Looking for the “Big Dialogue of Literature”

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Tom Nissley at Omnivoracious writes that Horace Engdahl, permanent secretary of the literature jury for the Nobel Prize, thinks Americans aren’t part of the “big dialogue “. Quoting Engdahl:

Of course there is powerful literature in all big cultures, but you can’t get away from the fact that Europe still is the center of the literary world … not the United States…. The U.S. is too isolated, too insular. They don’t translate enough and don’t really participate in the big dialogue of literature. That ignorance is restraining.

Ouch.

And yes he does sound a little old school — maybe 19th century old school.

Anyway, I’ve been looking for that big dialogue. Having a hard time finding it that’s for sure. But I can say one thing though, I don’t think it’s in Europe. No, I believe it’s moved lock, stock and barrel to China. Unfortunately, good literature comes from hard times. And they seem to have enough of that to fuel any literary aspiration.

The problem is that Europe is simply not translating enough, and THAT ignorance is restraining indeed.

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A Black Swan Has Struck Health Care Reform

The Black Swan (book)

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A Black Swan has struck health care reform. In May 2007 I wrote:

But for the moment, I don’t want to get into the specifics of contending views here, as much as I want to talk to how we go about our thinking in health care. One interesting way to see the current debate is through a notion now making the literary and intellectual rounds — the Black Swan. At the risk of being faddish, I think it’s worth exploring for a minute.

A Black Swan is a rare event we never see coming, has extreme impact, and after it occurs, we rationalize that it was ever so predictable. Nassim Nicholas Taleb, author of popular book in question, argues that history and societies do not proceed along some linear line, but “go from fracture to fracture, with a few vibrations in between.” It is the singular, the unseen, the accidental and the unpredicted — and our “chronic underestimation” of these possibilities — that account for the FUTURE straying from any course we initially envisioned.

It doesn’t take too much of a financial genius to figure out that the wall street meltdown will have at least two dramatic effects on health care reform: 1) coverage for the uninsured will be nearly impossible in the short run (a decade?); and 2) enormous pressure will build to constrain and shift costs to health insurers and providers further eroding the economic viability of the private health care sector. And while the Presidential candidates during the recent debate avoided the serious question of what has to wait, the adults in the room did not need to have things spelled out.

As I have said before, any of the official “futures” for health care reform at are now DOA. And we don’t need to pay any futurist to tell us how that story will end since the plot has yet to be revealed. Stay tuned.

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New Study Says Online Health Care Could Reduce Costs

A statue of Asclepius. The Glypotek, Copenhagen.

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A new study, authored by Arthur L. Wilmes, FSA, MAAA, principal & actuary at Milliman, estimated the impact of online care by developing individual actuarial cost models for a commercial and Medicare population from internal Milliman data sources. And here’s the money quote from the Government Technology website report:

The majority of savings estimated in Milliman’s analysis came from the potential for substitution of non-emergent ER visits and in-person visits (both acute and follow-up) with lower-cost live interactions using an online care platform. The savings for the commercial population amounted to 9.2 percent for the services analyzed, representing an estimated 1.2 percent reduction in overall medical costs. For Medicare, the savings amounted to 12.1 percent for the services analyzed, equivalent to an estimated 1.2 percent of overall medical costs. Milliman also identified other potential clinical applications of online care with cost savings potential, including chronic patient management, early disease detection and care management.

(Thanks to ICMCC)

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Why Aren’t Physicians Adopting Electronic Medical Records?

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From Karen Bell, Director of the Office of Health IT Adoption at the U.S. Department of Health and Human Services:

We still lack a compelling business case in terms of purchasing, upkeep, and decreased productivity. Physicians have to shell out considerable upfront costs and lose about 20 percent productivity in the first few months as personnel get used to the system. And the average primary-care physician doesn’t have time to research different systems and learn how to use them: every minute they are not seeing patients, they are not getting paid.

(Thanks to Technology Review)

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The Baby Powder Milk Scandal: To Speak or Not to Speak

From Professor Cui Weiping who teaches at the Beijing Film Academy. (Thanks to China Digital Times)

I need to write down slowly how I feel about the Baby Milk Powder Scandal. How horrible it is that more than ten thousand babies were hospitalized and many more harmed (by contaminated milk power)!

What can I say? What can we say? Am I waiting for other people to say what has not been said? Looking around, I find that many friends are as trapped in silence as I am. They are also tormented by speechlessness.

Are we too shocked to speak? Or have we already said what we should have said? Or is it because we can’t find any words to respond to such a cruel reality?

