Google Glass and a tablet device.

Grossman says that exposing students to the real life of a surgeon and their problems is critical for training and students should learn and mimic best practices early on. Furthermore, he adds that Google Glass education goes beyond the operating room, “Google Glass is a great start with practically limitless opportunities. “For example, how to connect with patients, how to teach bedside manner, how to prepare patients for surgery can all be best taught from real life examples. Google Glass records it and demonstrates best practice, from A to Z through the responsibilities of a practitioner,” he says.

Related: Is Google Glass the Future of Teletrauma? 


Plus, of course, these Google Glass recorded procedures can be shared across the globe. InnovatorArmando Iandolo, co-founder of Surgery Academy and his team have created an application for Google Glass that lets surgeons stream a heads-up view of procedures to students anywhere in the world. The big, bold innovation is to connect these streams in MOOCs (massive open online courses), says Iandolo. He and his co-founder are currently crowd-funding the idea on Indigogo. “Students will access an operating theatre online and watch a surgical intervention, live, for the procedure of their choice”, says Iandolo. “As we enter Universities, we want to become an integral part of the medical student’s study curriculum”.

MOOCs aren’t new either, but with the Surgery Academy everything seems to fall in place. By bringing the learner straight into theatre, simulation via Google Glass makes courses operate more like apprenticeships.

The patient would need to give their approval, but this is surely quite reassuring for the patient: which practitioner – and one good enough to teach – wants to screw up while being live-streamed to hundreds of students and fellow physicians?

The speed at which Google Glass eventually becomes a standard educational support tool is less certain, and we can learn from previous waves of innovation. In 2010, the Northern Ontario School of Medicine introduced a new mobile device program (medical students received laptops, iPhones and iPads). To assess its value, educators there how medical learners use mobile technologies. Their white paper concluded, “Students would adapt their use of mobile devices to the learning cultures and contexts they find themselves in.” Device value needs to be taught. It depends on how welcome new tech is perceived to be in classrooms, by students, teachers, and the wider ecosystem.

A typical fear is that, especially early in the curriculum (stage one above), medical students will miss out on basic knowledge. Search and find functions make it easier to zero in on an answer, but perhaps without the rich context and basic knowledge provided by reading cover to cover. Students – and teachers – could work just ‘for the test’.

Well, books have always had indices. It’s the process of search which has been accelerated, and there is no evidence that students would treat a digital medical textbook differently than its paperback version. In fact digital isn’t a replacement for the traditional textbook; it’s an opportunity to augment it. There is a generational shift in the learning styles of medical students, Mihir Gupta writes in aKevinMD article. Digital allows the stodgy textbook to be augmented with visual and multimedia, which will suit certain learning styles. “Innovative digital resources are vital for helping students retain knowledge and simplify difficult concepts”, says Gupta. These new resources are great for quick access to updated medical knowledge, but “it will not replace textbook learning, nor should it”.

Lucien Engelen, Director of the Radboud Reshape Center at Radboud University Medical Center, is currently working on various applications for Google Glass in medicine. He says that the only way to get Google Glass into education is “to make it part of education innovation”. He says, “Take some high profile doctors, professors and nurses and some patients and have them run some tests. All of a sudden the advantages (of Google Glass) seem to fall in place seamlessly”.

Frances Dare is Managing Director of Accenture Connected Health Services, which has partnered with Philips on a Google Glass proof of concept. She agrees with Engelen, cautioning that it is important to create an environment in which experimentation can take place and to understand the type of training needed to prepare clinicians to use Google Glass effectively and safely in practice.

But don’t bet against Google Glass. After all, educators have argued for decades over calculators in math class. Engelen says that he really doesn’t think of Google Glass as something special: it’s just another computer form-factor facing the same barriers of acceptance. It will take some time and discussion over privacy to achieve it, but the new wave is coming.

by Nick Saalfeld and Ben Heubl, Contributing Writers at HIT Consultant 


Nick Saalfeld is a corporate journalist and entrepreneur based in London, UK. He has written for seven years about health-tech for clients including Microsoft, Imprivata and He also co-founded Yoodoo, the online platform devoted to delivering behavioral change through learning experiences, with many applications in public health and clinical/pharmaceutical adherence.


Ben Heubl is a digital health advocate, activist and journalist for health 2.0 innovation.Ben Heubl is speaker at various healthcare innovation conferences and events, a TEDMED delegate, founded the non-for-profit organization Health 2.0 Copenhagen, Mentor at the HealthXL accelerator, and currently passionately writes for various online magazines in the context of digital health innovation and technology. Ben also currently supports a UK health innovation SME to change how citizens access healthcare. You can follow him on Twitter at @benheub

Can Google Glass Transform Medical Education? by Nick Saalfeld and Ben Heubl


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Can innovative solutions for mobile care meet your needs?

by System Administrator - Friday, 11 September 2015, 9:12 PM

Can innovative solutions for mobile care meet your needs?

The Visiting Nurse Association (VNA) California wanted to update their mobile technology to improve timely access to data. They had a few requirements:

  • Organizational effectiveness – mobile solutions to effectively provide secure in-home care.
  • High-quality, personalized care – for the most effective care, teams needed quick and accurate collaborations.
  • PC management and data security – their small IT support staff supports a highly mobile workforce, so any solutions would need to help manage all of their data security/compliance challenges.

Download the Case Study: Mobile Productivity for a Home Health Workforce to learn how VNA California provided their personnel greater performance flexibility and improved security with Intel®-based mobile solutions.

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Cancer Antibodies & Assays

by System Administrator - Thursday, 9 July 2015, 3:59 PM

Cancer Antibodies & Assays

Cancer research is dependent on reliable tools for interrogating and identifying the phenotypic differences between cancer cells and corresponding normal cells of the same lineage. The recent output of data from genomic, proteomic, and epigenomic studies comparing tumor and non-tumor cells points to several key traits or “hallmarks”, shared by most tumor types, that drive disease progression.

These hallmarks of cancer are important—not only because they represent opportunities for therapeutic intervention, but because they are opportunities to use tumors as models to decipher the signaling pathways underlying both normal and diseased cellular processes.

Recognizing both the tremendous opportunities and the challenges facing cancer research, Merck Millipore has been dedicated to developing and refining products for the study of cancer. With Merck Millipore’s comprehensive portfolio, including the Upstate, Chemicon, and Calbiochem brands of assay kits, reagents and antibodies, researchers can count on dependable, high quality solutions for analyzing the hallmarks of cancer.

Please read the attached whitepaper.


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Cancer Genomics Cloud Platform

by System Administrator - Saturday, 18 October 2014, 9:42 PM

Google Partners to Create Cancer Genomics Cloud Platform

The Research at Google team is partnering with the Institute for Systems Biology (ISB) and SRA International, Inc to develop a Cancer Genomics Cloud (CGC). The platform will serve as a large-scale data repository and provide the computational infrastructure necessary to carry out cancer genomics research at unprecedented scales.

The $6.5M two-year project funded by the NIH’s National Cancer Institute (NCI) will migrate data collected from the TCGA (The Cancer Genome Atlas) to Google Cloud Platform to provide easy and secure access to the large datasets. The new collaboration will accelerate large-scale genome sequencing for a faster understanding of the molecular basis of cancer. 

“The CGC will democratize access to the wealth of cancer genomics data by substantially lowering the barrier to accessing and computing over these datasets,” said Dr. Ilya Shmulevich, professor at ISB and CGC prime investigator in the press release. “Cancer researchers will be able to analyze and explore entire cohorts of rich genomic data, without needing access to a large local compute cluster. The CGC will also facilitate collaborative research by allowing scientists to work on common datasets and projects in a cloud environment.”

As part of the collaboration, ISB will manage the needs of the researchers spearheading development of apps that will provide community access to the cloud-based data and computational infrastructure. 

photo credit: glbrc.communications via cc

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by System Administrator - Tuesday, 14 October 2014, 6:39 PM



Written By: Arlington Hewes

Cancer often begins in one part of the body but spreads elsewhere via the bloodstream or lymphatic system. This spreading, called metastasis, makes the disease deadly and difficult to halt—even using chemotherapy drugs with serious side effects.

However, in a preclinical study in mice, a Stanford team may have discovered another way to slow or even stop tumors from metastasizing.

Cancer spreads when certain proteins link up on cells, causing them to break off from the tumor. The Stanford study focused on two such proteins. One protein (Axl) forms bristle-like receptors on the cell’s surface tailored to fit the other protein (Gas6).

When two Gas6 proteins interact with two Axl proteins, the cancer cells are able to drift away from the original tumor and form new tumors in other areas.

To prevent this interaction, the scientists engineered a decoy Axl protein that is as much as a hundred times as effective at binding with Gas6 as the naturally occuring version. When deployed in the blood, the decoy proteins can bind Gas6 proteins before they have a chance to interact with the Axl proteins on the cancer cells.

In a recent paper published in Nature, lead authors Jennifer Cochran, a Stanford associate professor of bioengineering, and Amato Giaccia, professor of radiation oncology, say the decoy protein significantly slowed metastasis in their study.

After testing the decoy protein in mice with breast cancer and ovarian cancer, the scientists found a 78% reduction in metastatic nodules in the breast cancer group and a 90% decrease in metastatic nodules in the ovarian cancer group.

And unlike current cancer drugs, the researchers say the decoy protein is nontoxic.

How the scientists engineered the protein is almost as fascinating as the results themselves. The team mimicked evolution—only at a vastly accelerated pace. Using advanced analytics software and lab equipment the team built and evaluated over ten million minor variants of the Axl protein to find the one that best fit Gas6.

The researchers hope their work may extend beyond Axl proteins. There are other receptors, Mer and Tyro3, that bind with Gas6 and are associated with metastasis—the decoys could further render both harmless as bound Gas6 wouldn’t interact with them.

There is, of course, a long way to go before a therapy based on the group’s findings might make its way into the mainstream. They’ll have to scale production of the protein, complete more animal tests, and eventually, do human trials.

In the meantime, however, it offers a ray of hope for a much more humane cancer treatment in the future and a fascinating glimpse into the promise of bioengineering.

Image Credit: protein courtesy of Shutterstock

This entry was posted in HealthMedicine and tagged Amato GiacciaAxl proteincancerdirected evolutionGas6 proteinJennifer Cochran,metastasisStanfordsynthetic biology.


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CDI Plan

by System Administrator - Saturday, 27 September 2014, 4:26 PM

71% of hospitals plan CDI partnerships to tackle ICD-10

Author: Jennifer Bresnick

The majority of hospitals won’t be staring down the challenges of ICD-10 clinical documentation improvement (CDI) on their own, Black Book Rankings says, but will seek consultants and service partners to help them make the necessary adjustments ahead of the new code set.  By October 1, 2015, 71% of hospitals plan to have engaged a CDI partner, and nearly 25% have done so already.

After gaining an extra year to prepare when the code set was delayed this spring, providers are finally realizing that collaboration is the key to a successful transition.  “Transitioning to ICD-10 is a complicated process and hospitals are leaning on the expertise and successes of outsourcing vendors,” says Doug Brown, Managing Partner of Black Book. “We still operate in an ICD-9 world, complicated by EHR implementations, value-based reimbursement models, compliance issues and optimizing reimbursement; a perfect storm from which outsourcers have the expertise to shield their clients.”

Eighty-eight percent of large hospitals that are already outsourcing CDI efforts have realized significant gains in revenue, the survey says, totaling over $1 million per facility.  Eighty-three percent also noted improvements to the quality of care and increases in the case mix index.  More than a quarter of hospitals that are already outsourcing their coding and CDI are considering upgrading their technology, as well, in an attempt to keep pace with physician practice acquisitions and EHR implementation efforts that have sapped time and resources from the ICD-10 transition.

Throughout the lengthy and oft-delayed transition, experts have urged providers to start with the basics: ensuring that the documentation produced by physicians contains every piece of information necessary for a coder to select the most detailed ICD-10 code available.  Physicians and coders often don’t view the same terms in the same way, which can lead to poor coding, a loss of rightful revenue, and a dip in quality metrics that don’t reflect the actual level of care being provided.


“The problem is that when physicians write in clinical terms that they understand, they assume everybody else understands those terms.  But they don’t.  We needed a bridge between clinical language and coding language, and we needed to explain to physicians that the coders cannot always interpret what they’re thinking,” said Dr. Georges Feghali Chief Medical Officer and Chief Quality Officer at TriHealth Medical, while explainingwhy his organization invested in a CDI program ahead of ICD-10.  “My doctors were looking like terrible physicians just because they weren’t documenting care the right way.”

“I’ve been doing CDI for 15 years and physicians still don’t provide all the details needed to ensure appropriate, thorough documentation,” says Mel Tully, MSN, CCDS, CDIP and Vice President of Clinical Services and Education at Nuance.  “Unless they’re being prompted and given a tool or person to help guide them, they will always document pneumonia as pneumonia.  There are many, many other ways to document it and even today, physicians still need guidance on how best to capture the specific details needed to accurately reflect the severity of the care provided.”

In the Black Book poll, Nuance Communications received the highest customer experience and client satisfaction scores among vendors of CDI and coding products or services.  Also ranking highly in the category were 3M, Optum, the Advisory Board, Navigant, Chartwise Medicla, Precyse, and DCBA.


Related White Papers:
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Chronic care management: 4 steps to implementation

by System Administrator - Monday, 9 March 2015, 3:26 AM

Chronic care management: 4 steps to implementation

 By Debra Beaulieu-Volk

Medicare's new chronic care management (CCM) program offers practices of all specialties a major opportunity to reap revenue from services they've thus far provided for free. With 1,000 qualified patients, a practice could earn an additional $511,200 per year, noted an article from Medscape.

IT concerns top the list of barriers to the programFiercePracticeManagement has reported, and some practices may also need to add to their existing infrastructure and staff to implement code 99490. Family physician Matt T. Rosenberg, M.D., of MidMichigan Health Center, for example, told Medscape he hired a full-time nonclinical manager to obtain patients' consent to be enrolled in the program, which requires a 20 percent copay. The manager also ensures that clinicians are documenting CCM activities, including going over medications or insurance issues by phone.

But while practices such as Rosenberg's are doing their best to design programs that enhance patient care, there is little guidance available to do so, noted an opinion piece published in the Journal of the American Medical Association.

"Although there has been discussion of the fiscal and operational challenges posed by the new payment, less consideration has been given to the implications of the new policy for clinicians who will wonder what is required of them and how can they do it well," wrote authors Louise Aronson, M.D.; Christopher A. Bautista, M.D.; and Kenneth Covinsky, M.D.

Thus, they recommended four-step process for doctors to approach CCM with each patient:

  1. Determine the likelihood of care coordination needs (e.g., two or more chronic conditions)
  2. Establish goals of care (e.g., current life and health priorities, treatment preferences)
  3. Assess care needs (medical, functional, psychosocial and environmental)
  4. Match resources to needs (medical, functional, psychosocial and environmental)

With all of the effort that these measures entail, providers also have to ask themselves tough questions regarding patients who refuse to sign up for the program, noted Medscape. "The decision was tough," Rosenberg said. "The best decision we came to is that if you are eligible for this program and you chose not to sign the consent, then we will no longer offer non-face-to-face interactions."


To learn more:
- read the article
- see the opinion piece (subscription required)

Related Articles:


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Ciclo de Ingresos: Watauga Orthopaedics

by System Administrator - Wednesday, 23 August 2017, 3:37 PM

Ciclo de ingresos | Estudio de caso: Watauga Orthopaedics triplica su tamaño

Watauga Orthopedics solía dedicar tres empleados a tiempo completo a confirmar la elegibilidad de seguro de los pacientes, y otro empleado era responsable de mantener un registro de las reglas cambiantes del ordenante.

El grupo médico ha triplicado su tamaño, reducido su tasa de negación y reducido la cantidad de trabajo administrativo que su personal asume, eliminando seis roles de empleados a tiempo completo y liberando personal. Para centrarse en los pacientes.

Por favor lea el PDF adjunto.


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Cloud, Big Data, Mobile and Social Drive Next Generation EMR

by System Administrator - Friday, 23 January 2015, 3:08 PM

Cloud, Big Data, Mobile and Social Drive Next Generation EMR

As healthcare providers respond to the Affordable Care Act and achieve initiatives for meaningful use of electronic medical records (EMR), growing demands for reduced costs and higher accountability are driving monumental change. Organizations are changing their business models with the objective of delivering safer patient care at a lower cost.

However, traditional IT infrastructures cannot continue to meet the demands of today’s value-based care model. More healthcare data is being generated than ever before as populations continue to age and the average life span continues to grow. To extract the most value from this large influx of patient data, healthcare providers need the tools equipped to ingest all of this structured and unstructured information.

Behold the hybrid cloud: a combination of public and private cloud options.

Private and public cloud tools enable healthcare IT to assimilate all of this patient health information driven by social, mobile and big data while remaining complaint to HIPPA and HITECH mandates on a limited IT budget.

Download these attached white papers to discover how a culmination of private and public cloud options offer the agility, security and cost-efficiency healthcare providers need to operate successfully.

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Colapso en Atención Primaria por la caída del “inservible” programa Medora

by System Administrator - Friday, 8 May 2015, 7:11 PM

La insoportable levedad centralizadora de la HCE

por Fernando A. Alonso López | Family Physician

Los programas informáticos de HCE... qué duda cabe que son un avance en el cuidado de la salud, pero sus desarrolladores ignoran la historia y están condenados a sufrirla. Internet nació como un proyecto militar de descentralización en la toma de decisiones en momentos de crisis. Posteriormente se amplio a todos los ámbitos de nuestra vida pero en el campo sanitario "alguien" olvidó la premisa de partida y se dejó atrapar por la centralización de los datos en lugar de favorecer que se compartan (era mas "fácil" pagar por grandes máquinas que pensar, y además era mas caro...). ¿No lo hacen los bancos nos decían?, olvidando la inversión económica que suponen los Centros de Proceso de Datos repartidos por todo el mundo que estos poseen y que, obviamente, la Sanidad Pública no se puede permtir ni en su décima parte. En el camino "alguien" perdió la lógica y han de ser situaciones como la presente las que le pongan en sus sitio

Colapso en Atención Primaria por la caída del “inservible” programa Medora

Los médicos salen a las puertas de los centros de salud por la imposibilidad de pasar consulta

Médicos a las puertas de los centros de Salud de Gamazo y Casa del Barco.

Profesionales a las puertas del cenytro de salud de Plaza del Ejército.

Facultativos y personal médicos a las puertas del centro de salud de Arturo Eyríes.

La atención primaria en los centros de salud de Valladolid (y otras provincias de Castilla y León) está colapsada. El cuestionado programa Medora que utilizan los facultativos para ver historiales y poder prescribir hoy se ha caído y durante toda la mañana ha hecho imposible que se pasara consulta.

La indignación entre los profesionales ha provocado que médicos, enfermeras y personal administrativo, hartos de esta situación, hayan protagonizado una improvisada protesta a las puertas de los centros de salud.

Este es el caso de los centros de Huerta del Rey, Arturo Eyríes, Gamazo y Casa del Barco, Delicias o Plaza del Ejército, así como algunos otros de Palencia.

“Cuando he llegado a la consulta esta mañana he podido entrar en el sistema, pero iba lentísimo. Se tardaban más de 15 minutos en poder prescribir. A estas horas ya no me deja ni entrar”, ha relatado a últimoCero uno de los médicos que han protagonizado la protesta sin ocultar su hartazgo e indignación.

Los problemas de operatividad del sistema Medora no son nuevos. Distintos responsables de centros de salud han trasladado a la Gerencia de Salud sus quejas por el mal funcionamiento de un sistema “que sólo parchean y nunca ha acabado de funcionar correctamente”.

El propio presidente del Colegio de Médicos de Valladolid, Antonio Otero, uno de los facultativos que hoy se ha visto afectado por la caída del sistema y que no ha podido pasar consulta ha “lamentado las deficiencias de un sistema que, pese ha haber sido denunciadas reiteradamente, no han tenido solución”. “El problema no sólo no se resuelve sino que va a peor. Hoy ya ha sido la gota que colma el vaso: directamente no funciona”, asegura Otero convencido de que el alcance de este problema sin solucionar es ya lo suficientemente grave “como para que alguno de los dirigentes sanitarios hubiera asumido sus responsabilidades”.

El descontento de los médicos con esta aplicación se remonta prácticamente a su puesta en marcha. Sin embargo, las protestas y quejas han arreciado en los últimos meses con el intento fallido de instaurar las historias clínicas únicas y, más recientemente, la inclusión en el programa de un módulo de prescripción de forma experimental en determinadas zonas de salud que nunca ha llegado a funcionar correctamente.

Ya en abril del año pasado, el propio director general de Planificación e Innovación de la Consejería de Sanidad, Rafael Sánchez, reconocía los problemas que estaba ocasionando la implantación de esta nueva versión del programa (la IV), que se une a la migración de los servidores de datos y que en esas fechas todavía no había concluido.

“Hay que entender que este es un salto tecnológico complejo y, como ocurre en la vida real, la casa está desordenada mientras duran las obras”, afirmó entonces Sánchez, tratando de restar importancia a lo que distintos médicos califican como un auténtico “calvario”.

Un calvario que hoy se ha traducido en el colapso de la atención médica de atención primaria en no pocos centros de salud de Valladolid y el resto de provincias de la Comunidad.

Respuesta de la  Gerencia Regional de Salud

La Gerencia Regional de Salud ha difundido un comunicado en el que pide "disculpas a los usuarios y a los profesionales de Sacyl por los fallos que está registrando en la mañana de hoy el programa Medora y los consiguientes trastornos que ocasiona".

"El pasado lunes se instaló una nueva versión del programa para la adaptación al proyecto de receta electrónica, y ayer, martes, funcionó con normalidad", indican como disculpa.

"Desde la Consejería de Sanidad se está trabajando intensamente para solventarlo, de manera que los profesionales puedan seguir desarrollando su actividad sin incidencias. Además, técnicos de las empresas Oracle, Tevlent y Microsoft están en estos momentos analizando la situación y tratando de lograr una solución lo antes posible", señalan, reconociendo que el problema afecta a toda la Comunidad y que aún no se ha resuelto.

Noticias relacionadas:


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Communicate Effectively with Medical Colleagues

by System Administrator - Thursday, 2 April 2015, 2:01 PM

Communicate Effectively with Medical Colleagues

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Cómo utilizar eficazmente las calificaciones de estrellas de CMS Hospital Quality

by System Administrator - Tuesday, 8 August 2017, 12:31 PM

 Fuente: Thinkstock

Cómo utilizar eficazmente las calificaciones de estrellas de CMS Hospital Quality

por Por Sara Heath | Traducido automáticamente con Google, contiene errores

Los hospitales pueden aprovechar las calificaciones de estrellas de calidad de hospital de CMS para mejorar la calidad de la instalación al mirar qué elementos son valiosos para los pacientes y las familias.

Hace casi un año, CMS dio a conocer su actualización de la satisfacción de los pacientes y la calidad de la hospital estrella calificaciones. Primero desplegado en 2014, esta escala de cinco puntos se estableció para ser una herramienta de cara al paciente para ayudar a los consumidores de la salud a tomar decisiones sobre dónde recibir atención.

Aunque las calificaciones de las estrellas - que parecen clasificaciones en sitios web minoristas o revisiones de películas - son una métrica sencilla para que los pacientes entiendan, la metodología utilizada para calcular las calificaciones fue cualquier cosa menos.

CMS utiliza 64 medidas de calidad - cualquier cosa desde reingresos de 30 días hasta el entorno hospitalario - y los reduce a un modelo simple de cinco estrellas. CMS seleccionó el modelo de cinco estrellas porque era fácil para los pacientes y los miembros de su familia para entender, dijo el anterior subdirector de la CMS para la innovación y la calidad y CMO Patrick Conway, MD.

"Puede ser abrumador cuando los consumidores se enfrentan a tener que elegir un proveedor de atención médica, como un hospital, asilo de ancianos, o médico", escribió Conway en un blog2014 "Los proveedores difieren en la seguridad y calidad de la atención que prestan, y tener calificaciones de calidad disponibles para comparar los proveedores puede ayudar a los consumidores a tomar decisiones más informadas sobre el cuidado de la salud".

Aunque la agencia se enfrentó a pushback cuando las calificaciones de estrellas debutaron en 2014, CMS consideró las calificaciones lo suficientemente valiosas para un relanzamiento en el verano de 2016.

LEER MÁS: Cómo los hospitales pueden aumentar la satisfacción del paciente, calificaciones CAHPS 

Esas actualizadas medidas de calificación de estrellas enfrentaron un nivel similar de controversia en su lanzamiento el 27 de julio de 2016.

"Estamos más decepcionados de que CMS avanzó con la liberación de sus calificaciones de estrellas, que claramente no están listos para el prime time", escribió la American Hospital Association en un comunicado en ese momento. "Como está escrito, no cumplen con los principios que la AHA ha adoptado para las tarjetas de calificación de calidad y sistemas de calificación".

Desde ese lanzamiento inicial, CMS siguió publicando revisiones de cinco estrellas para diferentes tipos de instalaciones médicas - agencias de atención médica en el hogar, hogares de ancianos, clínicas de salud rurales y numerosas otras clínicas.


Sarah Thomas condujo la investigación en las calificaciones de la estrella de la calidad del hospital de CMS. Fuente: Deloitte

Ahora, la consultora de salud Deloitte  publicó un informe  explorando la eficacia de estas calificaciones de estrellas, cómo los hospitales pueden recibir con éxito una revisión positiva, y si estas calificaciones de estrellas son una representación exacta de la calidad del hospital.

"Toda la literatura dice que la industria necesita hacer este tipo de cosas, integrando la satisfacción y la calidad en un conjunto de medidas para que sea sencillo", dijo Sarah Thomas, Directora General de Deloitte para el Centro de Soluciones de Salud.

LEER MÁS: Cómo las calificaciones de las estrellas del hospital de CMS impactan la satisfacción del paciente 

Es importante que CMS continúe ofreciendo retratos digestibles de la calidad del hospital y la experiencia del paciente, dijo Thomas en una entrevista con  PatientEngagementHIT.comAl hacerlo, la agencia apoya a los pacientes de todos los niveles de alfabetización en salud en la toma de decisiones sobre su propio tratamiento.

Sin embargo, hay algunas advertencias. La calidad es multifacética e incluye aspectos aparentemente interminables.

Aunque CMS ha empleado una metodología sólida para calcular sus calificaciones de estrellas, la agencia tuvo que tomar decisiones acerca de dónde atribuir el valor, y que no puede ser totalmente reflejo de las preferencias de cada paciente.

Depende de las organizaciones de salud determinar dónde impulsar los proyectos de mejora de la calidad. Thomas sugirió mirar donde tanto la CMS como los pacientes pesan la calidad. Esto idealmente dará una alta calificación de estrellas y conducir una mayor cuota de mercado de los pacientes.

CMS pesa diferentes categorías medidas más fuertemente que otros, según el informe de Deloitte. Las medidas de resultado, o aquellas que están vinculadas a los resultados físicos al final de un encuentro de cuidado, tienen más peso en una clasificación de estrellas que las medidas de proceso.

LEER MÁS: Los defensores de los pacientes defienden las calificaciones de las clasificaciones de estrellas de CMS Hospital 

"No es una mala cosa que CMS ha puesto más peso en esas medidas, porque son de hecho lo que muchos consumidores dicen que les importa, así como lo que los médicos dicen que les importa", explicó Thomas. "Muchos consumidores y muchos defensores de los  consumidores valoran los resultados  más que los procesos y ciertamente valoran la experiencia del consumidor".

Sin embargo, el éxito en la conducción de la calidad del hospital y la experiencia del paciente no se trata sólo de puntuar bien en las áreas CMS determinado valioso. También se trata de entender dónde los pacientes quieren que sus hospitales funcionen bien. Cuando un hospital puede medir lo que valora su población de pacientes, los líderes de mejora de la calidad pueden seleccionar sus medidas prioritarias.

"Hay muchas medidas aquí y es difícil trabajar en todos los frentes todo el tiempo", aconsejó Thomas. "Los hospitales deben estar pensando en su propia mezcla de pacientes. Los resultados y la experiencia del consumidor son importantes para todos, pero los hospitales también quieren echar un vistazo a donde están bajos en todas las medidas y luego pensar en su población de pacientes ".

Las encuestas internas son un excelente lugar para comenzar, dijo Thomas. La mayoría de los hospitales están emitiendo cuestionarios de pacientes y encuestas relacionadas con la calidad.

Hay numerosas herramientas diferentes atendidas para este propósito, pero los hospitales también deben ser conscientes de los elementos de atención de calidad que sus pacientes no ven sobre una base de primera mano.

"Hay mucho que un paciente puede decir que es importante para sus resultados, pero hay algunas cosas que los pacientes podrían no ser conscientes de que también son importantes", señaló Thomas.

Por ejemplo, las medidas de la tasa de infección pueden no saltar inmediatamente como valiosas para los pacientes, dijo Thomas. Aunque ningún paciente desea activamente una  infección adquirida en el hospital , es posible que los pacientes no entiendan cómo esta métrica representa una atención de calidad.

