The TAP-IN Blog

Sermo: Update on a Large Online Doctor's Community

At Tap-In, we believe that health care professionals interested in and engaged in volunteering at free clinics can benefit by interacting with one another via the Web. That's why we invite you to comment on these blog posts. Some question whether busy doctors, nurses and dentists can or will find the time to do so. But there's some strong evidence that doctors do use the Web to interact with one another.

This past October 22 and 23 in San Francisco, the third Health 2.0 Conference was held. Drawing from the widely used term "Web 2.0" this conference highlights the increasing use of social and interactive media in the health care industry. One of its presenters, who was interviewed on stage, was Daniel Palestrant, the CEO of Sermo, an online social network of physicians that was started about two years ago.

The business model of Sermo is to provide sponsoring companies - pharmaceuticals, medical products, and more recently financial news publishers - access to doctors and their conversations. There are no advertisements on the site and access is free as long as you can be verified as a practicing physician.

What makes Sermo newsworthy for Tap-In visitors and partners, is the assertion by Palestrant that it has over 90,000 member physicians and is adding about 7,000 new physician per month. And that "99.9%" of member visits are what is described as "peer exchange" rather than participation in surveys presented by commercial sponsors. As seen in this video of Palestrant's interview, he claims that almost 1/5 of the total number of physicians in America are registered members, and that contrary to expectations, the busiest doctors do join and log in.

Enhancing an Online Community for Clinic Workers

On several occasions I've blogged about the Community Clinics Initiative, created by the Tides Foundation to serve the needs of clinics in California. Specifically I've sung the praises of the Community Clinic Voice, the online community and resource pool that allows clinics to collaborate and share ideas.

Now, with the receipt of new funding, the Voice is extending a Request for Applications (RFP) seeking four issue-area experts as consultants to an Editorial Review Board (ERB) that will enhance its online library of tools and resources for clinics.

The Community Clinic Voice was launched in 2001 to provide an online gathering place for clinic professionals to network, share information and exchange ideas in order to build stronger and healthier communities.

To further support operational efficiencies in clinics, the Community Clinic Voice (CCV) will expand and enhance its collection of peer-recommended tools and resources in each of our four issue areas: Clinical, Financial, Information Technology and Operations. Our aim is for the CCV site to be a lasting resource for the field that continues to provide members with key information and tools to support their work.

Needed tools and resources will be identified and evaluated on specific criteria through an editorial review process, then organized in a "Recommended" collection that will include such documents as best practices, clinical protocols and guidelines, operational policies and procedures, model human resources forms, job descriptions, salary surveys, regulatory guidelines, IT strategic plans, fund development tools, and others.

For more detail on responsibilities, compensation and a timeline for the project, please follow the link to the RFA. The window for applications closes October 31. 2008.

North Carolina Web Site Directs Uninsured to Care

If you're a North Carolinian without insurance or a regular source of health care, you can look up your nearest options using this new Web site provided by the North Carolina Institute of Medicine. Using simple dropdown menus and checkboxes on a Web page, someone looking for care enters their location, their insurance status and the kind of care they're needing. The system searches its resources and provides them with the name, address, hours and phone numbers of clinics or other facilities that meet their needs, plus a map showing the exact street location.

Given the undercapacity of so many medical care facilities, information and referral systems like these should be available everywhere. Finding facilities is half the battle.

A recent study found that only about half of the uninsured were aware of community services that could help them.

"We wanted to put together a resource so people would know what's available in the community," said Pam Silberman, president and chief executive officer of the Institute of Medicine. "It also helps communities know where there are gaps" to establish new programs.

HOW DOES IT WORK? It lists each county and sorts for various services such as pharmacies, free clinics, mental-health programs, and doctors and dentists who take Medicaid, the federal insurance coverage for the poor. About 250 organizations are listed.

WHO PAID FOR IT? The effort was funded by grants from the Duke Endowment and Blue Cross & Blue Shield of North Carolina Foundation.

WHAT PROMPTED THE IDEA? A task force formed by the institute studied the services available to people in the state who don't have insurance and recommended in 2005 that the Web page be developed.

WHY NOW? More and more people in North Carolina have no insurance and are struggling to find health-care services, Silberman said. In 1999-2000, the rate of the state's uninsured increased 25 percent, she said, while it rose nationally 12 percent. The primary reason was a loss of employer-based coverage, she said.

 

Online Networking: More Advantages for Clinics

Community clinics must run tight budgets both in money and time allocations, so it's crucial that they don't waste time re-inventing wheels, i.e. solving administrative problems that have probably been solved by other clinics before. Sharing earned knowledge should be part of the standard operating procedure for volunteer-staffed clinics. The Web is the idea platform for facilitating that sharing.

Every week I get the email newsletter "What's New on the Community Clinic Voice!" And with every newsletter I get at least one more example of how such a communications organ can make life simpler for each of the clinics that receive it.

