Thursday, March 25, 2010

IFR for E-prescribing of Controlled Substances Available | News | Healthcare Informatics

On March 24, the Office of the Federal Register (Washington) made available for public inspection an Interim Final Rule with Request for Comments from the Drug Enforcement Administration (DEA), Department of Justice on Electronic Prescribing of Controlled Substances.

The Interim Final Rule specifies the rules that healthcare providers must follow in order to electronically prescribe controlled substances. Since DEA published the Notice of Proposed Rulemaking for e-prescribing of controlled substance, ONC, CMS, AHRQ and other HHS staff have worked closely with the organization to develop policies.  

The document is expected to be published in the Federal Register on Wednesday, March 31 and will include a 60 day comment period. To view the Interim Final Rules, click here.

Ok Doc's the real virtual office is now complete, now that our FDA is enabling electronic prescribing for controlled substances... say good bye to the prescription pad forever!!

To Your Best Health,

The Personal Medicine Team

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Wednesday, March 24, 2010

The Medicus Firm Study on Physician's Reaction to Reform

What if nearly half of all physicians in America stopped practicing medicine? While a sudden loss of half of the nations physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.

The Medicus Firm, a national physician search firm based in Dallas and Atlanta, conducted a survey of over 1,000 physicians to determine their expectations as to the impact of health reform on their practices, income, job satisfaction, and future career plans. In discussing career plans as part of the recruitment process, physicians have increasingly expressed apprehension and uncertainty regarding health reform’s impact on their practices, and The Medicus Firm wished to investigate this trend further. Additionally, the firm wanted to determine how doctors anticipate health reform to affect physician supply and the quality of medical care nationwide, as these are issues that will directly influence the physician recruiting industry. These factors are in addition to health reform’s more obvious impact on patients and providers of health care services. A total of 1,195 physicians from various specialties and career levels in locations nationally completed the survey.1

The results from the Medicus Firm survey, entitled “Physician Survey: Health Reform’s Impact on Physician Supply and Quality of Medical Care,” were intriguing, particularly in light of the most recently published career projections from the Bureau of Labor Statistics (BLS). The BLS predicts a more than a 22 percent increase in physician jobs during the ten-year period ending in 2018. This places physician careers in the top 20 fastest-growing occupations from 2008 to 2018. Meanwhile, nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.

“What many people may not realize is that health reform could impact physician supply in such a way that the quality of health care could suffer,” said Steve Marsh, managing partner at The Medicus Firm in Dallas. “The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients.”

It’s probably not likely that nearly half of the nation’s physicians will suddenly quit practicing at once. However, even if a much smaller percentage such as ten, 15, or 20 percent are pushed out of practice over several years at a time when the field needs to expand by over 20 percent, this would be severely detrimental to the quality of the health care system. Based on the survey results, health reform could, over time, prove to be counterproductive, in that it could decrease patients’ access to medical care while the objective is to improve access.

Furthermore, even if physicians are unable to act upon a desire to quit medicine, there could be an impact in quality of care due to a lack of morale in physicians who do continue to treat patients despite feeling significantly stressed.

Skeptics may suspect that physicians exaggerate their intent to leave medicine due to health reform. Some experts point to the malpractice crisis of years ago, when many doctors also expressed a desire to leave medicine. Some did quit; many did not. However, health reform could be the proverbial “last straw” for physicians who are already demoralized, overloaded, and discouraged by multiple issues, combining to form the perfect storm of high malpractice insurance costs, decreasing reimbursements, increasing student loan debt, and more.

Do physicians feel that health reform is necessary? The survey indicates that doctors do want change. Only a very small portion of respondents — about four percent — feel that no reform is needed. However, only 28.7 percent of physicians responded in favor of a public option as part of health reform. Additionally, an overwhelming 63 percent of physicians prefer a more gradual, targeted approach to health reform, as opposed to one sweeping overhaul. Primary care, which is already experiencing significant shortages by many accounts, could stand to be the most affected, based on the survey. About 25 percent of respondents were primary care physicians (defined as internal medicine and family medicine in this case), and of those, 46 percent indicated that they would leave medicine — or try to leave medicine — as a result of health reform.

Why would physicians want to leave medicine in the wake of health reform? The survey results, as seen in Market Watch, indicate that many physicians worry that reform could result in a significant decline in the overall quality of medical care nationwide.

