ajfortin.com

No, this is not the title of another movie about managed care, sorry.

But this post does have to do with beat-less human hearts– check out this article from MIT’s Technology Review. They discuss a new artificial heart with an innovative “pulse-free architecture.” They pump blood through the body continuously, rather than with the periodic beat of the normal heart. These devices (”device” sounds a little cold for a replacement heart) were designed by O.H. “Bud” Frazier, a prominent heart surgeon and pioneer in the development of cardiac devices at the Texas Heart Institute in Houston. They have “continuous flow pumps that are like little turbo machines,” says Tim Baldwin, program director of the advanced technologies and surgery branch of the National Heart, Lung and Blood Institute in Bethesda MD. They’re smaller, they can pump more blood, and they’re more durable than the alternatives. All of this is great news.

Besides the technical question of whether a pulse is important to get blood to all the small capillaries (some say yes, some say no), I cannot help but wonder what would living pulse-free be like. Instead of a thump in our chest, would there be a hum? What does having a beat mean to us? Is it fundamental to some universal life-rhythm without which we feel less than human? Who knows? And does any of this make one bit of difference when you are the one on the operating table? Probably not. But it does pose a challenge to song writers who will now have to learn something about fluid dynamics when composing love songs.

We know the health-care-consuming-public wants doctors to wire up and get serious about using information technology in their practice (see my earlier post). Their general reluctance to get on board stands in the face of an avalanche of private and public incentives, programs, discounts, subsidies — all literally begging them to join the rest of Planet Internet.

Here’s one more attempt, this time by the Centers for Medicare & Medicaid Services (CMS). CMS recently announced its DOQ-IT (Doctor’s Office Quality Information Technology) University, as one part of their Physician Focused Quality Initiative. The DOQ-IT is an on-line educational program designed to promote the use of health information technology in physicians’ offices nationwide. The program features an interactive web tool that initially will offer lessons on culture change, vendor selection, operational redesign, and various clinical processes. Lumetra, a San Francisco nonprofit, will help initiate the program to get doctors to use electronic health records and related technology.

In a pilot program conducted by Lumetra, the percentage of successful EHR implementations at small medical practices was 31 percent, twice as high as similar pilots by other vendors. Only 31 percent? (I’d like to see the ROI on this one.) But alas, the low numbers are unfortunately no surprise. They do give us, however, a good idea of just how rough this road is really going to be.

They say a picture is worth a thousand words.

I recently found this Summary of Health Plan Regulation chart (pdf) that outlines some of the regulatory complexity health plans deal with on a daily basis. Now I realize the chart is old (circa 2000) and the organization (AAHP) now goes by another name, but it’s instructive enough to give it one last 15 minutes of fame. Who knows–as the years go on we may come back to this chart and with a little nostalgic sigh say “Ahhh yes, those were the good old days, when times were simpler.”

* But were afraid to ask