Subject: News from Dr. Kevin Fickenscher
From: "Dr. Kevin Fickenscher" <[email-masked]>
To: <[email-masked]>
Date: Mon, 3 Aug 2015 16:01:02 -0400 (EDT)

The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg30WBSDgtyZ9-k8mDv0xXttG2QLff9d7i0zIGwgb72-msUqSpf-NIB2bFI9tjSdAGEW2kYFTVLug266wWVBztYd_86vExNq3kcYD0AV8ggx1BoglF1Khq_c3FD53CId0Nw==&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Fickenscher Files, Vol. 3, Issue 34
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg1arn_09Guys-fC-22JZGnmUSFHPpDhWfiSehnqDYbkAERIrDFJL-lkTYydWzP5eovwFdnoqLGujXqkyypeMlRLEtbPSyv4M5efEsPzBvi2UWpl4VCzm57XHsL0OOXGSrIU5LErSLwdDCbhmcta8ch1icV1IPme4hubbPLgbfRdrjoqXKlQF-KHngwHH9blA39rV6Y9IIIVsgrPYYtg0QTM=&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==],
MD, CPE, FACPE, FAAFP
@MDKev

A compilation of information, thoughts, and perspectives on the issues of the day
related to healthcare, technology, and beyond - including the latest culinary explorations.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Quote(s) Of The Week

"No one wants to turn back. But I don't want to create such a huge backlash among
doctors and hospitals that it derails a national effort to have an effective and
 easy-to-use electronic health care record system. That wouldn't be good for patients."

Senator Lamar Alexander (R-TN), Chairman of the Senate HELP Committee in talking
 with reporters on the need to delay implementation of the Meaningful Use Stage 
3 rule.

"I would not be surprised if in fifteen years from today we saw 50% fewer hospital
beds than we have today."

Howard Dean, MD, Former Governor of Vermont and Candidate for President in comments
at a Denton Webinar on the future of Medicare and Medicaid
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Errata

Information for your Consideration...

Medicare's Birthday - I had a typo in my last Fickenscher Files.  I noted that Medicare
passed in 1963.  No it didn't!!  I'm not sure what I was thinking because I know
 it passed in 1965.  In fact, LBJ signed the legislation into law at Harry Truman's
house on July 30th.  Thanks for the correction, Marty.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Consulo Indicium

Information for your consideration and reflection...

Getting Older - In case you have any questions about what it means to be getting
 older, you may want to check out the WebMD Getting Older Quiz [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MLlNrC6vqJzwqs_Q1odGk-a3G1d5m4St1UuuRFDLWj4QggwMkUtL1KEizEz-0MWIP7txbNfWSGG7kD4Uzwx8bDjDai1E1Z9S-ChVfdC83JXft5myn9aMwNTN8q896PXLVC7d8TLfa5azOUSSoXAlqVqcfIiPmqGex3vBYx2kxHDS8V0gVBJzhHMR_BaDU8uLswMvWltAe1cV9PktU4R5Bh4St5cBatq3pVfwY05INEqIg_TZ9XNdTMtYrPYLuMF61yycVUVfXLqGgrHVgr6upxtKZjWBDhshPHT_vn1x0DdCKUNmtMCotWg==&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==].
 It only takes a few minutes and what you'll discover is that there are some common
characteristics on "getting older".  And, the quiz offers immediate feedback on 
whether or not you understand those characteristics.  Oh by the way, yes - we are
getting older... J