Additionally, many physicians feel that health reform will cause income to decrease, while workload will increase. Forty-one percent of respondents feel that income and practice revenue will “decline or worsen dramatically” as a result of health reform with a public option, and 31 percent feel that a public option will cause income and practice revenue to “decline or worsen somewhat” as a result. This makes for a total of 72 percent of respondents who feel there would be a negative impact on income. When asked the same question regarding health reform implemented without a public option, a total of 50 percent of respondents feel that income and practice revenue will be negatively impacted, including 14 percent of total respondents who feel that income and practice revenue will “decline or worsen dramatically.” Additionally, 36 percent feel it would “decline or worsen somewhat.”

What do physicians propose for effective health reform? In the survey, physicians were prompted to provide ideas, and some common themes emerged among the hundreds of comments. Tort reform appeared repeatedly, as did patient responsibility and ownership in their health care and costs. Additionally, many physicians emphasized a need for addressing specific issues with separate legislation, as opposed to one sweeping, comprehensive bill.

What does this mean for physician recruiting? It’s difficult to predict with absolute certainty, but one consequence is inevitable. After health reform is passed and implemented, physicians will be more in demand than ever before. Shortages could be exacerbated further beyond the predictions of industry analysts. Therefore, the strongest physician recruiters and firms will be in demand. Additionally, hospitals and practices may be forced to rely on unprecedented recruitment methods to attract and retain physicians. “Health reform, even if it’s passed in a most diluted form, could be a game-changer for physician recruitment,” said Bob Collins, managing partner of The Medicus Firm in Texas. “As competitive as the market is now, we may not even be able to comprehend how challenging it will become after health reform takes effect.”

The survey sample was randomly selected from a physician database of thousands. The database has been built over the past eight years by The Medicus Firm (formerly Medicus Partners and The MD Firm) from a variety of sources including, but not limited to, public directories, purchased lists, practice inquiries, training programs, and direct mail responses. The survey was conducted via emails sent directly to physicians.

1This article was written in January 2010. The survey was conducted by The Medicus Firm, a nationally retained physician search firm, based on the health reform legislation in process at that time.

For more information on the study’s methodology, click here .  For any additional inquiries, please contact Director of Communications and Media Relations for The Medicus Firm.

Andrea Santiago
Director of Communications & Media Relations

To Your Best Health,

The Personal Medicine Team

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Tuesday, March 23, 2010

NYTimes: Slim Pickings? You Can Still Eat Well

From The New York Times:

RECIPES FOR HEALTH: Slim Pickings? You Can Still Eat Well

On a strict budget, you can make wonderful meals with simple ingredients.

Get The New York Times on your iPhone for free by visiting

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Sunday, March 21, 2010

Congress clears historic health care reform bill - 3/21/10 - San Francisco News

Very excited about the elimination of preexisting conditions for pediatric patients.

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Wednesday, March 17, 2010

Trans Fats in Plain View

This article is from the WebMD Feature Archive

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Trans Fats in Plain View

The amount of artery-clogging trans fats will now be listed on food labels.

The mysterious trans fats will be hidden in foods no more. The FDA now requires all manufacturers to list the amount of artery-clogging trans fats in foods.

What Are Trans Fats?

Trans fats, which are considered to be some of the most dangerous forms of fat, are engineered from liquid oils through a process known as hydrogenation.

Trans fats were once thought to be the ultimate fat because they enhance the way foods taste. They also extend the shelf life of foods and make crisp foods crunchier and creamy foods creamier. And the price is lower than other fats.

As a result, trans fats found their way into many of Americans' favorite processed foods. Only later did doctors begin to realize how damaging they can be to the heart.

Come Out, Come Out, Wherever You Are

Unhealthy trans fats lurk in most processed foods, including cookies, baked goods, popcorn, margarines, shortenings, crackers, doughnuts, chips, frozen waffles, and french fries.

Eighty percent of trans fats come from processed foods; the other 20% occur naturally in meat and dairy products. Although meat and dairy contain small amounts of trans fats, they can also be loaded with the equally unhealthy saturated fats, says nutritionist Elizabeth Ward, MS, RD.

Trans fats in meat and dairy are only a concern to people who eat large quantities of full-fat dairy and high-fat meat, says Ward. Choosing low-fat dairy and lean meats will reduce the harmful trans and saturated fats.

