Medicine to Train Health Care Professionals in Health Informatics

In response to the increasingly critical role of health care information technologies in the evolving health care delivery system, Duke Medicine has created the Duke Center for Health Informatics (DCHI) to provide a campus focus for health informatics.

DCHI will oversee an innovative interdisciplinary approach to education that will produce a new generation of physicians, nurses, and health care administrators with an expertise in the use of informatics to improve human health.

The DCHI is a collaboration among the nationally recognized Duke University Schools of Medicine and Nursing and the Fuqua School of Business and will reflect a synergy resulting from the various areas of informatics excellence across the three schools.

W. Ed Hammond, PhD, one of the world’s pioneers in health care information technology, has been named the director of the DCHI.

“There is little question that succeeding following health care reform will require health care professionals and executives to have an understanding of health informatics and how informatics can be applied using specific tools and capabilities,” said Victor J. Dzau, MD, chancellor for health affairs at Duke and CEO, Duke University Health System.

“I believe the DCHI will play a significant role in advancing the pragmatic application of informatics in many health care settings.”

DCHI will have a strong focus on the outcome of improving human health, a tight integration between health system operations and research programs, and a distinctly interdisciplinary curriculum and training environment. The program will, in all of its components, emphasize the use of information and information systems to improve human health.

Educational offerings are being planned and reviewed across the campus to advance this new center’s academic mission.

“Bringing these strong resources of Duke University together with an emphasis on applied health informatics is a unique vision, and one that will help meet the national demand for trained informaticists to guide the design, implementation, and evaluation of health IT for the betterment of human health,” said Asif Ahmad, vice president, diagnostic services, Duke University Health System, and chief information officer for DUHS and Duke University Medical Center.

“Students at Duke will be able to use the Duke Health Technologies & Systems as a ‘living lab’ in which to learn how to deploy and analyze these tools and technologies.”

The DCHI will be administratively housed in the Duke Translational Medicine Institute led by Robert Califf, MD, vice chancellor for clinical research and director of the Duke Translational Medicine Institute.

“The interdisciplinary nature of the Center and strong connection with the Translational Medicine Institute and the health system is a distinct statement of our commitment to leveraging health informatics to improve human health,” said Califf.

Over the past forty years, DCHI’s Hammond has held virtually every leadership position of significance in the world of health information technologies, and is widely recognized as having made seminal contributions to the field.

He is a past president of the American Medical Informatics Association (AMIA) and the American College of Medical Informatics. He served as a member of the Institute of Medicine Committee on Patient Safety Data Standards, served on several National Institutes of Health review committees, and has published over 300 technical articles.

The DCHI will bring together more than 50 Duke faculty and its initiation will be supported by a grant from the National Center for Research Resources (NCRR) through the American Recovery and Reinvestment Act (ARRA).

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Health Insurance Denied For Those Having Pre-Existing Medical Conditions

In a new report, “Coverage Denied: How the Current Health Insurance System Leaves Millions Behind,” the U.S. Department of Health and Human Services examines the insurance company practice of denying coverage to or discriminating against Americans who have pre-existing medical conditions.

A recent national survey found that 12.6 million non-elderly adults — 36 percent of those who tried to buy insurance on the private market — were discriminated against in the past three years because an insurance company deemed them ineligible for coverage because of a pre-existing condition, charged them a higher premium, or refused to cover their condition. Another survey found 1 in 10 people with cancer said they could not get health coverage, and 6 percent said they lost their coverage because of their diagnosis.

The insurance company practice of denying coverage because of pre-existing conditions is not confined to serious diseases. Even minor problems such as hay fever could trigger prohibitive responses. An insurer could charge high premiums, deny coverage, or set a restriction such as denying any respiratory disease coverage to a person with hay fever, according to the report.

What’s more, some insurance companies respond to an expensive condition such as cancer by initiating a thorough review of the patient’s health insurance application. If the company discovers that any medical condition, regardless of how minor, was not reported on the application, it could revoke coverage retroactively for the patient and possibly all members of the patient’s family, the report said. The practice is known as rescission.

Companies can do this even if the condition found is not related to the expensive condition or if the person wasn’t aware of the condition at the time.

At least one company encouraged employees to revoke sick people’s health coverage through rescissions, the report said.

Under health insurance reform, insurance companies would be prohibited from refusing coverage based on someone’s medical history or health risk. Companies also would be barred from watering down coverage or refusing renewal because someone becomes sick. Companies would have to renew any policy as long as the policyholder pays the premium in full.

Chemical Used In Plastic Bottles Harm Health

A new study from Harvard School of Public Health (HSPH) researchers found that participants who drank for a week from polycarbonate bottles, the popular, hard-plastic drinking bottles and baby bottles, showed a two-thirds increase in their urine of the chemical bisphenol A (BPA).

