Thursday, April 23, 2009

Save time and money - go online and improve your health

Everyone talks about how expensive healthcare is, yet few people have started to really look at how it could be cheaper for patients. Many of the costs of healthcare are the result of inefficient practices that arise from a system that has not been focused on patients, and has just assumed that patients will travel from one clinic to the next, from one lab to another, and from home to hospital. Most doctors practices and health systems try and save money for themselves, but not for patients, and often they actually make more money by being inefficient because patients end up having more consultations and repeat tests than are really necessary, and paying for them. There are now many ways that the internet can be used to save both time and money, and to therefore ultimately make healthcare cheaper for everyone.

As a practicing physician, here are my suggestions:

1. Try to travel less for your healthcare.If you can reduce the number of face to face consultations you have you will not only save the cost of those consultations, but will also save the time and travel costs they involved. Ask your doctor if they use email or secure messaging – often a quick email response saying that your results are normal can save a whole consultation for you. Or sign up for a personal health record that you can share with your doctor, and see all your own results online. Many health systems have shared electronic records. Think about using telemedicine for your consultations, if your primary care doctor has access, and avoid traveling long distances to see specialists for consultations in dermatology, ophthalmology, psychiatry, pediatrics and endocrinology, to name a few.

2. Make sure you are getting the best, and most up to date, treatment?Check out information on treatment guidelines and clinical trials on the internet, and make sure you are getting the best and most up to date treatment, so that you get better and back to work as quickly as possible. Nothing is more expensive than being off sick when you don’t need to be. Preventive care is particularly important so make sure you are keeping fit, and use the internet to find good nutrition and fitness guidelines.

3. Ensure you are receiving electronic prescriptions? Learn about your medications and ask your doctor if they e-prescribe. If they don’t then ask why not. Once your doctor e-prescribes you should be able to have your prescriptions sent automatically to the pharmacy of your choice – either the one closest to where you live, so that you can pick up your prescriptions in no time, or to a cheaper pharmacy, locally or by mail, that you have researched on the internet. Drug prices in the US are extremely high, and you can often save a lot of money by carefully comparing prices.

4. Get the most appropriate health insurance for yourself.Do some homework on the internet, compare health insurance programs, look at your needs, and choose the best value most comprehensive program you can find. Remember that the cheapest program is not necessarily the best, and you may find yourself paying large amounts of co-payments if you are not careful.

5. Find the best doctor for you and your family. Check out your doctor’s expertise, their qualifications and their experience. Go to the State Medical Board website and you will often be able to find out if they have ever had any claims against them. Many doctors now detail how many surgeries they have performed, what their infection rates are, and how many patients they have treated for a particular disorder. Choose experienced doctors whose patients are least likely to have expensive and time consuming complications – a huge potential waste of time and money for you, never mind the extra pain and sickness. See which hospitals your doctor works at if you need an inpatient admission, and check out the quality of those hospitals on the many “scorecards” that are becoming available.

The bottom line is that you can save lots of time and money by using the internet for your healthcare. Make sure you do as much research as possible before you see your doctor – let’s face it you don't go and see your accountant to do your taxes without collecting information beforehand. Do the same with your doctor. The Internet is the easiest source of information to use. So use it.

This article is based on the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at and most online bookstores. The eBook “Save time and money – go online and improve your health” is available from

Tuesday, April 21, 2009

How to design a new American Healthcare System - 3 simple proposals

Much is currently being written about how President Obama should re-shape the American Healthcare system. Most commentators agree that the current arrangement for healthcare in this country is too expensive, highly inefficient and provides unequal levels of care, including minimal care for the 47 million uninsured Americans.

As a physician with a longstanding interest in how health services are organized, and who has lived and worked in the USA, Australia and Britain, as well as consulted to many other countries, I have strongly held views on the types of directions America should take. And at one level they are remarkably simple, and can be summarized in three suggestions.

