Untangled Health

Consumers Unite To Drive The Changes We Need

Category: Cost of Care

Interview on The State of Things “A personal history”

Heck! With health insurance we can afford a cup of coffee!

Dear Friends, I am scheduled to be interviewed on “The State of Things” on WUNC, this Thursday at 12:06 PM. This is a one hour event regarding the Opioid Crisis in NC. I am the first speaker and will be reflecting on my experience with the disease of Opioid Use Disorder as a young man and later in life as a chronic pain patient; chronic disease management program manager and work as a community health program performance evaluator today. I invite all to listen.
All of my work is converging on a common mission: To inform others of the Strengths, Weaknesses, Opportunities and Threats in our Healthcare System. My work with #RightCare is all about recruiting citizens from the grassroots of my community to participate in reform while keeping the best of what we have. America has much to celebrate when it comes to our achievements and much to invent to raise us up to our potential.
This week; two things come to mind: The opioid crisis and how it creates an opportunity for us to recognize addiction as a chronic disease and chronic pain as a leading cause of disability in this country. What should be done, what can be done and what we are doing. Then the budget work in DC: The fact that there is no continuing resolution to fund the Community Health Centers of America who serve some nine million people. This venue is the most cost effective and important part of our health care system and it will surprise all to find out how these centers beat out the commercial, healthcare apparatus hand over fist when it comes to health outcomes and cost management. I hope everyone is on their phones and email to request their representatives for funding I the new budget. If we lose it, the economic and health burden will be tremendous.
Always thinking of you,
Jeffrey
PS: #RIghtCare Join Now!

Why We Need Universal Health Coverage

I am disgusted by the frequency of the statement: “Universal Coverage… We can’t do that… That would be Communist!”
As opposed to falling back to arguments relating to the Cold War (although Mr. Trump and Mr. Putin would be happy to re-engage past behavior) how about we look at EVERY OTHER INDUSTRIALIZED NATION IN THE WORLD and compare their health care financing strategy and health outcomes to ours. You see: We stand alone in the World. We are the only industrialized nation that refused to believe that the math of population health science (simple arithmetic) forces civilized nations to pool money and spread it across the entire population of infants, children, young adults, middle aged adults, young-old adults and old-old adults to bring the average cost of health care down to an affordable per-capita rate.
Here are the data from the 2016 OECD Report. You have heard of these folks haven’t you? They met in KOBE in 2016 to discuss global health.

The Study

How these countries finance healthcare

Nothing is different. The older you are, the more health care services you consume.

How long ago each country embraced Universal Coverage

Yes, the more you spend on health care the longer you live. But why is America so expensive?

The more you spend out of pocket the shorter your life span. The more Primary Care Doctors you have per unit of population the longer you live!

I found my Peeps. Why I joined The Right Care Alliance

To build a new system we need the voice of millions struggling to survive as they try to understand, coordinate and afford America’s health care resources

 

Since becoming disabled I have dedicated my time to reforming our healthcare system. My drive emerged from my experiences  living with diabetes and other complex co-morbid conditions since 1966 coupled with my experiences working within our healthcare system for thirty-three years as a hands-on the caregiver, administrator, program leader and HIT visionary. To date: After five years of dedicated personal time I located only one organization –PCPCC that brought all of the Stakeholders together necessary to alter a system that has failed so many. My work with PCPCC brought me to Washington DC and opened other opportunities to influence legislative language, such as the variety of submissions to CMS for defining the Patient Centered Medical Homes. That said, where the work and effort was worthwhile, I have reached a personal conclusion that the American Health Care Apparatus needs to be designed and implemented from the bottom up. Without soliciting opinion, educating the people about our failure in moral values we will not realize our dream. A long-time fan of Continuous Quality Improvement in medicine I notice a missing feed-forward element in design when it comes to our national perspective: The Patient Perspective. Much is celebrated about patient-family inclusion in health care delivery design yet I fear what we celebrate is often the result of Service Excellence Performance Surveys, JCAHO and CARF reviews, NCQA Accreditation Surveys and other attempts to qualify and quantify processes that have not fulfilled  my personal criteria for “Going to the people”. If we are going to do this thing: We need to start over. The Right Care Alliance is on track and I am thrilled to assist with the integration of the proper minds and voices necessary to build a functional health care system.