Exposure to BPA, used in the manufacture of polycarbonate and other plastics, has been shown to interfere with reproductive development in animals and has been linked with cardiovascular disease and diabetes in humans. The study is the first to show that drinking from polycarbonate bottles increased the level of urinary BPA, and thus suggests that drinking containers made with BPA release the chemical into the liquid that people drink in sufficient amounts to increase the level of BPA excreted in human urine.

In addition to polycarbonate bottles, which are refillable and a popular container among students, campers and others and are also used as baby bottles, BPA is also found in dentistry composites and sealants and in the lining of aluminum food and beverage cans. (In bottles, polycarbonate can be identified by the recycling number 7.) Numerous studies have shown that it acts as an endocrine-disruptor in animals, including early onset of sexual maturation, altered development and tissue organization of the mammary gland and decreased sperm production in offspring. It may be most harmful in the stages of early development.

“We found that drinking cold liquids from polycarbonate bottles for just one week increased urinary BPA levels by more than two-thirds. If you heat those bottles, as is the case with baby bottles, we would expect the levels to be considerably higher. This would be of concern since infants may be particularly susceptible to BPA’s endocrine-disrupting potential,” said Karin B. Michels, associate professor of epidemiology at HSPH and Harvard Medical School and senior author of the study.

The researchers, led by first author Jenny Carwile, a doctoral student in the department of epidemiology at HSPH, and Michels, recruited Harvard College students for the study in April 2008. The 77 participants began the study with a seven-day “washout” phase in which they drank all cold beverages from stainless steel bottles in order to minimize BPA exposure. Participants provided urine samples during the washout period. They were then given two polycarbonate bottles and asked to drink all cold beverages from the bottles during the next week; urine samples were also provided during that time.

The results showed that the participants’ urinary BPA concentrations increased 69% after drinking from the polycarbonate bottles. (The study authors noted that BPA concentrations in the college population were similar to those reported for the U.S. general population.) Previous studies had found that BPA could leach from polycarbonate bottles into their contents; this study is the first to show a corresponding increase in urinary BPA concentrations in humans.

One of the study’s strengths, the authors note, is that the students drank from the bottles in a normal use setting. Additionally, the students did not wash their bottles in dishwashers nor put hot liquids in them; heating has been shown to increase the leaching of BPA from polycarbonate, so BPA levels might have been higher had students drunk hot liquids from the bottles.

Canada banned the use of BPA in polycarbonate baby bottles in 2008 and some polycarbonate bottle manufacturers have voluntarily eliminated BPA from their products. With increasing evidence of the potential harmful effects of BPA in humans, the authors believe further research is needed on the effect of BPA on infants and on reproductive disorders and on breast cancer in adults.

“This study is coming at an important time because many states are deciding whether to ban the use of BPA in baby bottles and sippy cups. While previous studies have demonstrated that BPA is linked to adverse health effects, this study fills in a missing piece of the puzzle-whether or not polycarbonate plastic bottles are an important contributor to the amount of BPA in the body,” said Carwile.

The study was supported by the Harvard University Center for the Environment and the National Institute of Environmental Health Sciences Biological Analysis Core, Department of Environmental Health, HSPH. Carwile was also supported by the Training Program in Environmental Epidemiology.

Health Care Bill Page 58 Explained

Recently, health insurance companies have been funding certain emails meant to distort America’s view of what is happening with the new health care bill. Health Care Bill page 58 has been at the top of the list. The email has stated that everyone will be issued a National ID Healthcard. Page 58 of the Health Care Bill does not state this.

The Health Care Bill on page 58 does not state that there will be a national ID card. It also does not state anything about a card at all. The Health Care Bill does talk about how health care will be rendered at the point of service. The person’s ability to pay for services will be determined at the point of service. This information will determine what the person needs help with and if that person is eligible for a specific service at a specific place with a specific specialist or general physician.

In order to prevent a lot of hassle in hospitals and other health care facilities, over the years there has been changes in some parts of the nation. Computer chips have been tried with a person’s full health record on it. The person would carry this card around, and when health care is needed, then the person brings the chip with them. The health care provider is then able to put the chip in their computer and immediately have access to previous medical conditions as well as financial considerations in regard to that specific patient. Health Care Bill page 58 discusses a very similar thing.

With all the hype going on about a “socialized” medical system and government run health insurance, many Americans are naturally frightened. It is important to understand what the real bill says before getting all worked up about some email that most likely is not legitimate. The Health Care Bill Page 58 is specific as to how services and the eligibility for services will be accomplished.

If there is any question about what an email may be saying check it out. There are sources that are available to the public so that correct information can be obtained. Don’t just believe one source, check out many sources, looking at both the pros and the cons to make your own decision. Health Care Bill page 58 is definitely a bill that has been distorted in the vision of the United States. Become informed and check out the government pages and the bills listed and be able to spot the tricks when they come knocking at your door.

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