You start a new job, you sign a contract, and then the division hands you the employee code of conduct. Now, in addition to the “no wearing a speedo” to the office, dress code clause, there is a section on health. Imagine, just as important as your job description or dress code, is your health. From the first day you join the company, you are offered resources, motivation, and encouragement to also maintain health during the duration of your employment? This is the idea behind Health Codes of Conduct.

Most workplace health programs achieve modest gains in health behavior. In a study with 147 employees we collected reactions to a novel approach to workplace wellness that suggests promising directions for future programs. Specifically, the idea is to engage and motivate employees to assume responsibility for their health through a Health Code of Conduct from the first day they are hired.


Henry writes:

“What if someone approaching age 65 who lives in New Hampshire does not want to enroll in Medicare—what kind of health insurance alternatives might be available?”


The Evolution of Facebook’s Privacy Policy

Screen Shot 2015-08-12 at 1.31.08 PMToday a new online journal, ‘Technology Science’, went live. Harvard Professor Latanya Sweeney is the Editor in Chief and Publisher. The project is funded by the Ford Foundation.

Harvard researchers used Patient Privacy Rights’ Privacy Trust Framework to measure, describe, and rate Facebook’s changes to its Privacy Policy through the years.  Their paper is listed second on the Technology Science homepage. Download free at:

According to this new research paper, we know MORE about whether Facebooks’ Privacy Policies actually protect privacy (or not) than we do about US health-related or healthIT corporations.

Why is research on the effectiveness of Facebook’s Privacy Policies relevant to the US healthcare system?


Terry M. BennettIf ever there were an under-discovered, under-researched and under-treated epidemic, this is it. The Jessica McCassie case was all over the news this week, but a brief review of other publications, including your own, produced five or six other cases of road accidents or young people discovered dead without explanation to make me believe the statistics are grossly under-reported.

There are presently two programs in New Hampshire, which address diagnosed addicts and claim to be stabilizing and or curative. One, the methadone treatment centers, is a farce, and is operating at an enormous profit to the three doctors that own the chain, without effectively curing anybody so far as I can see from my viewpoint. It is worth noting the state of Maine has recently canceled any and all payments to methadone treatment programs because of their abysmal rate of return on investment. It is my opinion that New Hampshire should do likewise.

The second program in New Hampshire is the Suboxone program, which I participated in as a licensed MD with Suboxone training. This program is elegant, because, unlike methadone, Suboxone is not sedating. A Suboxone patient, once stable, can perform complicated tasks, operate a motor vehicle, behave as a responsible parent, and in general conduct their lives as if they were not using an opioid. Once again, however, the cure rate for addicts in the Suboxone program approaches zero, almost nobody tapers down and quits using opioids. So we, as a society, are faced with a fairly stark choice; continue Suboxone therapy indefinitely, or plan on relapse to street drugs including heroin, and the fatally murderously mixed version of heroin that has fentanyl added. There does not seem to be any predictable end in sight, once an addict has been created.


Screen Shot 2015-08-13 at 1.07.56 PM

Drug reference apps have become a go-to resource for healthcare professionals, with 46% of smartphone-using physicians accessing them at least once per week, and 26% daily. With so many choices, how do you know if the information you are referencing is accurate?  The good news is the most trusted resource for drug information just received an upgrade this summer.

Redesigned with the healthcare professional in mind, the new mobilePDR provides quick, easy access to the drug information you need, especially “when you’re on the clock, oncall, or on vacation” says PDR Chief Medical Officer, Salvatore Volpe, MD.

Make Informed, Patient-Centric Decisions with Fast, One-Tap Access to Powerful Drug Look Up

Amongst the enhancements, the new mobilePDR provides fast, one-tap access to powerful drug reference tools where you can search by brand, generic, or pharmacological class name. Plus, you can personalize the experience by saving searches for frequently prescribed drugs or access recent searches with a single tap.


I was recently on the phone with a medical device company executive who was describing his company’s efforts to develop a non-invasive diagnostic device that could quantify the degree of cirrhosis in a patient with liver illness.  It’s technology that his firm sees as timely given the recent introduction of Solavdi and other Hepatitis C therapies: the device will be offered as a way for healthcare systems (and insurers) to risk-stratify a bolus of patients who are waiting for hepatitis C antiviral therapy.

