Preventive Services and Health Care Reform

November 25, 2011

I sent the following message to many of my patients age 65 and older, and thought it worth posting here:

11/24/11

To my patients,

The Affordable Care Act (AKA health care reform) provides incentives for doctors to utilize electronic health records.

Doctors who do not will soon be penalized by Medicare.

While they really aren’t quite “ready for prime time,” electronic records should ultimately  confer some meaningful advantages for the quality of health care.

One requirement in the law  is that doctors must be able to  demonstrate “meaningful use.”   One of the many criteria for such use is to send reminders to their patients for “preventive and follow-up care.”  Such reminders do not include regular appointment messages.

While my practice does not focus on these services, I believe that it is worthwhile to provide you with access to information regarding such services.

If you are receiving this email, you are either 65 years of age or above, or have a child who is 5 or less.

For general information on Preventive Services, focusing on what is actually useful based on evidence from studies, please see the Agency for Healthcare Research and Quality.  The home page is http://www.ahrq.gov/clinic/prevenix.htm

The following link is very useful in that you can enter your age and sex and get a list of recommended and non-recommended services:  http://epss.ahrq.gov/ePSS/search.jsp

For information regarding Preventive Services available through Medicare, please see:  http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx

As you know, my website, www.drshevin.com has articles on various aspects of health and disease, including some that deal with prevention (such as the article on influenza).

As you also know, a strong feature of my philosophy of health care is that attaining a state of health is a crucial aspect of preventing future disease.  It is fair to say, however, that even the healthiest individual may benefit from preventive services.  Again, the search link given above will give you data regarding appropriate services, including the evidence base for them.

Services like periodic blood pressure readings, monitoring weight, cigarette cessation, PAP smears, etc., have proven benefits, and there are others.

Some services are more controversial.

Thank you for your time in reading this email.

As there is no personal health information in this communiqué, I can send it by non-secure email.

But for those of you who wish to communicate with me regarding your medical care, please use my secure portal at www.telehealthconnect.com

For those of you who missed the invitation to join the secure portal, which probably wound up in your junk mailbox, please contact Donna (donna@drshevin.com) and request that she send a new  invitation.

Please also follow the journal page on my website for updates on the flu (nothing really happening yet) and other health-related matters that I consider timely and important.

I also provide a separate alerts notification (see the forms page of my website) that you can subscribe to.

 

 

 

Secure Email

September 26, 2011

The following email has gone out to everyone on my patient list:

 

To my Patients,

This is an invitation to communicate with me by email, USING A SECURE PORTAL.  Sending specific medical information by regular email is not actually legal under current law (primarily under the HIPAA legislation), UNLESS YOU AGREE, IN WRITING TO ALLOW YOUR PERSONAL HEALTH INFORMATION to be unprotected.

For me, however, this is more than just a legal obligation.  Keeping your health information secure is important, and by signing up with TelehealthConnect.com (a service which I pay for but which is without cost to you), you can be protected.  TelehealthConnect.com also offers other services which may be helpful.

You will need to establish an account with Microsoft HealthVault, which is a simple process and which offers other services that you might be interested in.  The instructions are included in this email.

As many of you realize, for the past year I’ve used a “cloud-based” electronic health record which is hosted on a secure server.  One of the features of the system is to provide you free access to parts of your medical record such as medication lists, future appointments.  Other features will be added in the future that will make this more useful.  In addition, your participation will allow me to show compliance with current federal regulations.  The registration process is quick and simple, and I hope that you will participate in this also.

I also use my Health Alerts email list to keep you informed of emerging health issues, such as influenza, radiation leakages from nuclear accidents, other environmental risks, etc.  If you haven’t yet, I hope that you will be willing to sign up for this service, which can be done on the forms page of my website (www.drshevin.com).

I know that I’m asking you to sign up in 3 different places.  Someday this will all be integrated in a simpler format, but for now, this is the best that I can do.

I also want to invite those of you who have been significantly affected by the current economic crisis, and especially those of you who have lost your jobs and/or your medical insurance.  In the old days, before the passage of the Medicare and Medicaid laws, in a time when communities were smaller and people knew one another, doctors worked out their own arrangements with their patients.  I know that some of you, like millions of others across the country, are not receiving needed care and treatment because of financial problems.  I would like to find a way, for each of you, to receive needed services in a way that you can afford.  While I know that many of you do not want to have unpaid bills hanging over your heads, if the choice is between that and deteriorating health, I hope that you will choose your health.  Please know that I am committed to working out an arrangement that can work for both of us.  This offer extends to close family members whom I may never have seen.  In my entire 37 years of practice, I have never turned away an established patient who is in need.

In summary, to improve the security and usefulness of our communications, please:

1)      Sign up for TelehealthConnect;

2)      Sign up for my Health Alerts if you haven’t already done so;

3)      Sign up for access to your personal health record through PracticeFusion.

Thanks very much for your cooperation.

Dr. Shevin

 

 

Multivitamins found to be (theoretically) valuable

March 20, 2011

The following study, from the American Journal of Clinical Nutrition, was reported in the news media recently:  Multivitamin Use and Telomere Length in Women.

Telomeres are structures at the end of chromosomes which protect genetic information against degradation, and so are thought to be associated with longevity.