I've described the Voice and its host organization before, here and here. The newsletter directs its readers to a members-only online discussion community. In the current issue of the newsletter I find these pointers to online discussions where mutually valuable knowledge is being shared:

Patient No Shows – Policy and Procedures – Do you have a patient no show policy you can share? Or information on charging patients a no show fee after a certain number of no show visits?  Some info has been posted, if you have more to share please post here!
http://www.communityclinicvoice.org/webx?14@@.eeaeda3

Vacation and Sick PTO – Have you instituted a paid time off policy to replace your existing vacation and sick time policies?  If so, do you have recommendations or experiences to help avoid any pitfalls that could create problems?   How was the existing Sick time handled? Please post here with any advice!
http://www.communityclinicvoice.org/webx?14@@.eeaed86

Work Load Distribution – Do you employ multi-function staff at your site?  If so, how do you go about ensuring a balanced work load distribution?  If you have info to share, please post it here!
http://www.communityclinicvoice.org/webx?14@@.eeaea0d

Community Clinic Voice - the Web Used Well

The Web used well can save lots of time and money for communities of practice. Community clinic administrators fit the description, "groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly," but only if they interact regularly.

The Web facilitates that interaction among clinic workers who live and work at a distance from one another. Through that interaction, they can share their approaches to their common challenges and collaborate on confronting and solving them.

An online portal - managed by a very active and involved information service, based on a simple but versatile site design, providing poweful community tools and savvy - offers many clear benefits, raising the collective awareness, intelligence and efficiency of every participating clinic.

Four weeks ago I blogged about Community Clinic Voice, a new collaborative web site sponsored by the Community Clinics Initiative now being used by a growing number of clinics in California. It's an instructive, smart and progressive example of the Web used well.  As a guest you can see a lot of its information and discussions, but you need to be on staff at one of its member clinics to get access to its more operational discussions and databases.

Here the Voice describes "What Can You Find Here?"

The Community Clinic Voice is a valuable resource of current news and information about health care. The News, Trends & Healthcare Policy section is updated daily with the latest developments that have an impact on community clinics like health reform, Health IT, quality initiatives, reducing disparities, and more. Our news section highlights relevant information and research from key organizations such as California HealthCare Foundation, The California Endowment, CPCA, CSRHA, NACHC, and many others. Community members can choose to have the news items emailed to them daily. In addition, every month we email a News Digest to all community members. The digest is a summary of the main topics and headlines in the news throughout the month with links to specific articles for more information. The Calendar section is updated with seminars, conferences, and workshops available to clinics in California. The Job Postings section contains listings of open positions in community health centers. These three areas are open to the public, membership is not required.

Community members can also access discussions and a wide range of resources and tools in the Clinical, Financial, Operations and Information Technology sections, including notices of available funding and current RFPs. Community members can participate in any discussion, or start a new topic of their own. The discussions allow clinic professionals to share information, experience, ideas and support. Private sections of the site are also available for small groups who wish to exchange information or collaborate on particular issues.

What's most impressive to me is the effort extended by the Voice to invite and then support participation by the clinics. The Voice wants to learn and improve; that much is obvious. It will be interesting to follow the site and see how it affects the operation and success of member clinics.

California Clinics Launch Online Community

The Community Clinics Initiative (CCI) is a grantmaking program established by Tides and The California Endowment that supports community health clinics in California. It has recently moved its Web presence from a regular "static" site to an interactive group discussion site called the Community Clinic Voice, where anyone - clinic staff, patients, interested citizens - can register and take part in conversations about a wide range of topics.

The site includes job postings, a calendar and a directory of registered members. It launched with discussion forums on news, trends, healthcare policy, financial matters, clinical, operations and information technology. All of these are especially useful for clinic administrators and staff, who can now communicate, learn from one another and compare situations and solutions. Access to the system is free.

Kaiser - the Dot Org, Not the Hospitals

Full disclosure: I'm a member/patient of the Kaiser Permanente health care system. It costs an arm and a leg (though it's slightly cheaper than other plans with similar coverage), but I do appreciate the integrated, computerized model that saves me hunting around for specialists who are "in plan" as I've had to do with other providers.

But this article is about the Kaiser Family Foundation and its KaiserEdu.org web site. This is an information resource for researching your own health care and the health care situation as a whole. Its topics include Health and the Law, Health Systems, HIV/AIDS, Medicare, Medicaid, Minority Health, Prescription Drugs, Quality of Care, Women's Health and the Uninsured.

On the Uninsured page you can find plenty of information about the scope and scale of the problem, the politics that surround the problem and issues related to the problem. It even has its own weblog of the latest news and reports including this somewhat surprising one:

California Hospitals Collect More From Uninsured Patients Than From Medicare, Study Finds

California hospitals collect a higher percentage of their listed charges from uninsured patients than from Medicare, according to a study published on Tuesday in Health Affairs, the San Francisco ChronicleRAND and the University of Southern California analyzed data submitted to the state by hospitals from 2001 to 2005. The study found that from 2001 to 2002, hospitals collected on average 18% more of their charges from uninsured patients than from Medicare, and from 2004 to 2005, hospitals collected on average 20% more of the charges from uninsured patients.