Ward advises that we shift from fat-laden processed foods to more natural, wholesome foods that are chock full of disease-fighting, healthful nutrients.

"Eat a diet of fresh, whole ingredients, limit the amount of processed foods in your diet, and always choose the lowest-fat variety of meat and dairy to wipe out the bulk of harmful trans fats."

How Much Is Too Much?

"There is no dietary recommendation for trans fatty acids; consumption should be kept as low as possible" Theresa Nicklas, DrPh, tells WebMD. Nicklas is a member of the 2005 Dietary Guidelines Advisory Committee.

Trans fats increase LDL "bad" cholesterol levels, which increases the risk for heart disease, says Nicklas, who is also a professor of pediatrics at the Baylor College of Medicine.

"The Dietary Guidelines Advisory Committee recommendation is to limit the intake of trans fats, and with the help of food manufacturers, we can help educate Americans to make better food choices" says Nicklas.

Nutrition researcher Alice Lichtenstein, DrSc, says in addition to watching trans fats, one of the best ways to lower your risk of heart disease is to reduce the amount of animal fats in your diet as much as possible.

Total fats should make up no more than 25%-35% of your total daily calories, Lichtenstein tells WebMD. For example, someone who eats 2,000 calories a day should get 500 to 700 calories from fat -- about 55 to 75 grams of fat a day. And most of this should come from healthy fats.

Healthier oils include vegetable oils, such as corn, soybean, canola, and olive oils -- but not the tropical palm or coconut oils. Other ways to skim the saturated fat in your diet is to choose lean meats, such as skinless chicken and turkey, lean beef, and low-fat dairy, Lichtenstein says.

Good article from Web MD about trans fats...

To Your Best Health,

The Personal Medicine Team

Posted via web from Personal Medicine

Tuesday, March 16, 2010

Trans Fats: Facts, Risks, Foods to Avoid

Mission Possible: Avoiding Trans Fats in Restaurants
Some cities and states now ban the use of trans fats in restaurants. Do you live in a trans fat-free community?

Trans Fats in Restaurants

Nice Article on recent restaurant bans on trans fats.

Our opinion?? Good call.

To Your Best Health,

The Personal Medicine Team

Posted via web from Personal Medicine

Monday, March 15, 2010

About Us


Personal Medicine’s Mission is to be the world’s trusted leader in attentive house call care.

Core Values

Personal Medicine was founded to empower individuals and reinvent the lost art of house call medicine through innovation. The members of Personal Medicine have come together because we believe in the combined potential of house calls and the Internet to have a Transformative impact on the Physician-Patient Relationship. Innovation Transforms Relationships.  These Core Values represent what motivates us at Personal Medicine.

  • We believe that the content, community, and commerce of the internet plays a central role in transforming one’s health.
  • We believe that a human being’s comfort is of utmost importance during an illness and that in home care is best for families.
  • We believe that delivering exceptional evidence based care takes time and careful consideration.
  • We believe that the care of newborns, multiples, children with chronic illness and the elderly is facilitated by in home care.
  • We believe that prevention is critical for optimal health.
  • We believe that families should have direct means of communication with their physician enabled by emerging technologies.
  • We believe that paperless practice and transparent consumer access of medical records is an essential component of best practice health care.
  • We believe that the physician-patient relationship is best managed by physicians and patient families in direct medical practice.



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Recipe for Pineapple-Glazed Chicken with Jalapeño Salsa from

This recipe:
Pineapple-Glazed Chicken with Jalapeño Salsa
has been sent to you by a friend.

You can view the complete recipe online at:

Pineapple-Glazed Chicken with Jalapeño Salsa
1/4 cup pineapple juice
2 tablespoons (packed) brown sugar
1 tablespoon yellow mustard
3/4 cup 1/4-inch cubes fresh pineapple
3 tablespoons finely diced red bell pepper
3 tablespoons chopped fresh cilantro
1 1/2 tablespoons finely chopped red onion
1 1/2 tablespoons canned sliced jalapeño chiles, drained, coarsely chopped
4 boneless chicken breast halves with skin (1 3/4 pounds total)

Preheat oven to 400°F. Bring pineapple
juice, brown sugar, and mustard to boil in
small saucepan, stirring to dissolve sugar.
Boil until glaze has thickened slightly, about
1 minute. Season with salt and pepper.

