Find me at UpDox!

Andrew Barbash — Wed, 19 Nov 2008 11:25:53 +0000

I helped to establish and guide the development of the UpDox Network. Whenever I am online and available to do shared web meetings, live instant chat, share tasks, or setup time to get together, I am logged into UpDox.

Please do the following after clicking the JOIN link at the bottom

Create a new user account in the UpDox Network (it is free to do so)
When you first login click on the UpDox Network tab at the top of the screen (it shows number of people in network currently)

Find my name in the network and click to invite to your “personal network”–this lets us be able to chat with each other and send messages, because one has to have a “relationship” defined in order to send/chat with another member, of course
If you cannot find it (search process being refined)–just send me an email letting me know you registered and I will invite you)

Whenever you login–and there are alot of features around task management, document management etc you might find useful–the system shows you online, and me as well, We can do instant chat, If not online, can send each other messages.

JOIN UPDOX AND MEET ME ONLINE

Thanks

Andrew Barbash, MD

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Andrew Barbash — Sun, 16 Nov 2008 16:49:44 +0000


	Resource Center Update

The genesis and exodus of healthcare

Andrew Barbash — Thu, 10 Jul 2008 20:56:10 +0000

This poem is the copyright of Andrew Barbash, MD.
Presented to the Institute of Medicine, July 2006 (hence IOM reference at bottom of poem)

July 2008

Genesis and Exodus of the Healthcare Industry.

(Poem has been submitted for publication, so it cannot be posted on my public website yet If you are interested in seeing this, please send me an email)

AJB

Key business model principles for tele consultations

Andrew Barbash — Fri, 04 Jul 2008 12:25:20 +0000

In order to make sure that the incentives for providing and requesting teleconsultations for both expert providers, small groups, large organizations, hospitals, clinics and individuals are aligned and in support of the deployment issues, here are some thoughts..

Responsibility for costs and outcomes

Expertise Provider (specialist, et al)

Buy the PC/laptops, remote camera and any software needed on them, put your logo on them, and have them setup (I can help you do this, it is easy) exactly the way it wil
help you get the work done. The receiving institution, if they already HAVE this obviously wont need you to provide it, but assume that they DONT and modify cost of service if you also are providing the tools
Contract with whatever technicians/care managers, etc who MIGHT be needed in remote site IF the remote site does not already provide the same, or able to certify their competence
Pay for the “find me” communication services that makes it easy to “find, schedule and get hold of the right expert”–this stuff will amount to less than $100 a month for the entire group and probably many more, so no one should balk at that given the payoff
Determine the rates you will be charging for readings, and consultations and whether there is a direct pay component (i strongly urge this) or just relying on traditional insurance reimbursement (i am not terribly interested in this latter model, it retains all the same antiquated dependence on non-functioning industry)

What this does is defines the business model that puts the expert provider in command of whatever they need to enable other people to access their expertise virtually. But the expert and/or group has to really, really want to move to this type of model and see its potential broadly. Because if that is the case, it is not going to let any aspect of the project with any one hospital be dragged down by someone else’s challenges around technology, etc. The expert provider DEFINES the business

Hospital or other organization “requesting expertise”

Open Internet connections so that standard, inexpensive tools used by remote expert can be leverage with NO dependence on local IT resources
Imaging and other expensive capital devices, local physical plant resources, etc
Set aside of operational dollars, supported by foundations where feasible, but not required—so that there is a fund to DIRECTLY pay any provider of expert telehealth and not have these projects
depend on external reimbursement in order to get launched
Appropriate nurse/care manager support person to help initiate the request for consultation
Internal compensation or support for those (ER docs, OB docs, etc) who we WANT to be requesting remote expertise, making it easy as possible for them to do so, in terms of time, people, communication, etc

Moving away from dependency on payor models

Andrew Barbash — Sat, 28 Jun 2008 10:51:48 +0000

I posted this on medscape discussions today

http://boards.medscape.com/forums/.29e29ae4/25

Having worked online with individual clinicians in small practices to help solve the daily workflow issues around communications, information management, etc I have been able to meet (albeit “virtually”) people who have pursued all ends of this spectrum of “concierge, micropractice, boutique, patient-centered” care models. Rather than starting from the current broken paradigm of “third-party” centered healthcare and trying to patch some level of sustainability around it, what has impressed me about the micropractice clinicians is that for the most part they have decided that THEY will determine what the practice of medicine will look like for them and their patients, what hours they spend doing it, how they are reached when needed, how their patient-colleague relationships are defined, and how they will structure their office/overhead/added fees and services in order to achieve that goal.