This kind of torment has actually existed for quite a long time. We are wearied by the struggle between remaining silent and speaking out. Often times we can’t find the right words and choose to remain silent. Will our conscience become numb and impassive if we stay silent for too long?I think it is quite possible. If that happens, it would signify the end of our morality and spirituality.

I have actually encountered similar situations many times. I want to tell you something terrible that I’ve heard about but didn’t do anything about. I feel that I’ve participated in concealing something horrible whenever I think about it.

It was during the spring festival of 2005. I met a cousin who lives in the countryside. She told me that the rice they grew that year was not edible because a deadly pesticide had been applied to the plants. Some pigs died after being fed with the chaff from the rice. So the farmers bought rice from elsewhere to eat — and they sold the poisonous rice they grew to people in Shanghai.

My cousin didn’t say whether her own pigs had been poisoned. She has a limited education and doesn’t know much of the world outside her village. I am not sure whether she got it right when she said that the poisonous rice had been sold to Shanghai. But one thing was known for sure: the farmers bought rice to eat, and secretively sold their contaminated rice to others. And it’s something that farmers around the area all knew about.

What could I do after I heard something like this? Where could I go to report the problem? I can’t think of any official in the vast country who would patiently listen to me and try to address the problem. Most officials would probably regard me as insane if I went to talk to them. They would glance at me arrogantly from behind their desk. I don’t think I could stand the humiliation for even a few minutes. Why should I seek this disgrace? “There are all kinds of things like this happening in the country. There’s nothing I can do about it, ” I said to myself, trying to appease my conscience.

How pitiful I am! I already know that my effort will be useless even before I take any action. Is there a devil who lives in our hearts and sneers at our actions all the time? His mission is to deprive us of the ability to respond, to smother our enthusiasm, and to paralyze our will to take action. I am caught in the same situation as the impassive official I imagined. Both of us are controled by a curse and have lost the ability to take appropriate action…

But why should I know about things like this? Who are the people that constantly put them in front of my eyes and keep me suffering from this feeling of powerlessness? I hate to hear about things that reflect the darkness of human nature which I can do nothing about…I have no choice but to live with it. I place my heart and conscience in a corner, as if they are frozen and numb.

However, my humanity has been hurt. The damage is immeasurable. Trapped in this kind of silence and not able to do anything about it, I feel bad about myself. I almost feel that I’ve become a pile of dogshit, or a slave who only knows work but not how to speak. I chat and joke with people around me, but I am not able to talk about the biggest bewilderment on my mind.

To speak, or not to speak, this is the question. This is a question that is hard for our judgment. But what we’ve lost is the ability to make basic moral judgments.

McCain’s Erratic Sturm and Drang Campaign

The politics of the hidden upper cut, the surprise move, the high risk gambit, the unblinking fabrication, the bait and switch — in other words the erratic sturm and drang of McCain‘s campaign is angering even the most passive of citizens. We have seen this one trick pony before: a personality that thrives upon, and indeed deeply needs, the crisis of the day, in order to act out who they are. It is a temperament that craves self-centered drama. And if there happens to be none,  then some must be created as in the Palin disaster.  Now McCain’s brilliant strategy to deal with a real financial crisis is, of course, to first charge in with the imperious ‘off with their heads’ Stalinist solution — an immense public pandering and a major distraction to say the least. But wait! He’s not the President. Ok minor problem. Then, ahhh, to hell with the debates, McCain’s got to rescue America right now. I mean RIGHT NOW. Today. Oh, maybe it will take the weekend. Anyway once he’s dealt with those bastards then he can get back pussyfooting with Obama.

Please. Someone save us from this man.

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Health Care Quote of the Day on Personal Health Records

From Stephen Downs, senior program officer and deputy director of the Robert Wood Johnson Foundation Health Group.

The current understanding of a PHR is of an online repository of all of the information in your medical record—and that is way too limiting. We want to stretch the vision so that technology designers and policy-makers see PHRs as resources that don’t just allow patients to review their medical information, but instead enable them to make more informed decisions because of it.

Thanks to Digital HealthCare and ICMCC.

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Live Chat with Dr. Jason Hwang on Disruptive Innovation

At a Live Chat today with Dr. Jason Hwang co-author of The Innovator’s Prescription: A Disruptive Solution for Health Care, (Sponsored by the World Healthcare innovation and Technology Congress) I asked him how he saw the recent and fast paced developments in mobile phone applications and technology having an impact on health care. He replied

Similar technologies which decentralize care typically commoditize expertise and bring care closer to the patient. If we can encourage business models that fully capitalize on the advantages of these decentralizing technologies we will dramatically increase the value delivered by the health care system.