Thomas recomendó centrarse en una combinación de medidas que los pacientes identifican en las encuestas internas, así como las que son vitales para los resultados de la población específica atendida.

Además, Thomas sugirió buscar otros modelos de mejora de la calidad y de atención basada en el valor en los que el hospital está involucrado.

"Si los hospitales están involucrados en iniciativas basadas en el valor de la atención, tales como [organizaciones de cuidado responsable], tal vez deseen concentrarse en las medidas que están tanto en el programa ACO como en el programa de calificación en estrella", aconsejó Thomas. "Entonces se obtiene doble bang para su inversión en la mejora de la calidad."

La investigación de Deloitte también indicó algunas áreas de mejora para CMS con respecto a los cálculos de calificación de estrellas. Aunque el sistema ciertamente no puede ser "jugado", hay vacíos en la medición que beneficia a algunos hospitales más que a otros, explicó Thomas.

Por ejemplo, algunos hospitales más pequeños simplemente no tienen los datos para someter para ciertas medidas, que al final les beneficia. Sin la presentación de datos, estos hospitales no corren ningún riesgo de bajar su puntuación. Los hospitales más grandes que tienen datos en estas áreas pueden recibir indebidamente puntuaciones más bajas que sus contrapartes hospitalarias más pequeñas.

"Recomendamos a CMS que echen un vistazo a este sistema y piensen en otras estrategias que podrían hacer para tener en cuenta ese problema", dijo Thomas.

Y aunque Thomas declaró que las clasificaciones familiares de cinco estrellas hacen las cosas fáciles para los pacientes, ella señaló que hay una subpoblación de pacientes que pueden estar interesados ​​en la granular hospitales visión de la calidad. En el futuro, puede ser útil que estas ideas estén abiertamente disponibles además de las calificaciones de cinco estrellas.

"También es útil para los consumidores que tienen el grado de interés en el compromiso con la información de calificaciones de calidad para ser capaces de cavar", concluyó Thomas. "En un mundo perfecto, los consumidores podrían profundizar por debajo de las calificaciones de cinco estrellas para ver las medidas que más les importan, pero también creo que muchas personas quieren tomar una decisión muy rápida sobre la calidad del hospital".

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Convergence of Big Data and EHR Infographic

by System Administrator - Saturday, 2 August 2014, 12:10 AM



“In the next 10 years, data science and software will do more for medicine than all of the biological sciences together,” said venture capitalist Vinod Khosla. Data science holds great promise for patient health, but patient data is only actionable in so far as it is digital. This is where Electronic Health Records (EHRs) come in. By 2019, the majority of physicians will have adopted a basic EHR system, and with good reason, too. EHRs may reduce outpatient care costs by 3 percent.

The convergence of big data and EHR infographic created by UC Berkeley School of Information explores the how the growing relationship between health data and EHR adoption is transforming healthcare. 

Continue reading

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Conversaciones sobre eSalud

by System Administrator - Wednesday, 10 September 2014, 8:38 PM

Diálogos virtuales sobre presente y el futuro de las TIC y la Salud en las Américas


La Organización de la Salud / Organización Panamericana de la Mundial de la Salud (OPS / OMS) publicó la primera versión en castellano de una nueva publicación llamada “Conversaciones de eSalud”. La versión en Inglés de este eBook estará disponible muy pronto.

La obra consolida la visión de distintos profesionales que trabajan en el campo de la esalud quienes durante  varios encuentros intercambiaron intercambiar ideas, debatieron y reflexionaron sobre el presente y futuro de la utilización y aplicación de las tecnologías de información y comunicación en salud pública en las Américas.

La publicación de las “Conversaciones de eSalud”, desarrollada con el apoyo de la Agencia de Cooperación Española, representa una mejora importante para la estrategia de la OPS y el Plan de acción sobre eSalud, ya que explora las formas de aplicación de los mecanismos regionales con acceso libre y equitativo a la información y el conocimiento compartido.

Estas iniciativas están dirigidas a avanzar en el progreso hacia la meta de sociedades más informadas, equitativas, competitivas y democráticas, donde el acceso a la información de salud se considera un derecho básico. Una de las necesidades fundamentales para la mejora de la eSalud es la difusión de información, y la OPS está asumiendo un papel de liderazgo en este esfuerzo. El desarrollo de esta nueva publicación electrónica es un paso clave para difundir información estratégica, útil para los tomadores de decisiones, en el uso de estas tecnologías para la salud de las Américas.

A lo largo de sus 12 capítulos, Conversaciones eSalud presenta la opinión de especialistas, otras lecturas y experiencias exitosas de salud en línea. Este trabajo electrónica, presenta las conclusiones del proyecto en formato de diapositivas, e incluye entrevistas con los autores de las conversaciones y tweets difundidos a través de Twitter. Dado que el proyecto se basa en los componentes de la Estrategia eHealth y el Plan de Acción para las Américas, la obra aborda temas como la infraestructura, los sistemas de información, la telemedicina, el acceso a la información, las políticas, la educación, la seguridad del paciente, historia clínica electrónica, las normas para interoperabilidad, las cuestiones legales, la relación con los proyectos e iniciativas de administración electrónica y la gestión de la sanidad en línea. Cada tema fue discutido por un grupo de especialistas y la publicación cuenta con las conclusiones y recomendaciones sobre cada tema.

Debido a la variedad y actualidad de los temas abordados, este trabajo es útil para los profesionales de la salud, tomadores de decisiones, líderes políticos, los desarrolladores de programas relacionados con la salud y otros actores interesados ​​en el amplio campo de la salud en línea.
Estas recomendaciones pertinentes y otros aspectos analizados en Conversaciones eSalud ayudará a los países no sólo para desarrollar y mejorar sus tecnologías de la información y de la comunicación de planes estratégicos en materia de salud pública, sino también fortalecer los programas de salud electrónica en la Región de las Américas.

“Conversaciones sobre eSalud: Gestión de información, diálogos e intercambio de conocimientos para acercarnos al acceso universal a la salud”. Organización Panamericana de la Salud; 2014.

Los libros se pueden descargar en distintos formatos PDF ,  Epub (Para leer con iBooks, Nook, Sony Reader u otros lectores de libros electrónicos compatibles) y mobi desde la página de la OPS


>>Please read the attached whitepaper<<

Diálogos virtuales abordan el presente y el futuro de eSalud en las Américas

La Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) convocó a profesionales involucrados en temas de eSaludpara aportar ideas, debatir y reflexionar sobre el presente y el futuro de estos temas en las Américas.

La publicación de "Conversaciones sobre eSalud", realizada con el apoyo de la Agencia de Cooperación Española, representa un gran avance para laEstrategia y Plan de acción de eSalud de la OPS, ya que explora formas de implementar los mecanismos regionales con acceso libre y equitativo a la información y el intercambio de conocimientos.

Estas iniciativas tienen como objetivo avanzar en el progreso hacia la meta de sociedades más informadas, equitativas, competitivas ydemocráticas, donde el acceso a la información de salud se considera un derecho básico. Una de las necesidades fundamentales para avanzar en laeSalud es la difusión de información, y la OPS está tomando un papel de liderazgo en este esfuerzo. El desarrollo de esta nueva publicaciónelectrónica es un paso importante para difundir información estratégica útil para los tomadores de decisiones sobre el uso de estas tecnologías parala salud en las Américas.

A través de sus 12 capítulos, Conversaciones sobre eSalud presenta la opinión de especialistas, lecturas recomendadas y experiencias exitosas eneSalud. La obra, en formato electrónico, presenta las conclusiones del proyecto e incluye entrevistas con los autores de las conversaciones y tweetsdiseminados a través de Twitter. Como el proyecto se basó en los componentes de la Estrategia y Plan de acción sobre eSalud para las Américas, laobra aborda temas como la infraestructura, los sistemas de información, la telemedicina, el acceso a la información, las políticas, la educación, laseguridad del paciente, la historia clínica electrónica, los estándares de interoperabilidad, asuntos legales, la relación con los proyectos e iniciativasde eGobierno y la gestión en eSalud. Cada uno de estos componentes fue discutido por grupos de especialistas, y en la publicación se exponen lasconclusiones y recomendaciones sobre los temas individuales.

Por la variedad de temas que aborda y la actualidad de estos, esta obra es útil para profesionales de la salud, tomadores de decisiones,responsables políticos, desarrolladores de programas relacionados con la salud, y otros actores interesados en el amplio campo de la eSalud.

Estas recomendaciones importantes y otros aspectos analizados en Conversaciones sobre eSalud no sólo ayudarán a los países a desarrollar y mejorar sus planes estratégicos de tecnologías de la información y las comunicaciones en materia de salud pública, sino también fortalecerán los programas de eSalud en la Región de las Américas.

“Conversaciones sobre eSalud: Gestión de información, diálogos e intercambio de conocimientos para acercarnos al acceso universal a la salud”. Organización Panamericana de la Salud; 2014.


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Cuando el alzhéimer llega a los 39 años…

by System Administrator - Monday, 16 March 2015, 10:13 AM

Cuando el alzhéimer llega a los 39 años…y tu mayor deseo es concienciar. Mira esto!

Redacción | Juan Carlos Romero / Cuidador Alzheimer | Alzheimer Universal

La historia de Chris no es la de un paciente con Alzheimer Precoz a pesar de tener 39 años. Nuestra idea, al igual que la de Chris, no es otra que concienciar de que esta enfermedad puede llegar de varias formas y a edades en la que no “se la espera”.

Chris Grahan, es un joven de 39 años con un prometedor futuro en el ejército británico, al que de la noche a la mañana la vida le da un vuelco. “Padece Alzheimer” su familia y amigos no pueden dar crédito a ello, no pueden entender como una persona de su edad, culto, en buenas condiciones físicas… pueda tener una enfermedad que por regla general es de “personas mayores”. ¿Cómo me puede ocurrir a mí esto? Es una pregunta que el mismo se hace continuamente, y para la cual hay respuesta.

Son muy pocos casos los que padecen este tipo de Alzheimer, concretamente unas 400 familias lo sufren con los mismos síntomas que cuando el enfermo es mayor. Se puede decir con certeza que la familia de Chis es una “Familia Alzheimer”: Son portadores de una rara mutación genética, la cual este hereda de su padre.

La cura podrá llegar tarde para mi, pero ayudará a mis hijos. Hemos llevado al hombre a la luna, por lo que conseguiremos respuestas si ponemos los recursos para ello. Espero que lo que estoy haciendo inspire a la gente para ayudar aAlzheimer’s Research UK.”

Chris tiene 4 hermanos y todos tienen un 50% de posibilidades de heredar el gen de su padre. Ya son varios miembros de esta misma familia los que han padecido la enfermedad a edad muy temprana su padre falleció a los 42 años, su tía Thelma a los 41… De sus hermanos hasta este momento el único que lo ha heredado ha sido Tony de 43 años, el cual se encuentra en una residencia, no se puede mover y tiene que ser alimentado por una sonda. No habla pero eso si de vez en cuando sonríe.

Yo se que en algún momento terminaré como él, pues día tras día voy perdiendo recuerdos, habilidades y necesitando más ayuda. Por eso se lo que le me depara el futuro, dice Chris y por ello quiero luchar, ponerme frente al Alzheimer y decirle “Aun me quedan fuerzas para no ponértelo fácil” es un reto que me he impuesto y quiero ayudar dentro de mis posibilidades con la investigación.

Voy a hacer una ruta de 16.000 millas en bicicleta por Norte América. Para recaudar fondos para la investigación. (si quieres colaborar, entra en Me va a llevar un año hacerlo, pero espero tener un buen año para poder conseguir este reto y con esto ayude a ganar mejor calidad de vida para las personas con demencia.

Sigue este acontecimento en Facebook:

Os dejamos estos dos vídeos informativos, uno de la Fundación Diario de un Cuidador, que precisamente, para el mes que viene han organizado una gala benéfica que no te deberías perder.

Y este otro, también muy esclarecedor, de la Alzheimer’s Association (enlace en castellano)


Alzheimer de inicio precoz

¿Qué es la enfermedad de Alzheimer de inicio precoz?

La enfermedad de Alzheimer de inicio precoz es cuando el Alzheimer afecta a una persona menor de 65 años. Las personas que padecen de Alzheimer de inicio precoz pueden desarrollar síntomas ya en los 30 o 40 años de edad, pero la mayoría están entre los 50 o 60 años.

¿Es muy común el Alzheimer de inicio precoz?

El Alzheimer de inicio precoz no es muy común. Menos del 5 por ciento de las personas que padecen la enfermedad de Alzheimer tienen un inicio precoz.

¿Cómo se diferencia el Alzheimer de inicio precoz del Alzheimer de inicio tardío?

Cuando el Alzheimer comienza, la única diferencia no está entre el inicio precoz y “regular” o inicio tardío. Las otras diferencias incluyen lo siguiente:

  • Genética: Los médicos e investigadores han descubierto que, en algunas personas, ciertos genes extraños pueden hacer que los síntomas de Alzheimer comiencen a temprana edad. Cuando la genética es la causa, a menudo los genes se han transmitido a los familiares y pueden afectar a muchas generaciones.  Esta es la razón por la que el Alzheimer de inicio precoz algunas veces se conoce como Alzheimer “hereditario”.
  • Diagnóstico: Es probable que para un médico tome más tiempo diagnosticar el Alzheimer de inicio precoz. Aunque los síntomas del Alzheimer de inicio precoz son los mismos síntomas del Alzheimer de inicio tardío, la mayoría de médicos no busca ni sospecha que exista la enfermedad de Alzheimer en personas más jóvenes. Si está teniendo problemas de memoria, asegúrese de hablar con el médico sobre todos los síntomas.
  • Sobrellevarlo: Debido a que las personas que padecen Alzheimer de inicio precoz son más jóvenes, es probable que todavía estén criando hijos, que tengan trabajos y que sean activos en la comunidad cuando los síntomas comienzan. Esto puede hacer más difícil tratar con los cambios que la enfermedad de Alzheimer trae a la familia y vida personal. Las personas que padecen la enfermedad de inicio precoz son más propensas a sentirse enojadas, frustradas o deprimidas.

Consejos para vivir con Alzheimer de inicio precoz

Primero, es importante saber que no está solo. La enfermedad de Alzheimer afecta a cada persona de manera distinta, pero hay actividades que puede hacer para permanecer activo e involucrado en su propio cuidado de la salud, con la familia y los amigos y en el trabajo.


  • Siga los consejos de su médico sobre la dieta y el ejercicio. Si toma medicamentos, asegúrese de tomar la cantidad correcta en el momento apropiado. Visite o hable con el médico si tiene preguntas sobre su salud o tratamiento.
  • Piense en unirse a un grupo de apoyo. Para encontrar uno cerca de usted, comuníquese con el club local de la Asociación del Alzheimer.
  • Comparta sus pensamientos y sentimientos con los demás. No guarde todo eso adentro. Si no se siente cómodo hablando con su familia o amigos, siempre podrá hablar con su médico, miembros de la iglesia o con un terapeuta profesional.

Sea honesto con su familia y amigos

  • Hable con su cónyuge u otros familiares cercanos sobre sus pensamientos, temores y anhelos. Su familia puede ayudarle a planificar el futuro, incluso a tomar decisiones sobre el cuidado de la salud, así como acerca de asuntos legales y financieros.
  • Hable francamente con sus hijos sobre su enfermedad. Comprenda que es posible que estén preocupados, confundidos, molestos o asustados. Si es adecuado, deje que sus hijos participen en las discusiones y decisiones que afectan a toda la familia.
  • Es probable que sus amigos o vecinos no sepan cómo reaccionar a su diagnóstico. Posiblemente sientan que no saben qué decir o cómo ayudar y es probable que esperen a que usted tome la iniciativa. Invite a sus amigos a pasar tiempo con usted. No tenga miedo de pedir ayuda cuando la necesite.

Maneje su carrera profesional

  • Tenga en cuenta que, mientras los síntomas progresan, es posible que sea difícil realizar ciertas tareas laborales.
  • Planifique cuándo y cómo decirle a su jefe, supervisor o gerente.
  • Dígale al gerente que le gustaría continuar trabajando tanto como sea posible y pídale que sea flexible. Las posibilidades incluyen trabajar menos horas, reducir las responsabilidades o cambiar de puesto.
  • Trabaje con el departamento de recursos humanos para asegurarse de aprovechar todos sus beneficios como empleado. Investigue las opciones de jubilación temprana.


Alzheimer’s Association. Younger/Early Onset Alzheimer’s & Dementia

Alzheimer’s Association. Living with Younger/Early Onset Alzheimer’s

Un texto traducido por




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CVS Health Opens Digital Health Innovation Lab in Boston

by System Administrator - Thursday, 18 June 2015, 7:13 PM

CVS Health Opens Digital Health Innovation Lab in Boston


CVS Health today announced the official opening of its Digital Innovation Lab in Boston, a facility that is focused on developing cutting-edge digital services and personalized capabilities that offer an accessible and integrated personal pharmacy and health experience. The Lab will serve as a vital hub for the rapidly growing digital team at CVS Health, which will remain headquartered in Woonsocket, R.I.

“At CVS Health, everything we do is to help people on their path to better health, and digital technologies are an amazingly effective way to achieve this,” said Brian Tilzer, Senior Vice President and Chief Digital Officer for CVS Health. “Digital technologies are ubiquitous and highly configurable – a powerful combination, because it allows us to empower our customers anytime and anywhere. That’s why we are doubling our digital investment, anticipating our customers’ increasing preference to manage their health digitally. The opening of this Innovation Lab is a significant step forward on this path.”

The launch of the new Digital Innovation Lab is the latest manifestation of CVS Health’s commitment to prioritizing digital health. The new lab is staffed with developers, product managers, digital strategists, and user- experience designers. CVS has increased its focus on healthcare this year by making significant investments in telehealth visits with doctors at some of its MinuteClinics, sending text messages to customers about their prescriptions and sharing EHR data with select providers.

The Digital Innovation Lab will embody the CVS Health digital team’s mission to run like a startup, accelerating speed-to-market and impact of digital innovation across the enterprise, by using the resources of the Lab to rapidly test, improve and implement new programs.

“Boston’s position as a hub for healthcare innovation, coupled with our belief in the transformational capabilities of digital technologies, makes it an ideal environment for CVS Health’s new Digital Innovation Lab,” said Mayor Martin J. Walsh. “We’re proud to work alongside CVS Health to foster new advancements in the digital health space.”


Primary focuses of the Lab will include the exploration of breakthroughs for digital health through innovation in mobile, personalization, multi-channel e-commerce, connected health and digital therapeutics. CVS Health will further its pace and breadth of innovation through partnerships with promising startups and mature companies alike in the digital and health care space.


The Lab is also committed to developing future-looking health care solutions. For example, CVS Health plans to introduce a wide array of new digital services in the coming year and beyond, ranging from beacon capabilities that allow customers to receive in-store pharmacy reminders, to applications that turn mobile phones into remote diagnostic tools. CVS Health services reach 100 million customers annually, meaning these innovations are poised to make a significant impact in helping people manage their health.


The Digital Innovation Lab, located at 116 Huntington Avenue in Boston’s Back Bay neighborhood, will ultimately employ up to 100 team members, complementing the work of the more than 100 digital professionals currently at the company’s Digital Experience Center in Woonsocket. The company is actively recruiting talent with expertise in everything from application development and creative digital design, to engineering, coding, usability and customer experience.



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Cybersecurity in Healthcare: An Organizational Approach Focused on both Business and IT

by System Administrator - Tuesday, 26 January 2016, 10:00 PM

eBook: Cybersecurity in Healthcare: An Organizational Approach Focused on both Business and IT 

Your Cybersecurity Strategy Has Never Been More Important than Now.

According to the U.S. Department of Health and Human Services Office for Civil Rights, a staggering 1.6 million people had their medical information stolen from healthcare providers last year. Not only does this impact the healthcare organization, it has a heavy impact on the patient as well.  

Download this Healthcare Informatics e-book for an in-depth look at the impact data breaches have on healthcare organizations and how a cybersecurity strategy is more than just an IT initiative.

Some key focal points include:

  • The five-year outlook data breaches are predicted to have on healthcare organizations
  • How a cybersecurity strategy needs to be a focal point from the board of governors down to the employees in the trenches
  • The steps that need to be taken in the event of an attack
  • An in-depth interview with the CSIO of a 25-hospital integrated health system based in Arlington, Texas on their approach to protecting patient data

Please read the attached eBook.

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Data Analytics in Healthcare

by System Administrator - Wednesday, 11 March 2015, 9:35 PM

Data Analytics in Healthcare: Gain insights and take action

A new study commissioned by EMC asked federal agencies how big data can help them. Among the results published recently: The healthcare industry is chomping at the bit for data analytics. Because the innovative answers needed to improve patient experiences and the health of populations, while simultaneously reducing costs, comes from insights, trends, and clues hiding in big data.

“The underpinnings of EHRs need to be reconfigured to support the purposes of big data. ”

Dr. Karen DeSalvo

National Coordinator for HIT

Please read the attached whitepaper.


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Data Breach Reporting Requirements for Medical Practices

by System Administrator - Friday, 27 February 2015, 12:58 PM

Data Breach Reporting Requirements for Medical Practices

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Data Breaches Put Fear Into Patients

by System Administrator - Thursday, 12 March 2015, 9:23 PM

Survey: Data Breaches Put Fear Into Patients

by Rajiv Leventhal 

Nearly half (45 percent) of surveyed patients reported that they are at least moderately concerned about a security breach involving their personal health information, according to new research from the Austin, Tx.-based electronic health record (EHR) selection group Software Advice.

When asked to list the reasons behind their level of concern, the highest percentage of respondents (47 percent) said they are concerned about becoming the victim of fraud or identity theft. Coming in a close second was patient worries about maintaining the privacy of their medical history, followed by a lack of trust in technology’s ability to keep their data safe, according to the survey.

As such, 21 percent are withholding personal health information from their doctors. While the majority of the sample (79 percent) said this “rarely or never” happens, it is significant (and unfortunate) that 21 percent of patients withhold personal information from their physicians specifically because they are concerned about a security breach, according to the researchers.

What’s more, only 8 percent of patients “always” read doctors’ privacy and security policies before signing them, and just 10 percent are “very confident” they understand them. Notice of Privacy Practices (NPPs) are written explanations of how a provider may use and share health information, and how patients can exercise their privacy rights.

Additionally, a combined 54 percent of respondents said they would be “very” or “moderately likely” to change providers as a result of their personal health information being accessed without their permission. While 28 percent said there is nothing their provider could do that would convince them to stay, the greatest percentage of respondents (37 percent) would stick with their doctor if they provided specific examples of how the practice’s security policies and procedures had improved after the breach. Many of those same patients (13 percent) specifically said they would want the provider to purchase new software that protectspatient data. A breach caused by staff misconduct was reported as the most likely reason for patients to switch providers.

“The results of our survey on patient fears indicate that much work must be done to restore patients’ faith indata security, the researchers concluded. “Practices should strive to create an atmosphere where patients see promise instead of potential risk when it comes to the way healthcare data is handled,” they said.




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Data De-Identification: Getting It Right

by System Administrator - Saturday, 9 August 2014, 2:29 AM

Khaled El Emam and Scot Ganow

Data De-Identification: Getting It Right

Listen Now

When patient data is used for secondary purposes, such as research, it must be de-identified. But is this process consistently reliable in protecting patient privacy?

A privacy attorney and an experienced researcher explain in an interview with Information Security Media Group that de-identification is reliable if specific methods, as spelled out under HIPAA, are actually used. Too often, they say, those de-identifying data don't do the job effectively because they fail to follow best practices and standards.

Two Methods

Only two methods of de-identification can be used to satisfy the HIPAA Privacy Rule's de-identification standard, explains privacy and security attorney Scot Ganow of the law firm Faruki Ireland & Cox P.L.L.

The "safe harbor" method calls for removing 18 identifiers from patient information, including patient names, ZIP codes, Social Security numbers and birthdates.

The second method, "expert determination," is a more flexible standard that allows professionals to calibrate data de-identification based on the context for which data will be released for secondary purposes, explains Khaled El Emam, senior scientist at the Children's Hospital of Eastern Ontario Research Institute and Director of the multidisciplinary Electronic Health Information Laboratory.

The expert determination method involves using an expert "with appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable," according to federal guidance material on the subject (see De-Identification Guidance Offered).

De-identified data is considered HIPAA-compliant "and defensible" if either of these two-approved methods are used in de-identifying patient data, Ganow says.

Some privacy advocates complain that even HIPAA-compliant methods of data de-identification fall short, creating a risk that patients can be re-identified, especially if mistakes are made in the processes (see Sizing Up De-Identification Guidance).

But El Emam contends that privacy protection problems mainly arise when HIPAA guidance is not followed or is applied improperly. "Another mistake is applying only part of the standards. In that case, data is not going to be protected," he says.

"If you do a poor job with de-identification not based on standards, then it's easy for someone to reverse that. But if you do a good job, it's really hard to re-identify the data," El Emam contends.

One of the top reasons why data de-identification is sometimes done improperly is that there's a shortage of skilled individuals who know how to de-identify data according to best practices and standards, El Emam says. "There's a need to increase the pool of individuals who can do this work, he says.

Not Foolproof

But no method of de-identification is guaranteed to be 100 percent perfect. "When applying data de-identification methods in accordance to HIPAA, the standard is to have a very low risk of re-identification as opposed to saying something is completely de-identified," Ganow says. De-identification "doesn't happen in a silo. You have to think about: Who am I giving the data to? What's the purpose? What agreements and security do I have in place? It's not a silver bullet."

In the interview, Ganow and El Emam discuss:

  • Why de-identification is important to managing risk and ensuring patient privacy;
  • How the identities of patients with unusual and rare diseases, such as Ebola, can be protected;
  • How a shortage of skilled individuals is contributing to poorly de-identified data and why training programs and professional certifications can help.

Ganow is an attorney in the Dayton office of Faruki Ireland & Cox P.L.L. He had more than 10 years of corporate and compliance experience in Fortune 500 companies prior to becoming an attorney, including serving as a chief privacy officer for healthcare and pharmaceutical informatics companies. Ganow also holds the Certified Information Privacy Professional certification; has presented and written extensively on the topics of data protection and de-identification.,In addition to his work at the Children's Hospital of Eastern Ontario Research Institute, El Emam is founder and CEO of Privacy Analytics Inc., which offers enterprise software to safeguard data used for secondary purposes. Previously, Khaled formerly was a senior research officer at the National Research Council of Canada. He holds the Canada research chair in electronic health information at the University of Ottawa and is an associate professor on the faculty of medicine at the university. He has a PhD from the department of electrical and electronics engineering, King's College, at the University of London, England.




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Data Deluge to Disrupt Healthcare This Decade

by System Administrator - Tuesday, 18 November 2014, 1:43 PM

Exponential Medicine: Data Deluge to Disrupt Healthcare This Decade


You can’t really boil down four days, 59 speakers, and a few lovely musical interludes into a single word—but here goes. If there was an overriding theme to this year’s Exponential Medicine it was, in my humble opinion, information.

In his opening talk, Peter Diamandis said health and medicine are poised to undergo a greater transformation than any other industry or field in the next decade. Of course, he meant treatments and technology will meaningfully advance. But more than that, it is the liberation of data that will make care more targeted, proactive, and effective.

To understand the future, however, it’s critical to understand where we are now.

The Problem


Vinod Khosla; Exponential Medicine.

Venture capitalist Vinod Khosla wrote way back in 2012that modern healthcare is more about the “practice of medicine than the science of medicine.” Diagnosis and treatment are more art than most will admit, and this is problematic because, by definition, 50% of all doctors are below average practitioners—acceptable in art, frightening in medicine.

Tens of thousands of ICU patients die annually due to misdiagnosis. Go to three different doctors and you’ll get three different diagnoses and plans for treatment, Khosla wrote. This isn’t to slander doctors, but to say most are faced with an impossible task.

Further, just as today’s doctors make life or death decisions on extremely limited information, researchers and scientists similarly draw broad conclusions from small datasets, a tiny slice of the population over a short period of time. Indeed, in her keynote on clinical trials, Dr. Laura Esserman noted that 70% of clinical trials fail.

This is likely, in part, because the studies informing those trials are not backed by information over broad populations but are instead handcuffed by over-specificity and a dearth of data.

The Promise

Today, information isn’t free. But liberating forces are massing on the horizon.


Ariel Garten wearing Muse headband; Exponential Medicine.

Sensor technology, of course, is front and center. A profusion of body sensors are poised to be strung throughout the environment and in and on our bodies. These sensors are tiny, cheap, energy efficient, and most importantly, connected.

Sensors stand to collect information, not once every year or two, but every day, hour, or minute. They can open a window on disease before it becomes critical, before symptoms drive us to seek help, making diagnoses early and more accurate.

The best known health devices adapt smartphone motion sensors to detect movement (e.g., step trackers). But these are just the beginning. The next wave of sensors will measure a range of vital signs connected to the heart, blood, and brain.

