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Friday, 8 April 2016

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

Princess Health and Feds find security flaws in Kynect; state says no data breaches; problems also found in federal exchange. Princessiccia

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State health-insurance exchanges in Kentucky, Vermont and California had "significant weaknesses" in protecting their electronic information from hackers, the Government Accountability Office said in a report last month.

"These included insufficient encryption and inadequately configured firewalls, among others," said the report from the investigating arm of Congress. "In September 2015, GAO reported these results to the three states, which generally agreed and have plans in place to address the weaknesses."

Ricardo Alonso-Zaldivar and Frankfort-based Adam Beam of The Associated Press report, "Vermont authorities would not discuss the findings, but officials in California and Kentucky said this week that there was no evidence hackers succeeded in stealing anything."

The report said the federal Centers for Medicare and Medicaid Services, which oversees the exchanges, had not fully implemented its oversight of their security and privacy protections.

"The GAO report examined the three states' systems from October 2013 to March 2015 and released an abbreviated, public version of its findings last month without identifying the states," AP reports. "Thursday, the GAO revealed the states' names in response to a Freedom of Information [Act] request from the AP. According to the GAO, one state did not encrypt passwords, potentially making it easy for hackers to gain access to individual accounts. One state did not properly use a filter to block hostile attempts to visit the website. And one state did not use the proper encryption on its servers, making it easier for hackers to get in. The report did not say which state had what problem."

Steve Beshear, who was governor until early December, told AP through a spokeswoman that "because of the time required to fix the technical issues, not all those issues had been addressed" when Republican Gov. Matt Bevin took over. "It is important to note that there were never any security breaches of any kind, and no one's information was ever compromised."

Doug Hogan, spokesman for the Cabinet for Health and Family Services, told AP the fixes "are in various stages of completion and implementation" and security is "of the utmost importance" to the Bevin administration.

Bevin is dismantling Kentucky's exchange, which Beshear branded as Kynect, and planning to transfer the 93,000-plus people who used it to buy federally subsidized policies to the federal exchange, Healthcare.gov.

"But Kentuckians' information might not be any safer on the federal exchange," AP reports. "According to the GAO report, Healthcare.gov had 316 security incidents between October 2013 and March 2015. Such incidents can include unauthorized access, disclosure of data or violations of security practices. None resulted in lost or stolen data, but the GAO said technical weaknesses with the federal system 'will likely continue to jeopardize the confidentiality, integrity and availability of Healthcare.gov.'"

Princess Health and Dr. Nikki Stone and mobile dental team in Hazard have helped cut tooth decay in the region 20 percent in a decade of operation. Princessiccia

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By Ann Blackford
University of Kentucky

When Dr. Daria "Nikki" Stone, associate professor at the University of Kentucky College of Dentistry, became the director of the Ronald McDonald Care Mobile program in Hazard, she realized she was finally in the right place at the right time, where her piece of the puzzle fit in the big picture.

Growing up in Blackey, in Letcher County about 30 minutes from Hazard, she didn't know she wanted to be a dentist. She was always a good student and loved science classes in school but her passion had always been art. At her father's coaxing, she entered college as a pre-med major, and discovered through the UK Health Careers Opportunities Program that dentistry was a profession that merged her love of art and science.

Dr. Daria "Nikki" Stone (University of Kentucky photos)
"Now, I have a passion and love for what I do, preventing tooth decay in children in elementary schools, preschools and Head Start centers in Eastern Kentucky and advocating for underserved children," Stone said.

Stone married her high school sweetheart, Mark, and they have two children; Ana and Ian, 16 and 13. Her early career included part-time teaching and covering clinics in Prestonsburg and Hazard as a stay-at-home mom and working in New Mexico for the National Health Service Corps to retire a school loan. She got a transfer to be closer to family, and her last year with NHSC was just across the Kentucky border in Virginia.

She had been practicing dentistry for 10 years when UK hired her to head the Mobile Care program, coming full circle to the place she holds most dear.

