Plain Donuts

Today is the start of a long and complex system testing for our next major upgrade. The upgrade is an important component to make our system MU (Meaningful Use) Compliant.

It is so critical that I was asked not to leave for the Philippines this April to support the technical side of things.  My only consolation, unlimited supply of plain donuts.

Patient Care

I spent my weekend working to improve patient care through the use of technology in a foreign land. I hope I would have a chance to make it useful where it needed the most...back home.

#203: Transition

In about a week I will be starting a new adventure. I will be joining a team of Technology Experts that will push for an initiative to computerize Medical Records of more than 165,000 patients from about 700 Health Care providers in San Diego. This is indeed a daunting task. But first I need to wrap up things with my soon to be former employer to ensure a smooth transition. Proper way to part ways.

#191: Reading materials at Kaiser

It's always a common site when you go to a clinic where reading materials are everywhere. It's a way to tell you that "you're gonna get bored waiting and here's something to read while we let you wait".

Well, here's a interesting reading material at Kaiser while me and my daughter Deirdre were waiting to see a doctor. On the first glance it just another one of those magazines.

But wait take another look.

Yes this magazine is dated August 23, 1988. This is even older that my daughter. So you think Kaiser is High tech?

#134: It's about time

Yes, it's about time. The U.S. House of Representative just passed  a comprehensive Health Bill called the "Affordable Health Care for America Act," The Bill was pass  in a 220 to 215 vote.

You can read the the full text House bill here. All 1,990 pages of it. It may not be as dramatic as a Sydney Sheldon or a Danielle Steele novel, but this is very important for everyone. There are many key provisions of the bill but I specifically like:

 Creates a public health insurance option and a national exchange for the uninsured and small businesses to purchase health insurance. The Secretary of Health and Human Services would negotiate rates with doctors and hospitals on reimbursement rates.

This is a sigh of relief to have an option instead of being locked with an HMO.

 Insurance companies are prohibited from denying coverage based on a pre-existing condition. There are caps on deductibles and annual out of pocket spending is capped at $5000.

Again this will force HMO to give coverage to all individual regardless of their medical condition.

You can read more about this key provision here.

I've been working for a non-profit clinic for years. We see more than 20,000 patients a year of which more than 60% are either uninsured or under-insured. For the past years, that number have shoot up due to people losing their job and consequently lose their medical coverage. I've seen funding from the State and Federal Government reduced so much that it caused a heavy burden to Community Clinics. But we have no choice. Our clinic has a standing policy NOT to refuse patient regardless of their ability to pay.

This bill, (despite vigorous opposition) is a positive step towards fixing a broken system.  Is it perfect? maybe not but it's better than continuing what we have right now.  Of course this bill still has to pass through the Senate and expect a full throttle lobbying from the HMO's to kill this bill.

If nothing is done about the U.S. Health Care System then you either not allowed to get sick or move to Canada or France where they have universal health care.

#133: My plate's full

I'm having a hard time deciding what to write. It's one of those days that I feel like doing nothing after a hard day's work.

As always, my day starts by dropping off Nadire to school at 7:30 AM. My work doesn't start till 9AM so I had all the time to prepare.

My plate is full and projects keep piling up. First order of business in the office on fridays is a teleconference with our developers in implementing ClearHealth in our Clinic. Next is a new project to develop an online survey system based on LimeSurvey to be used by the sdAPI project. Another is a VOIP implementation of Elastix for a small business. Elastix is a tough nut to crack.

Later in the afternoon is another brainstorming session for my SimpleTransactions project which will soon be launched in December.

In between these craziness, I caught a glimpse of a scene from the movie "Erin Brockovich" (fast forward to 6:27)

Ed Masry: What makes you think you can just walk in there and take whatever you want?
Erin Brockovich: They're called boobs, Ed.