Sensors on display at Exponential Medicine included two elegant EEG devices for recording brain activity, the Muse headband and iBrain. And the winner of the XPRIZE Nokia Sensing Challenge, awarded at the conference, is a compact system capable of running a wide range of diagnostic lab tests with a single drop of blood.

Just as sensors begin collecting new information, we may begin unlocking and leveraging already existing data within the system. Hospitals alone offer a wealth of information which is invisible to patients and doctors alike.

The system has all but scrambled this information, but data scientists are showing how software can piece it back together and make it useful.

Dr. Isaac Kohane told the story of a group of patients seeking recurrent treatments for various injuries. Using software to analyze the pattern of treatments, Kohane made a surprising diagnosis—domestic abuse. Indeed, it was later reported that these patients were victims of abuse, but not until well after they’d been released from the hospital.

Kohane believes a lot more such information exists within hospitals, if only anyone cared to look.

In addition to doctors, researchers may use information from sensors and the system itself to study populations of tens or hundreds of thousands of patients. And these studies will cover periods of time before, during, and after disease strikes.

The famous Framingham heart study collected information every few years from a few thousand patients over several decades. Framingham yielded profound insights into cardiac disease. Now, imagine doing the same study again—only collecting information every day and expanding the study’s population by an order of magnitude or more.

The Health eHeart study, spearheaded by UCSF’s Dr. Jeff Olgin aims to do just that. Health eHeart shows not just what’s possible in the future study of heart disease, but in the study of all disease. Broad, detailed data may soon be the rule.

Making It Meaningful

Doctors are already overwhelmed by the flow. Keeping up with a body of research that doubles every five years is a herculean task—perhaps an impossible one for mere mortals. How will we fare when information exponentially increases?


Craig Venter; Exponential Medicine.

As genomics and synthetic biology pioneer Craig Ventersaid in his keynote talk, data isn’t the goal. The bigger objective is taking the data and making knowledge of it. How will we do that? Artificial intelligence.

Vinod Khosla believes computers will replace up to 80% of the tasks doctors perform today. This will result in significantly fewer errors, lower cost, less work per doctor, faster interactions, and more opportunities for doctors to do research.

But, as Exponential Medicine executive director Daniel Kraft noted: We shouldn’t think of it as AI but IA—intelligence augmentation. In the future, doctors will pair up with intelligent software to more quickly and comprehensively research, diagnose, and prescribe treatment plans.

IBM’s Watson, for example, is able to scan a field’s entire body of up-to-date medical research in fractions of a second and turn up relevant studies, rare drug side effects, even potential diagnoses. And as Watson searches text, machine learning techniques are equipping software with the ability to scan images.

Jeremy Howard, Founder and CEO of Enlitic and previous Chief Scientist at Kaggle, said the accuracy of object classification—identifying discrete features in images—has undergone massive improvement in the last several years. Already these algorithms are proving themselves superior to humans in the analysis of some cancerous tissues.

The convergence of these techniques will help us better manage all this new information—whether it’s finding causative correlations in genomic research or making more accurate, timely diagnoses in the doctor’s office and hospital.

But perhaps the most powerful effect of intelligent software on medicine? As machines do what they do best, doctors can refocus on what humans do best. Less overwhelmed by data they can’t possibly digest, doctors will find time to build relationships with the patient—answering questions, keeping them informed, making them comfortable.

The Dark Side


Marc Goodman; Exponential Medicine.

As more patient data is collected and made available for study and diagnosis, and more devices connect to the internet, health information will present a target for exploitation—if it’s online, it’s hackable.

According to Marc Goodman, typical identity theft is worth $2,000 to the thief—medical identity theft is worth more like $20,000. So far in 2014, medical cybercrime is up 600% because, Goodman says, it’s an easy target.

The answer isn’t to halt innovation but to pay more attention to security and enforcement. Goodman suggests some simple solutions: switching passwords on every website, securing connections to public networks, data encryption—and most critically, perhaps, taking care what information is shared online.

Technology as a Tool

Technology is amoral, it’s what humans do with it that determines whether it is a force for good or evil. In the coming years, we’ll have ample opportunity to adapt to a world awash in health information. We may decide to place severe limits on what and how information is shared. But the likelier outcome? The benefits of information sharing will outweigh the risks.

“We’ve gone from a data-poor world, to a data-rich world,” Larry Smarr told participants. “I’ve been through a lot of fields in my life. This is about as excited as I’ve been for research and what it’s going to do to change our lives.”

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Data-driven scheduling predicts patient no-shows

by System Administrator - Thursday, 11 September 2014, 2:55 PM

Data-driven scheduling predicts patient no-shows

By Michael B. Farrell

With all the advancements in health care, the medical profession still cannot get its appointment book in order.

Doctors are constantly overbooked. Patients constantly rescheduling. One day a waiting room is packed, the next it’s empty.

So when Gabriel Belfort attended a health care hackathon at the Massachusetts Institute of Technology in 2012, he challenged the coders, engineers, and clinicians there to fix that nagging issue.

“There’s a scheduling problem in medicine,” said Belfort, who at the time was a postdoctoral student studying brain science at MIT. “If you’ve had an appointment and you’ve showed up on time, you’ve probably had to wait.”

That dilemma posed by Belfort generated a very MIT proposal: What if you could use data science to determine which patients are likely to show up and which ones will be no-shows and manage office appointments around those tendencies?

“It was immediately clear to me that this is a problem that computers could solve,” Belfort said.

In short order, Belfort and an ad hoc team of nine people — students and health care professionals — at the hackathon built a prototype to prove out the concept. Then, so excited by the prospect that they could solve one of health care’s chronic pains, Belfort and three others who were strangers before that weekend launched a startup, aptly named Smart Scheduling Inc.

Here’s the gist: Smart Scheduling mines patient scheduling histories to determine who is more likely to cancel or miss an appointment. It then sends alerts to the scheduling programs that doctor offices use to book appointments.

If a patient is in a high-risk category, for instance, it prompts office schedulers to call with a reminder. If the patient cannot be reached, there is a good chance he will not show up at all. So, the doctors could then book another patient for that time slot, keeping the patient flow consistent throughout the day.

Within months of forming, Smart Scheduling attracted the interest of Healthbox, an accelerator program that invests $50,000 in promising startups and gives them free office space and mentoring. It also landed a meeting with executives at athenahealth Inc., which eventually resulted in Smart Scheduling’s becoming the first startup in the Watertown health information company’s new accelerator program. Athenahealth also made an undisclosed investment to help the company build out its marketing and sales efforts.

So far, Smart Scheduling has attracted some $500,000 in early-stage investment.


And already it has two large health systems signed up as customers: Martin’s Point Health Care, which runs health centers in Maine, and Steward Health Care System, one of the biggest hospital groups in Massachusetts, where the software is being used by about 40 of its doctors offices.

Dr. Michael Callum, president of Steward Medical Group, said Smart Scheduling helps take some of the ambiguity and guesswork out of making appointments; by eliminating unexpected down time, Steward doctors systemwide are able to see 100 more patients every week.

“When you leave it to the front-desk people in the office, they are not all that good of predicting flow in terms of when patients will show up,” Callum said. “It turns out that Smart Scheduling is much better at predicting that.”

Here is what Smart Scheduling has learned about us as patients: If we are single, or under 40, we are more likely to cancel an appointment than an older or married patient. New patients miss more appointments than regulars.

In general, expecting patients to show up for the 1 p.m. slot is a bad idea. On the other hand, Wednesdays are great, as patients are not likely to cancel on those days.

So far, Smart Scheduling has developed 722 variables that it uses to make predictions, based on an analysis of millions of data points about patients from athenahealth. And the more data Smart Scheduling can crunch, the better it gets at predicting behavior

The company says that, so far, its analysis has proven accurate 70 percent of the time when predicting cancellations.

“If everybody got a better schedule, we’d all be happier,” said Ateet Adhikari, director of the Healthbox accelerator program. “The patients benefit, the doctors benefit, and the insurer benefits. A more efficient system trickles down.”

Smart Scheduling was among the first companies that Healthbox invested in when it launched in Boston in 2012. Since then, it has backed 19 health-related startups.

Smart Scheduling exemplifies a new type of health care startup; instead of going after the big issues in health care — curing cancer, for instance — they are targeting more modest changes to improve the medical experience with technology.

“Companies like Smart Scheduling are dramatically improving health care not by producing a new drug,” said Bill Aulet, director of the Martin Trust Center For MIT Entrepreneurship. “It’s by streamlining the process and getting increased efficiencies.”

Belfort has since gone on to work at a local biotech company, although he remains an adviser to Smart Scheduling. Out of the group that came together to build the original product at the MIT hackathon in 2012, only Chris Moses has stuck around full time, and is now the company’s chief executive.

Improving patient flow in the doctor’s office is just the first step, Moses said. “The next step,” he added, “is to try to figure out who are the sickest patients and who the ones are that need to be seen first.”


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De-identification effective in maintaining patient privacy if done right

by System Administrator - Saturday, 9 August 2014, 1:28 AM

De-identification effective in maintaining patient privacy if done right

By Katie Dvorak

As hospitals and healthcare organizations adopt new ways to store and share data, privacy and security of the information is a top priority--and with that comes de-identification of data.

When it comes to HIPAA, there are two standards that allow for the sharing of data while maintaining privacy protections, according to privacy attorney Scot Ganow and Khaled El Emam, senior scientist at the Children's Hospital of Eastern Ontario Research Institute, both of whom spoke with

The first HIPAA method for de-identifying data, according to Ganow, of Faruki Ireland & Cox, is to strip out the data and identifiable elements, though, he added that doing so doesn't offer a lot of value. The second, he said, is to de-identify data through the expert determination standard, which allows researchers to "retain a lot of the value of the info ... [while] at the same time carrying a very low risk of re-identification."

Emam, who also serves as the director of the multidisciplinary Electronic Health Information Laboratory at the Children's Hospital institute, also emphasized using the expert determination method, saying it allows for more flexibility.

He told that not every organization uses the standards, and in those cases, the data won't be protected.

In addition to HIPAA, the Federal Trade Commission also has de-identification standards, including that an organization takes reasonable steps to de-identify protected data and announces that re-identification of data will not occur.

However, some are not sure that de-identification goes far enough in protecting patients.

Some studies have shown the possible ease with which de-identified data can be linked with a patient, including one by Harvard University researchers who were able to identify and link anonymous participants in a public DNA study with their personal data.

And while HIPAA specifies how data should be de-identified, a report by the Bipartisan Policy Center maintains that too much variability exists in the execution of anonymization.

Emam, though, said that if the process is done right, it is very difficult to re-identify data. He stressed that problems occur when organizations do a "lousy job" with de-identification, and that makes it easy for someone to reverse.

To learn more:
- listen to the interview

Related Articles:

Panel: Cloud's role in healthcare still up in the air
Anonymous research patients easily re-identified, Harvard researchers find
HIPAA burdensome to big data healthcare efforts, BPC says

Read more about: Federal Trade Commission, Deidentification


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Delivering Healthcare on an iPhone

by System Administrator - Tuesday, 16 September 2014, 9:05 PM

Delivering Healthcare on an iPhone

Joseph Kvedar at TEDxMidAtlantic

Joseph C. Kvedar, MD, is the Founder and Director of the Center for Connected Health, creating a new model of healthcare delivery, by developing innovative strategies to move care from the hospital or doctor's office into the day-to-day lives of patients. Dr. Kvedar is creating innovative programs to leverage information technology -- cell phones, computers, networked devices and simple remote health monitoring tools -- to help providers and patients manage chronic conditions, maintain health and wellness and improve adherence, engagement and clinical outcomes. Based on the technology platform developed at the Center, Healthrageous, a personalized health technology company, was launched in 2010, offering a range of health and wellness self-management programs to their clients.

In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.* (*Subject to certain rules and regulations).

Top 10 Essential iPhone Apps for Doctors and Medical Students

by Giriraj Ranawat


#1. Heart Pro III

Paid – $2.99

This app, offered by 3D4 Medical in conjunction with Stanford University School of Medicine, allows users to rotate, cut, and label different components of a realistic 3D heart. This latest version contains many improvement which include, complete 360 degree 3D horizontal degree rotation of any body part with a swipe of your finger, 19 free & 51 paid animations, 2 types of Quiz, 62 images isolating elements of the heart.

#2. Epocrates


This app is freely available across many mobile platforms including., Android, Blackberry and iPhone. Epocrates is a trusted clinical resource which helps in better patient care by delivering right information at the time it is required. More than 1 Million active members including 50 per cent US Physicians rely on this app to provide accurate and effective solution to there regular problems. It also perform dozens of calculations, such as BMI and GFR and timely medical news and research information.

#3. Medscape


Medscape is used by more than 3 million healthcare professionals throughout the world and was the most downloaded app in Medical category in the year 2010. Developed by WebMD, Medscape provides Medical news and critical alerts in 34 specialty areas. It has a large pool of clinical resource which includes., 4,000+ evidence-based articles, 600+ step-by-step procedure videos, 100+ tables & protocols and Medical Calculators.

#4. Anesthesiology i-pocketcards

Paid – $3.99

Developed by Börm Bruckmeier Publishing, this app is a concise clinical reference guide with a compilation of scores, classifications, algorithms, and dosage information necessary for the anesthesiologist’s environment. It also contains an effective fluids and electrolytes management system, a table of anti-coagulation and neuraxial anesthesia, and special information about cardiothoracic and obstetric anesthesia.

#5. Eye Chart


This is a great little app when you’re triaging, and can’t get the formal eyechart posted somewhere else in your department. Eye chart is used by eye care professionals and others to measure visual acuity. Snellen charts are named after the Dutch ophthalmologist Herman Snellen who developed the chart in 1862.

#6. Doximity


Meant for US Physicians only, this app proves to be an effective and reliable medium to communicate and keep up with other medical peers. There are already 1 lac Doctors on this network and is considered as the most powerful medical directory and communication tool in the world. This app can really help you in building your Social and Professional Network if you are a newbie in Medical field.

#7. The ECG Guide

Paid – 55 INR

ECG Guide is a reservoir if around 200 examples of common and uncommon ECGs. It also incorporates ECG Interpreter which help sin stepwise assistance with ECG interpretation. You can also test your knowledge with 100 multiple-choice quiz questions updated regularly.

#8. MedCalc

Paid – 110 INR

This Medical Calculator helps to sort out complex medical calculations and problems using a simple UI. MedCalc continues to be the best and trusted medical calculator of all time for medical personnels providing easy access to complicated medical formulas, scores, scales and classifications. It features a Customizable list of favorite equations too.

#9. Psych Terms


Verbal skills are must for any profession and the same goes for medical science too, with access to 1000+ frequently used psychiatric and mental health terms, phrases and definitions, Psych Terms continues to remain a quick and handy reference for both physicians and students. Surprisingly, these all words are available offline i.e., you don’t need a internet or Wi-Fi connection to access the resource.

#10. Pocket Lab Values

Paid – $2.99

Mathematical figures and values are quiet complicated and tedious to remember, so a ready reference to this stuff is necessary. Pocket Lab Values is the perfect companion for health professionals with access to over 320 common and uncommon lab values. Despite, of many apps providing the same feature, Pocket Lab Values contains more lab values than any other app on the store because of the consistent effort and feedback it takes from its users.

Does any of your favourite app made a miss from the list ?? It will be highly appreciated if you report the same to us and which will subsequently help us in mending the article too. 


Giriraj Ranawat

Giriraj Ranawat is a passionate tech blogger from Rajasthan, India. He is an avid traveler and love to explore new dimensions of technology. You can follow him at Twitter



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Demand for telehealth services causes price increase

by System Administrator - Thursday, 30 March 2017, 12:31 PM

Demand for telehealth services causes price increase

by Kristen Lee

The price of telehealth services may only continue to increase in the coming years as healthcare providers and businesses are using online consultations more and more. This has not only increased the demand for telehealth services during a three year period up to 2017, according to a market research report by IBISWorld, but also caused an increase in price. IBISWorld expects the price to only increase in the coming years through 2020.

However, telehealth market competition is helping keep price growth in check since the telehealth market is highly fragmented and competitive, the report said. Although, there are a few prominent players such as Teladoc and Doctor On Demand.

“IBISWorld estimates that there are about 640 firms currently operating in the US telehealth market. Moreover, most operators are small and midsize firms that are privately owned and operated. In the next three years, market share concentration is projected to remain low as new players enter the market, warranting strong price competition,” Anna Son, procurement research analyst at IBISWorld, said in a press release.

In 2017 alone, prices of telehealth services are expected to grow 3.5%, Son said in the release. This is because more and more employers are and will be offering more telehealth services to their employees. Son said in the release that this is “to help curb skyrocketing healthcare costs related to employee sickness and absenteeism.”

Regulations contribute to price increase

In the United States today 30 states and the District of Columbia require private health insurance carriers to provide the same coverage for telehealth services as they do for in-person visits over the next three years, the release said.

Furthermore, during the three year period in which the demand for telehealth services grew, there were also a number of regulatory changes as well with more to come, the release said. Currently, there are more pending legislations that are expected to help facilitate the adoption of telehealth in the future.

“A rising number of health insurance companies are planning on expanding their coverage for telehealth services. These regulatory changes will help accelerate the integration of telehealth services in healthcare settings, thus leading to anticipated double digit sales growth and rising service rates in the coming years,” Son said.


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Depresión en el anciano

by System Administrator - Thursday, 9 October 2014, 10:55 AM

Un cuadro complejo, con comorbilidades y alto riesgo

Depresión en el anciano

La depresión en el anciano es frecuente y conlleva mayor riesgo de suicidio que en otros grupos etarios. Hay tratamientos eficaces, como los inhibidores selectivos de la recaptación de serotonina (ISRS) y la psicoterapia.



La depresión en personas mayores de 60 años es frecuente y a menudo se asocia con enfermedades coexistentes, disfunción cognitiva o ambas. Los ancianos con depresión tienen mayor riesgo de suicidio.

La farmacoterapia o la psicoterapia se pueden emplear como tratamiento de primera línea. Los antidepresivos son eficaces para los ancianos, pero éstos pueden tener mayor riesgo de efectos colaterales. Los inhibidores selectivos de la recaptación de serotonina (ISRS) se consideran como tratamiento de primera línea.

La psicoterapia (conductual cognitiva o terapia de resolución de problemas) también es eficaz para la depresión en el anciano.

Cuadro clínico

La depresión en la vejez es la aparición de un trastorno depresivo mayor en adultos de 60 años o más. Se produce en hasta el 5% de los adultos mayores no institucionalizados y el 8 - 16% de los ancianos sufren síntomas depresivos clínicamente significativos. Las tasas de trastorno depresivo mayor aumentan cuando el paciente sufre otras enfermedades concomitante, hasta el 5-10% en atención primaria y hasta el 37% tras hospitalizaciones en cuidados intensivos.

En relación con los ancianos que refieren un episodio depresivo inicial en la juventud, aquéllos con depresión de inicio tardío son más proclives a sufrir trastornos neurológicos, entre ellos deficiencias en las pruebas neuropsicológicas y cambios relacionados con la edad mayores que lo normal en los estudios por imágenes; tienen también más riesgo de demencia ulterior. Estas observaciones generaron la hipótesis de que la enfermedad vascular puede contribuir a la depresión en algunos ancianos.

Tabla 1 Criterios Diagnósticos del DSM-5 para el trastorno depresivo mayor.
Deben estar presentes cinco o más de los siguientes síntomas casi todos los días durante dos semanas:

Síntomas principales (≥1 necesarios para el diagnóstico).

* El DSM-5 es el Manual Diagnóstico y Estadístico de Trastornos Mentales, Quinta edición.

El problema clínico

El mal estado anímico puede ser menos frecuente en ancianos con depresión que en adultos más jóvenes deprimidos, mientras que la irritabilidad, la ansiedad y los síntomas somáticos suelen ser más frecuentes en ancianos. Los factores psicosociales estresantes, como la muerte de un ser querido, pueden desencadenar un episodio depresivo, aunque las reacciones transitorias a las pérdidas importantes pueden simular depresión.

Las personas con depresión en la vejez tienen mayores tasas de enfermedades concomitantes y por lo tanto de empleo de medicamentos, que los que no están deprimidos. La relación entre depresión y enfermedad coexistente puede ser bidireccional: problemas médicos como el dolor crónico pueden predisponer a la depresión y ésta a su vez se asocia con peor evolución de enfermedades como las cardiopatías. Las enfermedades concomitantes pueden generar polifarmacia, entre otros, los efectos de los psicotrópicos sobre algunas enfermedades y sobre el metabolismo de otros medicamentos.

El deterioro cognitivo es frecuente en ancianos con depresión. La depresión puede ser un factor de riesgo para el deterioro cognitivo y una manifestación del mismo: se asocia con el aumento a largo plazo de demencia. Las deficiencias cognitivas pueden ser signos de envejecimiento cerebral acelerado que predispone y perpetúa la depresión.

Estrategias y evidencia

La U.S. Preventive Services Task Force recomienda la detección sistemática de la depresión si se cuenta con apoyo para asegurar el diagnóstico preciso y el tratamiento y el seguimiento apropiados. Para evaluar la depresión se deben emplear mediciones validadas, como el Patient Health Questionnaire 9, que refleja los criterios diagnósticos (véase tabla 1). Debido a que las tasas de suicidio son altas en los ancianos, especialmente en los hombres, es necesario explorar cuidadosamente la existencia de pensamientos suicidas.

En la tabla 2 se resumen puntos importantes de los antecedentes

Son signos de alarma para la intervención urgente: síntomas graves o que empeoran, las tendencias suicidas y el deterioro del funcionamiento cotidiano.

Los exámenes complementarios recomendados son: hemograma para descartar anemia, glucemia, tirotrofina, ya que el hipotiroidismo puede imitar los síntomas depresivos. Se recomienda también medir las cifras de vitamina B12 y folato ya que la frecuencia de deficiencia de vitamina B12 aumenta con la edad y las cifras bajas de ésta y de folato pueden contribuir a la depresión.

La prueba cognitiva (e.g.,Mini–Mental State) se justifica para personas que refieren problemas de memoria y puede revelar deficiencias en el procesamiento visual espacial o la memoria, aún si la puntuación total está dentro de lo normal.


Cambios en los hábitos de vida

Se debe estimular a los ancianos deprimidos a aumentar su actividad física en la medida de lo posible. En un metanálisis de siete estudios aleatorizados, controlados, el ejercicio de intensidad moderada redujo los síntomas depresivos. Otras recomendaciones son mejorar la alimentación y aumentar las actividades placenteras y las interacciones sociales. En general, debido a que la depresión aumenta la dificultad de iniciar cambios en los hábitos de vida, estas recomendaciones son insuficientes si no se efectúan farmacoterapia, psicoterapia o ambas.


Debido a sus escasos efectos secundarios y su bajo costo, los inhibidores selectivos de la recaptación de serotonina (ISRS), son el tratamiento de primera línea para la depresión de la vejez. En algunos estudios aleatorizados, controlados, aunque no en todos, ISRS como la sertralina, la fluoxetina y la paroxetina fueron más eficaces que el placebo para disminuir los síntomas de depresión.

En general, los que mostraron un beneficio significativo en pacientes con depresión de la vejez fueron grandes estudios; por ejemplo, los estudios que mostraron que la sertralina es beneficiosa tuvieron más de 350 participantes en cada grupo. En los estudios más importantes, las tasas de respuesta a los ISRS (≥50% de reducción en la gravedad de la depresión) oscilaron entre el 35 y el 60%, mientras que la respuesta al placebo fue del 26 - 40%. Las tasas de remisión (síntomas depresivos mínimos) fueron del 32 -44% con los ISRS versus 19 - 26% con el placebo.

Los efectos adversos comunes de los ISRS, que suelen ser leves, son náuseas y cefalea. Pero preocupan informes que observan mayor riesgo de accidente cerebrovascular (ACV) entre personas que reciben ISRS que entre los que no los emplean. Se observó aumento similar del riesgo de ACV con otras clases de antidepresivos, para lo cual no hay una explicación evidente.

Los inhibidores de la recaptación de serotonina-norepinefrina (IRSN) se emplean como fármacos de segunda línea cuando no se logra remisión con los ISRS. Al igual que con estudios en adultos más jóvenes, los estudios aleatorizados con ancianos no mostraron diferencias significativas entre los beneficios de los ISRS y los de los IRSN, aunque los efectos adversos pueden ser más frecuentes con estos últimos.

Si los ISRS o los IRSN son ineficaces, se pueden considerar los antidepresivos tricíclicos, que tienen eficacia similar, si bien sus efectos colaterales son mayores. Los antidepresivos tricíclicos están incluidos en la lista de los Beers Criteria entre los medicamentos que pueden ser inapropiados por sus frecuentes efectos adversos en los ancianos.
Estudios abiertos y pequeños estudios controlados avalan el empleo de bupropión y mirtazapina en pacientes con depresión en la vejez, pero faltan estudios rigurosos controlados por placebo.

Tras ser autorizados para su empleo auxiliar en la depresión resistente al tratamiento, los antipsicóticos de segunda generación olanzapina y aripiprazol se emplean cada vez más para tratar la depresión no psicótica. Un análisis conjunto de subgrupos que incorporó datos de tres estudios controlados por placebo, la mayoría con adultos más jóvenes, mostró que entre pacientes de 50 - 67 años, las tasas de remisión con 6 semanas de refuerzo con aripiprazol fueron mayores que con refuerzo con placebo (32,5% vs. 17,1%). La acatisia fue el efecto colateral más común, en el 17% de los pacientes ancianos. Son necesarios datos a más largo plazo en estos pacientes.


La psicoterapia es eficaz para la depresión de la vejez y se la puede considerar como tratamiento de primera línea. Los enfoques terapéuticos son, entre otros, una fase de tratamiento breve, consistente en visitas semanales durante 8 - 12 semanas. Aunque otros tratamientos también pueden ser eficaces, la evidencia más fuerte a favor del tratamiento breve es la de la terapia conductual cognitiva y la terapia de resolución de problemas.

Poder generalizar, sin embargo, es difícil, porque la mayoría de los estudios de psicoterapia para la depresión de la vejez son en poblaciones geriátricas con cognición intacta, con buen nivel educativo, blancos y relativamente jóvenes.

La terapia conductual cognitiva se centra en identificar y reformular los pensamientos negativos, disfuncionales y al mismo tiempo aumentar la participación en tareas agradables y actividades sociales. Su efecto puede ser más débil en personas con enfermedades físicas o con deterioro cognitivo.

La terapia de resolución de problemas se centra sobre el desarrollo de aptitudes para mejorar la capacidad de afrontar los problemas. Estudios aleatorizados con ancianos mostraron que el tratamiento de resolución de problemas produce mayor mejoría de la depresión que la atención habitual o la terapia de reminiscencia, una psicoterapia centrada en la evaluación y la reformulación de episodios de la vida pasada.

La terapia de resolución de problemas es eficaz para tratar los síntomas depresivos en ancianos con deficiencias cognitivas (sobre todo disfunción ejecutiva), grupo que con frecuencia no responde bien a los antidepresivos. En un estudio de población con deficiencias cognitivas, la terapia de resolución de problemas produjo más remisiones que la terapia de apoyo (el 46% vs. el 28% a 12 semanas), así como también mayor mejoría de la discapacidad y mantuvo los beneficios durante por lo menos 24 semanas.

La terapia interpersonal para ancianos con depresión se centra en las transiciones de roles, la tristeza y las cuestiones interpersonales. En estudios aleatorizados esta terapia redujo mucho más los síntomas depresivos que el tratamiento habitual. Al igual que con la terapia cognitiva conductual, las personas con otras enfermedades concomitantes o con deficiencias cognitivas quizás no respondan bien a la terapia interpersonal.

Tratamiento de mantenimiento

Estudios longitudinales mostraron beneficios significativos del tratamiento continuo tras la remisión. Uno de ellos se efectuó con ancianos con depresión recurrente que tuvieron una remisión breve con nortriptilina y terapia interpersonal durante 16 semanas.

Se asignó aleatoriamente a los participantes a tratamiento de mantenimiento con nortriptilina o placebo y a una sesión mensual de psicoterapia (terapia interpersonal) o a ninguna psicoterapia. Tres años después, las tasas de recidiva fueron significativamente menores entre las personas asignadas a tratamiento continuo con nortriptilina sola (43%), nortriptilina y terapia interpersonal (20%), o terapia interpersonal sola (64%) que entre las que recibieron placebo sin terapia interpersonal (90%).

Sin embargo, en un estudio similar sobre pacientes con un primer episodio de depresión, el tratamiento de mantenimiento con paroxetina (sola o con terapia interpersonal), pero no con terapia interpersonal sola, disminuyó el riesgo de recidiva a 2 años, en relación con ningún tratamiento de mantenimiento. No hay datos de estudios aleatorizados a largo plazo para evaluar la eficacia del tratamiento de mantenimiento con terapia cognitiva conductual o terapia de resolución de problemas para la depresión del anciano.