Read the whole article and you'll find that the results are not quite as clearcut as the title and first paragraph would lead you to believe.
reports. For the study, researchers from

Kansas City Region to Have Web Maps of Clinics

A press release came to my attention through one of my news feeds, announcing a contract by a regional association of city and county governments (MARC) and a GIS company to produce regional maps that specifically include community clinics. Having up to date information maps available can help with information and referral activities on the parts of local health departments, hospitals and the clinics themselves.

The Mid-America Regional Council (MARC) has awarded Applied Geographics, Inc. (AppGeo) a contract to develop a Health Net Mapping application. The project will use the latest in Internet mapping technology to present health clinic locations and attribute data (hours of operation, types of services offered) for the benefit of customers and social service agencies. Health clinics are facilities that provide health and wellness treatment services to uninsured and underinsured children, adults, and families. The Health Net website will be launched prior to the 2008 Cover the Uninsured Week, April 27-May 3.

MARC is the association of city and county governments as well as the metropolitan planning organization (MPO) for the bi-state Kansas City region, and it represents the interests of nine counties and 120 cities in Missouri and Kansas.

An Urban Doctor, Housecalls, Uninsured Patients and the Net

When a situation becomes untenable, as our American healthcare system has become, the times call for innovation and experimentation with new ways of getting things done. TAP-IN's approach of motivating and recruiting retired professionals to staff community clinics is one way of delivering healthcare to people who are left with no alternatives. Many general practice doctors are losing enthusiasm for what has become a nightmare of paperwork and business management when what they really want to do is treat people. Here's an example of a doctor tailoring his practice to allow him to do just that, and to treat the uninsured in the bargain.

On Healthblog, Microsoft's worldwide health director Bill Crounse, MD writes about how technology can help deliver healthcare to those who need it around the world. In an article blogged yesterday, he describes the unorthodox practice of Dr. Jay Parkinson of New York City, who does not operate out of an office, but  visits his patients in their homes and coordinates his patient communications through the internet. The blog article includes a link to a video interview of Dr. Parkinson by Dr. Crounse. Here is the written intro to the video interview, as provided by ScribeMedia, who produced the video:

Jay Parkinson, MD, started a new practice that services patients entirely through the Internet and house calls. Jay has no office of his own. He targets young urban professionals, artists and freelancers within NYC. Most of these people are web savvy and uninsured.

A form on the web site guides patients towards trying to make a diagnosis so that when Jay leaves for a house call he can have the appropriate tools and medicine with him. Because his costs are so low, Jay can pass on the savings to his patients. Essentially, Jay acts as a first line of defense for the health care industry to help guide patients towards a healthy resolution to what ails them. Jay often guides patients towards other providers within the health care system.

Most of Jay’s patients are uninsured. Jay acts, on their behalf, as a patient advocate and health financial consultant. He spends a lot of time finding the best value for a variety of services a patient might need beyond his core services. Jay can then refer patients to those providers that offer good service for a good price. For example, in Manhattan the price of a chest x-ray ranges from $50 to $350. Most patients are unaware of this discrepancy. Without Jay’s help, many would be paying more than what they need to pay for a variety of services.

Social Networking Doctors on the Web

The Web is a rich environment for sharing knowledge, so the idea for SERMO would have seemed obvious a long time ago. Sometimes the culture of the Web and the software it inspires combine to provide fertile conditions for new communities to discover a preferred electronic hangout space.

SERMO (Latin for "conversation") is an online community with over 32,000 registered members - all authorized practicing physicians in the U.S. It supports itself through funding provided by businesses interested in learning what doctors are talking about amongst themselves. The pharmaceutical company Pfizer has recently joined SERMO as a partner because it wants to hear more directly from doctors who prescribe its products. This has created some controversy within and outside of the SERMO community.

According to the SERMO FAQ:
"Sermo's business model is one of information arbitrage, the opportunity that arises when breaking medical insights intersect with the demand for actionable, market-changing events in healthcare."

I'm not a doctor, so I can't get a member's view of the "community" and its conversations, but here are some press descriptions of SERMO:

Business Week called SERMO "an online community where authorized health-care professionals meet to debate diagnoses and discuss best practices in medicine. Doctors can post specific problems, such as an image of an unusual X-ray, and survey other members on the patient's most likely condition (all patients remain anonymous). It's also a platform to debate larger issues facing all doctors."

NPR described how SERMO earns revenue: " Sermo was launched about a year ago, and now has more than 30,000 members. Doctors join for free. Sermo makes its money by letting hedge funds, government agencies and drug companies pay to peek at what all those doctors are talking about.