Nearly six years after California voters approved Proposition 63, Los Angeles County has seen a sharp decline in hospitalizations (67%), incarcerations (75%) and homeless (68%) rates among people with mental illnesses, according to county data. Countywide, the number of clients under the age of 18 hospitalized at psychiatric facilities due to mental health issues has dropped by 40%, according to LACDMH. The number of adults under the age of 60 hospitalized has dropped 44%, and the number of older adults has dropped 42%.  Hospitalization days dropped 16% for adults and 17% for older adults.

Proposition 63 levied a 1% tax on individuals with annual incomes higher than $1 million to raise funds for mental health initiatives. Officials said the extra funds have allowed Los Angeles County to contract with more private health care providers and mental health caseworkers.  County officials claim that the drops in jail and hospital days alone have saved $39.8 million overall

Hospital Association of Southern California” which represents most of the hospitals county wide.  LACDMH spokesperson Kathleen Piche said the programs have been effective in terms of diverting the mentally ill from ERs and into urgent care facilities or primary care physicians with extended office hours.

Consider these primary symptoms of the disorder known as Attention Deficit Hyperactivity Disorder (ADHD):

• Often has difficulty in sustaining attention in tasks
• Often does not seem to listen when spoken to directly
• Often has difficulty organizing tasks and activities
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
  Is often easily distracted by extraneous stimuli

Many of us admit experiencing most of these traits.  The new technologies ( texting, tweeting, facebook, google searching,…) are putting infinite demands on our attention and as we try to juggle them all, we literally weaken our capacity for absorbed focus. But what is the cost of it all on our well-being?  According to the former Microsoft and Apple researcher Linda Stone: “the consequence is we’re over stimulated, over-wound, and unfulfilled.”

Attention is like any muscle. It gets stronger by training it systematically. Here are three powerful attentional practices to get us started.

• Set aside at least one designated time each week to think creatively, reflectively, strategically or long term.
• Take at least a half an hour in the evening to read something challenging and absorbing – an antidote to churning out emails, and racing between websites.
• Do the most important thing first every morning, without interruptions, for at least 60 to 90 minutes. It’s the ideal way to take charge of your agenda and get the most challenging work done, with the highest efficiency. 

Source: Tony Schwartz, Posted June 1st, 2010 - The Huffington Post

According to Dr. Lucas Restrep, the new Arizona state immigration bill signed into law on April 23, 2010 will seriously obstruct, if not undermine, the practice of medicine in the state of Arizona. Arizona practitioners, hospitals, and medical associations need to ponder the extent of their liability under the new law and draft clear institutional policies to defend their patients and employees from potential harassment. As Dr. Resterp states this bill threatens one of the oldest traditions of medicine: physicians shall protect patients regardless of nationality or race. This legislation, if unchallenged, will force health care providers to choose between the dignity of their profession and the indignity of violating the law.

Source: New England Journal of Medicine

Does USA have “the best health care system in the world as claimed by conservative senate republicans? Not… according to Donal Berwick the president of the Institute for Healthcare Improvement (IHI).

Despite the fact that Berwick will be charged with beginning to squeeze $400 billion worth of waste and fraud out of the Medicare system over a period of ten years, in the two months since President Obama named Dr. Donald Berwick as his candidate to head the Centers for Medicare and Medicaid, (CMS) not one industry group has voiced opposition to his nomination. Industry insiders understand that as Berwick reins in unnecessary spending, their revenues will be trimmed. Nevertheless Berwick’s reputation for integrity, wisdom and success in protecting patients is such that the health care industry stands behind him, endorsing the president’s choice.

Berwick who has traveled the world seeing foreign health care system first-hand understands how much we have to gain by studying success in other nations as we design a “patient-centered” system that is both more affordable and safer. Berwick often points out that in other countries health care systems are more “system-like.” Doctors and hospitals collaborate to improve the population’s health. They share electronic records and co-ordinate care. Our system, by contrast, is fiercely competitive and fragmented, with most physicians working in small practices while surgical centers vie with hospitals for the most lucrative cases.

According to Berwick, the entire Western world testifies that there are fine ways to provide health insurance to absolutely everybody while investing less than 60 cents on every dollar that we spend today. We need to have the courage and confidence to figure out how to do that ourselves. To say that we spend 15 percent of our gross domestic product on health care and that that is not enough. . . . is ridiculous. It is dishonest. We have enough. We have plenty. What we lack is not social resources, it is honesty.

Source: Maggie Mahar Posted May 26,2010 @ Health Beat

A very cool tool that lets us organize our health options into a decision tree, a method for factoring in our inputs, mapping out our options, and guiding us along the best possible path. The idea is instead of checking in on our health when we visit the doctor or get lab test results, we can now tap into a constant stream of information and opportunity. We can minimize our uncertainty and maximize our control. By monitoring and tweaking our inputs, we can influence and even determine our well-being. Taken all at once, our health may seem inscrutable; laid out in a sequence, it becomes a series of decisions, each with risks, benefits, and trade-offs. For more information and a demo of the tool visit: http://www.wired.com/magazine/2010/01/ff_decisiontree/

Source: Wired Magazine

The findings of a research conducted at Stanford University Graduate School of Business suggests that denying people access to a product will make them desire it more and work harder to get it—but will also make them less likely to keep it.