Estimulación cerebral

El tratamiento electroconvulsivo (TEC) o electroshock es el tratamiento más eficaz para los pacientes con depresión intensa, incluidos los ancianos. Aunque los antidepresivos son el tratamiento de primera línea, el TEC se debe considerar si los pacientes son suicidas, no respondieron a los medicamentos antidepresivos, tienen un trastorno físico deteriorante o una discapacidad relacionada con la depresión que amenaza su posibilidad de vivir independientemente.

Datos de estudios abiertos, con pacientes que no respondieron a los antidepresivos, sugieren tasas de remisión del 70 - 90% con TEC. Faltan datos de estudios controlados de alta calidad con intervención simulada que empleen técnicas modernas de TEC. Estudios aleatorizados muestran altas tasas de recaída (40 - 50% en los 6 meses posteriores al tratamiento).

El TEC tiene pocas contraindicaciones. Los efectos colaterales más frecuentes son confusión con amnesia anterógrada y retrógrada; las técnicas actuales de administración disminuyen este riesgo y los síntomas cognitivos se resuelven tras finalizar el TEC. Las personas con enfermedad cardiovascular o neurológica tienen mayor riesgo de problemas de memoria relacionados con el TEC.

La estimulación magnética transcraneal (EMT) es un tratamiento más nuevo que emplea un campo electromagnético focal generado por una bobina situada sobre el cuero cabelludo, en general sobre la corteza prefrontal izquierda. Las sesiones se efectúan cinco veces a la semana durante 4 - 6 semanas.

Este tratamiento no tiene efectos secundarios cognitivos. Sin embargo, un metanálisis de seis estudios que compararon la EMT con el TEC mostraron que el TEC tiene mayores tasas de remisión. Algunos estudios sugieren que la respuesta en los ancianos deprimidos puede no ser tan positiva como la de los pacientes más jóvenes.


Los datos sobre la eficacia y la seguridad de muchos antidepresivos en poblaciones ancianas son escasos o ausentes y quizás haya riesgos específicos para estas poblaciones. Los datos sobre la farmacoterapia prolongada y las estrategias de mantenimiento de la psicoterapia en poblaciones ancianas también son limitados.

No es evidente cuál es la mejor manera de tratar las deficiencias cognitivas en pacientes ancianos con depresión. Estas deficiencias son pronósticas de poca respuesta a los antidepresivos; aún con la remisión de la depresión, las deficiencias pueden persistir e indican un alto riesgo de demencia. Ni la memantina, autorizada para tratar la enfermedad de Alzheimer, ni los estimulantes como el metilfenidato mostraron beneficios cognitivos en pacientes ancianos con depresión.


Las recomendaciones de este trabajo coinciden con las de la American Psychiatric Association. Estas recomendaciones subrayan la necesidad de una cuidadosa evaluación del riesgo de suicidio y de las enfermedades concomitantes en esta población.

Conclusiones y recomendaciones

Para el primer episodio depresivo en un anciano el tratamiento de primera línea podría ser la farmacoterapia o la psicoterapia, según las preferencias del paciente y la disponibilidad de la psicoterapia. Si se emplean medicamentos, el tratamiento inicial recomendado es un ISRS, con una dosis baja al inicio (e.g., sertralina 25 mg/día) a fin de evaluar los efectos colaterales en el paciente y aumentar después a la dosis terapéutica mínima (50 mg/día).

Pueden ser necesarias dosis mayores para obtener la máxima eficacia (e.g., 100 mg o más de sertralina diariamente), con mucha atención a los efectos secundarios. Si los síntomas depresivos no disminuyen se podría considerara cambiar a un IRSN, como la venlafaxina. Se deben efectuar pruebas de detección para deficiencias cognitivas y considerar pruebas neuropsicológicas si los síntomas cognitivos persisten o empeoran a pesar del tratamiento antidepresivo.


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29. Sheffrin M, Driscoll HC, Lenze EJ, et al. Pilot study of augmentation with aripiprazole for incomplete response in latelife depression: getting to remission. J Clin Psychiatry 2009; 70:208-13.
30. Rutherford B, Sneed J, Miyazaki M, et al. An open trial of aripiprazole augmentation for SSRI non-remitters with late life depression. Int J Geriatr Psychiatry 2007; 22:986-91.
31. Steffens DC, Nelson JC, Eudicone JM, et al. Efficacy and safety of adjunctive aripiprazole in major depressive disorder in older patients: a pooled subpopulation analysis. Int J Geriatr Psychiatry 2011; 26: 564-72.
32. Kiosses DN, Leon AC, Areán PA. Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatr Clin North Am 2011; 34:377-401.
33. Gould RL, Coulson MC, Howard RJ. Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc 2012; 60: 1817-30.
34. Pinquart M, Duberstein PR, Lyness JM. Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis. Aging Ment Health 2007; 11:645-57.
35. Crabb RM, Cavanagh K, Proudfoot J, Learmonth D, Rafie S, Weingardt KR. Is computerized cognitive-behavioural therapy a treatment option for depression in late-life? A systematic review. Br J Clin Psychol 2012; 51:459-64.
36. Arean PA, Perri MG, Nezu AM, Schein RL, Christopher F, Joseph TX. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychol 1993;61: 1003-10.
37. Areán PA, Raue P, Mackin RS, Kanellopoulos D, McCulloch C, Alexopoulos GS. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am J Psychiatry 2010; 167:1391-8.
38. Alexopoulos GS, Kiosses DN, Heo M, Murphy CF, Shanmugham B, Gunning-Dixon F. Executive dysfunction and the course of geriatric depression. Biol Psychiatry 2005; 58:204-10.
39. Sheline YI, Pieper CF, Barch DM, et al. Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial. Arch Gen Psychiatry 2010; 67: 277-85.
40. Alexopoulos GS, Raue PJ, Kiosses DN, et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry 2011; 68:33-41.
41. Mossey JM, Knott KA, Higgins M, Talerico K. Effectiveness of a psychosocial intervention, interpersonal counseling, for subdysthymic depression in medically ill elderly. J Gerontol A Biol Sci Med Sci 1996; 51:M172-M178.
42. Reynolds CF III, Dew MA, Pollock BG, et al. Maintenance treatment of major depression in old age. N Engl J Med 2006; 354:1130-8.
43. Reynolds CF III, Frank E, Perel JM, et al. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA 1999; 281:39-45.
44. Prudic J, Olfson M, Marcus SC, Fuller RB, Sackeim HA. Effectiveness of electroconvulsive therapy in community settings. Biol Psychiatry 2004; 55:301-12.
45. Prudic J, Haskett RF, McCall WV, et al. Pharmacological strategies in the prevention of relapse after electroconvulsive therapy. J ECT 2013; 29:3-12.
46. George MS, Lisanby SH, Avery D, et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry 2010; 67:507-16.
47. Slotema CW, Blom JD, Hoek HW, Sommer IE. Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry 2010; 71:873-84.
48. Lisanby SH, Husain MM, Rosenquist PB, et al. Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology 2009; 34:522-34.
49. Pallanti S, Cantisani A, Grassi G, et al. rTMS age-dependent response in treatment- resistant depressed subjects: a minireview. CNS Spectr 2012; 17:24-30.
50. Reynolds CF III, Butters MA, Lopez O, et al. Maintenance treatment of depression in old age: a randomized, doubleblind, placebo-controlled evaluation of the efficacy and safety of donepezil combined with antidepressant pharmacotherapy. Arch Gen Psychiatry 2011; 68:51-60.
51. Gelenberg AJ, Freeman MP, Markowitz JC, et al. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Washington, DC:American Psychiatric Association, 2010.


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Desarrollo de HATD (herramientas de ayuda a la toma de decisiones) derivadas de las recomendaciones de las Guías de Práctica Clínica

by System Administrator - Friday, 29 September 2017, 10:28 AM

Desarrollo de HATD (herramientas de ayuda a la toma de decisiones) derivadas de las recomendaciones de las Guías de Práctica Clínica

Pretende identificar y sintetizar las estrategias metodológicas propuestas para establecer un desarrollo colaborativo entre las GPC y las herramientas de ayuda a la toma de decisiones (HATD).




Por favor descargue la guía adjunta en formato PDF

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DevOps strategy for health site fueled by flash, CDM

by System Administrator - Thursday, 16 March 2017, 11:26 PM

DevOps strategy for health site fueled by flash, CDM

by Dave Raffo

Women's health website Lifescript 'transformed into a DevOps' shop after implementing all-flash arrays from Pure Storage and Actifio CDM.

Flash storage and copy data management helped women's health website Lifescript adopt a DevOps strategy that is crucial to its revenue generation.

All-flash vendor Pure Storage Inc. and copy data management (CDM) pioneer Actifio Inc. last year launched the Actifio AppFlash DevOps Platform, which runs Actifio software on Pure arrays. Lifescript had already been using Actifio and Pure in combination for years as an early proponent of both technologies. That combo formed a storage foundation for a DevOps strategy.

"We've always been chasing performance," Lifescript's CTO Jack Hogan said of his company's move to flash.

Lifescript started using flash in Hewlett-Packard 3PAR StoreServ hybrid arrays in 2012. The hybrid 3PAR arrays improved IOPS performance, but latency remained an issue. Hogan looked at Pure Storage's FlashArray in the early days of the all-flash startup and became one of its first 100 customers in 2013.

He cited Pure's built-in data deduplication as a major selling point, especially after he tested it and it ran without a performance hit. He said the data reduction made Pure more cost-effective for Lifescript.

"It was hard to part with 3PAR because we had a long-term relationship with them," he said. "But it became a no-brainer once we determined there was no performance hit introducing [Pure's] dedupe and compression. We were always constrained by latency, and HP was still struggling to get its data reduction in place."

HP -- now Hewlett Packard Enterprise following the Hewlett-Packard company split -- introduced an all-flash version of 3PAR around the time Lifescript switched over, but Hogan said it would cost about eight times what the Pure array costs for usable capacity.

All-flash arrays reduce latency, bump IOPS

"We're making real-time business decisions based on our ability to process data. And now, we're processing it so much faster."
Jack Hogan | CTO, Lifescript

Hogan said Lifescript sends up to 30 million emails a day to subscribers. The website runs complex data analytics to find relevant information to send to users. He said the Pure arrays decreased latency from 60 milliseconds to five milliseconds while running analytics, helping Lifescript pump out relevant information faster.

"We're making real-time business decisions based on our ability to process data. And now, we're processing it so much faster," Hogan said.

Lifescript has Pure FlashArrays running in separate data centers for a total of 92 TB of raw capacity. Hogan said the arrays give him a 3 1/2:1 data reduction ratio.

Flash, copy data management form DevOps strategy

Lifescript actually implemented Actifio before switching to all-flash. Lifescript started with an Actifio CDS data center appliance running at a managed third-party site. Now, it uses Actifio Sky virtual appliances to bridge primary and secondary data centers. Sky handles replication between Pure arrays, enabling disaster recovery for the company's VMware and Microsoft SQL Server applications.

"The primary reason [for going to Actifio]," Hogan said, "was the economies of copy data management, being able to spin up replicas, and move and replicate data easily."

Actifio's CDM fits into the DevOps strategy. Hogan said Actifio has made life easier on the six developers on Lifescript's 17-person IT team, allowing the team to quickly create copies of 10 TB-plus databases to use for development purposes.

"We've transformed into a DevOps shop," he said. "Our database group can quickly spin up copies of things, and our development group can run their new application against production-class platforms. We're not creating secondary block-level storage; we're just spinning up copies.

"That contention that used to exist between individual divisions in the IT group has gone away."

Next Steps


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Diagnósticos médicos a distancia

by System Administrator - Sunday, 19 October 2014, 1:44 PM

Diputados paraguayos aprueban ley de diagnósticos médicos a distancia


Los diputados aprobaron este jueves el proyecto de ley que "crea el Programa Nacional de Telesalud". | Foto: Archivo ÚH

La Cámara de Diputados aprobó este jueves el proyecto de ley que "crea el Programa Nacional de Telesalud", que da un marco legal a los diagnósticos médicos a distancia.

Este sistema permite que muestras médicas tomadas en cualquier punto del país puedan ser analizadas rápidamente por un equipo médico en Asunción. El documento pasa al Senado.

El diputado Carlos Núñez dijo que con este proyecto se establecerá un comité que trabajará para potenciar el sistema de telemedicina.

"El Ministerio de Salud aplica un sistema piloto con ecografías, electrocardiografía y otros estudios, en distintas ciudades. Actualmente unas 5 mil personas ya fueron atendidas con este sistema", explicó.

El diagnostico remoto es una herramienta que permitirá una mayor cobertura del sistema de salud en todo el país, con trasmisión de las pruebas a centros especializados que permitirán un pronto diagnóstico.

El documento fue propuesto en Diputados y pasa al Senado para su estudio.

El primer diagnóstico a distancia se realizó en Paraguay con un estudio remitido desde Fuerte Olimpo, Departamento de Alto Paraguay, y la recepción se hizo en el Instituto Nacional de Prevención Cardiovascular (Inpcard), se realizó en diciembre del 2013.


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Digital Forensics

by System Administrator - Tuesday, 19 September 2017, 9:42 PM

Digital forensics: The smart person's guide

By Dan Patterson

This comprehensive guide covers everything you need to know about digital forensics, the science of recovering data from computers, networks, mobile phones, and IoT devices.

"On the internet nobody knows you're a dog," famously joked Peter Steiner. To the layperson in 1993, when the cartoon was published in The New Yorker, both dogs and people were free to explore bulletin boards and chat on IRC with little fear of leaving a digital trail. The infant internet was a realm where ideas flourished and privacy was assured.

Today information and connected devices are abundant, but online privacy is a rare commodity. Though the web superficially appears to be anonymous, your behavior is tracked by your ISP and analyzed by the NSA, web marketers mine your clickstream, and even encryption, a tool deployed by the most privacy-sensitive web users, is under attack.

Digital forensics is the application of scientific tests related to crime detection. This type of forensics is a documentation and analytical method of recovering data from physical media, such as PCs, servers, mobile phones, and IoT devices.

For countless personal and professional reasons consumers and companies should be aware of how online activity can leave detectable breadcrumbs. This smart person's guide is a routinely updated "living" precis loaded with contemporary information about how digital forensics works, who it affects, and how to learn more about web analysis.

Executive summary

What it is: Digital forensics is the extraction, analysis, and documentation of data from physical media.

Why it matters: Digital life is not anonymous. As we use the web, we also scatter fragments of data in our wake. If collected, personal data fragments can present an accurate profile of our behavior and personality. Often this data trail is accompanied by legal implications. Digital forensic experts know how to assemble the picture. 

Who it affects: Because digital forensics experts are typically used in a legal setting, government organizations, SMBs, and enterprise companies may want to consider preemptively working with an expert to better understand potential vulnerabilities.

When it's happening: Digital forensics has been a thriving industry since the mid-1970s.

How to learn more: For interested job-seekers there are a number of digital forensics roles in both the public and private sector.

WATCH: Cracking The 'Great Firewall Of China' (CBS News)

What it is

Digital forensics scientists are responsible for capturing hard-to-access data from disc drives and flash storage and analyzing digital trails. Often part of the discovery process, in conjunction with a civil or criminal law, the results of digital forensic analysis can provide evidence used in court cases or documentation material to prove or disprove alibis and accusations.

By 2021, digital forensics is estimated to be a $4.9 billion industry.

Modern digital forensics is process-oriented and composed of three primary areas of emphasis and expertise: computer (PCs), network (connected PCs), and mobile (phones and IoT). Each of these disciplines requires a mastery of several hardware and software tools.


  • Forensic Bridge Also known as write blockers, these versatile devices connect to and safely extract data from an array of storage media.
  • FRED An acronym for Forensic Recovery of Evidence Device, these workstations plug directly into and analyze data on high-speed networks.
  • The SHADOW This is a speedy device that can image a suspect's hard drive at the scene of a crime.
  • Media duplication terminal This is a stand-alone evidence-grade box with modular inputs that can capture data from CDs and DVDs, USB, flash cards, and mobile devices.
  • Capture screens These are portable evidence scanners that can grab screen captures and record video in the field.


  • The Sleuth Kit This open source suite of applications can locate hidden files, recover lost documents, and analyze registry changes on Windows, DOS, Unix, Linux, Mac, and other common operating systems.
  • Wireshark This is a widely used open source network packet sniffer.
  • CAINE This Linux distribution is tailored for digital forensics and offers an integrated set of memory, mobile, and network forensic tools.
  • Registry Recon This software analyzes and can rebuild the Windows registry.
  • COFEE Developed by Microsoft, this data extraction and documentation tool is used by law enforcement agencies.
  • Volatility This memory forensics tool can extract information stored on RAM.

Additional resources

Why it matters

Everything we do online leaves a footprint. Love it or lump it, in legal disputes public and private this footprint is compiled and frequently used as evidence. Though the digital forensics field was once as wild and disorganized as early Silicon Valley, today experts are highly trained and follow rigorous protocols. These guidelines help protect law enforcement agencies from evidence contamination and help corporations fend off cyberattacks.

Additional resources

Who it affects

Law enforcement ranging from the United Nations to the FBI to local and state police all employ healthy teams of digital forensics analysts. As cybersecurity becomes a priority for business, corporations are hiring forensics experts to test network resiliency and help develop cyber-defense policy. Every major private sector cybersecurity firm retains trained and experienced forensics experts.

Consumers, protected by encryption on everything from mobile devices to bank websites, are affected by digital forensics. Apple, of course, famously went to war with the FBI to protect the company's right to use strong encryption on the iPhone. Still, with the right tools, iOS and Androiddevices are susceptible to data recovery tactics.

Additional resources

When it's happening

Digital forensics experts are investigators. Just as their offline counterparts dust for fingerprints at crime scenes, digital forensics analysts uncover and document data clues hidden on computers and mobile devices.

Born in the mid-1970s the art of digital forensics evolved in tandem with the growth of personal computing. Similar to hackers, progenitors of the profession probed early computer networks and documented vulnerabilities. The process was generally disorganized and relied on non-specialized available tools.

In the 1980s and 1990s computer crime entered the mainstream and along with it came the need for new tools, new standards, and new laws. Packet analyzers and write blockers emerged as essential utensils. Based in part on Kenneth S. Rosenblatt's famous publication High-Technology Crime, forensics analysis helped standards and procedures employed by courts, the FBI, and local enforcement agencies.

Academic and professional standards evolved in the 2000s, and the industry shifted focus to web and mobile cybercrime, hacking, and cyber-defense. By 2021, digital forensics is estimated to be a $4.9 billion industry.

Additional resources

How to learn more

The number of educational resources to support the burgeoning field is growing as well. Community colleges and major universities like Boston University, Pace, and Penn State, along with local and regional community colleges, offer digital forensics programs., a website that sells professional training courses, hosts a growing number of digital forensics how-to videos.

YouTube is a helpful and free resource to learn the fundamentals of digital forensics.

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Digital Health Coaching

by System Administrator - Tuesday, 18 April 2017, 3:19 PM

Digital health coaching not here yet; human health coaches predominate

by Shaun Sutner

With corporate health coaching expanding fast, human coaches are dominating the field, and autonomous digital health coaching systems are a long way off, according to one expert.


Melinda Huffman

Melinda Huffman is co-founder of the National Society of Health Coaches and a principal of Miller and Huffman Outcome Architects, a health coaching consulting firm in Winchester, Tenn.

Health coaching is fast becoming popular in corporate America, and while digital health coaching technologies are available in some wellness and telemedicine platforms, Huffman's stance is that human health coaches still predominate.

In this Q&A with SearchFinancialApplications, Huffman asserts that live, trained coaches -- sometimes in conjunction with technologies such as connected health devices -- are best equipped to provide motivational coaching support.

How important is technology to corporate health coaching, and how fast is that technology evolving?

Melinda Huffman: Technology has become one of the go-to strategies in corporate wellness and health coaching initiatives. But health coaching is primarily about engaging an individual through conversational skills. The technology piece is an additional part of that. It's kind of a two-pronged approach.

The social context of one's life is how people make healthcare decisions, whether you're an employee, a client, a member or a patient. One of the most important things a health coach does is take what your concern is, and put that into perspective. Especially for chronic conditions, if you have a treatment plan, are you going to follow it? We know that up to 60% of patients don't follow their treatment plans, and up to 50% don't complete their medications. They may not even fill the prescription. They may fill the prescription and not take it.

In terms of how technology can assist the health coach, employers can provide employees with Fitbits or pedometers or apps to help us track progress, track what kind of intervention has happened and share that with each other in a kind of peer coaching to motivate each other. Technology is primarily used to help an individual track their own progress or compare their progress to others in their group, and they can do that anonymously and compare themselves to an aggregate.         

What's the status of specialized coaching apps that use software to perform the coaching function, or that work in conjunction with human coaches?

Huffman: It's still very, very early. We don't see much of that yet, and the reason for that is the scientific basis of motivational coaching is based on your responses to me as a coach. It's not a yes-no algorithm. Because how you respond to me is how I make my next comment.

There are several different responses I could make to you, the patient or the client, and it's based on what you're saying to me and what I know about you. So [digital health coaching] software that would be completely independent is a long way off.

How do health coaching programs work with corporate wellness and well-being programs, other benefits offerings and health insurance plans?

Huffman: We train a lot of Fortune 500 companies, and they have their coaching staff on site, or off site, and we see a lot of self-insured companies reach out to help their staff be prepared to engage employees, rather than having an MCO [managed care organization] or third-party provide coaching.

An MCO may simply call someone a health coach or put them in the role of a health coach, but what they're doing is health teaching, and health teaching is a very small part of health coaching.

How do real-life coaches work with tracking devices, whether they are step counters, connected scales, blood pressure cuffs or glucometers?

Huffman: Individuals will either call in, text or go online to enter that information. Some of those [devices] can be connected via your smartphone. For example, you can directly download your glucometer readings to your phone, and the company can do whatever it chooses with that information, such as trend outcomes, aggregate outcomes or give you feedback on how you fit in relation to others your age and with the same condition.

In health coaching, as the National Society of Health Coaching defines it, there must be somebody else to engage you. The bottom line of health coaching is tapping into [the patient's] own self-motivation. [With connected devices] your doctor is just depending on you to have enough motivation to do what you're supposed to do and share the information with them.

With all these devices, and getting the data from point A to point B, whether it's a software interface or platform, that's only a part. That's just the data. That itself is not health coaching. There has to be someone there to do the coaching, whether it's over FaceTime or Skype or email or texting. But there's got to be someone there who has been trained in the skill of motivational interviewing.

"With all these devices, and getting the data from point A to point B, whether it's a software interface or platform, that's only a part. That's just the data. That itself is not health coaching."

Melinda Huffman | health coach


Next Steps



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Digital Pathology Repository

by System Administrator - Wednesday, 8 July 2015, 10:05 PM

Philips, Mount Sinai To Create Digital Pathology Repository


Today, Philips announced a joint development agreement with the Mount Sinai Health System to create a digital image pathology repository containing the digital scans of patient tissue slides and data analytics to pursue the discovery of new tissue-based tests and unlock pathology data. The collaboration aims to advance clinical research and ultimately enable better care for complex diseases, including cancer. Terms of this collaboration agreement were managed by Mount Sinai Innovation Partners, the technology development and commercialization group for the Mount Sinai Health System.

Collaboration Details

Together, Philips and Mount Sinai will create a comprehensive digital image repository containing the digital scans of all these patient glass tissue slides that will be made accessible to researchers. By integrating, analyzing and presenting the data available from whole slide pathology images, clinical laboratory services, genetic analysis, radiology, and surgical and molecular pathology, the data analytics obtained will enable the development of predictive analytics to help personalize patient care. Currently, Mount Sinai Health System comprises seven hospital campuses serving approximately 170,000 inpatients and 2.6 million outpatients annually.

“This collaboration with Philips has the potential to help drive a new paradigm in healthcare that includes the optimization of treatment efficacy and superior clinical outcomes,” said Dr. Carlos Cordon-Cardo M.D., Ph.D., Chairman of the Department of Pathology at the Mount Sinai Health System. “Our ultimate goal with this initiative is to translate data into knowledge to maximize personalized patient management.”


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Digitizing Surgery: How New Technologies Will Transform Old Medical Practices [Video]

by System Administrator - Sunday, 5 July 2015, 11:55 PM

Digitizing Surgery: How New Technologies Will Transform Old Medical Practices [Video]

By David J. Hill

From one point of view, surgery is a fairly barbaric means of improving your health. After all, your body is cut open, organs are moved around or removed, and doctors probe with their fingers and use instruments to repair damaged tissues. But these practices are in the midst of significant change.

At last year's Exponential Medicine conference in San Diego, Dr. Catherine Mohr, Vice President of Medical Research at Intuitive Surgical, took the stage to address how emerging technologies are reshaping medical practice. "We're talking about the future of intervention. When we look at where things are going in the future, it's always a good idea to understand what we're doing now and where we've come from."

Mohr provided a historical walkthrough of the advances that have increased longevity."We have been intervening with our health care for a very, very long time," she said. "Surgery has been going on for tens of thousands of years. We see evidence from archaeology of surgical procedures that were done on patients and they've lived afterwards."

Beginning with Egyptian surgical methods, Mohr proceeded from improvements in public health such as sanitation and access to clean water, through the age of antibiotics, and into the era of modern medicine, highlighting an amazing achievement in public health: Within a century, a life expectancy of over 50 years progressed from just a few countries to almost every country in the world.

She added, "In this last 50 years or so, we have been making huge strides in both the kinds of surgical therapies we can provide and the imaging that we can do to support it." Essential to surgery will be the ability to analyze the streams of data that will increasingly be available and make data-driven decisions for care.


Mohr outlined three pillars of medical care that technologies are improving:

  1. Prevention — enhancing wellness with the goal of reducing intervention
  2. Diagnostics — improving detection so that actions can be taken earlier and often
  3. Intervention — reducing the scale of need by providing care earlier and more precisely

One disease that Mohr expects new technologies to drastically disrupt our approach to care is cancer. She explained that because of improved methods of detection and imaging, cancerous tissue will be identified when it's the size of a pea. The impact on surgery will be the elimination of "big reconstructive surgeries."

Within a century, a life expectancy of over 50 years progressed from just a few countries to almost every country in the world.

So what is the future of medicine? What will digitizing surgery actually mean?

Mohr says that doctors will be "shifting more into the spare parts business." She continued, "As we get rid of cancer, we unmask the issues causing our bodies to sag and tear and wear out. The replacement of these parts is maintenance." Additionally, she noted that in the near term, advances with new instruments and the ability to insert robotic instruments through a very small opening in the body, the future of intervention will be defined by diagnostics driven by regenerative medicine and high-tech implants coupled with artificial intelligence and big data.

To learn more about Singularity University's Exponential Medicine conference, click here.


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Dime-sized device can separate healthy and cancerous cells

by System Administrator - Tuesday, 2 September 2014, 5:27 PM

Dime-sized device can separate healthy and cancerous cells

By Varun Saxena

The microfluidic instrument employs sound waves to sort cells

MIT scientists have developed a dime-sized microfluidic device that can sort rare cancer cells from healthy ones using sound waves--an innovation that could have applications for cancer diagnosis, drug discovery and clinical research. 

"Acoustic pressure is very mild and much smaller in terms of forces and disturbance to the cell. This is a most gentle way to separate cells, and there's no artificial labeling necessary," MIT researcher and study co-author Ming Dao said in a MIT news release.

The team, also comprising scientists from Carnegie Mellon and Penn State, managed to separate healthy cells from cancerous ones by running acoustic sound waves across the device's microchannel so that they met at an angle, creating a line of low pressure. Upon encountering the low pressure while flowing through the microchannel, the cancerous and noncancerous cells separate onto either side of the channel. The separation occurs based on different cellular properties such as cell size and compressibility, MIT explains.

The device was able to sort 71% of breast cancer cells from white blood cells. The team has filed a patent on the device. Next, the researchers plans to test the device using the actual blood of cancer patients, to see how it performs at separating the cells in clinical settings, according to the news release. More details are available in the Proceedings of the National Academy of Sciences.

"If you can detect these rare circulating tumor cells, it's a good way to study cancer biology and diagnose whether the primary cancer has moved to a new site to generate metastatic tumors," Dao said in the release.  

Microfluidic devices aim to create a "lab-on-chip" by acting as platforms that mimic biological systems in a simplified, in vitro (outside the body) setting.

The journal Microfluidics and Nanofluidics describes microfluidics as "the study of mass (including molecular and colloidal) and momentum transfer, heat transfer, and reactive processes, coupled with transport in microscale and nanoscale systems."  

The FDA's device arm is encouraging the creation of in vitro models for medical device development and assessment through the launch of a pilot program to validate research tools such as this one. However, in this case, the new device is likely to prove most useful as a tool for drug development or cancer diagnosis.

- read the MIT news release
- here's the study abstract in PNAS
read the article in its entirety (PDF)

Related Articles:
Researchers unveil lung-on-a-chip device
FDA launches pilot program for qualification of medical device development tools
Nanopores, microfluidics get $14.5M from NIH for new DNA sequencing tech
Harvard's bone marrow-on-a-chip could replace animal drug testing


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Dissatisfaction with EHRs

by System Administrator - Saturday, 2 August 2014, 1:21 AM

9 Key Drivers of Physician Dissatisfaction with EHRs

Recent RAND study provides the key drivers of physician dissatisfaction with EHRs and its affect on physician professional satisfaction.

