Ah, May. So glad you’re here. As anyone who knows me can attest, I can’t stand the change of seasons—to me, winter absolutely stinks. For the life of me, I can’t fi gure out why anybody likes the freezing cold, your car taking 15 minutes to warm up, scraping ice off your windshield, or having to bundle in Gore-Tex just to get your newspaper. The winter? Sorry, you can keep it.

I’m a Jersey Shore guy, so I’m always surrounded by water, boats, personal watercraft, the beach, the boardwalk, and all the sights and sounds that symbolize the summer. May is the month when all of that stuff starts to become noticed, and every year, I get all giddy inside. My backyard suddenly becomes an extra room, complete with radio (XM satellite, of course), comfy chairs, a table, fireplace, a giant cooler for adult beverages, an in-ground pool maintained at a refreshing 72 degrees, and my favorite centerpiece—my four grills. That’s right: four grills. I take my summer cooking seriously, and it takes the correct tools to cook the right types of food the way I want.

It’s not just “grilling” for me, and that seems to be a common misconception when we entertain. I like rubbing my meat, marinating my beef, and beer-canning my chicken before I even think of getting them on the fire. Depending on what I’m cooking, when I’m cooking, how many I’m cooking for, and whether I want to cook directly or indirectly, I have a nice selection of implements:

• Weber One-Touch Platinum 22.5” Kettle Grill. Cooking over a live fire has no substitute, and this beauty makes it simple to handle everything from thick steaks to tofu.

• Weber “Smokey Mountain” Smoker. When I need it done slow and low, my “bullet” provides the perfect blend of temperature, space, and ease of use.

• Char-Griller Smokin’ Pro BBQ Smoker. Another smoker, but in a more traditional horizontal barrel design. For lots of food, or big cuts of hog, this is the best.

• Ducane 32” Stainless Natural Gas Grill. 12,000 BTUs, five burners, side burner, infrared rotisserie, and 832” of cooking space... it’s the Cadillac of my backyard. Backed by these monsters, I do consider myself a grill jockey, but the term “grilling” is certainly a misnomer. 

True grilling is defined by two words — high heat – and it’s simply the act of placing and cooking food directly and quickly over a heat source. Usually reserved for small, tender cuts of meat, it’s the method most of us are familiar with.

The other method of “grilling”—indirect&mdash;is used for larger, tougher, or fattier hunks of meat (chickens, turkeys, baby back ribs, etc) that would burn if left over a direct flame. Using moderate heat (300 degrees or so), the food is cooked slowly over time next to the fire, lid closed… in reality, it’s an outdoor oven with all the flavor of grilled food.

And then there’s smoking, which is true “barbecue.” Smoking is taking indirect cooking to a whole new level, lowering the heat even more (225 to 275 degrees), extending the cooking time, and introducing the unmistakable flavor of wood smoke to the food. Cooking ribs, brisket, pulled pork, and salmon in this manner is common, but let me tell you

that if you have never had a true smoked turkey, then you’ve never eaten turkey at all.

And then there is the debate between gas and charcoal. Gas is great—get natural hooked up if you can!&mdash;for quick cooks during the week or when you have a small gathering that is fi ne with burgers and dogs and some sweet grilled corn. If you really want to dazzle though, try using charcoal or natural hardwood. First off , there is something about playing with a live fire that excites all men, and when you can confidently dance the tango that is temperature control with a charcoal fire and deliver food that pleases the eye and the taste buds, you’ve truly become a pit master.

• To get killer grill marks, place your steak on the lubricated HOT grill, directly over the fire; after 2-3 minutes, rotate the steak (with tongs, not a fork) a one-quarter turn. Repeat on the other side for perfect crosshatch marks.

• Don’t douse your food in sugary sauces while cooking over high heat; they will burn. Brush some on at the end of cooking to just give it a nice glaze.

• All food should “rest” after grilling. Let your meats sit for at least 3-5 minutes (tent in foil, if you like) before serving to let the juices flow back into the middle.

• Doneness test: poke the meat. Does it feel like your cheek? It’s rare. Chin? Medium rare. Tip of your nose? Well done (NOOOO!!!!). 

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Feature Articles

Ah, May. So glad you're here. As anyone who knows me can attest, I can't stand  the change of seasons, winter absolutely stinks.

Downtime: A View to a Grill

It appears that advocates of tort reform seeking to limit lawsuits and cap negligence awards have lost the battle in Congress, with no sign of substantive change on the political horizon. Trial lawyers are breathing easier in this more favorable political climate and are making inroads in their efforts to reshape the tort system and make lawsuit filing and judgment collection easier and more efficient. Too many lawsuits are discouraged, trial lawyers argue, because legal asset protection measures make collecting awards difficult or impossible. The solution they propose is to restrict or eliminate asset protection strategies. Let’s consider why trial lawyers want to get rid of asset protection and what will happen if they are successful.

A leading scholar in the field recently claimed that 

 and proposed specific remedies. The goals of deterring and punishing wrongdoers (both intentional and negligent) and providing compensation for injured victims are not being met under our current laws. The reason, he argues, is that too many potential defendants are effectively “judgment-proof”because their assets are legally shielded and therefore unreachable from a successful claim. As a result, the deterrent impact of tort law is nullified, there is no compensation for the “victim,” and lawyers are discouraged from taking these cases.

According to Gilles, although most individuals have sufficient assets or income to pay some claims, they are eff ectively insulated by available asset protection strategies and exemption laws, including state homestead laws that protect a portion or even all of the equity in a defendant’s home, the complete protection aff orded most retirement plans, social security payments, and the exclusion of 75% of wages from garnishment.

The proposed remedy for this perceived injustice is simply to remove all barriers to judgment collection. Under this plan, no meaningful assets could be protected from a judgment. Exemptions would be reduced or eliminated, and asset protection strategies would be illegal or restricted to non-tort judgments. For example, Gilles proposes that “federal law could forbid Americans to enter into OAPTs (Off shore Asset Protection Trusts) unless the trust provides that tort claimants shall have effective remedies against the trust proceeds, and unless the foreign jurisdiction actually enforces those provisions.”