Mix pineapple, red pepper, cilantro,
onion, and chiles in medium bowl. Season
with salt and pepper.

Line baking sheet with foil. Place
chicken on sheet and brush with glaze.
Bake 15 minutes. Brush again with glaze,
then broil until cooked through and golden,
watching closely to avoid burning, about
5 minutes longer. Let rest 5 minutes.
Spoon salsa over chicken and serve.

Bon Appétit
March 2010
by Jill Dupleix

Want to see how other cooks rated and reviewed this recipe? Go to

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Saturday, March 13, 2010

3 Rulings Find No Link to Vaccines and Autism

The three rulings are the second step in the Omnibus Autism Proceeding begun in 2002 in the United States Court of Federal Claims. The proceeding combines the cases of 5,000 families with autistic children seeking compensation from the federal vaccine injury fund, which comes from a 75-cent tax on every dose of vaccine.

Families of children hurt by vaccines — for example, who suffer fatal allergic reactions — are paid from it but are unable to sue the vaccine manufacturer. The fund has never accepted that vaccines cause autism; the omnibus proceeding, with nine test cases based on three different theories, was begun in 2002.

The antivaccine groups also lost the first three cases, which were decided in February 2009 by the same three judges, known as special masters. All three rulings were upheld on their first appeals.

Defenders of vaccines said they were pleased by Friday’s decision, while opponents were dismissive, saying they would never get a fair ruling from the omnibus arrangement.

In the three cases brought against the government, by the parents of Jordan King, Colin R. Dwyer and William Mead, all three special masters used strong language in dismissing the expert evidence from the families’ lawyers.

The master in the King ruling emphasized that it was “not a close case” and “extremely unlikely” that Jordan’s autism was connected to his vaccines. The master in the Dwyer case wrote that many parents “relied upon practitioners and researchers who peddled hope, not opinions grounded in science and medicine.”

Patricia Campbell-Smith, the master in the Mead case, also dismissed two subarguments made by a few opponents of vaccines, saying they “have not shown either that certain children are genetically hypersusceptible to mercury or that certain children are predisposed to have difficulty excreting mercury.”

She also echoed a contention by vaccine defenders that a shot is safer than a tuna sandwich. “A normal fish-eating diet by pregnant mothers” is more likely to deposit mercury in the brain than vaccines are, she wrote.

In a telephone press conference after the rulings, Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and the inventor of a rotavirus vaccine from which he receives royalties, praised the decisions, saying: “This hypothesis has already had its day in scientific court, but in America we like to have our day in literal court. Fortunately, we now have these rulings.”

Fears of thimerosal emerged more than a decade ago and have cast a pall over vaccines ever since, even though it has been removed from most of them. The fear has caused some parents to avoid them and made outbreaks of diseases like measles and whooping cough more likely.

Even with this decision, Dr. Offit said, “it’s very hard to unscare people after you’ve scared them.”

The Coalition for Vaccine Safety, a group of organizations that believe vaccines cause autism, dismissed the rulings.

“The deck is stacked against families in vaccine court,” said Rebecca Estepp, of the coalition’s steering committee. “Government attorneys defend a government program using government-funded science before government judges. Where’s the justice in that?” The coalition claims to represent 75,000 families.

Amy Carson, founder of Moms Against Mercury, who has a son with brain damage, called the vaccine court arrangement “like the mice overseeing the cheese.”

The vaccine injury fund and the court overseeing it were created in 1988 after judgments in state court lawsuits over vaccines became so inconsistent and so expensive that vaccine companies started quitting the American market.

The third theory, that measles vaccine causes autism, is still to be ruled on by the special masters. But Lisa Randall, a lawyer with the Immunization Action Coalition, which defends vaccines, said she believed some of the test cases had been “abandoned” by the families that brought them after the 2009 decisions dismissed a variant of the same theory.

Parents after 15 years of allegations, the truth and the science here is coming out. There is no causal link as alleged in Wakefield's original Study. This is why the global research has not supported his findings.

To Your Best Health,

The Personal Medicine team

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Friday, March 12, 2010

NYTimes: Warm Chickpeas and Greens With Vinaigrette

From The New York Times:

RECIPES FOR HEALTH: Warm Chickpeas and Greens With Vinaigrette

In parts of France, farmers make a traditional meal of boiled chickpeas and spinach or chard.