A recent RAND research report reveals that the current state of EHR technology significantly worsened professional satisfaction in multiple ways. The project sponsored by the American Medical Association (AMA) gathered data from 108 in-person interviews and received 447 written responses across 30 physician practices in six states: Colorado, Massachusetts, North Carolina, Texas, Washington, and Wisconsin.

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Docs accused of using EHR to steal patients

by System Administrator - Thursday, 8 October 2015, 5:15 PM

Docs accused of using EHR to steal patients

By Susan D. Hall

Valley Children's Hospital in Madera, California, has filed a suit against three pediatric lung specialists, claiming they wrongfully accessed patient records in order to lure them away.

The lawsuit names John Moua, M.D., David Lee, M.D., Paul Do, M.D., and two medical groups--University Pediatric Specialists and Central California Faculty Medical Group.

Records of at least 164 patients were accessed by the doctors while they were working at Valley Children's, Michael Goldring, interim chief legal officer and administrative officer, told The Fresno Bee. He called the access "a significant data breach" and a HIPAA violation.

Moua left his Valley Children's practice in August for Community Regional Medical Center, according to the lawsuit. Do had applied to practice at Valley Children's in April but instead in August took a job at University Pediatric Specialists to also practice at Community Regional.

The lawsuit's allegations include "unauthorized computer access, misappropriation of trade secrets, conversion and misappropriation of patients' personal health information ... to divert patients for their personal financial gain and commercial advantage."

Such instances add to growing legal concerns surrounding inappropriate access and use of such systems. 

That can include EHR fraud when it comes to billing as well as EHR-related medical malpractice problems.

Then there are situations that involve labor practices. To wit, in Missoula, Montana, Rocky Mountain Eye Center is fighting a ruling that terminating an employee for improper access to its electronic health record is an unfair labor practice under the National Labor Relations Act.

To learn more:

- here's the article - read the lawsuit

Related Articles:


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Does the "Doc Fix" Bill Help Telemedicine and Telehealth?

by System Administrator - Thursday, 23 April 2015, 8:16 PM

Does the "Doc Fix" Bill Help Telemedicine and Telehealth?

In a word: yes.  Telemedicine was one of the many beneficiaries of changes introduced by the so-called “doc fix” bill, formally titled the Medicare Access and CHIP Reauthorization Act (H.R. 2). The legislation was passed by Congress on April 15, 2015 and signed into law by the President on April 16, 2015. It introduces sweeping changes to the reimbursement methodologies and financing of health care in the United States, including a notable shift away from the traditional fee-for-service model and towards accountable care organizations (ACOs), risk-based payment, and a focus on quality and population health.

As organizations embracing telemedicine recognize, these new payment models are ideally suited to the improved access, quality and care management offered by telemedicine technologies. The Act is a signal to the provider community that embracing innovative care delivery, such as telemedicine and telehealth, is an important step to positioning your organization to best capture these new payment opportunities.

But the Act also includes specific provisions benefiting telehealth and remote patient monitoring (RPM), particularly for the Medicare program. It states: 

  • Telehealth and remote patient monitoring are expressly recognized as, and included in the definition of, “Clinical Practice Improvement Activities” along with care coordination, population health management, and monitoring of health conditions.
  • New “Alternative Payment Models” may include payment for telehealth services, even if the service is not otherwise covered by the traditional Medicare program (42 U.S.C. 1395(m)).
  • The GAO is required to conduct a study on telehealth and the Medicare program, publishing the report no later than April 2017. Specifically, it states:

STUDY ON TELEHEALTH SERVICES. The Comptroller General of the United States shall conduct a study on the following:

How the definition of telehealth across various Federal programs and Federal efforts can inform the use of telehealth in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

Issues that can facilitate or inhibit the use of telehealth under the Medicare program under such title, including oversight and professional licensure, changing technology, privacy and security, infrastructure requirements, and varying needs across urban and rural areas.

Potential implications of greater use of telehealth with respect to payment and delivery system transformations under the Medicare program under such title XVIII and the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.).

How the Centers for Medicare & Medicaid Services monitors payments made under the Medicare program under such title XVIII to providers for telehealth services.

  • The GAO is required to conduct a second study on remote patient monitoring and the Medicare program, publishing the report no later than April 2017. Specifically, it states:

 STUDY ON REMOTE PATIENT MONITORING SERVICES. The Comptroller General of the United States shall conduct a study:

of the dissemination of remote patient monitoring technology in the private health insurance market;

of the financial incentives in the private health insurance market relating to adoption of such technology;

of the barriers to adoption of such services under the Medicare program under title XVIII of the Social Security Act;

that evaluates the patients, conditions, and

clinical circumstances that could most benefit from remote patient monitoring services; and

that evaluates the challenges related to establishing appropriate valuation for remote patient monitoring services under the Medicare physician fee schedule under section 1848 of the Social Security Act (42 U.S.C. 1395w–4) in order to accurately reflect the resources involved in furnishing such services.

REMOTE PATIENT MONITORING SERVICES.— The term ‘‘remote patient monitoring services’’ means services furnished through remote patient monitoring technology.

REMOTE PATIENT MONITORING TECHNOLOGY.— The term ‘‘remote patient monitoring technology’’ means a coordinated system that uses one or more home-based or mobile monitoring devices that automatically transmit vital sign data or information on activities of daily living and may include responses to assessment questions collected on the devices wirelessly or through a telecommunications connection to a server that complies with the Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996, as part of an established plan of care for that patient that includes the review and interpretation of that data by a health care professional.

The Act contains many provisions intended to promote innovation and care delivery by catalyzing health care organizations to invest in and use the powerful telemedicine tools and technologies available in the marketplace. This vision is consistent with prior surveys of health care executive leadership. By continuing to develop their telemedicine programs and pursuing new payment options, leaders are showing they know that their smartest play is to be ready for the law to catch up — because it will.

Are you interested in learning more about telemedicine business models and new payment opportunities? Foley offers opportunities to get up to speed with the latest developments:

Online Resources

For more information on telemedicine, including publications, presentations and other materials, visit


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Dolor músculo esquelético ¿cómo abordarlo?

by System Administrator - Tuesday, 14 July 2015, 12:52 AM

Dolor músculo esquelético ¿cómo abordarlo?

Asociación Latinoamericana de Medicina Ortopédica (Argentina)

Fuente: IntraMed

La creación de una sociedad científica orientada al abordaje basado en evidencias de la patología músculo-esquelética, uno de los problemas de mayor prevalencia mundial. IntraMed entrevista a su vicepresidente, el Dr. Emilio Pastor para conocerla en profundidad. Usted encontrará en sus opiniones conceptos de alta relevancia que modificarán su práctica cotidiana.

La LAOM Argentina es la filial en la Argentina de la AAOM (American Association of Orthopaedic Medicine). Es una organización sin fines de lucro que provee información y programas de educación sobre el diagnóstico correcto y tratamientos integrales no quirúrgicos de los problemas músculo-esqueléticos.

Junto a la AAOM promovemos el desarrollo de la Medicina Ortopédica enseñándoles a los médicos técnicas diagnósticas y tratamientos no quirúrgicos integrales que incluyen inyecciones regenerativas (proloterapia, plasma rico en plaquetas), técnicas osteopáticas, ejercicios  terapéuticos e intervenciones nutricionales, farmacológicas y posturales.

Los métodos de diagnóstico y tratamiento de la LAOM Argentina son efectivos en dar alivio tanto para los dolores agudos como para los crónicos que provengan de la columna cervical (cervicalgias), de la columna dorsal (dorsalgias), de la columna lumbar y de la región sacroilíaca (lumbalgias), de los miembros superiores (omalgias, codos de tenista /golfistas, rizartrosis, túnel carpiano, etc.) y de los miembros inferiores (coxalgias, pubalgias, síndrome patelofemoral, gonartrosis, tendinosis, esguinces, fasciosis plantar, etc.).

VISIÓN Crear una organización mundial junto a la AAOM que difunda, enseñe, entrene y publique nuestro enfoque y manejo integral de los problemas músculo-esqueléticos.

MISIÓN LAOM Argentina es una organización sin fines de lucro dedicada a la educación médica en el diagnóstico y tratamientos no quirúrgicos de los dolores músculo-esqueléticos. LAOM Argentina junto a la AAOM promueven la colaboración trans-disciplinaria y crean una conciencia pública de nuestro enfoque integral.

Entrevista al vicepresidente de LAOM Argentina, Dr. Emilio Pastor

¿Cuáles son los orígenes y los objetivos de la LAOM Argentina?

La LAOM Argentina es la filial en Argentina de la American Association of Orthopaedic Medicine (AAOM). Estas entidades son organizaciones sin fines de lucro destinadas a la educación médica en el diagnóstico y tratamiento no quirúrgicos de los dolores músculo-esqueléticos. Tienen el objetivo de promover, enseñar y divulgar este enfoque entre los médicos y el público en general. Se hace hincapié en recuperar la habilidad semiológica para el diagnóstico de estos problemas de salud.

Así, la semiología minuciosa es nuestro principal elemento diagnóstico, utilizando los métodos complementarios de una forma racional y mesurada.  Dentro de las habilidades de que enseñan, la Proloterapia y las inyecciones de plasma rico en plaquetas (PRP) son las más importantes. Estos procedimientos son englobados dentro de lo conoce como inyecciones de regeneración. La sociedad promueve la investigación de estas técnicas.

¿Cuál es la relevancia epidemiológica de los problemas músculo-esqueléticos en la actualidad?

El dolor en general y el dolor músculo esquelético en particular, constituyen uno de los principales motivos de consulta ambulatorio. En cuanto a este último, trabajos recientes muestran que entre el 15 y el 20% de las consultas en medicina general son por dolores músculo-esqueléticos. Debido a que la expectativa de vida cada vez es mayor, es esperable que la prevalencia de estos problemas y el costo en salud y económico que generan continuará aumentando en los próximos años. 

Se sabe que el dolor repercute negativamente en las actividades de la vida diaria (AVD), en el sueño nocturno y en el funcionamiento del individuo en la sociedad. El dolor crónico genera discapacidad. Es muy frecuente que estas personas consulten a varios médicos y, también, debido a que no encuentran solución a sus problemas, a personas que no son médicos. Esta situación genera, por supuesto muchos tratamientos distintos y desgraciadamente al abuso de analgésicos antiinflamatorios, con los problemas que ello genera.  La falta de un diagnóstico funcional útil y el dolor per se, generan ansiedad tanto en el paciente como en su núcleo familiar. Además, cuando el dolor se torna crónico es probable que se asocie a depresión.

Como si esto fuera poco, es habitual ver en las consultas que el paciente llega con una pesada bolsa de estudios por imágenes pero sin un diagnóstico funcional. Esta situación, lejos de ayudar, en muchas ocasiones ha contribuido (junto a las sentencias negativas de profesionales de la salud como a las opiniones emitidas con liviandad por el círculo en el que se mueve la persona) a aumentar las expectativas negativas y ha amplificado su dolor. Es así que esta persona y su familia, llegan con gran frecuencia al consultorio con gran desconfianza y, en ocasiones, observando atentamente con cierto desdén al médico como si por dentro pensaran: “¿y ahora qué me van a decir?”

¿Cuáles son las causas relativas al estilo de vida contemporáneo que los producen?

"La sobrecarga mecánica y la propiedad viscoelástica del colágeno"

Esta es una pregunta muy interesante y para responderla bien haré alusión a dos conceptos: la sobrecarga mecánica y la propiedad viscoelástica del colágeno. La sobrecarga mecánica ocurre cuando existe un disbalance entre una carga mecánica (por ej. levantar un objeto) y la capacidad de nuestro sistema para adaptarse a esa carga (en este caso el sistema osteo-mio-neuro-articular). Es así que una sobrecarga ocurre cuando la carga mecánica aumenta por sobre la capacidad del sistema y/o cuando la capacidad de dicho sistema disminuye. Esto último ocurre con la falta de entrenamiento físico y con el envejecimiento, para citar algunos ejemplos.

El colágeno (que recordemos que es el tejido estructural de todo el sistema osteomioarticular), por su parte, se comporta ante una carga dinámica (como puede ser caminar, saltar, correr) en forma elástica, es decir se deforma y recupera su forma.

Desde un punto de vista evolucionista, el tejido conectivo está preparado para el movimiento. Por otra parte, cuando la carga es estática (por ejemplo, estar sentado en una silla detrás de un monitor 8 horas), el tejido conectivo se comporta en forma viscosa y se empieza a deformar, los ligamentos se relajan y los discos intervertebrales se aplastan y deshidratan. Esta carga estática, aunque parezca menos nociva, es terriblemente dañina para el tejido conectivo y genera lesiones.

Así, desde el punto de vista biomecánico podemos afirmar que el sedentarismo y el mantenimiento de posturas estáticas son las que más problemas producen en el sistema osteomioarticular en la población en general.

Esta situación ha sido confirmada por estudios epidemiológicos que así lo demuestran. La solución al problema sería aumentar la actividad física para entrenar nuestro sistema osteomioneuroarticular y evitar las cargas estáticas. Los ejemplos más claros son los dolores lumbares y cervicales.

También debemos mencionar aquí que otras lesiones como las deportivas y las de personas que usan herramientas o las amas de casa que retuercen los trapos pueden ser producidas por sobreuso ante una actividad repetitiva. La clave es identificar las sobrecargas mecánicas estáticas y dinámicas y trabajar sobre ellas.

¿Cuáles son sus modos clínicos de presentación más frecuentes?

El síntoma más prevalente del aparato locomotor es la lumbalgia que afecta al 60 al 80% de la población en algún momento de su vida. Los estudios señalan que el 3 al 4% de los adultos jóvenes (menores de 45 años) y que el 5 al 7% de los adultos de más de 45 años están crónicamente discapacitados por dolor lumbar bajo.

En cuanto al dolor cervical se sabe que entre 30 y el 40% de la población presentará un episodio de dolor cervical en algún momento de su vida. En un tercio de los casos los síntomas persistirán por más de 6 meses o serán de carácter recidivante.

En el consultorio se ven frecuentemente también problemas vinculados a los miembros inferiores y a los superiores.

Es fundamental tratar de distinguir si el dolor es mecánico o inflamatorio, el factor de perpetuación y el precipitante del problema. También, es útil, para su estudio intentar identificar cuáles son los componentes que predominan más en el dolor: el miofascial (de músculos y fascias), el articular, el neural y el visceral, así como identificar tanto los fenómenos de sensibilización periférica como central que amplifican los síntomas.

¿Cuál es el estado actual del abordaje de estos problemas en el mundo real y en qué medida se fundamentan en evidencias científicas?

"Mayormente el abordaje de estos problemas se realiza bajo un paradigma reduccionista estructural"

Desafortunadamente, mayormente el abordaje de estos problemas se realiza bajo un paradigma reduccionista estructural que deriva en soluciones quirúrgicas sobreindicadas bajo el imaginario médico y de la población de que así se alivia el dolor. Además, el “pensamiento mágico” sumado a la ansiedad por resolver el problema lleva a los pacientes a optar por soluciones quirúrgicas.

Básicamente, lo que ocurre en muchos consultorios (y aclaro aquí que no en todos), a modo de ejemplo, es lo siguiente: primero, el paciente consulta por un dolor en su rodilla izquierda; segundo, tras una anamnesis telegráfica y un examen físico fugaz y superficial el médico indica algún analgésico, sesiones de kinesiología y estudios por imagen; tercero, el paciente vuelve con el estudio que “diagnostica certeramente” el problema (para ese entonces el paciente ya leyó el informe, habló con sus familiares, vecinos y consultó con “Dr. Google”; cuarto, ya con el “diagnóstico” objetivable en la imagen el médico indica más sesiones de kinesiología, tal vez algún calzado y según lo que encuentre puede indicarle un estudio más complejo o proponerle algún tipo de cirugía; quinto, el paciente siente que tiene un problema sumamente grave que en algún momento requerirá cirugía y que es sólo cuestión de tiempo.

"Gran parte de los procedimientos quirúrgicos no están basados en evidencias científicas"

Se sabe también que gran parte de los procedimientos quirúrgicos no están basados en evidencias científicas. Más aún, recientemente el portal español publicó un artículo donde detalla los cinco procedimientos que con frecuencia suelen ser innecesarios, de alto costo y que pueden perjudicar al paciente:

  1. La vertebroplastia
  2. Las reparaciones del manguito de los rotadores en pacientes de edad avanzada
  3. Las intervenciones de fractura de clavícula en adolescentes
  4. Las intervenciones del ligamento cruzado anterior en individuos de bajo riesgo
  5. Las extirpaciones quirúrgicas de meniscos rotos.

Por supuesto, que aclaro aquí que, en pacientes seleccionados, las intervenciones quirúrgicas son necesarias. El problema es la sobreindicación de las mismas.

¿Cuál es el modelo conceptual más apropiado para abordarlos: el del daño estructural o el biomecánico?

El modelo conceptual más apropiado para abordar estos problemas es el biomecánico ya que los daños estructurales (lesiones) sobrevienen por disfunciones biomecánicas. Así, existe un período asintomático o paucisintomático de disfunción donde no hay daños estructurales, pero que si la disfunción (problema biomecánico) persiste terminará ocasionándolos. En este sentido, el modelo biomecánico nos permite estudiar las causas de la sobrecarga mecánica. Si trabajamos solo sobre el daño estructural solo veremos la consecuencia final del proceso y nos perderemos de diagnosticar un gran número de pacientes con dolor mecánico que aún no tienen lesiones. Además, el modelo biomecánico, nos permite detectar por qué ciertos pacientes no resuelven su problema.

Sin embargo, quiero remarcar también que si exageramos nuestra visión biomecánica sin el adecuado matiz de una evaluación psicológica teniendo en cuenta también la influencia de los factores sociales, espirituales y culturales, caeremos también en una visión un poco más ampliada que la del modelo estructural, pero reduccionista al fin. Dentro de la evaluación del paciente, la biomecánica es sólo una parte más a analizar.

¿Cuál es su opinión respecto del uso generalizado del diagnóstico por imágenes en esta clase de problemas?

"Existe con los métodos por imágenes una falsa ilusión de certeza diagnóstica"

Los estudios por imágenes pueden detectar algunos problemas estructurales, sin embargo rara vez detectan problemas funcionales. El uso exagerado de estos métodos, lejos de ayudar, pueden ser perjudiciales.

Un ejemplo típico es el uso de la resonancia para el dolor lumbar sin banderas rojas ni signos de radiculopatía. Se sabe que en personas de más de 40 años, la mitad tendrá imágenes compatibles con patología discal en la columna. Así, si a una persona cuyo dolor semiológicamente es típicamente miofascial del cuadrado lumbar se le practica una resonancia y se encuentra una pequeña protrusión discal, es altamente probable que se atribuya el dolor a ese hallazgo radiológico. No es que no exista la protrusión, es que la protrusión no es el problema, no es la que origina el dolor. Esta situación es sumamente frecuente y alarmante ya que genera por un lado gran ansiedad en el paciente y su grupo familiar y aumenta las chances a que se someta o a algún bloqueo o a alguna cirugía. 

"Con las imágenes muchas veces se intenta suplir el déficit de tiempo y la incapacidad de tolerar la incertidumbre"

Existe con los métodos por imágenes una falsa ilusión de certeza diagnóstica, como si la resonancia mágicamente dictaminara. Con las imágenes muchas veces se intenta suplir el déficit de tiempo y la incapacidad de tolerar la incertidumbre  propia de la práctica de la Medicina. La realidad es que las imágenes rara vez brindan certezas diagnósticas, si pueden evaluar algún daño estructural puntual. En patología músculo esquelética la mayoría de los diagnósticos se realizan en el consultorio escuchando, preguntando, revisando, pensado e interconsultando a algún colega avezado si es necesario. Los diagnósticos deben ser funcionales y las imágenes pueden colaborar para visualizar algún daño estructural.


¿Qué es la Proloterapia?

La Proloterapia (terapia de proliferación) es un tratamiento de inyecciones para reparar el tejido conectivo mediante la introducción de una sustancia en el sitio de la lesión. Por definición, no se usa material biológico por lo que las soluciones utilizadas en proloterapia no contienen nada de las personas que son inyectadas. La solución más utilizada en Proloterapia es la dextrosa. Esta técnica se encuentra incluida actualmente dentro de las terapias de inyecciones de regeneración junto con el plasma rico en plaquetas y la inyección de células madre. En estas últimas técnicas se inyecta material autólogo. El tratamiento con células madre para patología osteomioarticular se encuentra en investigación.

Básicamente lo que se busca hacer con la Proloterapia es generar un proceso inflamatorio en un tendón o ligamento degenerado (tendinosis o ligamentosis) y mediante esa inflamación inducir la reparación del tejido dañado. En sí, el principio es lógico y simple: “inflamar para reparar”.

La Proloterapia no es una técnica nueva. Surgió en Estados Unidos en el siglo pasado. El primer libro sobre esta técnica denominado “Ligament and tendon relaxation treated by Prolotherapy” data de 1956 y su autor fue el Dr. George S. Hackett. Con el correr de los años la técnica fue variando, se fue puliendo y extendiendo. Numerosos centros en el mundo la están aplicando y están haciendo trabajos de investigación al respecto.

¿Hasta qué punto está respaldada por evidencias científicas?

Hay cada vez más trabajos publicados al respecto. Algunos con mayor calidad metodológica que otros. El problema es realizar un diseño de investigación bueno, ya que es difícil generar un placebo en un paciente al que se le inyecta una sustancia. Sin embargo, esto no ha sido, ni debe ser, un impedimento para que avance la investigación.

Al momento la Proloterapia tiene trabajos con nivel de evidencia I en artrosis de rodilla, epicondilosis (codo de tenista), enfermedad de Osgood-Schlatter y artrosis de manos; nivel de evidencia II en dolor lumbar bajo, disfunción sacroilícaca, coccigodinia, fasciosis plantar, disfunción de la articulación témporo-mandibular, tendinosis del Aquiles, pubialgia por tendinopatía, laxitud del ligamento cruzado anterior y tendinopatía patelar.

¿Cuál es la formación necesaria para que un profesional se encuentre capacitado para aplicarla?

La Proloterapia es una técnica médica mínimamente invasiva que, para poder realizarla correctamente, requiere de años de formación para dominarla. Este entrenamiento es fundamental para que este tratamiento sea efectivo y seguro y dé el resultado que se espera a los pacientes.

Si bien la Proloterapia puede ser una excelente y eficaz herramienta para “curar” y otras veces para aliviar diferentes dolencias musculoesqueléticas, los médicos (requisito sine qua non) que la practiquen deben estar entrenados para seleccionar qué pacientes podrán beneficiarse con el tratamiento, con qué frecuencia debe realizarse el mismo y conocer, por supuesto, la técnica apropiada. Si bien los efectos secundarios no son frecuentes, los mismos existen y se minimizan con el entrenamiento. Se remarca que si bien los principios por los que se rige esta técnica son simples, no es aconsejable realizarla sin la adecuada formación.

Existen diferentes sociedades y universidades que dictan cursos teórico-prácticos rigurosos para la formación en Proloterapia. Éstas, al finalizar el entrenamiento otorgan las certificaciones correspondientes que acreditan el conocimiento de la técnica. Estos certificados de acreditación dan un aval al médico y brindan tranquilidad a los pacientes, quienes pueden comprobar que el profesional está formado en Proloterapia. Entre estas entidades destacamos a la American Association of Orthopedic Medicine (AAOM), a la Universidad de Madison en Wisconsin a través de laHackett Hemwall Foundation y a laLAOM Argentina. Los cursos de formación de la LAOM Argentina son homologables a las de la AAOM obteniendo la certificación por ambas sociedades.

Dr. Emilio Pastor
Docente de la 1° Cátedra de Clínica Médica. Universidad Nacional de Rosario (UNR)
Vicepresidente de la LAOM Argentina
Correo electrónico:



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Dr. Sarfaraz Niazi: Flexibility Is Key To Innovation

by System Administrator - Sunday, 12 October 2014, 2:46 PM

The Most Interesting Man Revolutionizing The Health World


Nicole Fisher | Contributor

He wrote his first world-renowned book at the age of 26. On weekends he recites love poems (ghazals) on Voice of America. He casually – and humbly – references his more than 70 patents that range from aging wine to chewing gum to bioreactors to air scrubbing systems at his infamous Chicago wine parties. And his mustache rules his twitter feed. In 2013 he was awarded the Star of Distinction, the highest civil award by the Government of Pakistan, for his inventions that are making significant impact in developing countries. He has written over 50 books, well over 100 research papers, and hundreds more articles in the field of science, philosophy, rhetoric, poetry and religion, drawing thousands of hits per day on his blog. Dr. Sarfaraz Niazi might just be the most interesting man in the world, but he is certainly the most interesting man pursuing biosimilars in the United States.


Dr. Sarfaraz Niazi

 Throughout his career his driving principle has been to make things simpler. He did this while at Abbott Labs, as a former tenured professor at the University of Illinois at Chicago (UIC), in developing countries, and presently in his independent career at Therapeutic Proteins International, LLC (TPI) where he is working on biosimilars – or “copies” of current biologic pharmaceuticals that are about to lose their patents. Although only 17 biosimilars have been approved to date worldwide, though none in US, Dr. Niazi and TPI have nine in the pipeline to transform the entire market.   According to photographer Steve Huff, Dr. Niazi is, “An amazing man, in fact the most interesting man in the world!”

Flexibility Is Key To Innovation

When asked his advice to other inventors in a recent interview, Dr. Niazi explained his philosophy that, “You should never get enamored by your thoughts. If the idea does not solve a problem or move the quality of life farther, there are many more things to be invented.” With that mentality, he is filing two products this year alone, similar toAmgen Inc.’s $6 billion molecule white blood count product, due to its expiring patent in the cancer market. Next year, the two molecules he plans to take to market are similar to AbbVie’s expiring $12 billion product Humira.

With movement like that, it’s no wonder Dr. Niazi claims that the U.S. Food and Drug Administration (FDA) is his “friend.” Nevertheless, he notes extreme complications with the rolling submission model, which can cost up to $4 million per submission in fees alone.  Additionally, the four levels of the FDA’s “analytical similarity” benchmarking can be troublesome if one has a new biologic entity. This benchmarking, however, allows scientists and the FDA to work together in a predictable, step-wise fashion to move products to market quickly that have fingerprint-like similarity to existing US-licensed biologic products.

Dr. Niazi’s strategy is to create an analytical and clinical equivalent to biologics with expiring patents, which is preferred even over a Phase 3 clinical trial. By doing this, the cost of production is reduced drastically and the speed of development increases by 2-3 times. Dr. Niazi estimates an overall reduction in production costs for his biosimilars of up to 50% or higher compared to market competitors.

By being flexible, his products are proving to be bio-revolutionary.

Can The United States Catch Up?

Additionally, thanks to the Affordable Care Act (ACA), a shorter licensing path for lower-cost versions of cell-derived drugs is now possible, giving inventors like Dr. Niazi another pathway for approval and distribution.

While he claims that the ACA will not reduce health costs, he does believe that independent shocks to the health market will. By this, he believes that making biosimilars easier, faster, cheaper and better translates directly into his mission of making all things simpler.  Further, cost-effectiveness in the US and European Union (EU) can directly convert into worldwide distribution and scalability that is safe.

Although a friend of the FDA, Dr. Niazi is not hesitant to note the tough decisions US-based companies face to stay in the states. Having FDA approval carries weight around the world, but the financial and regulatory burden can be great for inventors and business owners. In contrast, he asserts that the EU has moved ahead of the rest of the world, with the most established and advanced regulatory framework for the authorization and marketing of biosimilars, which has since been adopted by the World Health Organization (WHO).

Additionally, Dr. Niazi says that it is difficult to raise money in the US. Venture capitalists and corporate investors are less likely to take risk and have notoriously poor track records with the health sector.


Investing In The Windy City

In 2003, the TPI founder committed that his work and company would stay in Chicago.  He believed that from creation to manufacturing and testing to going to market, that TPI would excel in the Midwest due to Chicago’s health care ecosystem, experts and manufacturers.

Through a focus on creating “generic equivalents,” Dr. Niazi is proving that TPI can be wildly successful in the Midwest, and further, that in the same way generics revolutionized how people access pharmaceuticals, biosimilars can revolutionize the way those around the world access lifesaving treatments.

As his biosimilars enter the market with FDA approval, the ability of Dr. Niazi to impact the entire health sector grows because his biosimilars can be substituted for its reference product without provider or patient intervention. However, the FDA has not yet finalized these guidelines, and only 17 biosimilars have been approved internationally to date, of which none are by the FDA.

Ultimately, with numerous billion-dollar biologics coming off patent over the next six years, and the exorbitant cost for specialty drugs, the nine biosimilars TPI has in the pipeline stand to make a huge impact in the health sector. While Dr. Niazi could be doing many interesting things these days as an international man of mystery, he has devoted his research, time and energy to bringing high quality, cost-effective treatments to the US, and beyond. So long as he maintains his wine parties and poetry readings, its certain no one will complain.