The argument that asset-protected or judgment-proof individuals are more likely to commit wrongful acts is a theory that well serves Gilles’ purpose but lacks evidence and opposes common sense. Automobile accidents account for the vast majority of all tort claims. Would an increased threat of losing assets make drivers more careful? If rational self-interest in avoiding death or serious injury doesn’t make a driver cautious, the threat of a lawsuit isn’t likely to have much additional impact. Getting sued for malpractice has more to do with bad luck, circumstances, and deep-pocket economics than it does with any wrongful behavior. The threat of losing a malpractice lawsuit doesn’t make doctors deliver better patient care. It drives up expenses, inhibits needed treatment, and reduces available care for those in the most “risky” categories.

If the tort system has little practical role in deterrence, it is not apparent what social good would be achieved by eliminating asset protection for individuals. Most of the benefits of this plan would accrue to the trial lawyers, who know that people with unprotected assets are easy potential targets. The mere threat of a lawsuit, no matter how baseless, can force a potential defendant to settle simply to avoid steep defense costs and the uncertainty of a trial’s outcome. There are plenty of “deep-pocket” defendants who possess property and assets above the exemption amounts and who lack additional asset protection.

It’s difficult to predict whether the movement to expand the “litigation explosion” to create an even larger pool of potential defendants and make all assets reachable will be successful. Trial lawyers are a powerful political force, but popular opinion these days clearly favors relief from lawsuits and greater protection from business risks and frivolous claims. Will money and political influence overcome significant popular opposition? We’re likely to see this conflict played out in Congress over the coming years and we all have a significant stake in the outcome.

Robert J. Mintz, JD, is an attorney and the author of the book Asset Protection for Physicians and High-Risk Business Owners. To receive a complimentary copy of the book, call 800-223-4291 or visit 

It appears that advocates of tort reform seeking to limit lawsuits and cap negligence awards have lost the battle in Congress, with no sign of substantive change on the political horizon.

Covering Your Assets: The New Tort Reform: Should Asset Protection Be Illegal?

Of all the disease states requiring anticoagulation monitoring, atrial fibrillation (AF) may represent the greatest challenge to healthcare providers. The condition is already the most widespread type of 

 and continues to increase in both prevalence and clinical complexity. Fortunately, new monitoring technology—such as the CoaguChek XS System from Roche Diagnostics&mdash;is now available to help healthcare professionals bring the benefits of point-of-care (POC) prothrombin time (PT)/international normalized ratio (INR) testing to more patients with AF and others on anticoagulation therapy, along with faster treatment decisions and the potential to help prevent strokes and other adverse events.

It is currently estimated that 2.3 million adults in the US have 

, and some estimates suggest that—based on the aging US population&mdash;

 will increase to 3.3 million by 2020 and 5.6 million by 2050. The disease carries serious implications, including the potential for stroke. In fact, about 

occur in people with atrial fibrillation. Therefore, stroke prevention is imperative with these patients. The clinical guidelines for stroke prevention in at-risk patients include 

(bloodthinning) therapy with warfarin sodium. To ensure proper dosing of warfarin, clinicians must monitor the therapeutic effects of the anticoagulant, as each patient reacts differently. Therefore, clinicians test patients regularly to determine and regulate their PT, normally indicated in international normalized ratio (INR) units.

Conventionally, anticoagulation patients have gone to a laboratory or to their physician’s office to get a venous blood sample drawn for a PT/INR test to be done at a later time. It can take several hours or even days to obtain the results, which may potentially delay the therapeutic decision to adjust a patient’s dosage. This approach to anticoagulation therapy may increase the risk of adverse effects—such as thrombosis or bleeding&mdash;and may limit the healthcare provider’s treatment options for addressing them in the hospital should the patient have to be admitted for a thromboembolic or bleeding complication.

However, technology has been available since 1994 that enables healthcare professionals to easily monitor their patients’ PT/INR at the point of care. By providing immediate access to anticoagulation results, this technology allows caregivers to make on-the-spot therapy decisions and adjust medication dosages to help protect patients from complications. The caregiver can also explain the changes, make sure the patient understands them, and counsel the patient on diet or other lifestyle changes that can impact the anticoagulation therapy, all in one office visit.

Those benefi ts can now be extended to a broader range of anticoagulation patients, thanks to a new generation of anticoagulation monitoring technology. The CoaguChek XS System, recently FDA-cleared for office use and patient self-testing, provides on-the-spot information about the patient’s PT/INR level. This system offers “smart” technology that healthcare professionals can use to manage in-office PT/INR testing more effectively. The CoaguChek XS System is the only anticoagulation monitoring system to perform onboard quality control and determine patients’ results in a single test chamber, feature designed to save time and provide enhanced confidence in the quality of results. The system provides accurate, precise results in just one minute from a small (10μL) drop of blood obtained from a fingerstick with one device.

For more information about the CoaguChek XS System, visit 

Of all the disease states requiring anticoagulation monitoring, atrial fibrillation (AF) may represent the greatest challenge to healthcare providers.

TechSector: New Technologies Offer Greater Flexibility and Control for PT/INR Testing

 is focused on “helping people live longer, healthier, happier lives” through “discovering and developing breakthrough medicines; providing information on prevention, wellness, and treatment; consistent high-quality manufacturing of medicines and consumer products; and global leadership in corporate responsibility.”

Each day, Pfizer assists 38 million patients by utilizing the skills of 12,000 medical researchers and more than 100,000 colleagues. Part of Pfizer’s success in the pharmaceutical industry is in part due to the “entrepreneurial environment of a small biotech and the support of the largest drug discovery organization in the world,” which allows the company to take on risks in the pursuit of revolutionary approaches to drug discovery.

r (RTC) is a 97,000-square-foot research and development facility located between MIT and Harvard in Cambridge, MA. Founded in 1999, the RTC staff consists of 100 full-time employees who are focused on applying cutting-edge technology to address challenges that prevent patients from receiving the innovative medicines they need. Located in the vicinity of the world’s leading universities and hundreds of young biotech companies and major pharmas, the Research Technology Center is able to tap into a collective energy and expertise that is unmatched. The RTC “focuses on project work in the early stages of the drug discovery process, including target identification, high through-put screening, hit-to-lead chemistry, optimization, and chemical tool production.” One of the current RTC projects is the Kinases Platform, a strategy to “identify and prosecute members of the kinase gene family as drug discovery targets.”

 group is to “bring novel discoveries to Pfizer Global R&D through collaborations with academic groups,” with the ultimate goal being the introduction of new drugs that will treat unmet medical needs. The program, developed in 1996, is meant to seek novel molecular targets for discovering new drug therapies in areas such as allergic diseases, arthritis, cancer, diabetes, immune enhancement, obesity, tissue repair, and many more.