"I love that I've been able to come home to Appalachia, there is no more beautiful place or more wonderful culture," she said. "I love the way my people talk and hug and laugh, and I love that we are a deeply spiritual people who are deeply connected to one another. My children are 10th generation Appalachians and I wouldn't want to raise them anywhere else."

UK's North Fork Valley Community Health Center's mobile dental outreach program celebrated 10 years of serving children in 2015. Stone has directed the program since its inception. She and several dental hygienists and assistants provide preventive dental care twice a year to 2,400 Head Start children in Perry, Knott, Letcher and Leslie counties and once a year to all public elementary schools in Perry and Knott counties. Children receive dental exams, cleanings, fluoride treatments, sealants and both classroom-based and individualized educational sessions. Dental education is also available to parents and teachers at various community events.

"Teaching is actually one of my favorite parts of my job," Stone said. "I also love the practical, day-to-day side of being with children, and I also love the philosophical aspect of why we're doing what we're doing. . . . Children are truly a blessing to work with; they are so very honest and keep us laughing all day. I love that we are preventing tooth decay before it starts and lowering the tooth decay rates in Eastern Kentucky, which has some of the highest rates of tooth decay in the nation."

Stone and patient Wyatt "Bebo" Goins at
Roy G. Eversole Preschool in Hazard
Tooth-decay rates in the center's service area have decreased nearly 20 percentage points, urgent dental needs have been cut in half, and treatment-completion rates for Head Start children with urgent dental needs have increased dramatically, from 8 percent to more than 60 percent.

"When the UK dental outreach team started seeing children in local schools and Head Start centers in 2006, over half the children in Perry County had untreated cavities and 20 percent had painful abscessed teeth," Stone recalled.

Stone said she has found her place in the world. "I once had a very spunky little girl come on the mobile unit and she was very excited to be there," she recalled. "She couldn�t stop talking and she spoke really fast, going from one topic to another without transition. She jumped up in the dental chair and asked me this question, 'Did you wish upon a star to be a dentist?' It really caught me off guard and I had to stop and think about it for a couple of seconds. I realized I probably had not ever wished upon a star to be a dentist, but for some reason God chose to bless me with the opportunity to be a dentist to this beautiful little girl anyway, and to provide preventive dental care services to over 10,000 children just like her who have come on the mobile unit in the past 10 years. And maybe some of them will wish upon a star to become dentists someday."
Princess Health and Nominations are being sought for award recognizing lifetime contribution to rural health in Kentucky; deadline is June 17. Princessiccia

Princess Health and Nominations are being sought for award recognizing lifetime contribution to rural health in Kentucky; deadline is June 17. Princessiccia

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In June of 2003, the Kentucky Rural Health Association began an award honoring a lifetime contribution to rural health in Kentucky. The first recipient was Dr. Dan Martin of the Trover Foundation in Madisonville. The annual award now bears his name and is given each year to an individual who has provided many years of service to rural Kentuckians. Last year�s recipient was Joseph E. Smith of the Kentucky Primary Care Association.

KRHA is seeking nominations for this year's award. The nominee�s contributions might be in direct patient care, health professions education, health administration, health promotion or public advocacy. To nominate someone, please download the nomination form here and e-mail it directly to linda.asher@uky.edu or to her at the Office of Rural and Community Health, 2195 Harrodsburg Rd., Suite 125, Room 1213, Lexington KY 40504-3504, or fax to (859)323-1043. The deadline for nominations is Friday, June 17.

The award committee ranks the candidates using established criteria and makes a recommendation to the KRHA Executive Committee, which selects the honoree, if someone is deemed appropriate. The award will be presented at the KRHA annual conference Aug. 25-26 in Bowling Green. Any KRHA member who would like to serve on the Dan Martin Award Committee should email linda.asher@uky.edu. "There are many dedicated, compassionate people at work in rural health in Kentucky and we look forward to being able to give them some well-deserved recognition," Asher says. "Now is your chance to help us thank someone that you think deserves recognition. We need and appreciate your input."
Princess Health and Exercise can help prevent or slow cancer, study suggests. Princessiccia

Princess Health and Exercise can help prevent or slow cancer, study suggests. Princessiccia

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Exercise may keep you from getting cancer and slow the growth of a tumor if you get one, according to a mouse-based study published in the journal Cell Metabolism by researchers at the University of Copenhagen in Denmark.