Since becoming disabled in 2012 I have discovered what I consider to be a lack of attention to those consumers who are the most under-served; at times I fear a lack of respect for their capacity to contribute. My sense is that the arrays of NFP organizations working to define methods for health care reform and specify a concise mission are struggling with their identity (excluding folks like Families USA). Organizations such as The Society for Participatory Medicine actually have membership fees which prohibit some from joining in the effort. I participate in the private conversations among leaders and have brought this to their attention. They do however have a scholarship program for membership dues. Where the intent is respected this is hardly the mechanism to attract contribution from the community or patients who are actually the consumers accounting for 50%-70% of America’s health care budget.

When I analyzed the membership roster of S4PM in 2015 I found that 32% of their membership identified themselves as patients first. Confused, I brought this to their attention. One year later, many more patients emerged. These were mostly individuals who had more than 16 years of education and were actively engaged in other professional activities. We need these people, but once again they hardly represent the grass-roots of the healthcare services consumer.  Their mission is decidedly not health care reform, but focused on bringing patients and physicians together to form collaborative medical teams. We need these people in our discussion as we create our new system. However, I suggest their priority is not the same as the System Reformer for without a system that guarantees a bio-psycho-social care plan to all Americans we have failed. Other Patient-Centered Organizations such as Patient’s Like Me are providing a service and at the same time a clever disguise for a population research database that is funded largely through the Pharmaceutical Industry.  Patients like Me (I am a member)offers the opportunity to establish a virtual peer-support community and access to treatment guidelines and research. I love this system as it brings folks to my kitchen table that help me address the chronic pain I deal with each day, but at the same time I recognize we are freely giving away personal health information in exchange for the service. At the other end of the spectrum I have found Veritas Healthcare  where a small group of physicians, administrators, non-physician caregivers and patients are creating a new definition for those actively involved in saving lives from day-to-day through pushing the limits of healthcare reform in their local communities. They brand themselves Health Angels, I am a member and contribute to their initiative. We are many AND We are scattered.

Over the years I have come to fear we will miss an opportunity to establish a driving force as the most important voices in health care are lost or diluted through the diffusion of their input across an “over-abundance” of the organizations soliciting their involvement. Always anxious to help these stakeholders will easily donate a lot of their energy toward the cause “Fixing Healthcare” but once they sense they are being exploited will drop-out and assume a protective posture.

With experienced leadership, funding and most-importantly Humility I sense there is sufficient energy to establish a ‘critical mass effect on re-writing America’s plan for supporting the Health and Well Being of its citizens in future generations. That said, the barriers are many: Our present leadership in DC and a misinformed public that is being split into near civil-war we struggle to overcome the noise. So… time is of the essence and somehow, someway we need to corral these voices and experiences (hence knowledge) that is scattered throughout the internet, inner city and rural America into a single force. My prayer is that The RightCare Alliance will provide the necessary gravity to bring us together.

My Overstressed Physician (Prior Authorizations, Referrals, Stress, Prescription Assistance Programs, Electonic Health Records and More)

The following video covers just one aspect of my concerns regarding the infringement on Patient Centered Care by the “Business of Medicine”. I have reflected in the past about the cumbersome “Business Process Centered” components of health care delivery that prevent our providers (Doctor, Nurses, Technicians, Therapists ETC.) from focusing on the “Big Picture”. What I am referring to are the dimensions of health that require thorough assessment and attention to detail for the treating provider to accurately judge what is happening in our body, draft a treatment plan and execute the orders. Right Care to me is my team’s full understanding of my biology, culture, mental health and physical health needs, the social roles I play in my community and the support available in my community when it is necessary for me to stay healthy and productive.

During my visits to my doctor the processes’ of assessment, diagnosis, planning, intervention and monitoring are interlinked and any disruption will present a barrier and possibly introduce an error in treatment or missed opportunity to cure a silent condition. These missed opportunities to improve our health are often referred to as Co-missions or Omissions in care. Co-missions occur when our medications interact and cause an exacerbation of an existing illness or cause a new illness to occur. An example might be the treatment of a person with Diabetes who is taking insulin with a Beta-blocking drug such as Metoprolol. This might cause hypoglycemic Unawareness  and the patient will not be aware of a low blood sugar. An example of an Omission in Care  is when a patient is unable to continue taking a medication. The lack of evidence of prescription refills in the patient medical record might create and alert for the doctor to review, but one cannot assume that this is always the case. Beyond being aware of the missed refill the doctor or the clinics Care Coordinators should follow-up with the patient to determine the reason for non-compliance with the patients care-plan. In America financial reasons often prevent us from being able to adhere to our medication regimen and the answer to the dilemma can be as simple as contacting the drug manufacturer and applying for funds through a Prescription Assistance Program. The #partnership for Prescription Assistance is an organization that will help those with financial resource issues. So, what do you do if your doctor doesn’t have the time to spend educating you to look out for hypoglycemic unawareness, refer you to a Prescription Assistance Program or get transportation to the clinic each month for your periodic check of your blood clotting time? Should all of us be self-sufficient with these skills? I suppose in a perfect world this might be the case, but I certainly wouldn’t place this responsibility on the average lower to middle class patient today. We are far too busy just making ends meet and in many cases our health suffers.