The role of biology research in the development of new drugs “covers broad areas of 

, beginning with seeking out at the genetic level the mechanism believed to be involved in the target disease.” This process also involves “establishing an experimental regime that can screen large amounts of compounds; establishing an in vitro experimental regime that will uncover the lead compound and using it to collect and analyze data on the compound; and establishing an in vivo model regime to verify whether there is an effect on the disease.”

Pfizer scientists use the newest technology and equipment in the structure-activity relationship research that is the basis for drug development, evaluating drug effectiveness using animal disease models that reflect human pathology. The aim of this research is to “develop new disease models through active research on the pathophysiology of various kinds of pain, the pathophysiology of gastroesophageal reflux disease, and the mechanism of disease onset.”

 at Pfizer has two subdivisions, each with its own set of responsibilities. The information technology section “deploys and optimizes global systems, and databases, responds to requests from the laboratories, streamlines the analysis of data from test equipment, evaluates newly installed equipment, examines all types of applications, and conducts training for global applications.” On the other side, the research informatics group operates the library, manages information requested by the researchers, handles external communications, and offers guidance in copyright compliance. Pfizer’s global team has also developed a system that includes compound databases and experiment databases which researchers worldwide can use in common.

Pfizer’s Nagoya Laboratories has many research activities that are unique to their locations; however, to improve efficiency, the research informatics group “is involved with the research team from the beginning of a project, finds processes that can be systematized, and develops and installs a system.” With more than 700 personal computers at the site, the Nagoya Laboratories allows users to access approximately 2,000 periodicals from their PCs. 

Founded in 1849, Pfizer Inc. is focused on "helping people live longer, healthier, happier lives" through "discovering and developing breakthrough medicines; providing information on prevention ...

PharmaTech: Pfizer: Discovering the Future of Medicine

Although life-saving advances in medicine may get the most media attention, the effects of recent improvements in healthcare information technology and the Internet are also quite important and should not be overlooked. They are allowing medical professionals not only to provide better treatment, but also to provide services to patients that enable them to communicate with their physicians without visiting the office or making a phone call. As more patients demand access to reasonably priced

healthcare services after practice hours, physicians will have to change their traditional business models to ensure high levels of patient satisfaction.

Many practices and hospitals have realized that, in addition to providing the best possible treatments, it’s also very important that they provide patients with critical support services, such as patient education, health and immunization alerts, and automated appointment scheduling. More than two-thirds of US residents believe that having access to health and medical information online would give them more control over their own care, according to a survey conducted by 

Lake Research Partners and American Viewpoint

 in November 2006. According to the survey, 27% of respondents felt that they currently have too little control over making healthcare decisions, and 82% of parents said they would be interested in tracking their children’s health records and services (such as immunization dates) online. Patients are becoming more Web savvy and are turning to the Internet for convenience, preferring self-service over waiting on the phone.

survey, although 74% of respondents would like to be able to communicate with their physician via e-mail, a mere 4% currently use the technology. Further, 62% of respondents stated that the ability to communicate via e-mail with their physician would impact their physician choice “to some extent” or “a great deal.” Seventy-five percent of respondents also said they would like to be able to schedule appointments and perform other services online. With rising expectations, many practices and hospitals have revamped their static websites into fully functional, two-way patient portals to bridge the gap between the provider and the patient.

 offers patients a convenient, easy-to-use service they can use any time, anywhere through a secure Internet connection. The portal allows patients to log-in and request appointments, update or modify their health records, obtain personalized medical information, and view prescription history and information. The portal can also be used to refill prescriptions and transmit lab test requests. The OmniMD Patient Portals also use e-mail to send automated health alerts and patient education information. These two-way portals enable chronic care patients, for example, to quickly obtain answers to their questions, prescription refills or lab reports, and information on how to manage their own care, which can result in fewer office and hospital visits.

By delivering information and services to patients in a variety of ways, a fully functional patient portal helps maintain a seamless communication channel between patients and their providers, while improving overall efficiency of the delivery of care. Patient portals can be integrated with electronic medical record (EMR) software to provide a set of pre-defined functions and services for registered patients. Patients can request for selective access to their medical records, including lab reports, and can also schedule health reminders.

Patients can also use the portal to update or modify their demographics and family history, which can eliminate the need for data reentry and save valuable staff time. Hospitals and physician practices are increasingly relying on information technology solutions to help deliver better quality patient care while containing costs. With the increase in EMR adoption, patient portals will be a big part of the push for enhanced continuity of care, and will also help improve the patient—provider relationship.

For more information on OmniMD, the developer of HIPAA-compliant enterprise clinical solutions, visit the 

or contact the author at 914-332-5590 or 

Although life-saving advances in medicine may get the most media attention, the effects of recent improvements in healthcare information technology and the Internet are also quite important ...

Tech Sector: Healthcare Moves from Static Websites to Dynamic Portals

There’s a need to improve childbirth safety for mothers and newborns, in that nearly 600,000 women die each year during childbirth, as well as more than one million babies, which are deemed medically preventable. Our emphasis is overseas. We provide stateside education to broaden people’s awareness about conditions that exist overseas, because there’s such a big difference between medical conditions in the US vs. other parts of the world. I also take time off without pay from Wake Forest in order to fulfi ll some of the non-profit function.

What requirements are there for setting up a nonprofit organization?