1. A public-private partnership philosophy has to be central to the whole re-engineering of the health system. America is founded on capitalist principals, where the profit motive is central, and any new approach to healthcare must combine this with the need to develop core public services that may be less likely to ever achieve a profit. There must be the potential for cross investment in all directions - and with funding for care provided on the basis of annual or episodic whole of person care provided, rather than on individual piece rates as at present. Numerous studies have shown that if health systems can be given the incentive to provide quality care efficiently over defined time periods, and Kaiser Permanente is an excellent example, that they can do this. The primary importance of this approach is that it will force more resources into prevention of illness - to wellness promotion - rather than into the treatment of illness that has already commenced. Of course in such an environment anyone, no matter what their insurance, should be able to receive emergency care in any hospital at any time - public or private. This whole system should be underpinned by an extensive health information technology infrastructure that allows every citizen to have access to their own electronic health record, and to have a unique health identifier. This approach will greatly improve the security and privacy of health information, and will substantially increase the quality of care available nationally.

2. The public component of the healthcare system would include universal basic health insurance (including catastrophic care insurance) and many emergency and isolated health services, as well as much more public health focus on prevention and health promotion. Public programs should also pick up much of pre/post natal and early child care (by far the most important care in the whole health system) to ensure all mothers and babies are properly looked after, and probably care of some special populations who cannot afford private health insurance such as the unemployed, some seniors and certain impoverished or geographically isolated groups.

3. The private component would be funded with the aid of tax incentives to encourage most people (or companies) to take out private insurance with aim that at least 80-90% of the population should have private insurance. It is crucial to reach this level of insurance to be confident that patients have "skin in the game" and are financially responsible for at least a good proportion of their healthcare costs, and do not see healthcare as something that is provided by the government for free. The private sector should offer a full range of services from birth to death - with the ability to charge extra for certain "non-essential" services such as cosmetic surgery and other niche areas - but with regulation to prevent people being excluded on grounds of pre-existing conditions. A voucher system for certain groups, such as the chronically disabled, funded by government payments would allow all to access the private healthcare system depending on need. The insurance process for this private component needs a complete overhaul to reduce administrative overheads and simplify the payment process - my view of the simplest way of doing this would be to limit the number of private insurance companies and make sure that they are financially viable and large enough to offer reasonable regulated levels of healthcare services to their members.

These 3 steps to providing better care, and fairer access to care, for all Americans are taken from what I consider to be the best parts of the American, British and Australian health systems. No country has a perfect health system, and all are dependent on the core cultural philosophies held by the individual nation. America is the Land of the Free and can afford to choose the best of what other countries have attempted as it debates how to improve its healthcare system, and ultimately the strength and fortitude of its people.

Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 Simple steps to Better Health - an Insiders Look" is available at Smashwords at

Monday, April 20, 2009

Are non-experts the right people to introduce Health IT?

The recently written "spoof" about Amazon introducing a new Personal Health Record has achieved a lot of prominence in the blogosphere - however here is a great new blog taking this commentary a bit wider and asking the rhetorical question that , since M and M's look a bit like pills, why doesn't this give the manufacturer of M and M's the expertise to produce generic drugs? We know that health is a highly complicated and difficult industry to enter, and it is all too easy for those without an understanding to the industry to propose facile solutions, as happens regularly, and which usually fail. They only do so, however, because we in the health industry have not found our own solutions yet, and that is what we need to do. Until we do the Amazons and candy manufacturers of the world will still have the potential to offer us inappropriate "solutions". It is up to us as an industry to reform ourselves.

Tuesday, April 14, 2009

Health Informatics Specialists are key to the Obama Administration Health Inforamtion Technology Plans

As someone who has been teaching health informatics students for a number of years, it is rewarding to find this discipline finally receiving the attention and interest it demands. Most health experts have agreed for some time that the two academic disciplines of informatics and genomics are the key disciplines that will shape the future of American healthcare by enabling doctors to have access to personalized healthcare information at the point of care.

The American Recovery and Reinvestment Act includes specific wording supporting increased funding of health informatics programs around the nation. A recent article in the New York Times has noted that there is a greatly increased demand for "health informatics specialists" who have expertise in medical records, insurance claims, clinical care and computer programming as health care providers look to utilize the $19 billion in stimulus funding directed at implementing and expanding electronic health records.

Health informatics specialists usually start their career or education in computer programming or as health care professionals, and later earn a degree in health informatics and take midlevel or senior jobs at a hospital, doctor's office, insurance company, drug firm or other organization working with health care data. The experience of the UC Davis Health Informatics program, which I direct, is that most of our graduates have found senior positions in health informatics in both public and private sectors, including a number who have become faculty in health informatics programs, and are now teaching future generations of students.