Other questioners ask:

“Given your view on decreasing reliance on hospitals and physicians, how do you think the practice of surgery will be affected.?”

Patients are not going to be doing surgery on themselves, nor are non-surgeons going to be doing anything beyond biopses. However, for diseases which have causes the can be targeted with medications or devices the need for surgery can be precluded and disrupted.

“So with that response, how do you foresee Google and Microsoft’s initiatives playing out?”

The problem with Google and Microsoft initiatives is they maintain control for the data in that the data is still seen as the primary source of value. This is no different from how hospital systems already view their data. We would prefer to see a system that commodotizes data warehousing and in which profits shift to the companies that develop innovative applications through which to use that data.

“Can you give an example of truly disruptive technology that you see coming?”

The technology is already here but the importance is on how we employ it. Technologies can be utilized in a disruptive or sustaining fashion . . . Technologies help providers deliver more and more complex care. But that tends to increase overall cost of the system. That very same technology could be employed in a disruptive manner and a prime example today is telemedicine.

“EMR adoption is anemic. Will rising consumerism in health care prompt a rise in adoption?”

My view is that EMR (implementation by hospital systems and physicians) will likely remain stagnant. PHRs under the control of patients should disrupt the information and data infrastructure provided that we give patients a reason to collect and manage their own health care data.

On telemedicine:

Again there are two ways in which we can implement telemedicine. One way is we use technology to help our specialists see more patients more efficiently than they could in the past. However, the second way in which we use telemedicine is to help support less expensive caregiver and technicians to care for those very same patients is what will be disruptive to the system. If Web 2.0 technologies are used to help patients take better care of themselves thereby reducing the need to utilize costly expertise and expensive facilities, then that would truly be disruptive. I believe this can happen.

On electronic personal health records:

For disruptive innovation to get any traction we must identify areas of non-consumption. So in the united states there are a lot of affiliated health companies that have no access to the existing records database. I imagine that companies like spas, fitness centers, nutrition stores and wellness centers would be an ideal market in which to establish a disruptive PHR system. Eventually, traditional health care providers will see value in linking their system to the newer disruptive one.

On my question about virtual home visits:

For a growing number of conditions virtual home visits are more than adequate. In order to encourage adoption once again we need changes in our payment model. As I said before, we would suspect that these types of innovations would arise first from the integrated delivery systems that are able to capture the value gained by new delivery models such as this one.

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Our Trusted Health Valet? Google’s Future for Mobile Phones

From the Official Google Blog:

There are currently about 3.2 billion mobile subscribers in the world, and that number is expected to grow by at least a billion in the next few years. Today, mobile phones are more prevalent than cars (about 800 million registered vehicles in the world) and credit cards (only 1.4 billion of those). While it took 100 years for landline phones to spread to more than 80% of the countries in the world, their wireless descendants did it in 16. And fewer teens are wearing watches now because they use their phones to tell time instead (somewhere Chester Gould is wondering how he got it backwards). So it’s safe to say that the mobile phone may be the most prolific consumer product ever invented. (more)

How in health care do we tap the power on mobile devices featured in this pre-android deployment post on the future of mobile phones – smart alerts, augmented reality, mainstream crowd-sourcing, remote sensoring, development tool, and – I love this – trusted valet?

Trust is the most important currency in the always connected world, and your phone will help you stay in control of your information. You may choose to share nothing at all (the default mode), or just share certain things with certain people — your circle of trusted friends and family. You’ll make these decisions based on information you get from the service and software providers, and the collective ratings of the community as well. Your phone is like your trusted valet: it knows a lot about you, and won’t disclose an iota of it without your OK.

I hope it can help us know our health as well.

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AllOne Mobile and HealthVault: Using Cell Phones to Share Health Info

From Health Data Management:

Wilkes-Barre, Pa.-based AllOne Health Group Inc. will integrate its AllOne Mobile software with the HealthVault initiative of Redmond, Wash.-based Microsoft Corp. This will enable consumers to access and transmit their personal health information using cell phones and smart phones.

AllOne Mobile software enables a consumer to download a personal health record to a phone, or access it via the phone. The record can be changed either on a Web site or the phone and automatically updated on both ends. Under the alliance with HealthVault, an AllOne Mobile user will be able to fax information from a personal HealthVault account to a physician, family members and others via a smart phone or any cell phone with text messaging.

The technology will support Health Level Seven messaging standards and a standardized Continuity of Care Document.

See the video from AllOne Mobile.

(Thanks to ICMCC)

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