It’s important to partner with an attorney in the beginning. The partner I selected was a close personal friend for many years. Her law firm did the initial incorporation for us. Articles of incorporation and bylaws need to be developed. There are also legal documents that need to be filed through various state offices. So, a doctor who wanted to start his or her own foundation would need to hire a lawyer to set things up in the state where they want to be incorporated. If you’re incorporated in one state and want to operate through another, you need to file additional legal documentation within the state where the business operates. It’s possible to be incorporated in one state and operate in another, which is what we do.

You also need an accountant. We have a local accountant who was also heavily involved with this initially, and he is a CPA with experience and training in nonprofit organizations. Our accountant has provided me with a wealth of information and has essentially walked me through the process.

That’s an ongoing process and need. We have individual donors and corporate donors, including other medical companies and other medical organizations, such as the 

Society for Obstetric Anesthesia and Perinatology

. Many doctors from those organizations will actually go on the teaching missions with us. The 

World Federation Societies of Anesthesiology

. We have been doing some fundraising events, selling various handicrafts from the countries we serve. When we go in and do projects in a specific country, for example, we look for other charities that are operating in those local areas, in particular those that are supporting women’s and children’s causes. We purchase handicrafts that they make and we bring them back to the US to sell as fundraising. So, not only do we impact the medical community in those countries, but we also look to find ways to help the local community and have an ongoing presence there.

We’ve actually been taking these items to different medical meetings and venues and setting up displays. We’re developing an e-commerce site soon through our website where individuals can buy these items online.

What first steps (in addition to getting a lawyer and an accountant on board) would you recommend to another physician who has a cause and wants to get involved with a non-profit organization?

It is important to find a handful of people who are also committed to the cause, because it takes a lot of time and hard work. Also, an application needs to be filed with the IRS. Form 1023 is the application for recognition of exemption under section 501(c)(3) of the internal revenue code and is required to get you rolling. You have to make a check out for $750 to the United States Treasury as well. The application should contain supporting information about what your organization is doing or proposing to do. The feds want to see proof of support of a cause. So, we sent them copies of workshops and educational programs that we’d been conducting, some brochures and newsletters we’d written, newspaper articles that had been published, and miscellaneous teaching materials we developed and had been using. Those materials all become part of the application package that goes to the IRS. If a group of people want to start a nonprofit organization, it is very helpful to have previously established activities supporting that cause for several years.

In our case, we didn’t have a large financial base starting out, so we applied for an advanced ruling—which is a temporary ruling that lasts five years&mdash;as sort of a probationary period. They give you a determination letter, which says “yes, we think you’re a worthwhile charity and you can operate under this provisional status.” At the end of that timeframe, they ask you to submit further information about where your support has come from and the size of the contributions. The IRS needs to know that you can support your activities, and that the cause is worthy enough that people will donate money to it and the activities will be sustained. Then, they’ll give you a final determination letter. However, if you have a minimum of eight months of financial history operating the organization, you can ask for a definitive ruling from the start. With a definitive ruling, you do not have to be review  again for five years by the IRS, as is the case with an advance ruling.

The whole process is not for the faint of heart; it typically takes the IRS 90 to 120 days or longer to process the application. Even with the application properly filled out, the IRS can request additional information, and that request must be responded to. I think it’s important to work through an accountant; you could probably figure out how to do it yourself, but most doctors don’t have time to do that and would rather work with a professional. 

MDNG Interviewed Medge Owen, MD, Associate Professor of Obstetric Anesthesia, Wake Forest University, Winston-Salem, NC, and Founder of Kybele Incorporated, a non-profit ...

So You Wanna...Start a Non-profit Organization

Why is Microsoft becoming more involved in the healthcare industry?

Microsoft has been in the healthcare industry for years, providing products like Windows and Office to hospitals, health plans, and other players and technology partners. All the major vendors that provide health-specific software to the healthcare industry use some sort of Microsoft technology. Because of this, we have been ranked by some companies as the number-eight player in healthcare IT. In early 2006, we formed the 

, with the express intent of figuring out how to address what we see as some pretty significant gaps in the healthcare market. Last August, Microsoft purchased the Azyxxi application [more on this below], which is what we refer to as a unified health enterprise platform. We think it addresses one of healthcare’s biggest enterprise issues, and that is “how do healthcare providers—who put a lot of money in technology investments&mdash;get access to all the information in those

systems, for the benefi t of the clinicians and ultimately for the benefi t of the organization?” The bigger health systems

have made large investments over the years in IT, and most of them really don’t have all that data integrated.

We also see an important need for someone to step up and help address healthcare from the consumer’s perspective. In February, we acquired a company called Medstory. If you go to 

 and type in “earache” as one word, the first result is for a heavy metal rock band. That’s how most search engines work; whoever has the most hits is what flows to the top. If you’re a parent with a kid with an earache, that’s not what you want. You want a vertically relevant search. With Medstory.com, if you type in “earache” as one word, you get back information that would help you to get some answers and perhaps some opportunities to solve your earache problem.

What is it about the Azyxxi software that was so appealing to Microsoft, and how will it benefit hospitals and healthcare organizations?

One of the things that we love about that investment was that Azyxxi is really innovative technology built by physicians to solve a key critical information need that hospitals have: “How can they see all the data in one place about a patient?” On March 19, 2007, New York Presbyterian Health System became our first customer since Microsoft acquired 

. New York Presbyterian is a perfect example of the type of health system that will see a real benefit from Azyxxi. Like a lot of health systems, they have invested in applications—like CPOE (computerized physician order entry system), clinical systems, laboratory systems, radiology systems, imaging systems&mdash;yet they still aren’t able to leverage the investments and pull it all

together without tremendous expense. With Azyxxi, they will now have a single place in their information network to see every single piece of information about a patient.

What will Microsoft’s acquisition of Medstory mean for consumers?

We have a fair amount of experience working with consumers, and we tend to look at opportunities and problems from a consumer’s perspective. When we looked at the healthcare market, one of the first conclusions we came to was that health consumers frequently start their encounter with the health system through an online search for information. Medstory’s innovative search technology coupled with Microsoft’s marketing connection with consumers will allow us to provide powerful information a few clicks away to help somebody with a health concern, which is a great way to build a relationship with a consumer.