As background: Sovaldi was really the first pharmaceutical therapy to give healthcare economists serious heartburn.  It won’t be the last.  The coming era of targeted cancer therapy is extraordinary (and welcome).  My mother died from melanoma only 1-2 years before the extraordinary growth of knowledge of this lethal skin cancer led to a rash of new therapies– medications that target things like BRAF, MEK, C-KIT proteins. But, these and other oncology drugs are fabulously expensive. My mother’s therapy would have cost hundreds of thousands of dollars, which is an expense insurers and risk-bearing systems were’t expecting to take on.

Now, I don’t know how viable this device-assisted triage approach will be, either technically or practically– nor whether it will fly given patient expectations.  But I hold it out as a great example of an emerging trend: the emergence of new technologies introduced to the healthcare market to manage the use of other much more costly medical technologies.



Screen Shot 2015-08-10 at 2.04.19 PMIn the spring of 1938, Dr. Drayton Doherty admitted a sixty-year-old African –American man to the hospital. The small hospital was located at the edge of town in an old house that had been converted into a fifteen-bed hospital. Six of the beds were located upstairs at the rear of the house in what previously served as a sleeping porch. The patient was admitted to that porch.

Dr. Doherty went on to tell me that the patient, Vance Vanders, had been ill for many weeks and had lost over fifty pounds. He looked extremely wasted and near death. His eyes were sunken and resigned to death. The clinical suspicions in those days for anyone with a wasting disease were either tuberculosis or widespread cancer. Repeated tests and chest x-rays for both of these diseases were negative, as was the physical examination. Despite a nasogastric feeding tube, Vanders continued on a downhill course, refusing to eat and vomiting whatever was put down the tube. He said repeatedly he was going to die, and he soon reached a stage of near stupor. Coming in and out of consciousness, he was barely strong enough to talk.


In an effort to improve health outcomes and patient quality of life at lower costs, provider groups around the country are increasingly focused on developing a deeper connection with patients. Expanding digital engagement is central to this effort, with online patient portals at the center of virtual physician-provider relationships. Portals offer patients immediate access to their health records, allow them to schedule appointments and pay bills, and enable secure conversations with providers.

But, as many providers have discovered, simply offering patients an online portal does not mean they will use it.

Over the past few months, my colleagues and I have focused on portal adoption as part of the athenahealth Peak Performance Initiative, a program that combines big-data analytics, consultations with leading providers, and best-practice research to help provider groups improve various aspects of their practices. For the patient portal study, we analyzed more than 1,100 provider groups on the athenahealth network to determine exactly what distinguishes physician groups with very high portal adoption rates from average programs.


Frank writes:

I hope someone can help me understand the requirements for HIE enrollments.

I’m on the front line at a hospital as a patient advocate charged with enrolling admitted patients into the portal.  I get very little information from Administration or the Informatics office.  I know there is a financial incentive for the hospital to enroll patients and have them open one of their charts in the portal.  Initially, we were told in January 2015 that we needed to enroll five percent of our admitted patients bySeptember 30 and enough extra to account for the five percent we would have enrolled in October, November, and December of 2014, had we been involved in the program.  Given that information, we started doing it and we were told how many people we needed per day to meet the final goal.  Several of us have been doing this, mostly on a daily basis and we believe we have met the requirements to date.  Now, Informatics tells us we need to enroll almost 1000 people in August and September.



Tom Ferguson, MD, gave me this robot in 2002, part of the first (and only?) fourth class of awardees of the Ferguson Report Distinguished Achievement Awards. I have kept it on or near my desk ever since.

Reading Tom’s old essays, even as far back as the 1970s, is humbling. He foresaw so much of the world we live in now. I owe him a great debt since part of his vision was to see something in me that I didn’t yet see in myself. He believed in me.

Here is the introduction to the e-patient “white paper” (PDF) he was writing at the time of his death in 2006, which explains his attachment to robots:

DocTom-1948-robot-150x150I collect old toy robots. My Atomic Robot Man robot (Japan, 1948), shown [at right], is a personal favorite. For many years I didn’t understand the powerful hold these dented little metal men maintained on my imagination. One day I finally got it: They show us how the culture of the 40s and 50s imagined the future. Cast-metal humanoid automatons would do the work previously supplied by human labor.

That wasn’t how things turned out, of course. By making more powerful and productive forms of work possible, our changing technologies made older forms of work unnecessary. So instead of millions of humanoid robots laboring in our factories, we have millions of information workers sitting at computers. We didn’t just automate our earlier forms of work. It was the underlying nature of work itself that changed.