By the time I was done, it was 6PM and I have to rush back home to have dinner with the kids. Josh is out watching his school's football game. Nadire's out with her friend. So it was just me and Deirdre. We decided to go for Vietnamese food this time.

So many things to do, so little time. Can't wait for the long thanksgiving break.

#77: Don't get sick

I caught Pres. Obama's speech on the U.S. Health Care last Wednesday.  I was very interested since I have been involved with the Health Care Industry for quite a while.

I work for a non-profit community health center and I have a first hand witness on how this system is so broken. I couldn't believe at first that there's so many Americans who are either uninsured or under insured but it is the reality. What is more startling that these are not just the poor but actually in middle class. These are people who have jobs but cannot afford to get insurance either because it's to expensive or got refused due to pre-existing conditions.

Obama speaks of the truth when he said "I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable."

But of course, these very rich insurance companies will do everything to protect their business. They will not go down without a fight. They want the system to remain the same.

In the meantime, as the debate rages in this country, you are not allowed to get sick. If you do, you are screwed.

#52: Open Source Project for Health Centers in the Philippines

I've been involved with HIT (Health Information Technology) in a community clinic setting for the past 10 years using open source.

In my earlier post, I mentioned about my involvement with the ClearHealth Project. This project is more usable in the U.S. health care system.

So what if this project can be used in the Philippines? It could probably work but needs to be customized to reflect the health care landscape in the Philippines.

But then, I just stumble on an existing project called Community Health Information Tracking System or CHITS.

according to the official website,

The Community Health Information Tracking System or CHITS (www.chits.ph) is an extensible, modular, open source information system for rural health units (initially for the Philippines). It collects existing routine health data from vertical programs in the Field Health Service Information System (FHSIS) and integrates them into a unified, comprehensive computerized information system. Through CHITS, community-based health information is made available not only to public health agencies requiring community level information but also to the community itself which generates the information. It enables the community to use this information for local decision-making and health planning. In addition to software, CHITS also includes structured capability-building programs designed to improve the health information systems within local health centers, regardless of the level of automation. CHITS began in Pasay City and is now in 18 health facilities (July 2008) around the country with requests for installation from many more.

This is such an exciting project that can power up Health Centers in the Philippines at a low cost. Checking the system requirements, the program was written in PHP and uses MySql database and Apache web server. A platform that doesn't require expensive hardware. In fact, the project would cost around P20,000.00 per install.

The Philippines has 1,495 towns. If we have a community center per town that will cost about P30M. Quite an amount.

But there's a way to reduce this cost. Each province can establish a data center and install a higher capacity server to be shared by each health center within a province. Let's say a data center average cost is P200,000.00 x 81 (provinces), the cost will just be around P16M.

There may be some other cost not included such as maintenance and program development cost but think about a nationwide Health information system that will improve the delivery of health services in the rural areas. Think about a system that is free from the clouts of proprietary vendors.

Maybe the Provincial government of Abra might want to consider this project...

#21: Leveraging Open Source in Health IT

I was interviewed by linux.com in August 2008 (FOSS app eases the pain for San Diego community clinic) regarding my works in leveraging Open Source Technology in Health Care particularly to non-profit community clinics.

I first presented the idea on a round table discussion with other clinics around San Diego back in 2003. The discussion was attended by CEO's, CFO's and IT Manager. Unfortunately, the feedback was all negative and somehow even elicit some faint laughter. I remember one of the attendees said to radical, too good to be true and emphatically declared "if it's free it must be worthless". I left that meeting disappointment but not discouraged.

Six years later, I succeeded in bringing a cutting-edge Health Care software that enabled our clinic to survive the rapid changes. While other clinics are now struggling and confused on what to do next, our clinic is at full speed ahead in our implementation of a low-cost sophisticated EMR (Electronic Medical Record).

Every time I look back on what had happened through the years, I'm always reminded on Mahatma Gandhi's famous quote, "First they ignore you, then they laugh at you, then they fight you, then you win".