What is the Connected Health Framework Architecture and Design Blueprint?

 is a perfect example of Microsoft taking the leadership position in the healthcare space. It is available for free. It is basically a road map that health organizations can follow using a services-oriented

architecture (SOA) approach to implement connected systems. It’s not just about Microsoft; the service allows hospitals to use other companies’ technology. We’re sharing this blueprint in hopes of helping the industry get more connected, because we see connectedness as an essential component of providing for safety in medicine and better clinical outcomes. Since the Framework was announced at the 

Healthcare Information and Management Systems Society

 (HIMSS) conference in late February, we’ve had more than 20,000 free downloads.

When Microsoft was founded 30 years ago, information for the most part was locked up in datacenters, and the consumer of that data really didn’t have much of a say about it. Microsoft has helped change that paradigm. Today, information is generally available in a secure and unlocked form for the consumer to benefi t from. We think that the healthcare market really has that same sort of old paradigm today—lots of data locked up in individual stores, and

it’s not all tied together for the benefit of consumers. We think it should be. We think that will change, and we’re trying to play a lead role in driving that change.

 homepage describes the technology as “a unified health enterprise platform that aggregates and enables analysis of all relevant data, from across an organization’s existing systems, for one, nearly instantaneous view.” Microsoft claims that “customized and timely access to data that spans clinical, financial, and administrative systems enables healthcare workers to maximize the value of information and make the most informed decisions.”

The beat on the people, devices, and companies shaping healthcare. 

5 Questions with... Steve Shihadeh, GM of Microsoft Healthcare Industry Solutions Group

George Mason University Assistant Professor 

 coined the term “nana” technology last year as an all-encompassing name for the multibillion-dollar industry that serves the quickly growing elderly population with innovative devices and services. We include several examples here:

These pill dispensers use audio and visual cues, such as fl ashing lights, spoken words, and songs, to remind elderly patients when it’s time to take their medications. If the medications aren’t taken within a specifi ed time, some dispensers will call selected caregivers to alert them, and others will send a message to a secure Internet site, prompting a healthcare professional to check up on the patient.

Able to send a distress signal even if the patient is unconscious, these monitors—worn around the neck&mdash;recognize when the user has fallen, sending a wireless phone signal to a central offi ce that can dispatch help.

Elderly patients no longer need to get up and down or pull out their magnifying glass to adjust the temperature in their home, thanks to this innovation. After programming the device—some models of which feature talking buttons&mdash;users can put away the afghan and blanket and turn the temperature up using voice commands, after initiating them via large tactile buttons or clapping their hands.

These devices send wireless signals from the mailbox to a small receiver in the home or apartment—even those as high as seven

stories up—allowing seniors to avoid repeat trips to check if their mail has arrived, trips that can be especially risky during inclement weather or if the patient uses a walker or cane.

The mirrors used in these medicine cabinets are equipped with a camera and online computers with face-recognition software. The device will greet users by name, identifying different household members. The medicine cabinets will also warn when users are not adhering to their medication plans and enable patients to monitor vital signs and make doctor appointments. Search for “

Older adults at risk of falling may benefit from these soon-to-be-marketed shoes that feature insoles that send small vibrations to the bottom of the foot, “tickling” neurons and making them more sensitive to signals that would be detected in people with normal balance.

Futuristic walking aids may include walkers that steer away from obstacles and can be returned to the user by remote control when put away, as well as canes that sound alarms when the user is in danger of falling, by taking advantage of sensors that detect pressure and gait. These devices can also beep to help the user remember where they’ve been placed. 

George Mason University Assistant Professor Andrew Carle
(http://chhs.gmu.edu/directory/carle.html) coined the term "nana" technology last year as an all-encompassing name for the multibillion...

"Nana" Technology: Anatomy of Tomorrow

Lately, we’ve been bombarded with dire warnings about hackers, viruses, spyware, adware, and a host of other threats to our computers. By following six simple steps, you can erect a nearly impenetrable security perimeter that will keep out both human intruders and malicious software.

 Install a Software Firewall on Every Computer

Firewalls are designed to protect you from outside attempts to access your computer in order to eavesdrop on your activities, steal or sabotage data, or use your machine as a means to launch an attack on a third party. Basically, a firewall is a virtual barrier between your modem and your computer that prevents unauthorized access to your network. Firewalls monitor the data moving around your network and disallow unauthorized traffic and traffic that exhibits certain suspicious behavior or characteristics.

Many people get confused about firewalls because there are two types—hardware and software. Hardware firewalls are typically built into the broadband router you use to connect your local network to the Internet. Hardware firewalls can be effective with little or no specialized configuration, and they can protect every machine on a small local network. Even if your network has a built-in firewall, I recommend that you install a software firewall on every PC on the network. Hardware routers typically treat any kind of traffic traveling from the local network out to the Internet as safe, which could leave you vulnerable to Trojan Horses, e-mail worms, and other forms of software that are designed to install themselves on your machine and then surreptitiously communicate with someone via the Internet. Microsoft includes Windows Firewall with Windows XP Service Pack 2. Although this software is fine for the casual home user, I don’t think it is robust enough to protect a small office network. I would recommend trying McAfee’s Internet Security Suite, downloadable.

You should also install antivirus software on your computer and keep it updated to help prevent viruses, worms, and other security threats from damaging your computer or using your computer to spread viruses to others. McAfee, Norton, and other companies offer security suites that include robust antivirus programs that constantly scan incoming and outgoing data. It’s important to keep your antivirus software up-to-date to ensure you are protected against the newest threats; a subscription that provides regular updates will typically run you $30—50 a year. Many of these products off er the option of paying for the software once and installing it on multiple computers.

An antivirus program won’t do you any good if you don’t use it to regularly scan your PCs and network. You wouldn’t believe how many people who have an antivirus program installed on their computer turn off the scheduled antivirus scan and then forget to turn it back on. To avoid this, you should configure your program to automatically scan your system at a time when you are unlikely to be using the computer.