William Hersh MD, Chair of the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University was quoted in the New York Times as saying , "The health IT people run the servers and install software, but the informatics people are the leaders, who interpret and analyze information and work with the clinical staff." It is crucial to have highly trained experts in informatics who are able to work across both the disciplines of health and information technology, and who understand and are expert in both. Without these informatics experts it is hard to see how the Obama Administration policies for Health Information Technology can possibly be implemented.

The American Medical Informatics Association is the main professional body relating to health informatics experts and Don Detmer MD, the Chief Executive Officer, said, "My rough estimate is that we need about 70,000 health informaticists" to meet Electronic Health Record goals laid out in the stimulus bill. Prior to the stimulus bill, most experts agreed that just to keep progressing with Health IT implementation at our current relatively slow rate, it would be necessary to have another 10,000 health informaticists by 2012. All that is now changed, and there is an urgent need for many more highly trained health informatics specialists, and programs such as UC Davis are planning to more than double their current output of students within the next three years, assuming extra stimulus funding.

It is interesting how the public has caught on to the need for increased numbers of health informatics specialists. This is demonstrated by the already dramatically increased numbers of applicants to the UC Davis program, where we are currently working with more than 50 applicants to our Masters program, having recently also enrolled 30 students in the first quarter of our new Certificate program.

It is crucial that the health workforce is retrained for 21st Century medical needs, and with health being one of the relatively few expanding sectors of the workforce, training in disciplines such as health informatics is essential if we are to improve the way health services are delivered to the nation. We have to be realistic about the fact that there will be increased needs in future as the current 46 million uninsured are likely to be covered by some form of universal insurance and offered more comprehensive care than they have been able to receive in the past. This can only happen if we use Health Information Technology intelligently, and universally, and for that to happen we have to dramatically increase the number of health informatics experts around the country.

This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at

Tuesday, April 7, 2009

Green Health

I have published several articles on green health - and how it is important for health providers to promote ecologically sustainable practices. These articles have been published as video editorials on - just put "yellowlees and green health" into the youtube search engine and you will find three video clips. This is an important issue as changed practices in the health system in the US could save massive amounts of energy, paper, gas and plastic wastage. I am giving a paper on this topic at this years American Telemedicine Association conference in Las Vegas at the end of April - see for details of the conference. Health, as usual is way behind other industries when it comes to modernizing by making "green" changes, just as it has been in introducing information technologies, but the industry will get there in the end. One of the major opportunities is to use information technology to reduce wastage and cut down carbon emissions - by promoting EMR's, telemedicine, server virtualization, homecare and electronic disease management, as well as a whole series of internet related health care systems we can do our part by keeping the planet green as much as possible. Let's face it - it makes no sense for health providers to actually make future generations sick by using poor environmental practices when their whole aim in life is to improve health...!!

This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at

Monday, April 6, 2009

Virtual Worlds on It's All Virtual

I am pleased to see an excellent article about Second Life on an interesting blog called "It's all virtual" on April 5th.
It’s All Virtual covers the virtual world from a B-to-B perspective: Virtual Worlds, Virtual Tradeshows, Virtual Meetings and more. The blog provides insights from Dennis Shiao, a media industry product manager who worked on numerous Virtual Tradeshow (VTS) campaigns for B-to-B technology advertisers. In addition to VTS, the blog will cover virtual worlds (e.g. Second Life), virtual meetings and telepresence.
This is one blog I am going to follow - interesting and very relevant.

Wednesday, April 1, 2009

Why sex and money are not as popular as health.

I recently put the word “health” into the Google search engine. The search returned 1.32 billion web pages where the word “health” was mentioned. I do really mean the number 1,320,000,000 – more than 1.3 billion mentions. I followed up with other words. “Money” found 1.2 billion pages and “sex” 819 million. What an amazing statement about the popularity of health on the net – more mentions than sex and money! And numbers of references that are in the billions. When I did this same search in 2000, there were 27 million “health” references so this is more than a forty fold increase in the past 8 years. What an expansion of interest in health on the Internet.

The business of eHealth on the Internet is expanding rapidly. Two recent reports from the Pew Foundation and Harris Interactive have confirmed that 75-80 per cent of United States Internet users utilize the Internet for health information and healthcare – that is around 140 million people. This is over 65% of the entire adult population of the USA – an average of 8 million people every day! Not surprisingly those individuals with chronic illnesses, who have recently been diagnosed with a medical condition or who have broadband Internet connections use the Internet for healthcare more commonly than other Internet users, and their searches for health information are becoming a regular habit, often several times per month.