The boost to value comes from knowing we devoted extra effort to acquiring it, but it also has a negative self concept impact because we did not succeed on the first try. Desire and liking are independent from each other and also interact in strange ways. The more we want something, the less we’ll actually like it. It’s a lusting/loathing thing. The lusting/loathing effects were more intense with people who were less emotional, as measured on standard scales. “Emotional” people did not show the effect as strongly.

The results of this research make it clear that marketers should be cautious about using a strategic shortage to generate demand. It will increase demand right now but can have other costs. It will have implications for other products in your brand, repeat purchases, and loyalty. It comes down to what the goal of the company is. If it’s to make quarterly numbers, denying access may be a useful tool. It could be that marketers know what they’re doing and want those short-term gains; but it’s not a healthy long-term strategy.

Source: Harvard Business Review
Uzma Khan is an assistant professor of marketing at Stanford University’s Graduate School of Business

Why Interoperability?
To fully realize the potential of Electronic Health Record (EHR) systems we need to ensure a timely and secure access to such systems and to all those that are entitled to use them. Moreover, the information contained in EHRs should be up-to-date, accurate and, in its communication to another location, system or language it should be correctly understood. This is called interoperability.
Interoperable EHR systems are instrumental in enabling patient centered care, continuity of care, and support to mobility of patients.

Integration vs. Interoperability

Integration is the arrangement of an organization’s information systems in way that allows them to communicate efficiently and effectively and brings together related parts into a single system. Interoperability is the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.

Why Standards?
Health information systems have to adhere to the same standards in order to make interoperability possible. Systems must be able to implement the recognized standards in order to exchange information and work with other systems. With the regulatory issues and privacy / security challenges, standards help the systems to support the activities and perform the functions for which they are intended; and to protect and maintain the confidentiality of data entrusted to them.

On December 30, 2009, Centers for Medicare & Medicaid Services (CMS) announced a notice of proposed rulemaking (NPRM) to implement provisions of the Recovery Act that provide incentive payments for the meaningful use of certified EHR technology. 

Meaningful use criteria focuses on electronically capturing health information in a coded format, using that information to track key clinical conditions and communicating that information for care coordination purposes. It also calls for implementing clinical decision support tools to facilitate disease and medication management and reporting clinical quality measures and public health information.

Tim O’Reilly snagged a great interview with Aneesh Chopra at the Gov 2.0 Expo. They started off with a strong focus on the intersection of healthcare and gov 2.0 principles. Aneesh gives an overview of the incentive program for meaningful use of EHRs, reveals an interesting perspective of the genesis of the NHIN Direct project, and also talks about the criteria that patients are entitled to an electronic copy of their medical record. From a policy standpoint he wants to create the conditions for data liquidity and provide a platform for innovation.  Listen to their discussion by clicking on the following URL: http://ahier.blogspot.com/2010/05/healthcare-and-government-20-with.html

There are three catagories of colaboration: active collaboration, developing collaboration and potential collaboration.

▪ Active collaboration is collaboration of the highest level. The partners have successfully established stable collaboration that is sustained despite any uncertainties in the system. The partners have adopted common, consensual goals, developed a sense of belonging and mutual trust and reached consensus on mechanisms and rules of governance. As a result, professional practices should be transformed on the basis of a new consensual division of interprofessional and interorganizational responsibilities and the introduction of innovative practices.

▪ Developing collaboration is collaboration that has not taken root in the cultures of the partner organizations and may still be subject to re-evaluation on the basis of internal or environmental factors. Goals, relationships between partners, governance mechanisms, and formalization are the subject of a negotiating process that has not yet produced a consensus. The negotiations may be partial or a source of conflict, but they are nevertheless open, ongoing and accessible. This type of collaboration results in a tentative division of responsibilities between professionals and institutions; in timid transformations of professional practices; and in services that are less efficient than they might be. 

▪ Potential collaboration refers to collaboration that does not yet exist or has been blocked by conflicts that are so serious that the system cannot move forward and satisfactory forms of collaboration cannot be implemented. When potential collaboration is characterized by significant opposing forces, either negotiations do not take place or they are constantly breaking down. It is therefore hard to introduce the new professional practices that the network needs, for innovation is difficult in an environment beset by a whole series of conflicts. Services may suffer from a loss of accessibility and continuity. Only by resolving the conflicts can collaboration be implemented. 

Source: BMC Health Services Research

The following ten indicators can be considered to evaluate the processe of collaboration. The degree to which these indicators are achieved within an organization will show the gap between optimal collaboration and its current state.

The following four indicators are for evaluating the relational dimensions:

• Goals
• Client-centered orientation
• Mutual acquaintanceship
• Trust

The following six indicastors are for evaluating the organizational dimensions:

• Centrality
• Leadership
• Support for innovation
• Connectivity
• Formalization Tools
• Information Exchange

Source: BMC Health Services Research