It is, I believe, a more “creative” as opposed to “reactive” approach, regardless of which specific version (ie no staff, part time staff, pay for email, holistic services, etc) is sought or to which he/she might migrate over time. The EMR systems these docs select are more likely to be chosen by THEM, based on their perceived needs and interests, rather than by someone else in a hospital or larger group model. And therefore the EMR and communications systems approaches they seek will be unique. (not necessarily applicable to all others, but will also evolve to meet the needs of this type of model).

So it has always seemed to me that we would all be better off if leaders of both physician, consumer, healthcare, payor and governmental organizations would just convey a common message to all patients……”your physician is likely a highly accountable hard working, well trained person who is dealing constantly with incomplete information and partnering with you to make complex decisions in a timely manner. You can expect to partner with him/her also in determining what type of “model of care” will work best for you and you should just expect that healthcare is no longer something in which every “service” provided by such a professional, is adequately compensated by a third party. The nature of that service, its timeliness, severity, complexity, and the number of people and hours it takes to deliver it…is partly determined by your role, needs, the environment, and the business/service climate in which this professional functions. In any other industry you would expect to be participating in the payment model that determines what level and type of service you receive..just like a lawyer or accountant or even rental cars…so please expect the same from your doctor.” i.e…..please dont ask your doctor to apologize for being treated like the truly accountable professional that he/she is.

This is not about trying to patch together approaches that fill in the reimbursement gaps of different insurers really, even though that is a near term strategy for many. It is about acknowledging that any process whose outcomes depend on the active involvement of professionally trained people in their own businesses can only sustain itself with an economic model that matches who creates the need, what is needed, who supplies the service and what it costs to provide it!!

AJB

Poem in honor of Holy Cross Radiology Techs

Andrew Barbash — Fri, 13 Jun 2008 14:53:22 +0000

Radology Techs Graduation June 2008, poem written for their ceremony

Emerging today from the ground level rooms of a hospital micro college

From watch, learn, do..to “I’ll show you”. Less wonderment, more knowledge

Physics, process, communication, documentation, and rules

Patient service, education, mastering digitized tools

They crank up all the GE, Siemens, Phillips and Toshibas

Finding anatomicphysiopath from cartilage to amoebas

The docs in white might sign their names to written diagnoses

But we all know who makes or breaks this magnetic metamorphosis

Meeting demands of specialists, and surgical prima donnas

Data from 2 AM on-site techs to remote radiologists in pajamas

Pixels, voxels, fractionation, decaying isotopes

Avoiding too much radiation, while learning all the ropes

Oh, they also absorb all that billing code stuff, all those work rules and health regulations

Systems for data, results view and orders, time keeping tools for vacations

If our techs have mastered, from device to bedside, all these skills they can take to the bank

Then.. hero or martyr, we will all look much smarter, and we’ll have these new graduates to thank

Andrew Barbash, MD

Neurosciences Program Director

Holy Cross Hospital

Appreciator of the work of the Radiology Techs

June 13, 2008

www.ajbmd.com

Tele-ICU white paper from New England Healthcare Institute

Andrew Barbash — Fri, 13 Jun 2008 10:30:22 +0000

This is an interesting white paper I found as part of the American telemedicine site. It reviews the state of Tele-ICU medicine, opportunities and barriers

Barack and Hillary need to start governing now

Andrew Barbash — Sun, 08 Jun 2008 11:50:15 +0000

June 8, 2008
Kudos to Hillary for delivering an outstanding speech yesterday. Her portrayal of what has been achieved as a success rather than a failure in falling short of only one of her goals, is right on target. One of the best things that Barack Obama, with Hillary as a powerful associate, can do right now is to help begin governing as part of his campaign. The influence of the internet and social networking is a powerful tool in forming behaviors. And the country is absolutely at sea without any credible leadership when it comes to oil prices, financials, energy policy and a sense of the future. There is no reason why, given the methods by which general feedback and discussion can be obtained broadly thru the public media, that we should be waiting until November to begin influencing the policies and decisions of both individuals and groups. The formation of a vision of the future and the influence over the decisions individuals need to be making right now can occur through the same collective energy and wisdom that has characterized the campaign efforts to this date. Times have changed. Power is not limited to those “in formal power” and major personal changes in behavior (driving, saving, public outreach) can begin now, not waiting until a Democrat finally gets back into the White House. And thank you to Hillary for re stating that the biggest fear we all need to realize is not that one of us will fail, but that ALL of us will fail by perpetuating the failed governance, and short sighted “leadership” or lack thereof, of the last 8 years (and really longer than that)