Electronic Health Records were our great hope for unburdening the provider and the clinic staff from clerical activities that are required in the day-to-day management of a population of patients. The average primary care provider often has 2000 patients unless they are a concierge practice; which the average Joe or Jame cannot afford. Your referral to the laboratory for routine blood sampling frequently requires the doctor to link the appropriate diagnosis with the lab test or the chart will not close out after the visit and the order will not be communicated to the lab  performing your test. Today, I watched my doctor and his “documentation specialist” carefully navigate several screens in the EMR as the doctor ordered various labs and cross linked them to my problem list. These processes make a lot of sense when they relate to care quality. For example, you do not want a doctor to order tests that are not going to increase his or her knowledge of what’s ailing you.  However, in the cases I see today; and I see a lot since I am a person with multiple chronic illnesses: My doctor is dancing to the tune of the Insurance Company and looking over his back to make sure he isn’t over-utilizing or mis-utilizing his privilege to order expensive diagnostic procedures: When I see my doctor stressed out,  rushing through and missing pieces of his exam: I start to fret that he will leave his present employment and I will lose yet another good primary care physician (I have lost three in the last five years for these reasons).

So my doctor is overwhelmed with filling in the correct fields in a health record to avoid penalties from his administration. My quality of care is declining. The burden in my opinion is a caused by an over-complicated system created by folks interested in the possibilities of Big Data AND the residual business process requirements of a Managed Care Business Model that no longer is valid since our doctors today come well prepared to make high quality decisions based on the published  best practices emerging from the literature accompanied by embedded decision support in their information systems; or has someone been fibbing about what the technology does for us?

Are you willing to step up and work with your doctor to define and deliver the Right Care by the Right People, at the Right Time, in the Right Place?

 

21st Century Cures Act Trusted Exchange Framework and Common Agreement Kick-Off Meeting

Listening to a Webinar produced by the ONC (Office of National Coordinator for HIT) today I was content to hear about the progress of SHIEC (Strategic Health Information Exchange Collaborative) and NATE  (National Association for Trusted Exchange) during the morning review of National Trust Frameworks and Network-to-Network Connectivity.

It is clear that consumer need is receiving attention: We are far behind the curve wherein we have vocalized our frustration with barriers to accessing our  personal health information  and the industry is listening.

Keep in mind that you are the “master of your destiny”  and “captain of your ship” when it comes to assuring you receive the Right Care, from the Right People in the Right Place at the Right Time. Self-knowledge and System-Knowledge are your keys to success.

Best summarized by Cynthia Fisher the founding angel of ViaCord at the end of the morning session: “Patients are bound to institutions that have the keys to their data and are expected to write a blank check for services with no visibility of cost”. Passionately reflecting on the plentiful gaps in the information used to make critical health care decisions during our encounters with providers throughout the healthcare system, she said; “Healthcare Data is like a Liquid Asset; it needs to flow!”

Keep your eye on the target friends: The day when you are trusted to exercise your right to control both ownership and flow of the information that your life depends on!

Jeffrey

ONC Patient’s and Families 

Open-Access Guidelines for Patient-Centered Care (The tools we need are here!)

patient logo

How do I find the best treatment for me? Is it my doctors choice? Do I have anything to say about it? Is it possible that my doctor is unaware of best treatments?

Taken from the British Medical Journal. Click link to view the Aortic Valve Replacement Guideline.“The BMJ launched an innovative strategy to promote patient partnership in 2014. It took this step because it sees partnering with patients, their families, careers and support communities, and the public as an ethical imperative, which is essential to improving the quality, safety, value, and sustainability of health systems.”