Spyware and adware are software programs that are installed on your computer without your permission to spy on your online activities (spyware) or display targeted advertisements based on your online activities (adware). Both are

dangerous and annoying, and you need to check for these regularly, just as you check for viruses. You need to run anti-spyware/adware programs intermittently on every machine in your network—perhaps weekly or monthly. Th ere are plenty of very good programs available free online. Two that regularly receive high ratings are Ad-Aware from

LavaSoft and Spybot Search & Destroy. Download each of these, install them on your computers, and make sure you’re always running the latest versions (the programs ask you if you want to update when you start them).

Th e best way to protect yourself from malicious users is to password-protect all your user accounts. Each user should have a unique account with its own password. An effective password, according to Microsoft, is at least eight characters long and contains a mix of upper- and lower-case letters, numbers, and symbols.

Failing to keep their security software up-to-date is where most users go wrong. Yes, it costs money to keep up with antivirus subscriptions, and yes, it can be a hassle to constantly install new Windows updates—though they are now fairly easy to automatically install in XP and Vista. But the inconvenience and cost of staying up-to-date pales in comparison to the potential harm that can befall unprotected computers and systems. The bad guys are thinking up new viruses and worms all the time, so update, update, update!

Dr. Bertman is a Clinical Assistant Professor of Family Medicine at Brown University and president of AmazingCharts.com, a leading developer of electronic health record (EHR) software. He is also president

of AfraidToAsk.com, a consumer health-information website. He is in private practice in Hope Valley, RI. 

Lately, we've been bombarded with dire warnings about hackers, viruses, spyware, adware, and a host of other threats to our computers...

Tech Talk: How to Protect Your PC and Network

To blog or to social network, that is the question. With the growing popularity of online technologies like blogs, vlogs, and video sharing websites, physicians now have numerous ways to collaborate and share information. However, when it comes to uptake of these new tools, doctors have been voting with their feet (or more accurately, their browsers).

Nicholas Genes, MD, PhD, founder of the popular online event known as “Grand Rounds,” has been a major force

in medical blogging for many years. Grand Rounds brings together hundreds of physicians from around the world

who share and read superior healthcare-related posts each week. Despite the growing popularity of blogs in general, Dr. Genes has noted that physicians and other medical professionals have been slow to participate in significant numbers. On the other hand, social networks—online communities where doctors can quickly meet, network, and educate each other&mdash;have exploded in popularity.

It is clear that certain physicians (especially those who enjoy writing) have embraced blogging. However, the time commitment required to maintain a blog may be a big turnoff for some. According to an Envision Solutions/Medical Blog Network survey of healthcare bloggers, 44% of physician respondents report that they spend between one and two hours working on their blog each day. 

Why Social Networks Are Attracting More Eyeballs

Currently, it appears (at least according to anecdotal evidence) that healthcare providers itching for online interaction are turning to social networks. One key attraction is the level of community they provide. Although there is a communal aspect to blogging, it is largely a solitary activity. Social networks often require less time and effort to participate in and enable physicians to quickly post content and respond to others. Given this, social networks will likely continue to be more popular with the majority of physicians. One example of a successful physician social network is 

. Sermo is currently the nation’s largest online doctor community. Since its introduction in 2006, more than 10,000 physicians have signed up and spent thousands of hours each week discussing everything from diffi cult diagnoses and dealing with troublesome patients to handling sensitive staff issues and how to improve medical education.

Another social network that has attracted some attention is 

. Launched in 2006, it is “a social networking platform for translational medicine that allows basic science researchers, clinical researchers, practicing physicians,

medical students, residents, and healthcare professionals to communicate and collaborate on an open platform.” The Healtheva website notes that members can “fi nd other doctors or researchers, keep track of colleagues met at conferences, and collaborate on projects with others. In addition, members can upload documents, evaluate and discuss issues in the forums, or start a blog.”

To blog or to social network, that is the question. With the growing popularity of online technologies like blogs, vlogs, and video sharing websites, physicians now have numerous ways to collaborate and share information. However, when it comes to uptake of these new tools, doctors have been voting with their feet (or more accurately, their browsers). 

Make no mistake, blogs are (and will remain) important for medical professionals and the healthcare industry in general. However, social networks are attracting more eyeballs because they take less time to participate in and foster broader and more diverse communities.

The latest host (at writing) was Med Valley High. Grand Rounds Archives and Upcoming Schedule Access archived editions of Grand Rounds (dating back to September 2004) and see which blogs are hosting upcoming editions.

, a full-service healthcare marketing communications

To blog or to social network, that is the question. With the growing popularity of online technologies like blogs, vlogs, and video sharing websites, physicians now have numerous ways to collaborate..

Social Media Notebook: Blogs vs. Social Networks: Which Online Tools Will Physicians Flock To?

Americans have always traveled abroad for business and pleasure, seeking out exotic locales that offer excitement or financial opportunities that are not available back home. Now, we can add something else to the list of things Americans go abroad in search of: top-notch medical care. In recent years, the number of so-called “medical tourists” traveling overseas in order to seek medical care has steadily increased. Forced by skyrocketing US medical costs to turn to foreign hospitals and physicians, many Americans are booking trips to distant lands, attracted by the prospect of affordable operations and treatment ranging from cosmetic surgery to orthopedic procedures.

 traveled to countries like Costa Rica, Malaysia, and Argentina—with Thailand and India being the most popular destinations&mdash;in search of affordable medical care. That number is expected to increase as care here in America becomes more expensive and more people become aware of cheaper and comparable overseas alternatives. According to David Hancock, author of The Complete Medical Tourist, “Americans are expected to help turn global medical tourism into a 

Richard Wade, vice president of strategic communications for the American Hospital Association (

), says that Americans’ perceptions of who engages in medical tourism have changed over the years. In the past, the view was that Americans didn’t need to do such things, that the only medical tourists were the foreign patients who came to the US to receive treatment at our world-renowned hospitals. “They often looked like real medical tourists who’d come to New York, Baltimore, or Boston, have the care they needed done, and then go sightseeing or shopping,” Wade says.

Some foreign hospitals have begun to implement some of the latest healthcare information technology and recruit highly talented physicians (many of whom trained in the US), moves that have improved the level of care delivered at these institutions and raised the profile of medical tourism. Although these changes have made some foreign hospitals comparable to many US-based ones, it is still important for patients who are contemplating traveling overseas to seek medical care to thoroughly evaluate all benefits and potential risks.