Hold Back On Meaningful Use Stage 3 Implementation - Everyone is jumping on the 
hold-up-the-implementation-of-Meaningful-Use-Stage-3 bandwagon, it seems. The American
Medical Association (AMA) is stirring the pot on the MisUse of Meaningful Use Stage
3 by encouraging physicians to post their misuse stories on a new website, breaktheredtape.org
[http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MMuBBzfTif_3-5t8Gw6A5M55E0XgNmmOKB1QZsa9mJTbnrDuwS_CQ26oM1hpibc1akJCVZ8lQsnzNMjkZxDiqUofCGf2hAiKeqk8EI-Zhp6GR7udKHr-sWHahJ7tX0okeFT9pdGd96-0UTcGhVA5exDKpnh5y42PZ2N9B_tZUwKVCAQYXOtEKq8XilRKW_EntNAqzy7YslGZILuTk7xZ7arlWJdJsZn3sIj-R-BK6AINUS0YDzys_NkBmJ_kHHD7e1pudHh7lJwd45rVdactUrVChMptcgJlwQ9Jth0wVmdFynioRULP1-CrxwxA1AjDBXO0BFhLw36qe0owyZ1Zdnzv5mE02b7d19d_D1se5hTZQ0g__c11CeZR-4duiwODP_asnTXyB1NNEsTOJg9DJbWkLzpsK4jUjI-QnILFwm3BVwPqqLhAaBpYrgMZmwU1f_Jgh6askEY2vL3EiBUUMVG6Oq35qrVBtxSHZfQGzVhCGiOauAw5f9xHSuDtdcMJwlNBPcaMX1HOLRJ5ylBeck9ecI4bNXiVwpudMsvpurHxdlNAq_N5v3JCDL0w8JXHBcYQbgv9LzVNBHIJbNzKnrQ==&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]or,
on Twitter (i#FIXEHR).  The goals of the association are to "improve EHR usability
and workflow, and to 'pause' Meaningful Use Stage 3 so that it can be aligned with
other payment models."  Beyond the efforts by the docs, the Senator Lamar Alexander
(R-TN), Chair of the Senate HELP Committee and several colleagues havemet with Department
of Health and Human Services (DHHS) [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MKnbMybFx0-pzCtOQ4ho74KVWgQUzgE3xjDJrOiZQ1wIhYf2IqbTNUcQe8KHk3r_uZQHJxM9oV0Gnkgxftj9Ot2Bq8d1S1TGy22gRCGD45fQFcDu5vJQO2dbXoNt97VpDR5b0wLcCmeFv95RjUYew2ObhfNGlp1V4QGiSkMLLC-dLn_lZD0dKVqrR7v-o0z2NFS9Zu6XP__bMJB5L5rJEXVlVXuC8sCecnXx3uOnNiGQcTuFJwxWaTg==&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]representatives
urging them to delay stage 3 Meaningful Use rules.  But the move to stop further
 Meaningful Use Stage 3 implementation does not stop there.  Over on the House side,Rep.
Renee Ellmers (R-NC) and a nurse by training has drafted a bill, "Flex-IT 2" calling
for the same steps.  Here bill would prevent the administration from promulgating
stage 3 meaningful use requirements, or additional certification criteria, until
 either 75% of eligible hospitals and providers attested to meeting the second stage
meaningful use requirements OR the Merit-Based Incentive Payments rule are finalized.
 The momentum seems to be in the direction of holding up further implementation.
  My bet is that the administration will back off and slow the process down to appease
the growing chorus of concern.

The Fattening Foods Of Summer - Here in Boston, we're facing a sweltering 90+ degrees
of heat with high, high humidity.  Everyone's complaining but, then again, we were
complaining in January when there was 110" of snow on the ground
J. Regardless, it's clear that the barbecue season has begun.  There are baseball
games every night with lots of food options - all fattening.  And, then there is
 the fried chicken, the potato salad (what's your favorite? Yellow with eggs or 
German white?), cocktails, beer and an endless array of other options that all end
up helping us to gain weight.  WebMD has posted nice slide show [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8Mdz09WARW_AA13UNGmoP_5AvSyAK3-KjYtYzqyIUMfnOZdfLEjjCh_dIXU1mxa_wM1gOgAL-9dhWGbTBZPZ0Geyo1huWLXQMhhntqD95ajoP6A1pKMs_yBMfd9T34Ks3ivxYfSurrN9LY6HnIW3ytTHCBMhggF23LJtmFRqhLSHm1dI2OzUP79xjE_yX0v9Wfn5RFSJxEB15QVuVAUnrxFTCD5G3q9lOD0DcWyvFIrpO04f031hsSBDqIm89EjXC8UYZtKME686-0eGJkqUnES8d5Oo4M3IXpflgEbClLtOfauNbX3Z3xkS22gjxxxj3QqoohIslChEY=&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]
of these opulently caloric foods that includes all of the data so you can make an
informed choice.  Or, you can simply review the slides and figure out what you're
going to have for dinner.  Either way, it's a great review.