Get The New York Times on your iPhone for free by visiting

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iPad - Apple Store (U.S.)

OK today is the day for preorders... will Mr Jobs let Mozilla work on this thing??

What a dream Housecalls with an #ipad in a "virtual office" with 80% reduced costs...

Wow. From a physician's standpoint this has a feel emotionally of a clipboard which you can more easily hold in your lap as you are in the home. Not having that top of the laptop may serve as less of a physical barrier between you and the patient. I'm a big believer in real time charting while you are with the patient having done it that way for the last five years in practice. Advantages from the standpoint of housecalls bulleted below...

1. Significant battery life advance over current hardware choices.
2. Droppability as Mr Jobs has demonstrated is a massive advantage for the on the go traveling physician.
3. Short time to boot up compared to windows xp
4. Potentially better security, less hassle with antivirus software and maintenence.
5. Embedded wireless with fast 3g.
6. no massive surprise Cingular phone bill.
7. Skype application further drops communications costs.
8. 629$ price tag. nuf said.

Catch up with us for our upcoming events showcaasing our physician users in Lexington, Minneapolis and Jacksonville!!

To Your Best Health,

Natalie Hodge MD FAAP

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Tuesday, March 09, 2010

McAllen, Texas and the high cost of health care : The New Yorker

It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.

McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.

From the moment I arrived, I asked almost everyone I encountered about McAllen’s health costs—a businessman I met at the five-gate McAllen-Miller International Airport, the desk clerks at the Embassy Suites Hotel, a police-academy cadet at McDonald’s. Most weren’t surprised to hear that McAllen was an outlier. “Just look around,” the cadet said. “People are not healthy here.” McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate.

One day, I went on rounds with Lester Dyke, a weather-beaten, ranch-owning fifty-three-year-old cardiac surgeon who grew up in Austin, did his surgical training with the Army all over the country, and settled into practice in Hidalgo County. He has not lacked for business: in the past twenty years, he has done some eight thousand heart operations, which exhausts me just thinking about it. I walked around with him as he checked in on ten or so of his patients who were recuperating at the three hospitals where he operates. It was easy to see what had landed them under his knife. They were nearly all obese or diabetic or both. Many had a family history of heart disease. Few were taking preventive measures, such as cholesterol-lowering drugs, which, studies indicate, would have obviated surgery for up to half of them.

Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. Rates of asthma, H.I.V., infant mortality, cancer, and injury are lower, too. El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen. An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high. (Or the reason that America’s are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.)

Was the explanation, then, that McAllen was providing unusually good health care? I took a walk through Doctors Hospital at Renaissance, in Edinburg, one of the towns in the McAllen metropolitan area, with Robert Alleyn, a Houston-trained general surgeon who had grown up here and returned home to practice. The hospital campus sprawled across two city blocks, with a series of three- and four-story stucco buildings separated by golfing-green lawns and black asphalt parking lots. He pointed out the sights—the cancer center is over here, the heart center is over there, now we’re coming to the imaging center. We went inside the surgery building. It was sleek and modern, with recessed lighting, classical music piped into the waiting areas, and nurses moving from patient to patient behind rolling black computer pods. We changed into scrubs and Alleyn took me through the sixteen operating rooms to show me the laparoscopy suite, with its flat-screen video monitors, the hybrid operating room with built-in imaging equipment, the surgical robot for minimally invasive robotic surgery.

I was impressed. The place had virtually all the technology that you’d find at Harvard and Stanford and the Mayo Clinic, and, as I walked through that hospital on a dusty road in South Texas, this struck me as a remarkable thing. Rich towns get the new school buildings, fire trucks, and roads, not to mention the better teachers and police officers and civil engineers. Poor towns don’t. But that rule doesn’t hold for health care.

Here are the costs of poor diet and nutrition. With House calls physicians are in the home making assessments of diet, implementing lifestyle changes... 80% reduced physician costs...

To Your Best Health,
The Personal Medicine Team

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Monday, March 08, 2010

NYTimes: Obama Warns Democrats of Urgency of Health Bill

While the parties are arguing... The time for innovation is now for docs and patients...

From The New York Times:

Obama Warns Democrats of Urgency of Health Bill

In an appearance that harked back to his 2008 campaign, President Obama made an emotional pitch for public support to push legislation through a final series of votes.

Get The New York Times on your iPhone for free by visiting

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