 

My suggestions:

Make sure you read the educational material your clinic gives you at the end of the visit then compare it with what you are able to find independently. This is most important when you are diagnosed with a new condition or your doctor recommends a diagnostic or surgical or therapeutic procedure. By the way, new medicines are therapeutic procedures.

Since errors happen…what I choose to call Therapeutic Misadventures I like to check out the current best practices and research outcomes published in Europe, Japan and the USA.

Cool Tools are here!  Everyone knows that I am a big promoter of physician-patient partnership when it comes to researching treatment methodologies and selecting interventions for our personal care-plans. I received notice today on the MAGIC projects publication of guidelines in the British Medical Journal. This particular guideline is for Aortic Valve Replacement. BMJ provides an online experience for doctors and patients called Partnering with Patients. The  content provided on the site includes best practice guidelines for many medical procedures. One source of the guidelines is MAGIC project.

This is an international group, originating in Oslo, Norway operating as the MAGIC project. Magic is an acronym for “MAking GRADE the Irresistible Choice,” where GRADE is a system to develop high-quality guidelines that consider the whole body of evidence on a certain therapy in an objective way, and incorporate patient values and preferences, as well as other considerations.

For the consumer this implies the MAGIC team applies a scientific rigor to weighting the evidence supporting the effectiveness of medical and surgical interventions. The real bonus is that they also employ the patient’s perception of effectiveness which can often be missing in research studies. A common example I like to use is change in mortality rate. Example: If I have emphysema and experience failure of my respiratory system I will die. However, there is a variety of life sustaining interventions available to me in the USA. These include: Supplemental Oxygen, inhaled and oral medications and mechanical ventilation. Virtually all people with severe emphysema are faced with making a decision as to the technologies they will use to extend their life. Many choose all three: Then again, I have had many patients in the past elect to not receive mechanical ventilation as the notion of being connected to a ventilator for the remainder of their life is not acceptable.

When any of us with chronic illness take advantage of a therapy I would hazard a guess that we should always take the pre and post treatment morbidity and functional status into account. Questions we need to ask must include the published guidelines reported changes in health related quality of life after treatment.

I hope these projects become the foundation for a curated library of best practice and treatment outcomes in the near future. Of course my preference would be to make them free for patients which might level the playing-field for those with low incomes in societies with huge disparities in care and health between the wealthy and impoverished. That said, as I learn more about the availability of the guidelines and find those that are free and unbiased by funding resource or error in design I will publish them here.

Have fun and educate yourself prior to making any decisions on how to manage your health.

Warmth to all of my friends along the way.

Jeffrey 

Here are link to Magic

 

The Onslow Magic Project for clinical guidelines

 

 

Waking to Trump: Healthcare is the least of our problems.

 Untangled Health was created to illustrate confusion in US health policy and give myself a place to vent my frustrations as just one more American caught in the routine of “Stay, Stay, Stay, Staying Alive”. The last eleven days have reordered my priorities. Since 1979 I have been fixed-on-fixing the vulnerable people using your health care system then as I was having my morning coffee today I saw a note from a LinkedIn Friend Maria K Todd MHA PhD. She was describing her inability to create words of sufficient magnitude to describe how she was feeling since the change of administrations. I  looked inside and emotions spilled-forth with the following imagery of life, family and purpose.

 

 

 

 

 

 

Waking to Trump (click here for trip to the Cheshire Cat’s den)

I wake:Breathless, exhausted,fearful,powerless; lost: A stranger in a strange land: Who are these men? My hackles are up and I can’t remember the dream: Something about a red-haired, bright bulbous nose dude with the stink of vodka on his breath screaming “WRONG”!

Waking each morning to the same reality. Memories of 50 years attending to diabetes; age ten; being told I might be blind and lose my feet if I didn’t care for myself. Memories of what it “took” to take CARE of myself; sometimes feeling ashamed to borrow money for insulin . Experiencing life on track Zero then again on Track number Ten. Attaching myself to groups of “loving-others”: finding the barriers to “well-being” and removing them; one-person-at-a-time.

Signs of my disease pointing to the Fall of my life: then Seizing 2008 with an army of friends and moving NC to the Blue as we were “tailed by skinheads” and protected by the FBI. Wondering if this is what my father felt as he was beaten up by classmates calling him “Stinky Saul the Jew Boy”; When his name changed from Halbstein to Harris so his family could keep their business. Choosing to put life on the line in WWII, he went on to live a life of patriotism he died an honorable man. One recognized for his contributions in our Space Race; Father of the Titan II Rocket.