For many patients, the most attractive aspect of medical tourism is the 

 offered overseas—a 20—80% difference compared to the cost of many US procedures. This is a big deal, especially for the estimated 46 million Americans without health insurance who are unable to afford quality care. Imagine for example that you don’t have health insurance and you need a hip replacement, which costs approximately $40,000 in the US, but only $5,800 in India&mdash; would you choose to go abroad in order to save tens of thousands of dollars? Patients who have answered “yes” to that question and traveled abroad for a medical procedure have often reported receiving excellent care from qualified physicians and found better nurse-to-patient ratios and physician-to-patient ratios in many foreign hospitals that cater to medical tourists. 

Access to and availability of care are also factors driving this phenomenon. Medical procedures and treatments that have not obtained FDA (

 elsewhere. Given these benefits, are patients still putting themselves at risk when they seek treatment outside the US? 

editorial board member Jonathan Bertman, MD, says “I tell my patients that it’s risky,” when they ask about overseas healthcare. “It’s not like they’re risking losing a little bit of money—they’re risking their life. The question is, how important is it to them?” 

In response to patient demand and in order to protect the safety of American medical tourists, several US medical institutions— including Johns Hopkins, The Mayo Clinic, and The Cleveland Clinic&mdash;have established affiliations with overseas hospitals. Many American healthcare professionals are also traveling abroad to study with local hospitals and universities and also to train local physicians, further improving the level of care they provide. The Joint Commission International (

), a non-profit organization whose focus is to “continuously improve the safety and quality of care in the international community,” has accredited an estimated 

 that have met JCI healthcare standards. If standards of care continue to improve in foreign hospitals and clinics, some aspects of healthcare in the US “could soon follow the flight of manufacturing, services, and software development to the developing world where a lower cost of living translates to cheaper treatment,” said 

, marketing director of the Bumrungrad Hospital, based in Bangkok, Thailand. 

Still, it remains important for patients to adopt the mindset of “buyer beware” when considering the risks associated with traveling abroad to receive medical care. One concern Bertman mentions is the lack of oversight. “The biggest thing is that overseas care is not regulated the way it is here. You just don’t know what you’re getting into.” There is also the lack of 

, which means if complications occur, a patient’s legal recourse could be limited. Other important considerations patients should keep in mind include complications that could arise from traveling so soon after undergoing a procedure, language barriers, and difficulty obtaining follow-up care.

The Internet has greatly facilitated the rise in medical tourism by making it easy for patients to find information on physicians, medical institutions, and medical travel agencies. A quick Google search on “medical tourism” returns thousands of links to information on the topic, including links to medical travel agencies. Their role is to act as the middlemen between the patients and hospitals by booking airline tickets, scheduling surgeries, reserving hotel rooms, etc. Many agencies will also send employees overseas to evaluate the medical facilities and meet administrative staff and medical staff. Agency employees often act as guides and take prospective patients step-by-step through the entire process. 

, “The big value we have is basically being able to help guide someone through the whole journey and process and find a way to ensure their experience is far beyond what they expected.” He said IndUSHealth and other agencies are “tapping a market of individual consumers who are seeking excellent healthcare options elsewhere in order to afford being able to receive good care when they need it.” However, healthcare professionals must also familiarize themselves with these agencies, which may be involved solely for monetary gain, which could put patients in harmful situations. IndUSHealth has been in business since 2005 and focuses on sending its clientele only to India. According to Rao, “the hospitals there provide the best combination of quality and cost” because of what’s known as the “Indian Advantage.”

, an Illinois-based medical travel agency, spent its first year and a half on due diligence. Patrick Maresk, Program Director of MedRetreat, said that meeting the staff of the overseas hospitals allowed the company to “establish the program and explain what the model of the American medical tourist is, so the hospitals could best cater to their needs, which are much different from the local people.” Maresk also explained that cosmetic surgery, orthopedics, and gynecology are the three most popular medical reasons MedRetreat clients go overseas. In fact, the company is anticipating that by the end of 2007, it will send more than 

 abroad to affiliated hospitals in Brazil, Thailand, and Turkey for procedures. 

For now, medical tourism is consumer-driven, but companies like IndUSHealth and MedRetreat have begun investigating the possibility of providing businesses the opportunity to receive lower insurance premiums if employees go abroad for healthcare.

Although the US still offers the best healthcare, rising costs have pushed many Americans to search elsewhere for treatment. Dr. Bertman says, “The fact that medical tourism exists and there’s a demand for it, is a reflection on problems within our own healthcare system.” 

, senior fellow at the Center for Health Policy in Stanford, CA, echoed this view. “Global healthcare is coming and American healthcare, which is pricing itself out of reach, needs to know there are alternatives,” in order to improve. 

To remain competitive, US hospitals will need to figure out a way to make quality patient care available at affordable costs. Bertman says this can be a good thing. “I think competition can lower prices, which is what we want.”

Not too long ago, the idea that Americans would need to go overseas to have complicated surgeries would have seemed ridiculous.

Medical Tourism: The American Invasion

We rely on the Internet to get the latest news, stock quotes, and sports scores; conduct online banking; and purchase goods and services from vendors worldwide. Thanks to e-mail and wireless Internet connections, we’re never out of contact for too long; in fact, many of us now stay in touch with our offices and even our patients 24/7. The Internet allows us to access CME (continuing medical education) on demand—including live streaming video&mdash;and use knowledge-based medical information services, such as 

. Vast amounts of medical information are available on the Web, enabling us to look up clinical articles and information on drugs and clinical syndromes. Our patients do the same thing, often using the ever-popular and highly productive search engine

Google was created by two Stanford students, Larry Page and Sergey Brin, who in 1996 developed 

, a search engine that analyzed back links (the number of Web links that point to a particular website). From there they introduced the unique concept of ranking pages based on how many other pages link to it (when you do a Google search, the pages with the most links pointing to them are higher up in the results list). With an investment from Andy Bechtolsheim (a founder of 

) and others, Google, Inc. was founded in September 1998. Since then, the company has steadily improved on its search engine technology in an effort to streamline the search process and ensure search queries return the most relevant and useful information (for example, if you think Bechtolsheim’s name is misspelled, just check for yourself; in fact, try misspelling it, and Google will correct you).