FOLLOW @nic_fisher on Twitter, Google+ or on


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by System Administrator - Wednesday, 1 October 2014, 6:14 PM

E-Prescribing Giant Surescripts Emerges As A Player In Push For Interoperability

Zina Moukheiber | Contributor

With health care providers scrambling to meet a government deadline this year to electronically send and receive patient information, an unlikely actor has emerged to facilitate that transaction.

As the country’s largest electronic prescribing network, processing 1 billion prescriptions last year, Surescripts has amassed information on more than 200 million patients—from phone numbers to birthdate. Capitalizing on its network, it started four years ago offering health care providers the ability to exchange clinical messages using government-sanctioned standards. The service, slow to take off, has quadrupled since March, with health care providers exchanging nearly 1 million clinical messages in August. Jeff Miller who heads clinical network services, says that number is rapidly rising. Surescripts has signed up 130 health systems, including Geisinger Health System, Mount Sinai Health System, and St. Joseph’s Hospital Health Center.

Donny Patel who’s director of interoperability at Mount Sinai, a 7-hospital system in New York, implemented Surescripts’ messaging service earlier this year, ahead of his July deadline. The second phase of meaningful use calls for health care providers to transmit a patient summary electronically in order to qualify for financial incentives. Instead of fax or phone, a doctor at Mount Sinai can now forward to another physician on a different electronic health record a patient’s discharge instructions, medications list, and diagnoses, among other things. Mount Sinai uses electronic health records from multiple vendors. “They [Surescripts] have a network, and they know my vendors,” says Patel.

Giving Surescripts a major boost is Epic. The dominant electronic health record connects to Surescripts’ clinical messaging service, and many of Surescripts’ clients are on Epic. Other major vendors that use Surescripts include Siemens (now part of Cerner) and Meditech.

Surescripts says it added 1,000 hospitals to its network this year. The more it adds, the more likely it makes its clinical messaging service indispensable.


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Edge Consolidation Delivers Peace of Mind for IT

by System Administrator - Monday, 11 August 2014, 2:46 PM

Data Management Alert

Edge Consolidation Delivers Peace of Mind for IT


As organizations consolidate backup and disaster recovery operations, WAN optimization plays a key role in mitigating risk without sacrificing performance. Discover a new architectural approach that extends the virtual edge of the data center to the branch for complete server and data consolidation without a performance compromise.

Please read de attached whitepaper.

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Effective and Efficient Use of EHR System

by System Administrator - Tuesday, 19 August 2014, 12:07 AM

Three Tips to More Effective and Efficient Use of Your EHR

By Avery Hurt

Choosing, buying, and installing EHR software is hard enough. Then there's training staff and making sure patient data is secure. And for practices that choose to take part in CMS' meaningful use program, learning to use the EHR as efficiently and effectively as possible is crucial.

"This is not an easy task," Steven Waldren, director of the American Academy of Family Physicians' Alliance for eHealth Innovation told Physicians Practice. "We've struggled to help our members with this." Nonetheless, he has some practical advice. "Keep in mind that the goal is not just to automate your practice, but to make it work better. In order to do this, you have to think outside the box." 

Here are some ideas to get you started to get the most of your EHR to meet those meaningful use requirements:

• Examine work flow.
In order to best use your EHR, you may need to step back and get your nose away from the computer screen, so to speak. Waldren suggests doing a very basic analysis of your practice, looking closely at work flow. Ask yourself: Where are people stumbling? Who is struggling to get work done and who has extra time? Waldren gives an example from the early days of electronic records: "Back when e-prescribing first came along, if a doctor decided to prescribe a new drug for a patient, the doctor then had to figure out what pharmacy the patients used, which location, and so on. It quickly became clear that things went much more smoothly if all this information were gathered at intake. By studying work flow and observing how patients are moving through the system, you can find ways to make the process go more smoothly."

• Have a practice powwow.
Don't try to figure this out all on your own. Brainstorm with everyone in your office. Your staff will often have good ideas. They know what's slowing them down and very often have good ideas about what can be done to fix the problem.

• Reach out to peers.
Brainstorm with other doctors as well. "We're trying to pull together innovators and disseminate information about what they are doing," said Waldren. Meanwhile, ask other doctors you know what has worked for them and let them know what's working for you.

Don't be overwhelmed by the challenges of integrating this technology into your practice. "Little steps make a big difference," said Waldren, "and you'll have more success in the long run if you consider this another quality improvement practice."


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eHealth at WHO

by System Administrator - Friday, 1 August 2014, 8:27 PM

eHealth at WHO

eHealth is the use of information and communication technologies (ICT) for health. The eHealth unit works with partners at the global, regional and country level to promote and strengthen the use of information and communication technologies in health development, from applications in the field to global governance. The unit is based in the Department of Knowledge Ethics and Research in the cluster of Health Systems and Innovation.

Programmes and projects

WHO's work in eHealth includes programmes and projects in areas such as policy and governance, standardization and interoperability, research and global surveys, eLearning and capacity building, networking and South-to-South collaboration, as well as eHealth applications.



WHO Sitemap

Help and Services

WHO Regional Offices

Contact information

Department of Knowledge, Ethics and Research 
World Health Organization 
20 Avenue Appia
1211 Geneva 27 

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EHR Adoption Hits Record Levels for Hospitals and Physicians

by System Administrator - Thursday, 7 August 2014, 5:41 PM

HHS: EHR Adoption Hits Record Levels for Hospitals and Physicians


EHR adoption for hospitals and physicians are higher than before, according to two new studies published today by the HHS Office of the National Coordinator for Health Information Technology (ONC).

Finding Details

The studies, published in the journal Health Affairs, found that in 2013, almost eight in ten (78 percent) office-based physicians reported they adopted some type of EHR system. About half of all physicians (48 percent) had an EHR system with advanced functionalities in 2013, a doubling of the adoption rate in 2009. The information in the studies was collected by the Centers for Disease Control and Prevention’s National Center for Health Statistics and the American Hospital Association in 2013.

About 6 in 10 (59 percent) hospitals had adopted an EHR system with certain advanced functionalities in 2013, quadruple the percentage for 2010. Unlike the physician study, the hospital study does not have an equivalent, established measure of adoption of some type of EHR system; it only reports on adoption of EHRs with advanced functionalities.

“Patients are seeing the benefits of health IT as a result of the significant strides that have been made in the adoption and meaningful use of electronic health records,” said Karen DeSalvo, M.D., M.P.H., national coordinator for health information technology. “We look forward to working with our partners to ensure that people’s digital health information follows them across the care continuum so it will be there when it matters most.”

The data from the report provides an early baseline understanding of provider readiness to achieve Stage 2 Meaningful Use of the Medicare and Medicaid EHR Incentive programs.  Stage 2 will begin later this year for providers who first attested to Stage 1 Meaningful Use in 2011 or 2012. According to the data, 75 percent of eligible professionals and more than 91 percent of hospitals have adopted or demonstrated Stage 1 Meaningful Use of certified EHRs.

Stage 2 Meaningful Use Struggles

According to CMS  data from 2013, the meaningful use dropout rate was 20% when providers only had to attest for MU stage 1 and is expected to increase even higher as more providers  prepare for MU stage 2. The CDC data also show that more work is needed to support widespread health information exchange and providers’ ability to achieve Stage 2 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs. Among the details include the following:

  • In 2013, health information exchange among physicians was relatively low: 4 in 10 (39 percent) reported they electronically share data with other providers, but only 14 percent electronically share data with ambulatory care providers or hospitals outside their organization.
  • In 2013, the vast majority of hospitals had capabilities that could be used to support many Meaningful Use Stage 2 objectives but were not being used. However, 10 percent of hospitals were providing patients with online access to view, download, and transmit information about their hospital admission.

According to the 2014 Medscape EHR Report, 22% of physicians are opting out of meaningful use. Thesurvey found that 16% said they will never attest to meaningful use requirements, and another 6% of participants said they are abandoning meaningful use after meeting the requirements in previous years, up 2% from 2012. Overall, 78% of participating physicians said they were attesting to meaningful use Stage 1(30%) or Stage 2 (48%) in 2014.

HHS: EHR Adoption Hits Record Levels for Hospitals and Physicians by Jasmine Pennic



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EHR Optimization Strategies

by System Administrator - Wednesday, 19 November 2014, 8:53 PM

Physician Perspectives on EHR Optimization Strategies

Author Jerri Cowper of Innovative Consulting Group

I recently shared my thoughts on the physician perspective of EHR optimization strategies and physician EHR use. Now I have decided to expand the conversation by getting the take of two individuals, both within large health systems: Philip Baney, MD, from Reading Health System and Trista Eidmann, Clinic Administrator with UnityPoint Clinic.

We discussed how the EHR adoption has affected their physicians’ productivity, the types of optimization activities they have conducted, how the EHR has changed physicians seeing patients, and what they have done beyond an application optimization to improve the quality of the patient visit.

They brought varying perspectives, as Reading Health System has been on their EHR for one and a half years while UnityPoint Clinic has been on their current system for over 10 years. UnityPoint is in the process of switching over to a new application and is in the process of implementing their new system across their multi-state organization.

Trading eye contact for clicks

When asked about the top complaints in their organization regarding physician productivity in the EHR, the concerns were not surprisingly similar. Dr. Baney indicated that there are “more clicks, more busy work” and Ms. Eidmann responded that with more being handed down to them, they are “documenting more and more” and reimbursement isn’t any higher. Patients do not understand why the physicians’ heads are in the chart.

Years after organizations have implemented their EHR, I was not surprised that this continues to be a concern. Dr. Baney had a creative way to deal with this concern when he first started on the EHR. He would have a ruler in the room that he would give to patients and told them that when they were tired of looking at his ear they were allowed to use the yardstick to move his head so that he was looking at them. Most physicians have found that balancing the interaction with the patient and the time spent on their workstation in the exam room takes some effort. Dr. Baney added that he tries “to do as little on the computer when I am in the room with the patient and incorporate them in the process.”

Additional complaints within the organizations are that the providers are not getting their charts done, managing their inbox, or getting the bang for their buck. With all the data going into the system, they are not able to easily extract that information without additional steps being added.

But you’ve optimized, right?

When I asked what types of optimization activities their organizations have conducted to date, Ms. Eidmann responded that their efforts these days are to identify gaps in their current system and prepare to move over to the new system. Dr. Baney indicated that “there have been some attempts to identify things, but unfortunately many of those optimizations seems to be more clicks for the providers” and that he felt there was much more that could be done. This confirms what many organizations have already realized, that optimization and utilization of their EHR will be an ongoing process. This is especially true as a pay for value service is on the horizon.

Healthcare providers do not want to worry about where or how they put the data in the system — their focus is getting it in there as efficiently as possible. As developers and builders of the application, the focus should be on making the data entry easier for the end-user with the ability to easily extract that data out of the system.

Going beyond optimization

I next posed the question I discussed in my first article: What can be done beyond application optimization? Dr. Baney shared an anecdote about how his group realized that around the time school was out, their system would begin to run slowly. They discovered that their service provider didn’t have them on any higher provider priority, and all the school age kids would come home from school and suck up the bandwidth. What appeared to be an application issue was really a task for the internet provider. Another crucial problem identified was to have a triple redundant system. A final recommendation Dr. Baney made was training and evaluation — using their pulse reports to identify another provider who is strong who could mentor providers who are struggling. All of these are great recommendations for organizations that have not looked outside their application in their optimization efforts.

We must take the perspective of optimizing our systems so that end-users can work more efficiently while ensuring we can extract the data needed and also maintain a standard of quality patient visits. It will take time and creativity, but we have the tools needed to add value and increase enthusiasm to use an EHR. I thank Dr. Baney and Ms. Eidmann for their valuable time and input.

Jerri Cowper serves as Ambulatory National Practice Director at Innovative Consulting Group.

Tagged Ambulatory EHREHR AdoptionEHR OptimizationPhysician EHR

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EHR Replacement Guide

by System Administrator - Thursday, 1 January 2015, 8:27 PM

EHR Replacement Guide

Making the decision to replace a subpar EHR is not easy, and the process of installing and optimizing a new system is certainly not a simple one. Earlier this year, Black Book findings indicated that EHR end-users were assessing the value of EHR vendors and their products based on their ability to deliver innovative tools capable of supporting clinical quality improvements in a few key areas.

"Top scoring EHR vendors that are attracting the available market share are looking for patient engagement tools, clinical decision support, quality measurement solutions, mobile capabilities, intelligent interoperability, and financial analytics as part of their EHR compendium," the research firm's Managing Partner Doug Brown said in March. "There are growth opportunities for vendors actually delivering those robust product strategies to the market." 

With tight budgets, cramped time frames, frustrated staff, and a pressing need to keep business moving as usual, undergoing an EHR replacement is a serious undertaking with far-reaching effects. Many healthcare organizations and providers find themselves in the same predicament, searching for an EHR replacement that will enable them to reach their goals. Their aims may differ — ranging from achieving quality improvements and enabling clinical integration to qualifying for meaningful use incentives and avoiding penalties as a result of federal or state mandates — but their belief that EHR technology will help them achieve their goals do not.

The purpose of this guide is to help healthcare organizations and providers understand the potential problems they are likely to face as they work to replace their current health IT infrastructure. This guide comprises important insights from industry insiders and subject-matters with ample experience navigating the process of replacing EHR systems efficiently and effectively.

Please read the attached whitepaper.

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EHRs and improved life expectancies

by System Administrator - Saturday, 2 August 2014, 2:36 AM

Could there be a correlation between EHRs and improved life expectancies?

Beckers Hospital Review - Written by Bob Herman

According to the National Center for Health Statistics, the current life expectancy in the United States is roughly 78 years. For the rural population served by the Peter Christensen Health Center in Lac du Flambeau, Wis., which is primarily composed of Chippewa Indians, the life expectancy was only 56 years in 2005. But in the past five years, the life expectancy of the community has gone up to 59 years. So what changed? 

Continue reading

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EHRs: Moving Past the Mandate

by System Administrator - Monday, 28 September 2015, 7:36 AM

EHRs: Moving Past the Mandate

by Pulse Systems, Inc.

While the industry is transitioning to a value-based care model, physicians will need an EHR system to collect and track patient metrics. Exploring the stage beyond the government mandate, practices can utilize several tools within an EHR to aid them on their reimbursement path ahead. Pulse Systems provides guidance on the opportunities to attain operational efficiencies, deeper patient engagement, and increased revenues all through utilizing their EHR system.

Please read the attached whitepaper.

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El brote de Ébola

by System Administrator - Saturday, 30 August 2014, 8:55 PM
Todo lo que hay que saber

El brote de Ébola día a día

Ante la emergencia internacional se requiere que todo el personal sanitario conozca los fundamentos de la enfermedad y de las medidas preventivas. IntraMed actualiza la información diariamente.

¿Qué es?

Enfermedad por el virus del Ebola

  • El virus del Ebola causa en el ser humano la enfermedad homónima (antes conocida como fiebre hemorrágica del Ebola).
    Los brotes de enfermedad por el virus del Ebola (EVE) tienen una tasa de letalidad que puede llegar al 90%.
  • Los brotes de EVE se producen principalmente en aldeas remotas de África central y occidental, cerca de la selva tropical.
  • El virus es transmitido al ser humano por animales salvajes y se propaga en las poblaciones humanas por transmisión de persona a persona.
  • Se considera que los huéspedes naturales del virus son los murciélagos frugívoros de la familia Pteropodidae.
  • No hay tratamiento específico ni vacuna para las personas ni los animales.
  • El virus del Ebola causa en el ser humano la EVE, cuya tasa de letalidad puede llegar al 90%.

El virus se detectó por vez primera en 1976 en dos brotes simultáneos ocurridos en Nzara (Sudán) y Yambuku (República Democrática del Congo). La aldea en que se produjo el segundo de ellos está situada cerca del río Ebola, que da nombre al virus.

El género Ebolavirus es, junto con los géneros Marburgvirus y Cuevavirus, uno de los tres miembros de la familia Filoviridae (filovirus). El género Ebolavirus comprende cinco especies distintas:

    • ebolavirus Bundibugyo (BDBV);
    • ebolavirus Zaire (EBOV);
    • ebolavirus Reston (RESTV);
    • ebolavirus Sudan (SUDV), y
    • ebolavirus Taï Forest (TAFV).

Las especies BDBV, EBOV y SUDV se han asociado a grandes brotes de EVE en Africa, al contrario de las especies RESTV y TAFV. La especie RESTV, encontrada en Filipinas y China, puede infectar al ser humano, pero hasta ahora no se han comunicado casos de enfermedad humana ni de muerte debidos a ella.


El virus del Ebola se introduce en la población humana por contacto estrecho con órganos, sangre, secreciones u otros líquidos corporales de animales infectados. En África se han documentado casos de infección asociados a la manipulación de chimpancés, gorilas, murciélagos frugívoros, monos, antílopes y puercoespines infectados que se habían encontrado muertos o enfermos en la selva.

Posteriormente, el virus se propaga en la comunidad mediante la transmisión de persona a persona, por contacto directo (a través de las membranas mucosas o de soluciones de continuidad de la piel) con órganos, sangre, secreciones, u otros líquidos corporales de personas infectadas, o por contacto indirecto con materiales contaminados por dichos líquidos.

Las ceremonias de inhumación en las cuales los integrantes del cortejo fúnebre tienen contacto directo con el cadáver también pueden ser causa de transmisión. Los hombres pueden seguir transmitiendo el virus por el semen hasta siete semanas después de la recuperación clínica.

La infección del personal sanitario al tratar a pacientes con EVE ha sido frecuente cuando ha habido contacto estrecho y no se han observado estrictamente las precauciones para el control de la infección.

Entre los trabajadores que han tenido contacto con monos o cerdos infectados por el RESTV se han registrado varios casos de infección asintomática. Por tanto, parece que esta especie tiene menor capacidad que otras de provocar enfermedad en el ser humano.

Sin embargo, los datos recopilados al respecto solo se refieren a varones adultos sanos, y sería prematuro extrapolarlos a todos los grupos de población, como los pacientes inmunodeprimidos o con trastornos médicos subyacentes, las embarazadas o los niños. Son necesarios más estudios sobre el RESTV antes de que se puedan sacar conclusiones definitivas sobre su patogenicidad y virulencia en el ser humano.
Signos y síntomas

La EVE es una enfermedad vírica aguda grave que se suele caracterizar por la aparición súbita de fiebre, debilidad intensa y dolores musculares, de cabeza y de garganta, lo cual va seguido de vómitos, diarrea, erupciones cutáneas, disfunción renal y hepática y, en algunos casos, hemorragias internas y externas. Los resultados de laboratorio muestran disminución del número de leucocitos y plaquetas, así como elevación de las enzimas hepáticas.

Los pacientes son contagiosos mientras el virus esté presente en la sangre y las secreciones. El virus del Ebola se ha aislado en el semen hasta 61 días después de la aparición de la enfermedad en un caso de infección contraída en el laboratorio.

El periodo de incubación (intervalo desde la infección hasta la aparición de los síntomas) oscila entre 2 y 21 días.


Antes de establecer un diagnóstico de EVE hay que descartar el paludismo, la fiebre tifoidea, la shigelosis, el cólera, la leptospirosis, la peste, las rickettsiosis, la fiebre recurrente, la meningitis, la hepatitis y otras fiebres hemorrágicas víricas.

Las infecciones por el virus del Ebola solo pueden diagnosticarse definitivamente mediante distintas pruebas de laboratorio, a saber:

  • prueba de inmunoadsorción enzimática (ELISA).
  • pruebas de detección de antígenos.
  • prueba de seroneutralización.
  • reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR).
  • aislamiento del virus mediante cultivo celular.

Las muestras de los pacientes suponen un enorme peligro biológico, y las pruebas tienen que realizarse en condiciones de máxima contención biológica.
Prevención y tratamiento

No hay vacuna contra la EVE. Se están probando varias, pero ninguna está aún disponible para uso clínico.

Los casos graves requieren cuidados intensivos. Los enfermos suelen estar deshidratados y necesitar rehidratación por vía intravenosa u oral con soluciones que contengan electrólitos.

Tampoco hay ningún tratamiento específico, aunque se están evaluando nuevos tratamientos farmacológicos.

Huésped natural del virus del Ébola

Se considera que los murciélagos frugívoros, en particular Hypsignathus monstrosus, Epomops franqueti y Myonycteris torquata, son posiblemente los huéspedes naturales del virus del Ebola en África. Por ello, la distribución geográfica de los Ebolavirus puede coincidir con la de dichos murciélagos.

El virus del Ébola en animales

Aunque los primates no humanos han sido una fuente de infección para las personas, se cree que no son el reservorio del virus, sino huéspedes accidentales, como los seres humanos. Desde 1994 se han registrado brotes de EVE causada por las especies EBOV y TAFV en chimpancés y gorilas.

El virus RESTV ha causado brotes de EVE grave en macacos cangrejeros (Macaca fascicularis) criados en Filipinas, y también se ha detectado en monos importados de Filipinas a los Estados Unidos en 1989, 1990 y 1996, y a Italia en 1992.

Desde 2008, el virus RESTV se ha detectado en varios brotes epidémicos de una enfermedad mortal en cerdos en Filipinas y China. También se han notificado casos de infección asintomática en cerdos, pero las inoculaciones experimentales han revelado que este virus no causa enfermedad en el cerdo.



Control del virus del Ébola de Reston en animales domésticos

No hay ninguna vacuna para animales contra el RESTV. Se considera que la limpieza y desinfección regulares (con hipoclorito sódico u otros detergentes) de las granjas de cerdos y monos es eficaz para inactivar el virus. Si se sospecha que se ha producido un brote, los locales deben ponerse en cuarentena inmediatamente.

Para reducir el riesgo de transmisión al ser humano puede ser necesario sacrificar a los animales infectados, supervisando estrechamente la inhumación o incineración de los cadáveres. La restricción o prohibición del movimiento de animales de las granjas infectadas a otras zonas puede reducir la propagación de la enfermedad.

Como las infecciones humanas han estado precedidas de brotes por RESTV en cerdos y monos, el establecimiento de un sistema activo de vigilancia de la sanidad animal para detectar casos nuevos es esencial con el fin de alertar de forma temprana a las autoridades veterinarias y de salud pública.

Reducción del riesgo de infección humana por el virus del Ébola

A falta de un tratamiento eficaz y de una vacuna humana, la concienciación sobre los factores de riesgo de esta infección y sobre las medidas de protección que las personas pueden tomar es la única forma de reducir el número de infecciones y muertes humanas.

En África, cuando se produzcan brotes de EVE, los mensajes educativos de salud pública para reducir los riesgos deben centrarse en varios factores.

  • Reducir el riesgo de transmisión de animales salvajes al ser humano a consecuencia del contacto con murciélagos de la fruta o monos o simios infectados y del consumo de su carne cruda. Deben utilizarse guantes y otras prendas protectoras apropiadas para manipular animales. Sus productos (sangre y carne) deben estar bien cocidos antes de consumirlos.
  • Reducir el riesgo de transmisión de persona a persona en la comunidad a consecuencia del contacto directo o estrecho con pacientes infectados, especialmente con sus líquidos corporales. Hay que evitar el contacto físico estrecho con pacientes con EVE y utilizar guantes y equipo de protección personal adecuado para atender a los enfermos en el hogar. Es necesario lavarse las manos con regularidad tras visitar a enfermos en el hospital, así como después de cuidar a enfermos en el hogar.
  • Las comunidades afectadas por la EVE deben informar a la población acerca de la naturaleza de la enfermedad y de las medidas de contención de los brotes, en especial la inhumación de las personas fallecidas. Los enfermos que mueren por esta causa deben ser sepultados rápidamente y en condiciones de seguridad.
  • En África, las granjas de cerdos pueden participar en la amplificación de la infección debido a la presencia de murciélagos frugívoros. Deben implantarse medidas de bioseguridad para limitar la transmisión. En lo que respecta al RESTV, los mensajes educativos de salud pública deben centrarse en la reducción del riesgo de transmisión del cerdo al ser humano a consecuencia de prácticas poco seguras de cría y sacrificio, así como del consumo de sangre fresca, leche cruda o tejidos animales.
  • Deben utilizarse guantes y otras prendas protectoras apropiadas al sacrificar o manipular animales enfermos o sus tejidos. En las zonas en las que se han notificado casos de infección por RESTV en cerdos, todos los productos animales (sangre, carne y leche) deben estar bien cocidos antes de su consumo.

Control de la infección en centros de atención médica 

La transmisión del virus del Ebola de persona a persona se asocia principalmente al contacto directo o indirecto con sangre o líquidos corporales. Se han notificado casos de transmisión al personal sanitario en situaciones en las que no se habían adoptado medidas apropiadas de control de la infección.

No siempre es posible identificar precozmente a los pacientes con EVE porque los síntomas iniciales pueden ser inespecíficos. Por este motivo, es importante que los profesionales sanitarios observen en todo momento y todos los centros las precauciones habituales en todos los pacientes, independientemente de su diagnóstico. Entre ellas se encuentran la higiene básica de las manos, la higiene respiratoria, el uso de equipos de protección personal (en función del riesgo de salpicaduras u otras formas de contacto con materiales infectados) y prácticas de inyección e inhumación seguras.

Los trabajadores sanitarios que atienden a pacientes con infección presunta o confirmada por el virus del Ebola deben aplicar, además de las precauciones generales, otras medidas de control de las infecciones para evitar cualquier exposición a la sangre o líquidos corporales del paciente y el contacto directo sin protección con el entorno posiblemente contaminado. Cuand tengan contacto estrecho (menos de 1 metro) con pacientes con EVE, los profesionales sanitarios deben protegerse la cara (con máscara o mascarilla médica y gafas) y usar bata limpia, aunque no estéril, de mangas largas y guantes (estériles para algunos procedimientos)

Quienes trabajan en el laboratorio también corren riesgo. Las muestras tomadas a efectos de diagnóstico de personas o animales con infección presunta o confirmada por el virus del Ebola deben ser manipuladas por personal especializado y procesarse en laboratorios adecuadamente equipados.

Respuesta de la OMS

La OMS aporta conocimientos especializados y documentación para apoyar la investigación y el control de la enfermedad.

La OMS ha elaborado una lista de verificación de las precauciones generales que se han de adoptar en la asistencia médica (en fase de actualización). Esas precauciones están concebidas para reducir el riesgo de transmisión de agentes patógenos, entre ellos los de origen sanguíneo; su aplicación universal ayudará a prevenir la mayoría de las infecciones transmitidas por exposición a sangre o líquidos corporales.

Se recomienda aplicar las precauciones generales cuando se atienda y trate a cualquier paciente, independientemente de que sea un caso de infección presunta o confirmada. Estas precauciones representan el nivel básico de control de las infecciones e incluyen la higiene de las manos, el uso de equipo de protección personal para evitar el contacto directo con sangre y líquidos corporales, la prevención de los pinchazos de aguja y las lesiones con otros instrumentos cortopunzantes, y un conjunto de medidas de control ambiental.

Preguntas frecuentes


El virus del Ebola causa en el ser humano la enfermedad homónima (antes conocida como fiebre hemorrágica del Ebola). Los brotes de enfermedad por el virus del Ebola (EVE) tienen una tasa de letalidad que puede llegar al 90%. Los brotes de EVE se producen principalmente en aldeas remotas de África central y occidental, cerca de la selva tropical. El virus es transmitido al ser humano por animales salvajes y se propaga en las poblaciones humanas por transmisión de persona a persona. Se considera que los huéspedes naturales del virus son los murciélagos frugívoros de la familia Pteropodidae. No hay tratamiento específico ni vacuna para las personas ni los animales. 

Preguntas frecuentes sobre la enfermedad por el virus del Ebola

1. ¿Qué es la enfermedad por el virus del Ebola?

La enfermedad por el virus del Ebola (denominada anteriormente fiebre hemorrágica del Ebola) es una enfermedad grave y con frecuencia letal cuya tasa de mortalidad puede llegar al 90%. La enfermedad afecta a personas y a primates no humanos (monos, gorilas y chimpancés).

Se detectó por primera vez en 1976 en dos brotes simultáneos, uno en una aldea cercana al río Ebola, en la República Democrática del Congo, y el otro en una zona remota del Sudán.

Se desconoce el origen del virus del Ebola, pero las pruebas científicas disponibles apuntan a que los murciélagos frugívoros (familia Pteropodidae) son sus huéspedes más probables.

2. ¿Cómo se infectan las personas con el virus?

El virus del Ebola se introduce en la población humana por contacto estrecho con órganos, sangre, secreciones u otros líquidos corporales de animales infectados. En África se han dado casos de infección asociados a la manipulación de chimpancés, gorilas, murciélagos frugívoros, monos, antílopes y puercoespines encontrados muertos o enfermos en la selva. Es importante reducir el contacto con animales de alto riesgo (es decir, murciélagos frugívoros, monos o simios) y no recoger los cadáveres de animales muertos que puedan encontrarse en la selva ni manipular su carne cruda.