Staring at his penciled drawing of the completed rocket, complete with team signatures : I hear his voice; shouting loudly to reject any form of bigotry. I miss his presence and the smell of his after-shave that day in July 1969 when he rescued me from the “Darker Side of America”; bar-fly’s and deviates and bourbon breath…the Department of Social Services and my fantastic Pop chased them away. There are reasons to keep the children in focus for what they inherit is their ability to thrive in the safe-space we leave behind.

I miss you “Saul Halbstein” remembering you in your prime; the Saturn V booster rockets on their test stands “shaking the windows from our home” ; hand on my shoulder, “have no fear Jeff; were going to the moon”. 

If you are out their Pop, the joke is on you. Not a believer; you now gaze down at a country you could barely recognize: Save the memories of your childhood, the War and the 1960s.

Now I know why you were still angry when you died. When you own best friend accused you of being another “New York Jew” ; broke your heart and left your side. Those last weeks of your life in December 2015 you kept reminding me of the forthcoming debate; you seemed to believe it was extremely important; you spoke of the “transparent man” who was in the next hospital room. You called him “Mr. Deal” and warning me about his ties to the bad guys. Were you by chance having a premonition?

I asked you today if I should publish this. Then the mailman came delivering an empathy card for your death:  One-Year-Late

My Pops in his prime!

Teaching others to teach others

Missing Pop

 

What is at risk if Obamacare is Rescinded

Reconciling data in my six health portals

What is at risk for all subscriber to commercial insurance programs if Obamacare is Rescinded?

This analysis with specific allegorical references was posted by my friend Wendy today. I find it accurate and far beyond my skills to interpret and describe What is at risk for EVERY-BODY

Obama Care is. . . The ACA (Affordable Care Act)
Last night as his first order of business the new president signed an executive order to repeal the ACA. Here’s what this means… even if you are safely covered behind employer-provided insurance, the protections set forth in the ACA (Affordable Care Act), apply to you too. And if those protections are repealed along with the rest (or any part) of the program, you will also be affected.
That means you may be trapped in a job, because your pre-existing condition may mean you will not qualify for new insurance offered by another employer, and the cost of private insurance would be prohibitive. If your employer shuts down, lays you off, or even changes insurers, well, you are out of luck. The Senate GOP voted this week that they would not require an eventual ACA replacement to protect against discrimination for pre-existing conditions, which was the standard before the ACA.
It means that you (a young adult under the age of 26) or your adult children (over 18) may find yourselves without the protection of insurance, as the Senate GOP voted last night that an eventual ACA replacement will not be required to allow young people to remain on their parents’ insurance up to the age of 26.
It means that if you have a high-risk pregnancy, or life-threatening illness such as cancer, you may not be able to afford all the care you need, because you may hit lifetime or annual caps. If you have an infant born with any kind of severe medical condition, or premature, they may hit their lifetime insurance cap before they are old enough to walk. The Senate GOP voted last night that an eventual ACA replacement program would not be required to prohibit lifetime insurance caps.
It means that if you are a struggling parent who is uninsured or under-insured, you will no longer be able to count on at least your kids getting the routine medical and dental care they need under the Children’s Health Insurance Plan (CHIP). The Senate GOP voted that CHIP is not required to be protected by an eventual ACA replacement.
These provisions of the ACA affect everyone in this country, not just those without insurance through their employers.
If you are not okay with these changes, call your representatives and let them know what’s important to you. Nothing has been set in stone yet, but our legislators have shown us a map of what they plan to do if constituents don’t make their voices heard loud and clear.
Hold down here to copy, paste, and post (do not share) on your timeline, if you feel this information needs to be passed on.