Who's Needed The Most And Who's Paid The Most - Merritt Hawkins, a physician search
firm, recently released a report [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MihkgNDfnIimi9yPsxpcKBICQFPCB0NVETW1Tt3P5fdHqKUOcMg87gRyD5KETbfXaBRIUqnFOMTnNbeq0qG4vHTpqZlDydEWZ0UWngSnZS34X9D103fvCWXVsnOAxrcDI71a13b3OVG-XJUMXM0cx79_qUwM7oG6AuldWL5Ws2mzvsiRtaQghev_YhKMg_lGos1OAaSsGyjNsrZgcYU1T5vEAR7PQ9a7DnykFSgx8Ju8=&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]
on the trends related to physician recruitment over the last year.  The highest 
demand was for psychiatrists which reached a record high in the past year. Based
 on my experience, the problem is particularly acute for the rural areas of the 
nation that are woefully underserved in mental health services.  But, the problem
is ubiquitous across all geographic areas.  Also, the impact of the move from volume-based
to value-based care is finally coming to fruition.  The demand for team-based care
and population health management is driving a demand for primary care physicians,
physician assistants, nurse practitioners, obstetricians/gynecologists and other
 physicians who manage the common, chronic illnesses (e.g. pulmonologists, cardiologists).
 At the same time, the report notes that compensation is still tied to the volume-based
metrics such as Relative Value Units, net collections and patient visits. My contention
is that efforts to drive value-based behavior will ultimately be unsuccessful until
the metrics change.  Regardless, here are the top 10 in demand practitioners and
 their average compensation:

1.      Family medicine physician ($198,000)

2.      Internal medicine physician ($207,000)

3.      Psychiatrist ($226,000)

4.      Hospitalist ($232,000)

5.      Nurse practitioner ($107,000)

6.      Obstetrician/gynecologist ($276,000)

7.      Orthopedic surgeon ($497,000)

8.      Emergency medicine physician ($345,000)

9.      Pediatrician ($195,000)

10.  General surgeon ($339,000)

Medicare Trust Fund Stable But Headed For Bankruptcy - The Medicare Trustees issued
their annual report [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8M0Ab_w5Kr8rHQfjFuyIuvBCK9ayHCuHUjRX5PF5N15QpuBNhY66roq-aKo8ew5Koaf2SGCKxvZd022uTCQgKjYJKysuevLiBfhxWFmz49D1d81gCU8KJdwXbeBhndjiKfAhjSzvnnuYqTDbnS5Bu13QcBgsOCBqIzA9BRwTYsVpFvsAI8u-SGd1vxia3GT7RF_-aNzrRGnDU=&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]
several weeks ago noting that the trust fund will exhausted its financial reserves
by 2030.  That means, we're stable but heading towards a day of reckoning.  The 
same projection was made last year.  At the same time, as a result of changes in
 Medicare reimbursement policies, spending was $316 billion lower than expected 
between over the period 2009 to 2013 with the annual growth rating dropping by 1.8%.
 While the long-term picture is a bit bleak for Medicare, in general, the people
 receiving Social Security disability benefits are facing very, very steep cuts 
next year unless Congress acts.  In fact, the fund will run out of money in 2016
 - in the midst the Presidential campaign, adding ample fodder to an already acrimonious
campaign. When the fund hits the wall, it will trigger automatic cuts of 19% from
the disability benefits structure.  So, it's clear something needs to be done.  
The question is when? The debate in Congress is whether or not funds from the Social
Security retirement fund should be shifted to the disability fund.  Republicans 
are adamant that they want changes that encourage disabled workers to re-enter the
workforce - in part because of recent reports that an increasing number of recipients
are not all that disabled - and initiatives to reduce fraud.  So, long story short,
there are enough funds to make the Social Security retirement fund last until 2035.
 So, as part of my retirement planning, I'm trying to manage my IRA and pensions
 so that they last a tad longer than 2035 J.