They report that training mice regularly on a wheel (the mouse version of a treadmill) decreased the growth of multiple types of tumors, including skin, liver, and lung cancers. Also, mice that exercised regularly had a smaller chance of developing cancer in the first place, and less cancer-associated weight loss.

The researchers linked the anti-cancer effects to the release of adrenaline (also called epinephrine), a hormone central to the mammalian �fight-or-flight� response. Exercise stimulates the production of adrenaline, which mobilizes immune cells, including one called a "natural killer." NK cells are recruited to the site of the tumor by the protein IL-6, which is secreted by active muscles. NK cells can then infiltrate the tumor, slowing or completely preventing its growth.

The researchers pointed out that injecting the mice with adrenaline or IL-6 without the exercise was not sufficient to inhibit cancer development, showing that regular exercise was needed to activate the hormone and the protein.

Thursday, 7 April 2016

Princess Health and April 7th, 2016 Their Imaginations. Princessiccia

Princess Health and April 7th, 2016 Their Imaginations. Princessiccia

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April 7th, 2016 Their Imaginations

Today was successful despite being extremely busy. I left the studio just after 4pm, headed to the store for a couple things--then home to freshen up, relax and enjoy a holdover of some sort until a later dinner--then it was off to an annual event I've been a part of for eight years through the radio stations I've called home.

Annual events tend to hold significance in my brain based on what I've experienced during the same stretch of time. Obviously, the last seven and a half years have been transformative for me--and every year, annual events like this one--and many of the people in attendance, see changes in me based on year increments. Regular attendees of the event tonight have witnessed me in every form along the way. From 500 pounds to 300 pounds, 230--then back up and up, and up a little more---then back down and now, where I find me, today. It's interesting to note that--no matter my size, I've always felt welcomed and appreciated--and truly, I've never had a reason to believe my physicality mattered to anyone, but me. Isn't that something? The struggle with that stuff in this specific situation--and in most other situations, lived exclusively in my head. Never before have I felt this level of confident peace.

This annual event thing is significant to me because there was a time when I couldn't stand being out in a large group of people who knew me almost exclusively from my radio show. For the majority of my broadcasting career, I didn't have the perspective I hold dear today. I loved radio for many different reasons--still do, but back in my heaviest days, I also loved the idea of listeners whom I hadn't met face to face, relying on their imaginations to determine my appearance. Appearing in public risked shattering those illusions. If I had a dollar for every time I heard the phrase, "you don't look like you sound," I'd have at least twenty-eight dollars.

I'm hitting the pillow and allowing the Tweets to take it the rest of the way tonight.

I finished the day having met all of my personal goals.  

Today's Live-Tweet Stream:












































Thank you for reading and your continued support,
Strength,
Sean
Princess Health and "Immersion Day" to Expose Hospital Board Members to Real Health Care for a Day - A Great Idea, but Why Should It Be News?. Princessiccia

Princess Health and "Immersion Day" to Expose Hospital Board Members to Real Health Care for a Day - A Great Idea, but Why Should It Be News?. Princessiccia

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Last week, the New England Journal of Medicine published an article by Bock and Paulus describing an innovative program at Mission Health in Asheville, NC to expose health system board members to the real world of health care.(1)  The article was nice, but begged an important question: why was such a program news?

The Immersion Day Program

 The article asserted:

The U.S. health care industry has long been beset by seemingly intractable problems: incomplete and unequal access to care; perverse payment incentives; fragmented, uncoordinated care that threatens patient safety and wastes money; and much more.