El virus del Ebola puede propagarse en la comunidad de persona a persona cuando una persona entra en contacto con un animal con el virus. La infección se produce por contacto directo (a través de membranas mucosas o heridas abiertas en la piel) con la sangre u otros líquidos o secreciones corporales (heces, orina, saliva, semen) de personas infectadas. También puede producirse infección cuando las heridas abiertas en la piel o las membranas mucosas de una persona sana entran en contacto con entornos contaminados por los líquidos infecciosos de un paciente con el virus del Ebola, como prendas de vestir o ropa de cama sucias o agujas usadas.

El personal de salud se ve con frecuencia expuesto al virus cuando atiende a pacientes enfermos. Existe riesgo si no llevan puesto equipo de protección personal, como guantes, al atender a los pacientes. Los proveedores de atención sanitaria de todos los niveles del sistema de salud –hospitales, dispensarios y centros de salud– deberían recibir información sobre la naturaleza de la enfermedad y su transmisión, y acatar rigurosamente las precauciones recomendadas para el control de la infección.

Las ceremonias de inhumación en las cuales los integrantes del cortejo fúnebre tienen contacto directo con el cuerpo del difunto también puede que intervengan en la transmisión del virus del Ebola. Deben utilizarse guantes e indumentaria protectora resistente para manipular a las personas fallecidas por esta enfermedad, que deben ser sepultadas inmediatamente.

Existe posibilidad de contagio mientras el virus esté presente en la sangre y las secreciones. Por ello, los profesionales médicos efectúan un estrecho seguimiento de los pacientes infectados y les someten a pruebas de laboratorio para verificar que el virus ya no circula por su organismo antes de regresar a su hogar. Cuando los profesionales médicos determinan que los pacientes pueden regresar a su hogar es porque ya no son infecciosos y no pueden propagar el virus en sus comunidades. Los hombres pueden seguir transmitiendo el virus a su pareja por el semen hasta siete semanas después de la recuperación clínica. Por ello, es importante que eviten mantener relaciones sexuales durante al menos siete semanas o que utilicen preservativos en caso de mantener relaciones sexuales antes de transcurrido ese plazo.

3. ¿Quiénes corren mayor riesgo?

Durante un brote, quienes mayor riesgo de infección corren son:

  • El personal sanitario.
  • Los familiares u otras personas que hayan estado en contacto estrecho con personas infectadas.
  • Los integrantes del cortejo fúnebre que hayan tenido contacto directo con el cuerpo del difundo como parte de las ceremonias de inhumación. 
  • Los cazadores que hayan tenido contacto con animales muertos hallados en la selva. 
  • Es necesario seguir investigando para entender si algunos grupos, como las personas inmunodeprimidas o con enfermedades subyacentes, son más susceptibles que otras a contraer la enfermedad. 
  • La exposición al virus puede controlarse mediante el uso de medidas de protección en dispensarios y hospitales, en reuniones comunitarias o en el hogar.

4. ¿Cuáles son los signos y síntomas típicos de la infección?

La enfermedad se suele manifestar con la aparición súbita de fiebre, debilidad intensa, dolores musculares, de cabeza y de garganta, síntomas que van seguidos de vómitos, diarrea, erupciones cutáneas, disfunción renal y hepática y, en algunos casos, hemorragias internas y externas.

Los resultados de laboratorio muestran disminución del número de leucocitos y plaquetas, así como aumento de las enzimas hepáticas.

El periodo de incubación (el intervalo desde la infección a la aparición de los síntomas) oscila entre 2 y 21 días. Los pacientes son contagiosos desde el momento en que empiezan a manifestarse los síntomas. No son contagiosos durante el periodo de incubación.

Las infecciones de la enfermedad por el virus del Ebola solamente pueden confirmarse mediante pruebas de laboratorio.

5. ¿Cuándo se debe buscar atención médica?

Alguien que haya estado en una zona con casos confirmados de enfermedad por el virus del Ebola o en contacto con una persona presuntamente infectada o cuya infección se haya confirmado debe buscar de inmediato atención médica.

Todos los casos de personas presuntamente enfermas deben notificarse sin demora al centro de salud más cercano. La atención médica temprana es esencial para mejorar la tasa de supervivencia a la enfermedad. Es también importante contener la propagación de la enfermedad, para lo cual es necesario iniciar de inmediato los procedimientos de control de la infección.

6. ¿En qué consiste el tratamiento?

Los casos graves requieren cuidados intensivos. Los pacientes suelen deshidratarse y necesitan sueros intravenosos o rehidratación por vía oral con soluciones que contengan electrólitos. En la actualidad no se dispone de ningún tratamiento específico que cure la enfermedad.

Algunos pacientes se recuperarán con la atención médica adecuada.

Para contribuir a contener la propagación del virus, los casos presuntos o confirmados deben aislarse de los otros pacientes y ser tratados por personal de salud que aplique estrictas precauciones para controlar la infección.

7. ¿Qué puedo hacer yo? ¿Puede prevenirse la enfermedad?

En la actualidad no existe ninguna vacuna autorizada contra la enfermedad por el virus del Ebola. Hay varias vacunas en fase de pruebas, pero en estos momentos ninguna está disponible para uso clínico.

La única forma de reducir los contagios y la muerte es divulgar información sobre los factores de riesgo y las medidas de protección que pueden adoptarse.

Formas de evitar la infección

  • Entender la naturaleza de la enfermedad, cómo se transmite y cómo impedir que siga extendiéndose.
  • Reducir el contacto con animales con elevado riesgo de estar infectados (es decir, murciélagos frugívoros, monos o simios) en las zonas de la selva afectadas.
  • Los productos de origen animal (sangre y carne) deben ser bien cocinados antes de su consumo.
  • Deben utilizarse guantes y equipo protector si se atiende a una persona enferma.
  • Se recomienda lavarse las manos con regularidad tras visitar a pacientes en el hospital o cuidar a enfermos en el hogar.
  • Las personas que hayan muerto por esta causa deben ser manipuladas utilizando equipo protector resistente y ser sepultadas de inmediato.

8. ¿Y el personal de salud? ¿Cómo se protege del elevado riesgo que supone atender a los enfermos?

El personal de salud que trata a pacientes con infección presunta o confirmada corre un mayor riesgo de infección que otros grupos.

  • Además de las precauciones generales en la asistencia médica, el personal de salud debe aplicar rigurosamente las medidas recomendadas para el control de la infección con objeto de evitar la exposición a sangre o líquidos infectados o a entornos u objetos contaminados, como la ropa de cama sucia de un paciente o las agujas usadas.
  • Debe utilizar equipo de protección personal, como batas, guantes, mascarillas y anteojos, o caretas protectoras, todo ello de uso individual.
  • No debe reutilizar el equipo o la indumentaria de protección a menos que se hayan esterilizado debidamente.
  • Debe cambiarse de guantes entre pacientes presuntamente infectados por el virus del Ebola.
  • Los procedimientos invasores que pueden exponer a los médicos, el personal de enfermería y otras personas a una infección deben realizarse en estrictas condiciones de seguridad.
  • Los pacientes infectados deben mantenerse separados de otros pacientes y de personas sanas, en la medida de lo posible.

9. ¿Y los rumores de que algunos alimentos pueden prevenir o curar la infección?

La OMS recomienda encarecidamente que se solicite asesoramiento de salud creíble sobre la enfermedad por el virus del Ebola a las autoridades de salud pública.

Si bien no existe ningún fármaco específico contra el virus del Ebola, el mejor tratamiento son los cuidados intensivos prestados en el hospital por el personal de salud que utiliza procedimientos rigurosos de control de la infección, como las medidas de protección recomendadas.

10. ¿Cómo protege la OMS la salud durante los brotes?

La OMS facilita asesoramiento técnico a los países y las comunidades con objeto de que se preparen para los brotes de virosis del Ebola y respondan a ellos.

Entre las medidas de la OMS cabe mencionar las siguientes:

  • Vigilancia de la morbilidad e intercambio de información entre las regiones para que estén alerta ante posibles brotes.
  • Prestación de asistencia técnica en la investigación y contención de las amenazas para la salud cuando ocurran, por ejemplo ayuda in situ para detectar a las personas enfermas y hacer un seguimiento de las características de la morbilidad.
  • Asesoramiento sobre prevención y opciones de tratamiento.
  • Despliegue de expertos y distribución de suministros sanitarios (como equipo de protección personal para el personal de salud) cuando el país los solicite.
  • Comunicaciones para dar a conocer la naturaleza de la enfermedad y las medidas sanitarias de protección para controlar la transmisión del virus.
  • Activación de redes regionales y mundiales de expertos que proporcionen asistencia, en caso de solicitarse, y mitiguen las posibles repercusiones sanitarias internacionales y las perturbaciones en los viajes y el comercio.

11. Durante un brote, ¿el número de casos notificados por los funcionarios de salud puede aumentar o disminuir? ¿Por qué?

Durante un brote de virosis del Ebola, las autoridades de salud pública del país afectado informan del número de casos y muertes provocados por la enfermedad. Las cifras cambian cada día y reflejan los casos sospechosos y los confirmados en laboratorio. A veces las cifras de casos sospechosos y casos confirmados se notifican al mismo tiempo, otras veces por separado. Por ello, los datos pueden variar.

Analizar las tendencias de los datos a lo largo del tiempo, y disponer de información adicional, es por lo general más útil para evaluar la situación de salud pública y determinar la respuesta adecuada.

12. ¿Es seguro viajar durante un brote? ¿Qué recomienda la OMS en los viajes?

Durante un brote, la OMS examina periódicamente la situación de salud pública y recomienda restricciones de viaje o de comercio, de ser necesario.

El riesgo de infección para los viajeros es ínfimo puesto que la transmisión de persona a persona se deriva del contacto directo con los líquidos o secreciones corporales de un paciente infectado.

Recomendaciones generales de la OMS en los viajes

  • Los viajeros deben evitar todo contacto con pacientes infectados.
  • El personal de salud que viaje a las zonas afectadas debe acatar rigurosamente las orientaciones sobre el control de la infección recomendadas por la OMS.
  • Las personas que hayan estado en zonas con casos recientemente notificados deben conocer los síntomas de la infección y solicitar atención médica al primer signo de la enfermedad.
  • Se aconseja a los médicos clínicos que atiendan a viajeros que hayan regresado de zonas afectadas y que presenten síntomas compatibles que consideren la posibilidad de la enfermedad por el virus del Ebola.

"Suero secreto"

La OMS considera ético el uso del ‘suero secreto’ contra el Ébola

La Organización Mundial de la Salud (OMS) ha celebrado una reunión con especialistas en ética médica para valorar si es adecuado usar el fármaco experimental ZMapp, nunca antes probado en humanos, contra la epidemia de ébola. Su respuesta es “sí”, siempre que se respeten criterios de transparencia, dignidad y consentimiento informado.

El tratamiento contra el ébola que están recibiendo dos pacientes en EE UU con el fármaco experimental ZMapp, y que ayer empezó a recibir el hoy fallecido Miguel Pajares, ha obligado a la OMS a plantearse dudas éticas. ¿Se pueden utilizar terapias cuya seguridad no está probada y con efectos adversos desconocidos? ¿Quién debe recibir el tratamiento con este ‘suero secreto’, del que se dispone de cantidades limitadas?

Por eso, ayer la OMS reunió a un panel de especialistas en ética médica para debatir el uso de estos medicamentos contra el brote de ébola en África occidental, que ya se ha cobrado más de mil vidas, según datos de la organización.

Por consenso, el grupo de expertos determinó que teniendo en cuenta las circunstancias de este brote, sí es ético utilizar fármacos experimentales para el tratamiento o la prevención del ébola, aunque su eficacia no esté probada y se desconozcan sus posibles efectos secundarios, siempre que se cumplan ciertas condiciones.

En las circunstancias de este brote, la OMS considera ético utilizar fármacos experimentales contra el ébola, aunque su eficacia no esté probada

Según informa la OMS en un comunicado, este tipo de intervenciones deben guiarse por criterios éticos estrictos que incluyen la transparencia absoluta, el consentimiento informado, la libertad de elección, la confidencialidad, el respeto a la persona, la preservación de la dignidad y la participación de la comunidad.

Contra el ébola no hay medicamentos ni vacunas. Durante la última década, numerosos grupos de investigación han trabajado para desarrollar fármacos. Algunos de ellos han ofrecido resultados prometedores en el laboratorio, pero todavía no se ha evaluado en humanos su eficacia y seguridad, una condición que, en circunstancias normales, es imprescindible para administrar un medicamento a los pacientes.

Obligaciones morales

El grupo de expertos de la OMS ha concluido que, en este caso extraordinario, es lícito utilizar fármacos experimentales para tratar a los pacientes, y que, con vistas a evaluar la eficacia y seguridad de ZMapp, producido por la empresa Mapp Biopharmaceutical, “existe la obligación moral de recoger y compartir todos los datos generados, incluidos los del uso compasivo de un medicamento no aprobado fuera de un ensayo clínico”.

Quedan cuestiones pendientes: ¿qué criterios de prioridad se deben emplear para distribuir estas terapias?

Los especialistas se han mostrado unánimes en que es necesario evaluar los resultados del nuevo fármaco con ensayos clínicos diseñados en las mejores condiciones posibles, a pesar de que las circunstancias no sean las idóneas.

El panel ha dejado sin resolver otras cuestiones que, según su opinión, necesitan de un análisis más profundo: ¿Cómo recopilar los datos de estos ensayos de manera ética y dar a la vez una atención óptima a los pacientes? ¿Qué criterios de prioridad se deben emplear para la distribución equitativa de estas terapias experimentales en los países afectados?

Fuente: Agencia SINC

OMS respalda uso de medicamentos experimentales contra ébola en África Occidental

* Liberia tratará a médicos infectados con medicamento de prueba ZMapp
* Sacerdote español que recibió ZMapp muere en Madrid
* No existen tratamientos autorizados ni vacunas para el ébola
* Virus ha causado la muerte a más de 1.000 personas en África Occidental

Por Kate Kelland y Stephanie Nebehay

LONDRES/GINEBRA - Las personas infectadas por el brote de ébola en África Occidental pueden acceder a medicamentos no probados, dijo el martes la Organización Mundial de la Salud, pero los escasos suministros plantean interrogantes sobre quién tendrá prioridad para recibirlos durante la epidemia del virus.

Liberia dijo que planeaba tratar a dos médicos infectados con un medicamento no probado para el ébola llamado ZMapp. Un sacerdote español que el Ministerio de Salud del país dijo que también había recibido ZMapp falleció.

La epidemia del virus ébola en África Occidental -la mayor y más mortífera del mundo hasta el momento- ha causado la muerte de 1.013 personas en Guinea, Liberia, Sierra Leona y Nigeria.

La OMS la ha declarado una emergencia internacional de salud y estima que la epidemia continuará durante meses.

No existen tratamientos autorizados ni vacunas para el ébola, pero varias empresas de biotecnología y equipos de investigación han estado trabajando en posibles medicamentos.

"Hubo un acuerdo unánime entre los expertos respecto a que ante las circunstancias especiales de este brote de ébola es ético ofrecer intervenciones no registradas como posible tratamiento o prevención", dijo la subdirectora general de la OMS, Marie-Paule Kieny, después de que una comisión de ética publicó su orientación.

La comisión de especialistas en ética médica convocada por la OMS dijo que varios posibles medicamentos habían pasado las fases de estudio laboratorio y en animales para desarrollo y que ahora deberían pasar en vía rápida a ensayos clínicos y también estar disponibles para el uso compasivo.

"Si estos tratamientos pueden salvar vidas, como lo sugieren estudios animales, ¿no deberíamos usarlos para salvar vidas cuando demasiadas vidas se están perdiendo?", afirmó Kieny.


La reunión de la comisión de ética de la OMS fue convocada después de que se administró el medicamento experimental ZMapp para el ébola, elaborado por la empresa estadounidense de biotecnología Mapp Biopharmaceutical, a dos socorristas estadounidenses que contrajeron el virus en Liberia.

Ambos han mostrado algunas señales de mejoría desde que recibieron el medicamento y Kieny dijo que ha oído informes de que el tratamiento había tenido un efecto rápido e importante en esos pacientes.

Según la OMS, sólo han sido elaboradas entre 10 y 12 dosis de la droga experimental. Liberia se preparaba para tratar a dos médicos locales con ZMapp después de que autoridades estadounidenses aprobaron su exportación.

El Ministerio de Salud de España informó que el martes falleció en un hospital de Madrid un sacerdote de 75 años que también había sido tratado con ZMapp. Había contraído el ébola en Liberia mientras trabajaba para una organización no gubernamental.

Ben Neuman, un virólogo de la Universidad de Reading en Gran Bretaña, dijo que la decisión de la comisión de la OMS era bienvenida.

"El caso humanitario para tratamiento en una enfermedad tan mortal como el ébola es muy claro. Si yo tuviera ébola, estaría buscando cualquier tratamiento disponible, incluso si estuviera sólo en fase experimental", sostuvo.

La comisión de ética de la OMS afirmó que era probable que las primeras pruebas de los medicamentos en humanos sean realizadas en los próximos dos a cuatro meses, pero advirtió que incluso entonces, y si las pruebas eran exitosas, los suministros serían limitados.

"Es (...) probable que el número de dosis disponibles para nuevos estudios y/o desarrollo desde fines del 2014 hacia adelante siga siendo insuficiente para satisfacer la demanda", dijo la comisión en el comunicado.

Entre las empresas con posibles tratamientos figuran Tekmira Pharmaceuticals, Biocryst Pharmaceuticals y Siga Technologies.

GlaxoSmithKline y científicos estadounidenses del Instituto Nacional de Alergias y Enfermedades Infecciosas esperan iniciar un ensayo clínico de una vacuna experimental para el ébola tan pronto como el mes próximo, tras prometedores resultados de pruebas en primates.

Otra vacuna experimental de la unidad Crucell de Johnson & Johnson debería entrar en ensayos clínicos de fase I a fines del 2015 o inicios del 2016, mientras que Profectus Biosciences también trabaja con científicos estadounidenses en otra vacuna preclínica.

(Reporte adicional de Ben Hirschler en Londres, Clair MacDougall en Monrovia, Daniel Flynn en Dakar, Teresa Larraz en Madrid y Jenny Clover en Kigali; escrito por Kate Kelland. Editado en español por Patricio Abusleme).


Salud Pública

Declaración de la OMS sobre la reunión del Comité de Emergencias del Reglamento Sanitario Internacional acerca del brote de enfermedad por el virus del Ebola de 2014 en África Occidental

Declaración de la OMS

El miércoles 6 de agosto de 2014, de 13.00 a 17.30, y el jueves 7 de agosto de 2014, de 13.00 a 18.30 (hora de Ginebra; CET), se celebró por teleconferencia la primera reunión del Comité de Emergencias, convocada por la Directora General de conformidad con el Reglamento Sanitario Internacional (2005) [RSI (2005)], para tratar del brote de enfermedad por virus del Ebola (EVE) de 2014 en África Occidental.

Los miembros y los asesores del Comité de Emergencias se reunieron por teleconferencia ambos días.1 En la sesión informativa de la reunión, celebrada el miércoles 6 de agosto, participaron los siguientes Estados Partes en el RSI (2005): Guinea, Liberia, Nigeria y Sierra Leona.

Durante la sesión informativa, la Secretaría de la OMS presentó la información de última hora y una evaluación del brote de EVE en África Occidental. Los mencionados Estados Partes expusieron la evolución reciente en sus países, y las medidas que han adoptado a fin de poner en práctica estrategias para controlar rápidamente el brote, así como las deficiencias y los problemas que plantea la respuesta.

Después de debatir y deliberar sobre la información aportada, el Comité consideró:

Que el brote de EVE en África Occidental constituye un ‘evento extraordinario’ y supone un riesgo de salud pública para otros estados.

Que las posibles consecuencias de una mayor propagación internacional son particularmente graves dada la virulencia del virus, su intensa transmisión tanto en la comunidad como en los centros sanitarios, y la debilidad de los sistemas de salud en los países afectados y en los que corren mayor riesgo de verse afectados.

Que es esencial una respuesta internacional coordinada para detener y revertir la propagación internacional del virus.

Por unanimidad, el Comité consideró que se han cumplido las condiciones para declarar una emergencia de salud pública de importancia internacional.

El actual brote de EVE empezó en Guinea en Diciembre de 2013, y en la actualidad hay transmisión en Guinea, Liberia, Nigeria y Sierra Leona. A fecha de 4 de agosto de 2014, los cuatro países habían notificado 1711 casos (1070 confirmados, 436 probables y 205 posibles), 932 de ellos mortales. Se trata del mayor brote de EVE registrado hasta ahora. Para responder a él, varios países no afectados han emitido una serie de consejos o recomendaciones en relación con los viajes.

Las exposiciones hechas por los Estados Partes y los posteriores debates del Comité han permitido identificar varios problemas en los países afectados:

Sus sistemas de salud son frágiles y tienen importantes deficiencias en recursos humanos, económicos y materiales que comprometen su capacidad para montar una respuesta que permita controlar el brote adecuadamente.

Carecen de experiencia sobre los brotes de EVE; los conceptos erróneos sobre la enfermedad, y en particular sobre su modo de transmisión, son frecuentes y siguen constituyendo un gran obstáculo en algunas comunidades.

La población tiene una gran movilidad y ha habido varios casos de desplazamiento transfronterizo de viajeros infectados.

Ha habido varias generaciones de transmisión en tres capitales: Conakry (Guinea), Monrovia (Liberia) y Freetown (Sierra Leona).

Ha habido un gran número de infecciones en profesionales sanitarios, lo cual indica que las prácticas de control de la infección son inadecuadas en muchos centros.

El Comité presentó a la consideración de la Directora General los siguientes consejos para abordar el brote de EVE en conformidad con el RSI (2005).

Estados donde hay transmisión del virus del Ebola

Los Jefes de Estado deberían declarar el estado de emergencia en sus países; dirigirse personalmente a la nación para informar de la situación y las medidas adoptadas para hacer frente al brote, y explicar el papel fundamental de la comunidad para garantizar su control rápido; proporcionar acceso inmediato a financiación de emergencia para iniciar y mantener las operaciones de respuesta; y garantizar que se toman todas las medidas necesarias para movilizar y remunerar al personal sanitario necesario.

Los Ministros de Salud y otros líderes del sector de la salud deberían asumir un papel destacado de liderazgo en la coordinación y ejecución de las medidas de emergencia para hacer frente al brote, y en este sentido sería fundamental que periódicamente se reunieran con las comunidades afectadas y visitaran los centros de tratamiento.

Los estados deberían activar sus mecanismos de gestión de desastres/emergencias y establecer un centro de operaciones de emergencia bajo la autoridad del Jefe del Estado, a fin de coordinar el apoyo de todos los asociados, así como los sectores de la información, la seguridad, las finanzas y otros, con miras a garantizar una aplicación y supervisión eficiente y eficaz de las medidas integrales de control de la EVE. Dichas medidas deben incluir la prevención y control de la infección, la sensibilización de la comunidad, la vigilancia, la disponibilidad de pruebas diagnósticas de laboratorio exactas, el rastreo y seguimiento de los contactos, la atención clínica a los casos y la comunicación puntual de información exacta entre los países. En todas las zonas infectadas y de alto riesgo deben establecerse mecanismos similares en el ámbito estatal/provincial y local para garantizar la coordinación en todos los niveles.

Los estados deberían velar por la existencia de medidas a gran escala y sostenidas para lograr la participación de la población, a través de los líderes locales, religiosos y tradicionales y de los curanderos tradicionales, de modo que las comunidades desempeñen un papel central en la identificación y rastreo de los casos y la información sobre el riesgo; la población debería ser plenamente consciente de los beneficios del tratamiento precoz.

Es fundamental que se establezca un sistema de suministro sólido, de modo que haya productos médicos básicos suficientes, en especial equipos de protección personal, para quienes los necesiten, tales como los profesionales sanitarios, los técnicos de laboratorio, el personal de limpieza y mortuorio, y otras personas que puedan entrar en contacto con pacientes infectados o materiales contaminados.

En las zonas con transmisión intensa (por ejemplo, la zona fronteriza de Guinea, Liberia y Sierra Leona), la prestación de atención clínica de calidad y de apoyo material y psicosocial a las poblaciones afectadas debería utilizarse como base principal para reducir los movimientos de población, aunque puedan adoptarse medidas complementarias extraordinarias, como la cuarentena, si se consideran necesarias.

Los estados deberían velar por que los profesionales sanitarios dispongan de medidas adecuadas para garantizar su seguridad y protección, cobren puntualmente sus salarios, y si procede, primas por peligrosidad, y reciban formación y capacitación adecuadas en materia de prevención y control de la infección, y en particular sobre el uso apropiado del equipo de protección personal.

Los estados deberían velar por que: haya centros de tratamiento y laboratorios de diagnóstico fiables tan cerca como sea posible de las zonas de transmisión; que estas instalaciones dispongan de suficiente personal capacitado y de equipos y suministros proporcionales al número de casos que atienden; que se garantice la seguridad del personal y se reduzca al mínimo el riesgo de altas prematuras; y que periódicamente se le recuerden al personal las medidas de prevención y control de la infección y se supervise su cumplimiento.

Los estados deberían examinar en los aeropuertos y puertos marítimos internacionales y en los principales pasos fronterizos terrestres a todas las personas que salgan del país, a fin de detectar enfermedades febriles compatibles con una posible infección por el virus del Ebola. Dichos exámenes deberían consistir, como mínimo, en un cuestionario, el registro de la temperatura y, en caso de la persona tenga fiebre, una evaluación del riesgo de que su causa sea la EVE. Se debe impedir el viaje a toda persona con enfermedad compatible con la EVE, a no ser en el contexto de una evacuación médica apropiada.

Los casos de EVE y sus contactos no deberían hacer viajes internacionales, a no ser en el contexto de una evacuación médica apropiada.

Para reducir al mínimo el riesgo de propagación internacional de la EVE:

  • Los casos confirmados deberían ser aislados y tratados inmediatamente en centros terapéuticos específicos para la EVE, y se deberían impedir los viajes nacionales o internacionales hasta que se obtengan resultados negativos en dos pruebas diagnósticas específicas realizadas con un intervalo mínimo de 48 horas entre ellas.
  • Los contactos (no se consideran como tal los profesionales sanitarios protegidos adecuadamente ni el personal de laboratorio que no haya tenido exposición sin protección) deben ser examinados cada día, y se les deben restringir los viajes dentro del país e impedir los viajes internacionales hasta 21 días después de la exposición.
  • Los casos probables y posibles deberían aislarse inmediatamente, restringiéndose sus viajes en función de su clasificación como casos confirmados o contactos.

A fin de reducir el riesgo de infección por el virus del Ebola, los estados deberían velar por que los funerales y entierros sean llevados a cabo por personal bien capacitado, permitiendo la presencia de la familia y las prácticas culturales, y de conformidad con las reglamentaciones sanitarias nacionales. Se debería prohibir el traslado transfronterizo de restos mortales de casos posibles, probables o confirmados de EVE, a no ser que se cumplan las disposiciones de bioseguridad reconocidas internacionalmente.

Los estados deberían velar por la disponibilidad de atención médica apropiada para las tripulaciones y el personal de las aerolíneas que operen en el país, y colaborar con estas para facilitar y armonizar las comunicaciones y la gestión de los pasajeros sintomáticos de conformidad con el RSI (2005), los mecanismos de rastreo de los contactos en caso de necesidad, y el uso de registros para localizar a los pasajeros cuando proceda.

Los estados donde haya transmisión de la EVE deberían considerar la posibilidad de postergar las concentraciones multitudinarias hasta que se interrumpa dicha transmisión.

Estados con algún caso posible o confirmado de EVE y estados no afectados que tengan fronteras terrestres con estados afectados

Los estados no afectados que tengan fronteras terrestres con estados en los que haya transmisión del virus del Ebola deberían establecer de forma urgente una vigilancia de los conglomerados de casos de fiebre de origen desconocido o de muertes por enfermedad febril; establecer acceso a un laboratorio cualificado para el diagnóstico de la EVE; velar por que los profesionales sanitarios tengan conocimientos y capacitación en materia de procedimientos adecuados de prevención y control de la infección; y crear equipos de respuesta rápida con capacidad para investigar y atender los casos de EVE y sus contactos.

Todo estado en el que se detecte por primera vez un caso confirmado o sospechoso de EVE, un contacto o conglomerados de muertes debidas a enfermedades febriles de origen desconocido debería tratarlos como una emergencia sanitaria y adoptar inmediatamente medidas para investigar y detener en las primeras 24 horas un posible brote de EVE, tratando a los casos, estableciendo un diagnóstico definitivo y procediendo al rastreo y seguimiento de los contactos.

Si se confirma que está habiendo transmisión del virus del Ebola en ese estado, se aplicarán las recomendaciones para los Estados donde hay transmisión del virus del Ebola a nivel nacional o subnacional, dependiendo del contexto epidemiológico y del riesgo.