AJB

Setting up phone communications

Andrew Barbash — Tue, 03 Jun 2008 10:56:53 +0000

Q:I will eventually have 2 locations, but I want the phones to be answered at both locations live by a staff member that will stay at the location to answer phones/make appointments. Any advice on how to set this up so I don’t lose out on making appointments for patients. I know I can forward the numbers to various other numbers. However, that wouldn’t make sense for me either. Does my dilemma make sense to you?

A: Well, once you start getting into having live humans answering phones at physical locations with unique numbers, you are in a different realm because you end up with the following paradigm:

Local phone number with local phone company at X per month at each location
If no answer after Y rings, phone call is redirected to your Onebox.
Then if you want different onebox message box for each location, you are into the onebox receptionist mode

Easy to setup, but you have to really ask yourself how likely it is that Z percentage of calls coming into those live numbers are ONLY for the purpose you want, and how likely it is that a human will answer the phone as opposed to letting it ring to message center and retrieve messages

As usual, this stuff really takes some planning and realistic expectations. In my strong recommendation, one needs to move to Message Management, not Answering the Phone. You only want a live phone for a scenario where the caller has determined they absolutely MUST have a live person now, or they are answering a page, callback, etc. And even there you need to assume that the person manning the live phone still will not actually answer the phone, but that the messages left must then trigger a notification to that same person’s cell phone, or whatever that a more urgent msg is waiting. This is really interesting, it is why it is so important to a develop a little “personal/group” communications project plan!

Telemedicine specifications

Andrew Barbash — Wed, 28 May 2008 21:40:44 +0000

Posted on the NeuroDox site:

We are all trying to best understand how to establish a truly pragmatic approach to broader tele-stroke, tele-neurology. I know people have been looking at InTouch, Reach, PolyCom, and different variations, but I was more interested in having us establish a set of specifications of what the “technology” needs to enable, and where the “resources” should both come from and enable, as well as optimal methods of notification and communication. The more I work with others on issues of interfacility transfer for complex neuro, stroke, neurosurgery in particular, the more obvious it is that some broader, collaborative regional approach to tele-consultative neuroscience support, including stroke, critical care neuro, neuroradiology, neurosurgery, interventional expertise, etc is needed. Whenever I can see the inevitable I feel a need to begin working toward that, not the things in between which just wont ever quite get there!. Here are some thoughts

Whatever physical devices and network setups are used for teleconsultation, a few criteria are key
It must be simple to deploy without excess dependence on local/hospital/office IT resources, technical support or even capital expense

It must enable simple bidirectional audio/video when desired, but at least bidirectional “switch back and forth” to alternate between expert and recipient
It must have some pragmatic mobility until such time as every single bed has the same capability in every room and location
It must enable a multitude of experts, in different places at different times, to easily connect into it via the web, without any special hardware or complex software installed on the experts workstation, mobile, laptop, etc (this is where I struggle with the InTouch approach, to be honest)
MOST of the money for this should be allocated for compensation of the person providing expertise and even the busy clinician taking the time to request decision support, NOT into the technology itself, given that the fundamentals of telecommunications are more ubiquitously available
It should make the documentation of events, recording of them, etc much easier without introduction of new complex data systems or duplication of work

I know many have been working on proposals to states and regions, etc. and there are many telemedicine associations, grants, etc But it seems to me that the most important thing is for a group of neurologists and other neuroscience experts who are likely to be engaged in the provision of virtual care to map out the essential elements of capability, deployability, operational support, costs, compensation, etc BEFORE looking at specific technologies and systems. because technologies evolve quite rapidly nowadays, and most of this is overlapping with developments in the generic telecom industry
I think this is where we are heading in maryland and elsewhere, in order to more readily provide distributed decision support to ER< ICU, hospitalists, that creates a broader “virtual critical care” environment less dependent on a small number of physical neuro icu beds in a few large hospitals.

Adjunctive Treatment of Patients With Late-Stage Parkinson’s Disease

Important considerations in managing patients with advanced PD are addressed in this interactive, case-based program. Other than motor symptoms, what specific issues should be the focus of treatment? Read more at the Parkinson’s Disease Resource Center.