So the hypothesis on which the program was based was:

These challenges are particularly vexing to the people who oversee or set policy for health care organizations. The disconnect between health care in its intimate, real-world setting and the distilled information delivered in the boardroom or policy discussions is a key barrier to responsive governance and policymaking. Sometimes seeing with new eyes can lead to transformational understanding

In particular, the two physician authors of the article noted

Yet until 2013, none of our lay board members had ever been afforded the opportunity to see the complexities of care delivery, except when they were patients, visited someone in the hospital, or watched a TV show like Grey�s Anatomy. Like most boards, we did our work in the boardroom. There, management and our four physician board members did our best to paint accurate pictures of our system�s complexity: the workflows and the choreography, the opportunities for error, the forces behind increasing costs, and the good derived from serving all patients regardless of ability to pay. We shared our struggles and successes using PowerPoint presentations, graphs, spreadsheets, and patient statements.

So Doctors Bock and Paulus came up with the idea of providing basically provided a one-day clinical immersion program to members of the hospital system's board of directors.

we created 'Immersion Day,' when board members and thought leaders could spend 9 to 12 hours in scrubs, behind the scenes, immersed in the nuances of care delivery.

Board members went from pre-operative care, to the operating room, to intesive care, to surgical wards to rounds with "nephrologists, pulmonologists, trauma surgeons, and hospitalists, finally to the emergency department.

The board members apparently greatly appreciated thr program:

Board members have called their Immersion Day 'eye-opening and endlessly fascinating,' 'unforgettable and humbling,' even 'the best-spent day of my life.' One said, 'I learned more about hospitals and health care from my 10 immersion hours than 6 years sitting on our board.' Our staff benefits, too: when a physician or nurse meets a board member in scrubs, the encounter builds trust and admiration in both directions. Word spreads. Caregivers express gratitude that the board is spending time seeing what they do; many had never previously met a board member. Physicians� relationships with the board and management, though imperfect, are far better than they�ve been in years, despite ever-increasing challenges.

The authors are now trying to make the program available to journalists, and "state and federal policy makers."  Their conclusion was:

we�ve built a transformative experience that can guide our board. Deep immersion in the work of our health system has strengthened governance and engendered trust in our community, staff, and physicians, while elucidating health care for policymakers. After three years of Immersion Days, we cannot imagine being governed by a board that hasn�t seen so intimately how a health system works.

There are some obvious limitations to this article, which unfortunately were not addressed in the text.  The article was entirely impressionistic.  It presented no data about actual end results of immersion day, much less a comparison to any other kind of interevention.

Furthermore, the authors did not describe some important characteristics of their hospital system which may differentiate it from others.  In particular, the management of Mission Health is much less generic than that of other hospitals.  Half of the top hospital administrators have medical or nursing degrees.  The CEO of the hospital is a physician.  In fact, he was the second author of the article. Five of 21 directors (including the CEO) are physicians.   So it is not clear how this program would work in a hospital whose management is dominated by people with business backgrounds.

Why Is This News?

But the article begged the questions of why this is news? The article stated that there is a big "disconnect" between what is discussed in hospital board rooms, and the health care that goes on in hospitals day by day.  Furthermore, it stated that many hospital board members had no direct experience with health care.  Instead, the article described the non-physician board members, who were by far in the majority, as "educators, attorneys, manufacturers, investors, and bankers."  It did not say why the majority of people responsible for the governance of a health care organization had no direct familiarity with health care.  That does not seem to make sense.  So why did it take so long to try to give them such familiarity, and why would a program to do so be newsworthy? 

The article also failed to note that the hospital in which the immersion program was initiated actually had a board that was more familiar with health care that the typical hospital board.  Many hospital boards of trustees are completely dominated by "attorneys, manufacturers, investors, and bankers," that is, wealthy businesspeople without health care experience, and parenthetically probably without much familiarity with the context of the many less financially fortunate patients of their hospitals.  Mission Health at least had a few physicians on its board.

We have posted some vivid stories about the skewed natures of hospital boards before.  For example,
-  the board of IU Health (Indiana), dominated by top executives and board members of large for-profit corporations (look here).
-  the board of the Hospital for Special Surgery (New York), of whose 42 members, 23 had major relationships, often top executive positions or board memberships, just in large financial firms, including some which were responsible for the great recssion.
Other examples can be found here.