In the conclusion to the article’s abstract (see link above), the authors state:  This study provides the first epidemiologic evidence that multivitamin use is associated with longer telomere length among women.

They noted specific correlations with vitamin E and vitamin C, which held true even for women who did not take supplemental vitamins.

While it sometimes appears that science works hard to validate common sense, I think that there is great value in studies such as this one.  But we must be careful about the conclusions, in many ways.

It is safe to say that there are many aspects of good diet which are beneficial for all living creatures.   Wherever possible, we must strive to eat well, in a very broad-based way.

While total calories, adequate (but not excessive) protein, healthy grain carbohydrates, good fats, and adequate intake of vitamins and minerals have been the hallmarks of our thinking about good nutrition, in recent years other aspects of nutrition have emerged.

I am now thinking specifically about the “information” present in nutrition, which helps our bodies regulate genetic expression and therefore influence almost every aspect of our daily functioning.  This “information” takes the form of various chemicals, called “phyto-nutrients” or “phyto-chemicals” (“phyto” refers to being plant-based).

These phytonutrients are found primarily in the colored pigments of fruits and vegetables.

Radiation update 3/20/2011

3/20/2011 — Very low-level radiation has been detected in milk and spinach grown within a 20 mile zone from the disabled nuclear reactor in Fukushima, Japan, including Cesium 137 and Iodine 131.  While nothing can be done about the Cesium, in any case, the levels are not considered high enough to be of significant concern.

A couple of days ago, newspapers in the US reported detection of Iodine 131 in air samples in California, but at exceedingly minute doses (as would be predicted).

At this time, there is no need for any of us to alter our supplement practices.

While continued awareness and monitoring is certainly necessary, barring some dramatic deterioration in the situation in Japan, we in this country are not at  any acute risk.

As the news media has reported, there has been a “run” on commercially available iodine.  This is panic-buying and could be counter-productive for the people of Japan, for example, should there be need to ship large quantities of iodine supplements to protect that country.

Radiation Warning — informational only at this time

March 15, 2011

3/15/2011 — The biggest immediate danger to North America, from the nuclear catastrophe unfolding in Japan, is currently estimated to arise from the pools of spent nuclear fuel rods stored in each reactor building.  Owing to systems failures, these pools  may not be adequately cooled and could conceivably catch fire, which would result in the release of nuclear isotopes into the atmosphere.

The prevailing winds are to the east, meaning that they would head out towards the Pacific coast of the United States.  The amount of radiation reaching the US would depend on the then current wind and weather conditions, but would presumably dissipate to a significant degree before reaching us, owing to the distance involved.  However, like the Chernobyl disaster 25 years ago, the effects would spread across the globe, but would be the most significant nearest the source of the radiation leak.

The composition of the radiation would also depend on the type of fuel rods and their age.  In particular, the presence of radioactive Iodine 131 would become progressively less significant as the rods age.  By 2 months, the iodine would have decayed into harmless isotopes.  But the heavier elements, such as Cesium, uranium, and in the case of one of the spent fuel pools, plutonium, would remain problematic for a very long time.  There is no known way to prevent damage from these heavier radioactive elements except to avoid the exposure.

Damage from radioactive iodine can be mitigated by taking in Potassium iodide by mouth prior to and during exposure.  The organs that readily take up iodine (most notably the thyroid) will be less likely to take up radioactive iodine if they have already taken in significant quantities of potassium iodide by mouth.

For the many of you that are now taking Iodoral as part of the iodine program,  or who took it in the past for at least several months, you are probably already protected, although should a significant exposure occur, we would add a higher dose for a short time (see link in the next paragraph).

For those of you who have never taken iodine supplements, I would strictly follow the CDC guidelines for the use of Potassium iodide.

What I do not know at this point is how much danger is to be expected from radioactive iodine from the Japanese reactors.  This may be significant, or it may be next-to-nothing.

At this time, no one should alter their present supplement programs.  I do not know if there will be any need for us to do anything.  I will continue to post information as if becomes available if it influences possible prevention strategies.

Still flu season and interesting historical notes

February 23, 2011

2/23/2011 — Flu season is still upon us.  I’ve had a few phone calls for achiness, fatigue, muscle pains, and a nasty sore throat and cough.  So far, everyone has responded to their constitutional remedies.

I got a very interesting post regarding Abraham Lincoln’s relationship with homeopathic medicine, which makes interesting reading.

Homeopathic medicines and Nobel Prize-winning scientists

February 1, 2011

Given the recent severe attacks on homeopathy that have been taking place in England in the last year or so, it is interesting to hear the comments of 2 highly respected Nobel Prize-winning scientists.  An article pertaining to this can be found on my website by clicking here.

Influenza update 1/17/2011

January 17, 2011

1/17/2011 — Flu is now reported as being “widespread” in Connecticut and several neighboring states.

The CDC reports, at their flu site, that although some indicators have decreased, it is likely that the flu epidemic for this year has NOT yet peaked.

So far, I’ve not seen anyone with severe disease, although there is some strep going around Rhode Island, and I’ve spoken to several people with a bit of diarrhea, some sore throat, and mild flu-like symptoms.

For those of you who use Influenzinum, start now if you haven’t already.

Everyone should be up on their vitamin D intake, as good blood levels of D appear to be protective.  Please don’t forget common sense and hygiene.  More information is available in the article on my site.

I’ll update this notice from time to time