Preventing Alzheimer's With Regular Exercise - If I'm getting a little over the 
top with my coverage of Alzheimer's it's because my Mom is going through it.  I've
come to learn that Alzheimer's is not just a personal disease, it's a family disease
because of its impact across the entire network of family members who are involved
in the care of someone.  At the recent Alzheimer's Association International Conference,
it was reported that exercise may benefit people with mild cognitive impairment 
and "mild to moderate Alzheimer's disease." Researchers noted vigorous workouts 
by people with mild memory impairment decreased the levels of Tau, the protein deposits
in the brain that seems to be the source of the problem.  Not only did patients 
who exercised exhibit increased blood flow in memory and thought processing regions
of the brain but their cognitive test results also showed improvement in their attention,
planning and organizing abilities. Heck, maybe I should start regular exercise just
to get those improvements!!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Future Health

Delivering care in the new virtual world...

Online Symptom Checkers Not Ready For Prime Time - Harvard Medical School recently
released a report based on an audit [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8M_SVj4sr1g27DPj0Hm5ih1jeQFVVLE0KHUwAXxGmuYboP4A5RjVylt5T3jMGhNqUWc1xMhfgnNqMagPIjZStJIR30sKLl6EiMHnPJdmCTmd8dQUkedDVSV4ZXjRSAdVj3rRluw9O321E3dzvQ3HZbMLgKXM4qnhNr0T-Kb2s77dNdrIcEc1VAnqRns4tB7tzS15OqxuHFCaIDz-pbNcW-ODaNg5XebQC6ES3Vx3YdQ4bzz8pK2CDOe6cman3kDeu7_6-GTCDjE17mO2j315PR3MONTSVhJcpKur28215sLHEu6vbqgo5G22Tz2eJGi4ng&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]of
23 online "symptom checkers".  These are programs developed and deployed by the 
likes of the Mayo Clinic, the American Academy of Pediatrics, WebMD, and others 
that provide information on diagnoses and triage advice - based on the information
the individuals submits.  The symptom checkers were deemed accurate from a high 
of 71% to a low of 29%, of the time - with both extremes being relatively low in
 accuracy.

Gene Mutation As a Cause Of Cancer - While the cause of cancer is somewhat variable
based on the type of cancer which presents, it is clear that genetic mutations often
force normal cells to grow abnormally.  The problem is that the mutations are far
too frequent to manage successfully.  Scientists as Memorial Sloan Kettering; however,
have been working on a unique approach [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MgAEGC2Sl6IzNeIqIaFHAWF6RwVUSiWVjDJe1Icw_IjcMfQOdNSuk7ks0LL5lX74QFzj91ZmlUdTC_FkyFgFKhHC7-5d8xJO6NWsbopFMYKF0r-6iwJwGXAvUOb08cvlyGtUTshLL8IF168il9-hOH0aAy7OVEhrD8zaDH10Wt-Xy0sdx21t1EFLAYJp54EQO03ZwqwyDUojzXoBogofdMA==&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]
whereby they are determining which gene is the "governor" of these mutations so 
that by controlling gene expression, the cancer is also controlled.  And, for colorectal
cancer, the approach they've taken seems to have merit.  Colorectal cancers are 
one of the more frequent causes of cancer, killing more than 700,000 Americans each
year.  The Memorial Sloan Kettering researchers identified a gene - "APC" or adenomatous
polyposis coli - which is found in over 90% of colorectal cancers.  Other cancers
exhibit similar findings where a gene seems to be present in the vast majority of
cases.  The scientists were able to demonstrate by turning the gene expression off
and on with RNAi technology, the presence or absence of colorectal cancer in mice.
 The results are very significant and were report in the journal, Cell.  The end
 result is that by controlling the cascade effect created by the gene, the cancer
is prevented.  It's an entirely new approach toward cancer treatment that holds 
considerable promise and, is applicable across a number of different cancer types.

Interoperability - An Ethical Issue? - William Stead, MD and his colleague Michael
Johns, MD of Vanderbilt University's Center for Medical Interoperability recently
published an editorial [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MMhpoHF8krwsR0XDQTOhKXUQ1DAws1Whawpi7-hO6kCJLYGeeieLeO9f69hvgAZhIux-p8FSCAM6T3k8eeIZq-mqH0osMRAmMv8lE-ar5laG-mcLzQdm-Nn1PJQx6iap8Gae7C49_1sjopBdvf-QeS4UzltUgwCwjFx2Oxa54TcwMYrCeG1QNsvn3KYLzF2ciQ9_6IFg1r_7IliRStp604-_zLUZYcKVmBm5Q3Sv8nwcz97rzDfk0cQ==&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]
that took the position that "interoperability" is not a technical or operational
 issue but, an ethical issue.  In essence, they are argue - and, I absolutely agree
- that without interoperability vital information on the individual under the care
of provider is frequently missing or incomplete because of lack of interoperability.
 If the information is there but can't be retrieved - that makes it an ethical consideration.
 The authors note in their editorial that "We have an ethical obligation to develop
and implement plug-and-play clinical devices and information technology systems."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Article(s) Of The Week

Information for your Consideration...