Hospital boards whose members are unfamiliar with health care may reflect hospital management that is similarly unfamiliar with health care. In fact, most hospitals and hospital systems, like most US health care organizations, are not led by health care professionals.  Instead, they are led by generic managers, following the dogmas of managerialism.

We have frequently posted about what we have called generic management, the manager's coup d'etat, and mission-hostile management. Managerialism wraps these concepts up into a single package.  The idea is that all organizations, including health care organizations, ought to be run people with generic management training and background, not necessarily by people with specific backgrounds or training in the organizations' areas of operation.  Thus, for example, hospitals ought to be run by MBAs, not doctors, nurses, or public health experts.  Furthermore, all organizations ought to be run according to the same basic principles of business management.  These principles in turn ought to be based on current neoliberal dogma, with the prime directive that short-term revenue is the primary goal.

Of course, if top hospital leaders do not perceive their own unfamiliarity with health care as a problem, they are unlikely to perceive their boards' unfamiliarity as a problem too.  So it really was news that at one hospital, the management thought it necessary to better educate their own board about what really goes on in hospitals outside board rooms and management suites.

At a really manageralist hospital, whose management is dominated by people with business backgrounds, which may lack any top managers who have any health care background, and whose board is dominated by wealthy businesspeople with backgrounds outside of health care, the management would likely not bother trying to improve their board members' or their own familiarity with health care.  Were they to do so for some reason, I hypothesize that an immersion day for board members would have little effect.  The apparent, but not clearly proven success of  "immersion day" at Mission Health may be due to the important presence of health care professionals in top management and on the board of trustees, but may not generalize to most other hospitals.

In fact, the current leadership of hospitals and other health care organizations almost entirely by generic managers, reporting to boards made up almost entirely of generic managers, defies common sense.  Although trying to give board members some rudimentary familiarity with the health care context, during one day of the year, is obviously better than nothing, it clearly is only a tiny bandage on a gaping wound.  When one hospital deploys such a bandage, it is news.  That most hospitals' managers and boards would not even think of deploying such measures is a scandal.

So as we have said endlessly,...  

We need far more light shined on who runs the health care system, using what practices, to what ends, for the benefits of whom.

True health care reform would enable transparent, honest, accountable governance and leadership that puts patients' and the public's health over ideology, self-interest, and self-enrichment.

Reference
1. Bock RW, Paulus RA. Immersion day - transforming governance and policy by putting on scrubs.  N Engl J Med 2016; 374: 1201-1203.  Link here. 
Princess Health and Flu remains widespread in Kentucky; vaccinations still advisable. Princessiccia

Princess Health and Flu remains widespread in Kentucky; vaccinations still advisable. Princessiccia

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This year's round of influenza hit Kentucky later than usual, and that probably means this year's flu season could run past May, its usual end, the state Department of Public Health said in an alert April 6.

The flu is �widespread� in Kentucky for the ninth straight week, the health department said. "That means there�s increased flu-like activity or flu outbreaks in at least half of the regions of the state," Darla Carter reports for The Courier-Journal.

The department still recommends a flu vaccination, if you haven't had one for the current season, �particularly children 6 months and older and those people at high risk for complications related to the flu, to check with doctors� offices, local health departments, pharmacies or other providers about getting the vaccine,� said Dr. Kraig Humbaugh, senior deputy commissioner.

The agency recommends other precautions:

  • Avoid close contact with sick people.
  • If you have the flu, limit your contact with other people.
  • Stay home for at least 24 hours after your fever is gone. Your fever should be gone for 24 hours without the use of a fever-reducing drug.
  • Cover your nose and mouth with a tissue when you cough or sneeze, then put the tissue in the trash.
  • Wash your hands often with soap and water. If they are not available, use an alcohol-based rub.
  • Avoid touching your eyes, nose and mouth.
  • Clean and disinfect surfaces and objects that might be contaminated with flu and other germs.
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