Search engines are arguably most valuable because they enable users to quickly find information on a variety of medical and non-medical topics. Many of us have slipped into the habit of using Google as a medical search engine to identify drugs, find articles, and even point patients toward references for their own edification. More often than not, when prescribing a new drug or making a new diagnosis, I will ask my patient if he or she is Web savvy and then send him or her to the Internet for a quick review of the literature prior to a return visit to initiate therapy. It saves time, informs the patient, and is generally reliable; hardly ever are you confronted with bad information that takes the patient off track and takes extra time to explain.

It is also not very difficult to locate a colleague almost anywhere in the world for consultation, referral, or communication using Google or any other popular search engine. In fact, it is downright scary to realize how much information is available on the Web. Just recently, one of my colleagues from the west coast required a formal letter from me inviting him to participate in a CME program. It took only seconds to Google him and find his e-mail address and phone number, and to find out what he has been up to and what transitions have occurred in his career. If you really want to give yourself a wake-up call, open up Google and type in a few-word description of yourself and your specialty. Did you realize there was that much information about you online?

 provides a simple way to rapidly search for information, but narrows the target information to include only scholarly literature. From one place, you can search across many disciplines and sources: peer-reviewed papers, books, abstracts, and articles from academic publishers, professional societies, preprint repositories, universities, and other scholarly organizations. Still in beta testing

though very robust, Google Scholar identifies the most relevant information across the world of scholarly research. It “aims to sort articles the way researchers do, weighing the full text of each article, the author, the publication in which the article appears, and how often the piece has been cited in other scholarly literature.”

The most relevant results will always appear on the first page. Use Google Scholar to “search diverse sources from one convenient place; find papers, abstracts, and citations; locate the complete paper through your library or on the Web; and learn about key papers in any area of research.” 

 is Google’s newest directory, providing up-to-date products, medical reviews, and access to overall health information listed by category (eg, Men’s Health, Addictions, Weight Loss, etc). Google Health lists related Web pages in Google’s typical page-rank fashion, by total number of hits per page. Google Health takes your standard search and breaks it down into more precise categories, until you have an exact match:

> > > > > Susan G. Komen Breast Cancer Foundation

 explored why the company recently decided “to improve the information that comes up in a Google search on health information.” At the 

Fourth Health Information Technology Summit

, Google Vice President Adam Bosworth said “a large percentage of all Google queries are searches on health issues” and fall into one of four categories: symptoms; treatment for a specific illness; experts in treating a specific illness; and coping advice. 

Although Google searches retrieve the most popular health information, the company has been working to identify the most reliable healthcare information and has reconfigured its search engine to display that information at the top of search results. Bosworth mentioned that although doctors may not always agree on which course of treatment is best, “consumers deserve to be armed with the most—and best&mdash;information possible.” He also identified several types of important information that is currently difficult to find online&mdash;including information about how many times a particular doctor has performed a given procedure, mortality rates, and guidance on interpreting this information&mdash;and noted that Google is working on finding ways to make this information available.

Let’s return to the subject of how much and what kind of information is available online to patients looking for information about their physicians. We mentioned before just how easy it was to use Google to find personal information about a colleague. Having all that information out there for anyone to see makes the concept of being “on call” take on a whole new meaning, doesn’t it? And this was merely a case of one professional colleague who wanted to contact another. Just think who else might be looking up our information—it could be anyone from our patients, to our high school classmates, to our bill collectors, or even the occasional stalker! This raises an important question: “Are you Googleable?” And if you are, is that necessarily a good thing?

One of the main reasons patients will research a physician online is to find contact information in order to try and schedule an appointment. Looked at in one way, this a benign use of the Internet to acquire information, but from the perspective of most primary care providers (PCPs), who needs more business? Most practices are overrun, so who needs another patient searching for a PCP? Besides, the search for contact information may possibly also turn up all sorts of other information about a physician, including his or her home address, phone numbers, e-mail addresses, and other information.

Do you want your patients knowing what lectures you have given, your employment history, other areas of interest, and any additional ways in which you have applied your expertise (at least since the dawn of the electronic era)? And this applies only to information that you yourself have more or less directly generated. What about information generated by others, such as opinions expressed about you in online chat rooms and other forums, comments on blogs, etc? As the Internet expands to accommodate greater use of social media and other information-sharing applications, the amount of information online will also expand. So, can you “control” the information available about you online, at least to some extent? Not really. But you can provide an ideal platform for the presentation of most of the information about yourself and your practice for which patients are searching. 

Most professional societies now offer their members the opportunity to subscribe to some kind of home page or portal that gives them both the opportunity to link to their professional affiliations and the capacity to provide their patients with access to the practice. Some are quite sophisticated and serve as your front desk. Many of our readers might already be familiar with the likes of 

. Visit the Medfusion website to learn more about the custom website development solutions offered by the company. Practices can create secure patient portals that enable patients to pre-register for appointments, schedule appointments, request prescription renewals, conduct “virtual office visits” to receive minor-acuity and non-emergent care, assess their symptoms, pay bills online, and find out lab results. Practices can even use the service to offer an “

If you are in the market to develop a patient portal, plenty of additional vendors exist, and a simple Google search of “patient portal” will return enough information to provide you at least an hour’s worth of browsing. To give you an idea, on the day I performed that search, I looked at results one through 10 of about 2,490,000.

On the other side of the equation are those select individuals who remain “

.” This can occur either by intent or just from lifestyle choices alone. “Ungoogleables don’t post online, blog, publish, or build web pages using their own names,” says 

We rely on the Internet to get the latest news, stock quotes, and sports scores; conduct online banking; and purchase goods and services from vendors...

May 2007

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Social Media Notebook: Blogs vs. Social Networks: Which Online Tools Will Physicians Flock To?

Medical Tourism: The American Invasion

Are You Googleable? Your Resume, Your Life--Online

5 Questions with... Steve Shihadeh, GM of Microsoft Healthcare Industry Solutions Group