Changing The Paradigm Of Healthcare Delivery - Sundar Subramanian and colleagues
 recently published a very interesting article in the June issue of the Harvard 
Business Review [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8M5w8CK9odJB8GMrJcBpL1u5yGuA9xps79Op8GAbfm4atGO8YF4C3E4YY8BwDpWXp50aEnLbLNsH64lIHLQMynaEB67QWWcXPsFfEVAyEHBDF1TBhd9ITvTfomxhzt3_VmyCSb534S_IXuCkQPKbeC3VGMOPjX8ApyYqtF1H64BO-wLEd5BK49MouGfsHq7PFeYr7fd8Ewam8=&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==],
"Personalized Technology Will Upend The Doctor-Patient Relationship".  They offered
two metaphorical directions on the directions for the healthcare business models
 that will evolve over the coming years using the Gold Rush of the 1840s as their
metaphor.  Specifically, they projected that we will see the evolution of Goldminers,
who dig deep in one major area, and Bartenders, who offer customized and convenient
options to address routine needs.  The Goldminers will be the vertically integrated
healthcare organizations that will create value by managing care more effectively.
 Their focus will be on the small percentage of patients that consume the vast majority
of healthcare resources.  The Bartenders will be new players - frequently from outside
of the traditional healthcare community (e.g. retail providers like Walmart, software
vendors like Google, electronic firms like Samsung, and others).  These organizations
will focus on improving the consumer experience and, it will be profoundly disruptive.
 The article is definitely worth a read and it does, in fact, outline a clear path
on where healthcare seems to be headed from my perspective.

On China - The New York Times has a great article recently on the importance of 
China's investments across the globe [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MiyIlZ_PajRreka44guOQIkc526PIWpa7lzXH7uyYDpOygRxMXqyOcQZyIGPQiDx4te3wYNvWKoMBe2PQ3lGFvHC1UVAdurYz2bNYGUZyELzz1KIQ3Os7SXCIh83n_gIL95nUhysHiRBSRQgogOZuaxMIc_zGGQPr_f8jtuKjFxlRJSvdlK6vV5cboaFlKMH-L9Cg6vya4iKp2Z7f5R0knXMi5yFCWFB-mJUM0c5UDcQX3ezdHeQM5d-Y6yUT5euOZQumjkzLZ6C7mQqz4-fu7oAnW8WKePJ8S43H3AztwEfCXlA5MMpavXp6OrZQ-0S5X6yl2Cn2WRjNPfoAsyrkzg==&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==].
 The example was Ecuador with a mere 16 million people where China is making major
investments in infrastructure.  The article discusses how China is the new America
in terms of its global investments and presence.

The Status of Chief Medical Information Officers - SSI Search recently completed
 their CMIO Survey 2015 [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8MAxW15fKWlh-OXKDvvSq5-T97-g7oJRukRurIyKGOAhVLBAh6GAxrya95xtX7CW4bA6FR9fZbrAbbREtYzZZbj7knGUoY1guHTmXqKKGlCuZB4EXf7bAOEmLkTItGZiZ4WZAHoeitbkWhr0hS9M6RQKAqLqTftjXHUNyYt8cIAO2KfK2o2zFXkB-6XKmOZTwj&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==].
 It provides a good overview on the state of work by CMIO's across the nation and
their importance as a strategic asset for healthcare organizations.  For anyone 
in the C-Suite, this is worth a quick review.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Weekly Whisk

Musings from a foodie...