Business sees the healthcare sector as a particularly attractive industry that will benefit from web-based technologies because of its enormous size, inefficiency and information intensity. Moreover, the healthcare industry is particularly fragmented with a large number of participants, including general practitioners and primary care clinicians, specialists, institutions (public and private hospitals and diagnostic companies), health funds, pharmaceutical companies, retail pharmacies and, of course, patients.

John Chambers, from Cisco Systems, has been quoted many times as saying that “the Internet waits for no-one”, and now that we have the rise of what is being called the second Internet revolution, with the influence of social networking and sites like facebook, twitter and youtube, the importance of the Internet has increased dramatically as it has entered the social fabric of our lives. We know that the radio took 30 years, and the TV 15 years, to build an audience of 60 million people around the world. The Web won 90 million people in its first three years and hasn’t looked back so that there are now well over one and a half billion Internet users around the world - 23% of the entire population of the world.

Countries like China, and regions like South America and the Indian subcontinent, with their large populations and economic bases, are becoming significant powers in the Internet world. I visited India in 2003 and while driving along the main road from Agra to Delhi was astonished to see broadband fiber being laid in hand dug trenches alongside the roadway, and to learn from my driver that this was now commonly seen as the whole of India was being rapidly wired.

Many forces enable the practice of Internet healthcare to advance rapidly, including the following:

ð consumers are spending more of their own income on health, with an estimated increase in cost of 2.5% to 3.5% per year as the population ages.

ð consumers are being encouraged to take more responsibility for their health, and to know more about treatments offered for them, their effectiveness and the track record of the individual provider or medical team offering the treatment.

ð it is well known that conventional health services are associated with many unintended injuries or complications, and government task forces in the United States, Europe and Australia have all strongly recommended more information technology involvement in the healthcare system to reduce errors and mistakes.

ð health practitioners are now generally highly computer literate, and the medical students of today have grown up in a world where they have never known of life without the Internet. Many doctors have their own homepages, and the culture of health is changing. It is now well understood by both patients and doctors that patients can drive their care through accessing good quality information.

ð the spread and increasing access to fast Internet connections via broadband has led the whole internet to become so much more accessible than was the case when most people connected by dial up. It is now a major force in our daily lives.

ð major publishing companies have developed substantial healthcare Internet programs, and Google and Microsoft have recently entered the health industry with a bang, both focusing on building personal health records for patients, and working with premier health organizations, such as the Cleveland Clinic.

The presence of "health" on the Internet, as one of the most popular and generic search terms used on Google, is massive. It is easy to see why this term is more popular than "sex" or "money" when you examine all the forces driving Internet healthcare. The challenge for consumers is to sort out good quality information, from biased and inaccurate sources.

This article is based on excerpts from the recently published book “Your Health in the Information Age – how you and your doctor can use the Internet to work together” by Peter Yellowlees MD. Available at and most online bookstores. A shortened version of the book, available as an e-Book for download to iPhones, Blackberry's, PDA's and other mobile devices called "4 simple steps to better health - an insiders look" is available at Smashwords at

healthcare and social media

I am fascinated by how social media, such as facebook, twitter, delicious etc, and the internet can be used in healthcare. I have my own facebook page - do join facebook , look me up and join as a friend where I am happy to talk to you - comment on this blog, or email me direct at To give you an example of the internet and healthcare - a woman from many hundreds of miles away in California phoned me yesterday for advice about her mother who had a major behavioral problem - she had found me on the internet via my website - - and had then followed the links from there to check me out. We had a good short discussion and I was able to advise her on the best approach to take with her mom. But what interested me is that she had not problem checking me out online, and then finding my phone number to speak to me direct - she knew that I was a relevant expert and would be able to help her if she could contact me - and none of this would have been possible had I not had an obvious internet profile. So let me ask all of you to comment - do you have stories of how the internet has helped you for healthcare - and in particular how the social media sites have helped? Do contact me and tell me - I am fascinated. Thanks indeed.

Remember that you can also find other examples of how to use the internet for healthcare in my book "Your health in the information age - how you and your doctor can use the internet to work together" available through Amazon and most online booksellers, as well as at The eBook short version is available through if you want to download it to your pda or iPhone.