This is a comment from NORA on FaceBook
As a person with R.A. (pre-existing condition) Before ACA I was never able to purchase even basic insurance for under $1500 a month and thus went without insurance from the time I graduated University until I was 49 years old. It’s $2000 per visit to a Rheumatologist, so I only went once a year and could not afford medications. I lived with daily debilitating pain and exhaustion among other things. If you know somebody with RA you know is serious. ACA provided me with good affordable care at a price I can afford $359 a month. I responded very well to BASIC medications for RA that I could never afford before (but with ACA can) and am now able to live life normally and run my small business again. My great Doctors also noticed I had serious liver damage from years of taking OTC pain relievers like Tylenol and Aleve. They were able to fix that too. They said it may have killed me or become cancer without treatment, at the least led to early death. If I lose coverage for my Meds am already planning to go on SSD and Medicaid and close my business. True Story. #ACAWORKS PS Only deplorables don’t want people to have health insurance.
Like · Reply · 1 · 19 hrs · Edited
Wendy Lannon
Wendy Lannon I think of you Nora whenever I hear people say ACA doesn’t work. #ACAWORKS

The cost of care: ($ X Count)+((Caregiver calories X Time)X Caregiver metabolic rate)+Caregiver drain in emotional well-being

someone-to-watch

I have been giving classes to groups of elders on normal age dependent functional decline. Here is a note from my 55 year old cousin discussing her situation providing care for her husband. Wherein her State did not expand Medicaid and this man only needs custodial care she does all the work. Like my friend said earlier this week: The Women are the Warriors in our Society. My poor cousin Michael is waiting for a liver, probably won’t make it since nobody is around to keep him in shape.
Imagine retaining 100 lbs of water in your belly, being short of breath and unable to prepare a sandwich.
Their insurance by the way is through a New Jersey County.
Here are Wendys comments.

“Tired frustrated disappointed angry probably everything in between & yes I just hoped for easy fix. Silver lining. Physically I know it’s hard on him and I know he needs more physical care like his adl’s. I think I’m going to have to start working doing his adls with him. He doesn’t do that well anymore. He’s afraid to get in the shower almost never had shaves. I just don’t know when I’m going to get to that stuff I often run out of time and don’t do well with that stuff myself reality is I don’t know what I’m going to do you know animals are so much easier usually. Such a Monumental responsibility caring for another human being why I never had children”

Suck it up friends, we had a start on care coordination in the home but lost it on November 8th. Start saving now…….

SalesForce as a Patient-Centered Longitudinal Care Platform | I am one happy Diabetic!

The technology facilitating Patient Centered Care arrived over ten years ago. It was all a matter of configuration!

The technology facilitating Patient Centered Care arrived over ten years ago. It was all a matter of configuration!

I am pumped!
Years ago…1997 I believe; I had a job working for DocSite: the company founded by Physiatrist John Haughton MD that became one of the premier Registry products used as the EMR community was attempting to define itself. In the DocSite product we collected measures or “clinical indicators” that were compiled around the patient and associated with an infinity of conditions. Essentially the data design allowed physicians and grant recipients to have a single patient record yet extract, analyze and report on any constellation of outcome measures without having to spend money on redundant disease registry products. Example: Blood pressure is an important measurement for diabetes and heart failure. In diabetes the measure importance is 1) how often it is done and 2) the blood pressure value. In Heart failure the same measures of process (measurement frequency) and outcome (BP value) are required but they might be different depending on the cardiovascular guideline and contrasting diabetes guideline. In the DocSite system the blood pressure recording was simply a vital sign. The rules defining threshold for compliance with guideline were defined separately and associated with multiple conditions. When the doctor generated the data for PQRI and the Cardiovascular Excellence programs a single patient outcomes dataset was generated based on the programs associated with the patient. When the patient returned to any clinician using the Docsite system the Visit Encounter Sheet displayed the current measures due, the last values and trends for each measure and gave the physician or extender a place to generate an education note. Inexpensive, simple, multi-user, modifiable for EBG and data submission automated through clerical “generate and send PQRI data”. Now, I owned some stock in the company so I am biased but quite frankly I thought the system was elegant once it received data feeds from pharma and labs!

All of us at DocSite used a Client Relationship Management cloud application in our client services department. After using it for three years or so those of us that had worked in a previous company “the forerunner of DocSite” called Cognimed all thought that Sales Force had the proper design to create a community wide care coordination and patient centered care planning tool We had built one in the 1990s and sold it and moved on with our lives.
Today I see SalesForce has entered the arena. Knowing what I know about its capabilities I hope they capture the market by landslide. Please if you thinking about building a new care management platform…dont. As a patient, I would love to see this thing as an App. in all of my clinicians hands and on my IPhone please. Check out their demo. I am sure it all does not work as advertised but I can attest to the fact that they had the correct data model ten years ago!

Reconciling data in my six health portals

Reconciling data in my six health portals