During the summer months, we all succumb to the cravings of summer food - BBQ, grilling
and the like.  To mollify those cravings, I recently tried a BBQ place here in Boston
that offered up some of the best BBQ I've tasted in a long time.  A group of us 
got together and coordinated our orders.  I can say that to a person, we all thought
that Blue Ribbon BBQ [ * * * * *] did an outstanding job!  I've been to lots of 
such places over the years but only the outside venues in Texas outshine this place,
in my estimation.  Most of you who travel to Boston will likely not venture out 
into the western suburbs.  But, if you do - head to Newton and the Blue Ribbon BBQ.
 You can order your favorite foods and enjoy the afternoon.  But, remember - eat
 in moderation J. Blue Ribbon BBQ [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8M1F_Lb-AEuqaU2G3WWSMQPrr5OEIzGXOvRgu8u6YeqlzgREEhIETdbc439Euz1rcHSeNXC04HTOuhmjbVwLFc7c4AhJ5gxX7Ug_lBiwpLT5Y=&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==]
- 1375 Washington Street - West Newton, MA - (617) 332-2583
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, And The Ugly

The ongoing saga...

The Great - Actually, "THE INCREDIBLE" or, flyby of New Horizons past Pluto [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8M5_9ngro0Joih2q0reiylBHJYwgmt41G3DVDTIR5WyPsOc-1LmFISEfriZDF7_1m2UuYWtTnbnS3ikcwirQADoGTpC_lk6lj2f9lcJ0UIy1ZK3hD_Izu5yBgDf-soYb5G6GRhipOhkEEWQNWTutwadc-CYeXZvkWz57rp0-0xp5OVWIANUz80X76GL13TjGRMzx3Dx86iHnN2aOoSB8AVqkcHuvaTKdYISGaVqHVLkDdkjkn-DZgfNq85ES0NtLiZSyggK9xtLnhqew_btKiHSeBWNprWYQsQz6oVFm1Pdvw=&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==].
 For many of us, Pluto has only been a "concept" up in the sky until the photos 
made it real!  We keep talking about how the world is getting smaller.  Well, it
 is...

The Good - Hmmm.  Exercise continues to show up as a common denominator for keeping
us healthy.  I wonder what we should do about it.

The Bad -The state of mental health services in this country is abominable!!  Last
week, I opened the newspaper.  On the front page was a description of the shooter
in South Carolina and a headline on the shooter in Chattanooga.  On the inside page
was the results of the verdict for the Aurora, Colorado shooter. Overall, the common
thread - in addition to guns - was the state of mental health for the individuals
involved.  We've got to do something about mental health services...

The Ugly - Chart of the day: After a sharp increase in prices, eggs are not the 
cheapest source of protein. "The price index for eggs, which tracks the average 
national increase people have to pay, rose by almost 20 percent in June alone, on
the heels of one of the worst egg crises this country has ever seen. The single 
month spike is the largest we have endured in more than 30 years... The reason egg
prices are out of whack dates back to December, when a yet unfamiliar virus was 
first discovered in Washington State. For months, the avian flu lay somewhat dormant,
spreading slowly, leaving egg supplies virtually untouched. But then in April the
flu caught fire, causing chicken farmers around the country to kill off entire flocks."
Roberto Ferdman in The Washington Post [http://r20.rs6.net/tn.jsp?f=001V2UUPiqujwX-PFSNbn8H0BRDvnLSvMAZjrjLtikl4ubDL5r4TLQIg9d_8m284F8Mt46d5quwj5u1OtsP5zW5BcYBsWPQwPTRupCuv4JsW0t29Jd4uBkXCAhNqDc_GZeTcH2npzwXkXvQiejCoqWz8cwhqXpTSk2B0VxPLvgghsbKQ6B6VtchHUyTwj12fblIAogg9HZfilS3pFgDTEHRVj-xrD0U-R3MaUqdTkFRS16G2fCNHzjlsq_SRU4esGJJ&c=he5KbVsB6SI-pvArI0QYmllp0cBLcLeSRAwXHGk417-09HX_l3g7Yw==&ch=4C-fnyIgcG0MiCgRLVk2vreV2zfRqmtl9Qe97zJgY4WhLjBOA4AdXw==].

The statements in The Fickenscher Files are the personal views of Kevin Fickenscher,
MD and do not reflect the views or policies of any organization with which he is
 affiliated.
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