Todos los estados

No deben prohibirse de forma generalizada el comercio ni los viajes internacionales, aunque deberían aplicarse las restricciones definidas en estas recomendaciones con respecto a los viajes de los casos de EVE y sus contactos.

Los estados deberían proporcionar a los viajeros a zonas afectadas o de alto riesgo la información pertinente sobre los riesgos, las medidas para minimizarlos y consejos sobre cómo actuar en caso de posible exposición.

Los estados deberían estar preparados para detectar, investigar y atender casos de EVE, y ello debería incluir el acceso garantizado a laboratorios cualificados para el diagnóstico de la EVE y, cuando proceda, la capacidad para gestionar los viajeros procedentes de zonas infectadas que lleguen a los aeropuertos internacionales o a los principales pasos fronterizos terrestres con enfermedades febriles de origen desconocido.

La población general debería disponer de información exacta y pertinente sobre el brote de EVE y las medidas para reducir el riesgo de exposición.

Los estados deberían estar preparados para facilitar la evacuación y repatriación de sus ciudadanos (por ejemplo, profesionales sanitarios) que hayan estado expuestos al virus del Ebola.

El Comité hizo hincapié en la importancia del apoyo continuo de la OMS y de otros asociados nacionales e internacionales para lograr la aplicación eficaz de estas recomendaciones y la supervisión de su cumplimiento.

Fuente OMS:

Guinea declara emergencia sanitaria pública por ébola

Por Saliou Samb

CONAKRY (Reuters) - Guinea declaró una emergencia sanitaria pública por una epidemia de ébola que ha provocado la muerte de más de 1.000 personas en estados de África occidental, y enviará trabajadores del sector de la salud a todos los puntos fronterizos afectados, informó el jueves un funcionario de gobierno.

Se calcula que en Guinea han muerto 377 personas desde marzo, cuando estalló el peor brote del ébola a nivel mundial en zonas remotas de la región que limita con Sierra Leona y con Liberia.

Guinea asegura que la enfermedad está controlada dentro de su territorio y que el número de nuevos casos está disminuyendo, pero que se necesitan nuevas medidas para evitar más infecciones desde los países que están en el centro de la epidemia.

"Se van a destinar camiones llenos de insumos de salud y a personal de seguridad a los puntos fronterizos con Liberia y con Sierra Leona", dijo Aboubacar Sidiki Diakité, presidente de la comisión de ébola de Guinea.

Cerca de 3.000 personas están aguardando en 17 puntos fronterizos para que se les permita el ingreso al país, agregó el funcionario.

"Cualquier persona que esté enferma será aislada de inmediato. Se les harán seguimientos a las personas. No podemos tomar el riesgo de dejar entrar a todos sin revisiones", agregó.

Sierra Leona ha declarado el ébola una emergencia nacional, al igual que Liberia.

Nigeria, que también declaró una emergencia nacional el jueves, dijo que registraba 11 casos de ébola luego del contagio de un doctor que trató a un ciudadano liberiano que llevó la enfermedad a Lagos.

Número sin precedentes de personal médico infectado con Ébola

OMS. Evaluación de la situación - 25 de agosto 2014 


El brote de la enfermedad del virus del Ébola en África occidental no tiene precedentes en muchos aspectos, entre ellos la alta proporción de médicos, enfermeras y otros trabajadores de la salud que han sido infectadas. 

Hasta la fecha, más de 240 trabajadores de la salud han desarrollado la enfermedad en Guinea, Liberia, Nigeria y Sierra Leona, y más de 120 han muerto. 

El Ébola ha cobrado la vida de médicos prominentes en Sierra Leona y Liberia, privando a estos países, no sólo de la atención médica con experiencia y dedicación, sino también de los héroes nacionales inspiradores. 

Hay varios factores que ayudan a explicar la alta proporción de personal médico infectado. Entre estos factores incluyen la escasez de equipo de protección personal o su uso inapropiado, demasiado poco personal médico para un brote tan grande, y la compasión que hace que el personal médico trabaje en salas de aislamiento mucho más allá de la cantidad de horas recomendadas como seguras. 

En el pasado, algunos brotes de Ebola se hicieron visibles sólo después de que la transmisión se amplificó en un entorno de atención de salud y los médicos y enfermeras se enfermaron. Sin embargo, una vez que se identificó el virus de Ebola y se pusieron las medidas de protección adecuadas en el lugar, los casos entre el personal médico se redujeron drásticamente. 

Por otra parte, muchos de los más recientes brotes de Ébola han ocurrido en zonas remotas, en una parte de Africa que está más familiarizada con esta enfermedad y con las cadenas de transmisión que eran más fáciles de rastrear y romper. 

El brote actual es diferente. Ciudades capitales, así como áreas rurales remotas se ven afectadas enormemente, aumentado las oportunidades de que los casos no diagnosticados tengan contacto con el personal del hospital. Ni los médicos ni el público están familiarizados con la enfermedad. El miedo intenso gobierna aldeas enteras y ciudades. 

Varias enfermedades infecciosas endémicas en la región, como la malaria, la fiebre tifoidea y la fiebre de Lassa, imitan los síntomas iniciales de la enfermedad del virus del Ébola. Los pacientes infectados con estas enfermedades a menudo se necesitan atención de emergencia. Sus médicos y enfermeras pueden no ver ninguna razón para sospechar Ebola y no ven la necesidad de tomar medidas de protección. 

Algunas infecciones documentadas han ocurrido cuando los médicos no protegidos se apresuraron a ayudar a un paciente que estaba visiblemente muy enfermo. Esta es la primera reacción de la mayoría de los médicos y enfermeras: ayudar al enfermo. 

En muchos casos, el personal médico están en riesgo porque ningún equipo de protección está disponible - ni siquiera guantes y mascarillas. Incluso en las salas dedicadas al Ébola, los equipos de protección personal a menudo son escasos o no se utilizan correctamente. 

La capacitación en el uso adecuado es absolutamente esencial, como son los estrictos procedimientos para la prevención y el control de infecciones. 

Además, el equipo de protección personal es caliente y pesado, especialmente en un clima tropical, lo que limita seriamente el tiempo que los médicos y las enfermeras pueden trabajar en una sala de aislamiento. Algunos médicos trabajan más allá de sus límites físicos, tratando de salvar vidas en turnos de 12 horas, todos los días de la semana. El personal que se agota es más propenso a cometer errores. 

Todo el equipo de protección personal enviado o aprobado por la OMS cumple con los estándares internacionales de seguridad apropiados. 

La pesada carga sobre los trabajadores de la salud en este brote tiene una serie de consecuencias que impiden aún más los esfuerzos de control. 

Se agota uno de los activos más importantes durante el control de cualquier brote. La OMS estima que, en los tres países más afectados, únicamente dos médicos están disponibles para tratar a 100.000 personas, y estos médicos se concentran en las zonas urbanas. 

Esto puede conducir a la clausura de los establecimientos de salud, sobre todo cuando el personal se niega a trabajar, temiendo por sus vidas. Cuando los hospitales se cierran, otras necesidades médicas comunes y urgentes, tales como un parto seguro y el tratamiento de la malaria, se descuidan. 

El hecho de que gran parte del personal médico haya desarrollado la enfermedad aumenta el nivel de la ansiedad: si los médicos y enfermeras se infectan, ¿qué oportunidad tiene el público en general? En algunas áreas, los hospitales son considerados como incubadoras de la infección y son rechazados por los pacientes con cualquier tipo de dolencia, reduciendo de nuevo el acceso a la atención médica general. 

La pérdida de tantos médicos y enfermeras ha hecho que sea difícil para la OMS asegurar el apoyo de un número suficiente de personal médico extranjero. 

La Unión Africana ha puesto en marcha una iniciativa urgente de contratar a más trabajadores de la salud, de entre sus miembros.


OMS retira personal de laboratorio ébola en Sierra Leona tras contagio de médico

Por Umaru Fofana y Media Coulibaly

FREETOWN (Reuters) - La Organización Mundial de la Salud (OMS) anunció el martes que cerró un laboratorio en Sierra Leona después de que uno de sus trabajadores se infectó con ébola, una decisión que podría obstaculizar sus esfuerzos para reforzar la respuesta global al peor brote histórico de la enfermedad.

Al menos 1.427 personas han muerto y 2.615 han sido infectadas desde que la enfermedad fue detectada en marzo en las selvas del sur de Guinea.

La OMS ha destinado casi 400 trabajadores propios y de organizaciones asociadas a la lucha contra la epidemia de la altamente contagiosa fiebre hemorrágica, que ha atacado Sierra Leona, Liberia, Guinea y Nigeria. Un brote separado fue confirmado el domingo en República Democrática del Congo.

El ministro de Salud de Nigeria declaró el martes que su país había "contenido hasta ahora" el brote de ébola.

Una de las enfermedades más mortíferas conocidas por el hombre, el ébola se transmite por contacto con los fluidos corporales y el brote actual ha provocado la muerte de al menos 120 trabajadores médicos.

La OMS dijo que retiró al personal del laboratorio que hacía análisis de ébola en Kailahun -uno de los únicos dos en Sierra Leona- después de que un epidemiólogo senegalés fue infectado con ébola.

"Es una medida temporal para cuidar el bienestar del resto de los trabajadores", dijo a Reuters Christy Feig, portavoz de la OMS.

La OMS dijo en un comunicado posterior que el personal podría regresar cuando culmine una investigación, y agregó que mientras tanto las pruebas continuarán en el laboratorio Kenema.

El médico senegalés -el primer trabajador de la OMS infectado- será evacuado desde Sierra Leona en los próximos días, señaló Feig.

El único tratamiento para la enfermedad es un medicamento experimental y hasta ahora su uso ha arrojado resultados dispares. De los seis trabajadores de la salud tratados con el fármaco ZMapp, dos han muerto.

En Liberia, el país que ha reportado más muertes por ébola, el Ministerio de Salud ha reportado más de 200 nuevos casos supuestos, probables y confirmados en un periodo de tres días. Muchos de ellos en la capital Monrovia, donde dos barrios están en cuarentena custodiados por el ejército.

Algunos funcionarios liberianos han abandonado el país o simplemente no acuden al trabajo por temor a contraer el virus, lo que empujó a la presidenta Ellen Johnson a emitir una orden amenazando a aquellos con rango ministerial con el despido.

Muere médico liberiano que recibió medicamento experimental ZMapp para el ébola

DAKAR (Reuters) - Uno de los tres médicos africanos infectados con el virus de ébola tratados con el medicamento experimental ZMapp murió en Monrovia, dijo el lunes el ministro de Información de Liberia, Lewis Brown.

Liberia, el país de África Occidental donde el ébola se está expandiendo más rápidamente, recibió tres dosis del tratamiento el 13 de agosto.

Las autoridades dijeron inicialmente que los tres médicos, los liberianos Zukunis Ireland y Abraham Borbor y el nigeriano Aroh Cosmos Izchukwu, estaban respondiendo bien al tratamiento, generando optimismo sobre la terapia experimental.

Al pedirle que confirmara la muerte de Borbor, el ministro Brown dijo: "Es correcto. Murió ayer".

Dos trabajadores estadounidenses de ayuda que contrajeron ébola en Liberia fueron declarados libres del virus la semana pasada y recibieron el alta tras recibir el mismo tratamiento. Pero un cura español a quien le suministraron ZMapp murió.

Mapp Biopharmacutical, el fabricante del medicamento con sede en Estados Unidos, dijo que los limitados suministros se habían acabado y que producir más tomaría tiempo.

Hay otros medicamentos en estudio, pero ninguno está probado y aún deben pasar por lo menos la primera etapa de los ensayos clínicos.

El ébola provocó la muerte de al menos 1.427 personas en el brote más mortífero de la enfermedad hasta la fecha.

En la semana hasta el 22 de agosto fueron reportados 292 nuevos casos sospechados, probables y confirmados de ébola en Liberia, el mayor número semanal desde que la epidemia comenzó en marzo, según un reporte de la agencia para la infancia de Naciones Unidas.

El ébola puede provocar la muerte de hasta un 90 por ciento de los infectados aunque la tasa de mortalidad producto de la actual epidemia es de cerca del 60 por ciento.

La OMS confirma que uno de sus trabajadores ha contraído el ébola en Sierra Leona    

La Organización Mundial de la Salud (OMS) ha confirmado este domingo que uno de sus trabajadores en Sierra Leona ha contraído el ébola y ha indicado que el enfermo está recibiendo la mejor atención médica posible. La OMS no ha descartado la posibilidad de evacuarle si lo considera necesario.

Desde el comienzo del brote de ébola, el pasado mes de diciembre en Guinea, la OMS ha desplegado a casi 400 trabajadores de la organización y de la Red Global de Alerta y Respuesta contra Brotes para lidiar con el ébola que se ha propagado por Liberia, Sierra Leona, Nigeria y República Democrática del Congo.

El ébola no se transmite por el aire como otras enfermedades, sino que es necesario un contacto directo con sangre, secreciones, órganos internos o fluidos corporales de personas o animales infectados, vivos o muertos.

Los trabajadores sanitarios que atienden a los infectados por el ébola son considerados un grupo de alto riesgo. Entre ellos, la OMS ha reconocido que hay riesgo de que los trabajadores de la organización puedan contraer la enfermedad y ha asegurado que se toman todas las medidas necesarias para asegurar la protección de aquellos que están desplegados sobre el terreno. Una vez que los trabajadores han llegado a las zonas afectadas por el brote, la organización se asegura de que todos los trabajadores cuenten con el apoyo médico apropiado.

Europa Press

Umar Khan, héroe de la lucha contra el Ébola

La propia enfermedad que combatía acabó con la vida del médico de Sierra Leona



Umar Khan, médico fallecido de Ébola, en junio de este año. / UMARU FOFANA (REUTERS)

El jeque Umar Khan representa, como pocos, la dureza del brote de ébola que afecta a su país, Sierra Leona, y a los vecinos Guinea y Liberia. Responsable de la lucha contra el virus en el departamento de Kenema (Sierra Leona), ingresó en el Kailahun Ebola Centre, atendido por Médicos sin Fronteras, hace poco más de una semana. Falleció el 29 de julio. El próximo 11 de septiembre habría cumplido 40 años.

Khan ha sido considerado un héroe por las autoridades de su país. Dirigía en su hospital el departamento de Lassa, otro virus hemorrágico primo hermano del ébola. Con razón y orgullo presumía de que su centro era el único del África Occidental que estaba preparado para diagnosticar el ébola y otros virus parecidos, y todo gracias al trabajo de su equipo. Antes de ello había que mandar las muestras a Alemania.

La importancia de este tipo de avances se ha hecho más evidente que nunca en el actual brote, que según el último recuento va por los 1.323 afectados, de los que han fallecido 729. Tener un diagnóstico rápido del ébola, sobre todo al principio de su manifestación, cuando los síntomas no son concluyentes, es muy importante para proceder al aislamiento de los enfermos e intentar, así, romper la cadena de transmisión. Organizaciones como el Instituto Pasteur francés o el CDC estadounidense, aparte de la Organización Mundial para la Salud, han desplazado laboratorios a la zona para agilizar este paso fundamental.

El médico también había ayudado a combatir el estigma de la enfermedad, y, por su afición a la genómica —una de las ramas que él consideraba con mayor futuro— había concluido que el ébola no era tan extraño a Guinea como se creía, y que el virus no había llegado a la región desde otros países, sino que ya estaba en ella, aunque no se hubiera manifestado.

Khan había estudiado en el College of Medicine and Allied Health Sciences (COMAHS) de Sierra Leona, donde se graduó en 2001 en Cirugía y Medicina Tropical. Tras ocupar varios puestos oficiales, en 2005 llegó al hospital de Kenema. Se da la trágica coincidencia de que su predecesor como responsable de la lucha contra las hemorragias víricas, Aniru Conteh, había muerto de otro de estos patógenos, el virus de Lassa.

Khan ha sido quizá el más destacado de los médicos y profesionales sanitarios que, en su intento por ayudar a los afectados por esta enfermedad, que puede tener tasas de mortalidad cercanas al 90% (aunque, de momento, este brote ronda el 60%) han resultado infectados. En algunos momentos se ha calculado que hasta un 30% de las víctimas pertenecen a los servicios sanitarios. Esto es una muestra de la extrema peligrosidad de su trabajo. Khan estaba considerado como uno de los mayores expertos mundiales en el tratamiento de estos enfermos, por lo que, para él, las medidas de prevención no eran en absoluto desconocidas. Esa experiencia no fue suficiente, lo que demuestra la gravedad del reto al que se enfrentan los sanitarios de los países afectados.

Fuente: El País, Madrid

Muere sacerdote español contagiado con ébola tras ser repatriado desde Liberia

MADRID (Reuters) - El sacerdote español Miguel Pajares, repatriado la semana pasada desde Liberia tras enfermar de ébola durante el peor brote de la enfermedad, murió en un hospital de Madrid, dijo a Reuters una funcionaria local de salud.

Pajares, de 75 años, fue ingresado en el Hospital Carlos III después de llegar a Madrid en un avión medicalizado el jueves y había empezado a ser atendido con un medicamento experimental.

Una portavoz de la Consejería de Sanidad de la Comunidad de Madrid no pudo ofrecer más detalles y no fue posible contactar con la ONG San Juan de Dios, para la que trabajaba el religioso, que fue el primer europeo enfermo de ébola en ser repatriado desde Africa.

Pajares trabajaba en un hospital del país de África Occidental, donde el brote de ébola ha causado más de 1.000 muertos, de acuerdo con los datos entregados el lunes por la Organización Mundial de la Salud (OMS).

Varios compañeros suyos, entre ellos la hermana Chantal Pascaline Mutwamene, fallecieron también tras contagiarse por estar atendiendo a enfermos en el Hospital San José de Monrovia.

Se trata del peor brote del letal virus en la historia, y la OMS dijo el viernes que representa una urgencia de salud internacional que seguirá extendiéndose durante meses.

A los fallecidos se suman más de 1.800 enfermos por una enfermedad que no tiene vacuna o cura conocidas.

El Ministerio español de Sanidad informó el lunes que Pajares sería atendido con el fármaco experimental bautizado ZMapp, con el que se está tratando a dos estadounidenses repatriados a su país.

Junto con Pajares fue repatriada a España otra religiosa, Juliana Bohí, quien permanece ingresada en el mismo hospital como medida de precaución tras no mostrar síntomas de la enfermedad por el momento.

(Reporte de Teresa Larraz Mora. Editado en español por Marion Giraldo y Rodrigo De Miguel).

Fallece por ébola en Liberia el religioso Combey, compañero de Pajares

El religioso George Combey, compañero del sacerdote Miguel Pajares, ha fallecido este lunes en el Hospital ELWA, en Monrovia (Liberia) a causa del virus del Ébola, ha informado la Orden Hospitalaria de San Juan de Dios.

Esta organización también ha señalado en un comunicado que el estado de salud de los religiosos Miguel Pajares y Juliana Bonoha sigue "sin cambios" desde la última información que ofrecieron este domingo, aunque han recordado que los dos pacientes no quieren que se hagan públicos los detalles sobre su estado de salud.

MSN Argentina

Ante el alerta de la Organización Mundial de la Salud
Argentina se prepara para detectar eventual introducción de casos de ébola en el país

Siguiendo los lineamientos recomendados por la Organización Panamericana de la Salud (OPS) y la Organización Mundial de la Salud (OMS), el Ministerio de Salud de la Nación extremó la vigilancia ante la potencial recepción de casos.

Atento al brote de ébola que afecta a África occidental y que motivó hoy a la Organización Mundial de la Salud (OMS) a declararlo "como una emergencia pública sanitaria internacional" el Ministerio de Salud de la Nación, a cargo de Juan Manzur, distribuyó ayer información técnica a todas las Direcciones de Epidemiología del país y a la Red de Laboratorios y las medidas previstas a nivel nacional para dar respuesta ante la potencial aparición de casos en Argentina.

"Estamos ante el brote más severo y complejo en cuatro décadas de historia de esta enfermedad", afirmó la directora de la OMS Margaret Chan al tiempo que el organismo internacional estableció una serie de recomendaciones. Para todos los países, la OMS determinó que no debería existir una prohibición general para los viajes y el comercio internacional salvo de que se trate de casos con ébola o personas que estuvieron en contacto con algún infectado. Quienes viajen a las zonas afectadas y con riesgo deben contar con información sobre los riesgos, las medidas de prevención y de manejo ante una posible exposición al virus.

Anticipándose a la declaración de la OMS, la cartera sanitaria nacional había instado ayer a las autoridades de Salud de las provincias a fortalecer la vigilancia epidemiológica y a adoptar las medidas necesarias en el nivel local y provincial para enfrentar la eventual presentación de casos en su jurisdicción.

Se considera caso sospechoso a toda persona que haya tenido fiebre (mayor a 38°); contacto con algún caso confirmado de ébola en los 21 días anteriores a la aparición de síntomas y que haya viajado a regiones con circulación confirmada del virus. Otros síntomas de la enfermedad son dolor muscular, de cabeza y garganta y debilidad. La enfermedad evoluciona con vómitos, diarrea, rash, fallo renal y hepático y hemorragia masiva interna y externa. En el estadio final, los pacientes desarrollan un fallo multiorgánico.

Desde marzo pasado autoridades sanitarias internacionales notificaron la propagación de un brote epidémico de ébola en Guinea, que luego se extendió a Liberia, Sierra Leona y Nigeria, países que tienen una alta circulación fronteriza, lo que dificultó la contención del brote, entre otros factores.

Si bien el movimiento de personas entre Argentina y los países donde se ha documentado la transmisión de la enfermedad no es frecuente, la potencial vía de introducción del virus del ébola (EVE) en el territorio argentino es el ingreso de viajeros afectados desde zonas con transmisión activa, aunque el país no dispone de vuelos directos con los países donde se registra el brote.

Ante el eventual arribo al país de casos sospechosos, estos serán aislados, evaluados y eventualmente trasladados cumpliendo con las medidas de protección al Hospital de Alta Complejidad "Néstor Carlos Kirchner" (de la localidad de Florencio Varela) o al Hospital de Pediatría "Juan P. Garrahan", establecimientos designados para la atención de estos casos. El laboratorio nacional de referencia que se ocupará de analizar las muestras y confirmar los casos, en caso de ser necesario, es el INEI-ANLIS "Carlos Malbrán".

El Ministerio de Salud también instó a extremar la vigilancia epidemiológica con el objetivo de captar y notificar oportunamente los casos sospechosos para así minimizar los efectos de la posible introducción del virus del ébola y disminuir el riesgo de diseminación posterior.

Otras características del ébola

El virus del Ébola produce una enfermedad hemorrágica febril. Es considerada una patología severa con una alta tasa de letalidad que va del 50 al 90 por ciento y afecta a personas de todas las edades. Como no existe vacuna, ni tratamiento específico probado resulta fundamental adoptar medidas de prevención y control de los posibles casos.

El virus se propaga en la comunidad mediante la transmisión de persona a persona, por contacto directo (a través de las membranas mucosas o de soluciones de continuidad de la piel) con órganos, sangre, secreciones, u otros líquidos corporales de personas infectadas, o por contacto indirecto con materiales contaminados por dichos líquidos. No está demostrada la transmisión aérea.

En África se han documentado casos de infección asociados al contacto con chimpancés, gorilas, murciélagos frugívoros, monos, antílopes y puercoespines infectados.

Fuente: Ministerio de Salud Argentina

FDA advierte contra fraude



La FDA advierte acerca de productos fraudulentos para el Ébola

La Food and Drug Administration de Estados Unidos recomienda a los consumidores ser conscientes de los productos que se venden on line que dicen prevenir o tratar el virus del Ébola. Desde el brote del virus Ébola en África Occidental, la FDA ha visto y recibido quejas de los consumidores acerca de una variedad de productos que dicen ser efectivos ya sea para prevenir el virus del Ébola o para tratar la infección.

Actualmente no hay vacunas o medicamentos aprobados por la FDA para prevenir o tratar el ébola. Aunque existen vacunas y tratamientos experimentales en fase de desarrollo, estos productos en investigación se encuentran en las primeras etapas de desarrollo del producto, aún no han sido plenamente probados acerca de su seguridad o eficacia, y la oferta es muy limitada. Hay vacunas no aprobadas, drogas y productos en investigación para el Ébola disponibles para su compra en Internet. Por ley, los suplementos dietéticos no se pueden anunciar para prevenir o curar la enfermedad.

La FDA monitorea estos productos fraudulentos y falsos anuncios

Las personas que promueven estos productos no aprobados y fraudulentos deben tomar medidas inmediatas para corregir o eliminar estas reclamaciones o enfrentar una potencial de acción de la FDA.

Es importante tener en cuenta que de acuerdo con los Centros para el Control y la Prevención de Enfermedades (CDC), el Ébola no plantea un riesgo significativo para el público estadounidense. Por desgracia, durante situaciones de brote, los productos fraudulentos que pretenden prevenir, tratar o curar una enfermedad con demasiada frecuencia aparecen en el mercado. La FDA monitorea estos productos fraudulentos y falsos anuncios y toma las medidas adecuadas para proteger a los consumidores.

El virus Ébola es la causa de una enfermedad, la fiebre hemorrágica viral. Los síntomas incluyen fiebre, dolor de cabeza, dolores articulares y musculares, debilidad, diarrea, vómitos, dolor de estómago, falta de apetito, y sangrado anormal. Los síntomas del virus pueden aparecer en cualquier lugar de 2 a 21 días después de la exposición, pero es más frecuente en los días 8 a10.

En Estados Unidos, el Ébola no es una enfermedad transmitida por el agua o por los alimentos y no se transmite a través del aire. El virus Ébola se transmite por contacto directo con los fluidos corporales de una persona infectada o con objetos como agujas que han sido contaminados con el virus. Las personas que no presentan síntomas no son contagiosas.

Se anima a los consumidores que han visto estos productos fraudulentos o falsos reclamos a informar de inmediato sobre ellos a la FDA.

La FDA, la agencia dentro del Departamento de Salud y Servicios Humanos de Estados Unidos, protege la salud pública asegurando la seguridad, la eficacia y la seguridad de los medicamentos humanos y veterinarios, vacunas y otros productos biológicos para uso humano y dispositivos médicos. La agencia también es responsable de la seguridad y la seguridad del suministro de alimentos en los EE.UU. así como de los cosméticos, suplementos dietéticos, productos que emiten radiación electrónica, y de regular los productos de tabaco.

Noticias día a día

OMS advierte de "zonas grises" y casos ocultos en brote de ébola

GINEBRA (Reuters) - La escala del peor brote mundial de ébola no se ha podido apreciar en su totalidad debido a los casos de familias que ocultaron en sus casas a personas infectadas y la existencia de "zonas grises" donde los médicos no pueden ingresar, dijo el viernes la Organización Mundial de la Salud (OMS).

La agencia de la ONU emitió un comunicado detallando por qué el brote en África Occidental fue subestimado, luego de recibir críticas de que había sido demasiado lento en contener el virus mortal, que ahora está fuera de control.

Expertos independientes plantearon preocupaciones similares hace un mes sobre que el virus contagioso podría ser peor de lo reportado debido a que pobladores desconfiados han expulsado a los trabajadores sanitarios y rechazado el tratamiento.

La OMS dijo el viernes que 1.427 personas murieron por la enfermedad, en 2.615 casos registrados, y muchos expertos no esperan que la epidemia pueda controlarse este año.

Los casos no reportados son un problema especialmente en Liberia y Sierra Leona. La OMS dijo que estaba trabajando con Médicos Sin Fronteras (MSF) y con los Centros para el Control y la Prevención de Enfermedades de Estados Unidos para producir "estimaciones más realistas".

La titular de MSF, quien ha instado a la OMS a hacer más, dijo a Reuters en una entrevista el jueves que la lucha contra el ébola estaba siendo subestimada por la falta de liderazgo internacional y habilidades del manejo de emergencias.

El estigma que rodea al ébola representa un grave obstáculo en los esfuerzos para estimar el brote en Liberia, Sierra Leona, Guinea y Nigeria, que se ha cobrado más víctimas que cualquier otro episodio de la enfermedad, descubierta por primera vez hace unos 40 años en los bosques de África Central.

"Como el ébola no tiene cura, algunos creen que sus seres queridos infectados estarán más cómodos muriendo en sus casas", dijo el comunicado de la OMS.

"Otros niegan que un paciente tenga ébola y creen que el cuidado en una sala aislada, vista como una incubadora de la enfermedad, llevará a una infección y a la muerte segura. La mayoría teme el estigma y el rechazo social que padecen las familias cuando un diagnóstico de ébola es confirmado", agregó.

Los cuerpos son usualmente enterrados sin notificación oficial, dijo la OMS, mientras otro problema es la existencia de numerosas "zonas grises", o pueblos rurales donde hay rumores de casos y muertes que no pueden ser investigados debido a la resistencia de la comunidad o la falta de personal y transporte.

En otros casos, donde el tratamiento está disponible, los centros de salud están sobrepoblados de pacientes, lo que sugiere que hay muchos posibles infectados que no están en el radar de los sistemas oficiales de vigilancia.


La OMS dijo el viernes que había di