Cardiology Gets a New Blog

Finally, theHeart.org from WebMD is joining the fray.

Go on over and say "hi."

-Wes

Today's Healthcare: The Davids vs the Goliaths

This is a first in a series of "point-counterpoint" debates between myself and Pete and Matt over at MarketIntellNow - a blog devoted to the promotion of e-health, the Electronic Medical Record, and the Patient Medical Record. Our topics will revolve around three areas:

1. Consumer-Driven Healthcare-- crock or crusade?
2. Doctor and hospital ratings-- fad or phenomenon?
3. John & Jane Doe-- patients or consumers?

I'm starting, then they'll counter, then I get a rebuttal, and so forth. Hopefully, it'll be entertaining and informative. Feel free to join in and make your thoughts known (I don't mind being handed my fanny once in a while.)

Unfortunately, I have to go first, so here goes...

* * *


Pete and Matt are right. E-health is all about the patient. Really it is.

After all, the Goliaths of Business tell us so.

You know them: Google, Microsoft, Walmart, Walgreens, IBM, Aetna, UnitedHealth, MedCo, Blue Cross, Quest Diagnostics and many, many many others. All told, as of 20 May 2008, the valuation of these companies alone exceeds $953 billion (yes, that’s right, nearly one trillion) dollars: a sum that is half the entire domestic product of all of China and a formidable sum to even begin to comprehend.

You the Consumer

With that purchasing power, we are now only too happy to hear that they are all about health, too. No doubt some of this corporate response is driven by the need to simplify an abysmally complex healthcare delivery system and Byzantine medical billing systems. But just as probably because the nation’s healthcare tab exceeds $2.3 trillion dollars and represents a rich cornucopia of new revenue streams. So, like knights with really shiny armor, each is ready to swoop down to rescue the healthcare system and its "consumers" with nothing but pure beneficence as their goal. Yes, dear patients, they’re all about you, the "consumer" and your "wellness."

After all, you are entitled to any healthcare you want. You deserve the best, the newest, the shiniest, the most plush accommodations. Anytime, anywhere, 24/7. You, dear consumer, can have it all. Oh, it might cost you a bit, sure. But our ever-friendly insurers are here to help with that. Just please, keep “consuming,” for when you consume healthcare services, you feed the beast that feeds our new economy. Our business partners will be sure to provide the information about your choices for hospitals and doctors and testing facilities for “screenings” and “prevention” right at your fingertips. And because they know that each state has different rules and different insurance policies, they’ll even allow you to filter the choices by where you live!

But that’s not all. Many will also provide you with the “best” hospitals and rehab facilities for your care, complete with rankings, too. No doubt they’ll steer you to the plan that suits you and your budget, dear consumer, the best. Have fun choosing. (Just be sure to make the right choice, will you, lest you be stuck paying a $105,000 cover charge for your cancer treatment.)

So they make websites. Quite expensive websites. Unfortunately, these websites might not save costs to our healthcare system, but heck, who cares? It's all about you, the healthcare consumer computer-surfer, remember? After all, they won't be built with the Goliath's money, mind you, but yours. Personal Health Records and informational sites. Tons and tons of them. Some better organized than others – some with pleasing color schemes and most with lots of smiling faces. And each of these sites will promise to house healthcare needs (and portions of your medical record) under one roof, provided you give your “permission.” For some, you can even grant other pharmacy, laboratory and hospital services to upload your medication, laboratory, and procedural information, too – all neatly organized. What's not to like?

But God help you if you make a typographical error or your name is a common one like John Smith (he'll need his Social Security Number and date of birth to differentiate himself from the other John Smiths out there – while providing yet another exposure for identity theft – but, hey, the information will just be used for healthcare – and maybe a bit of advertising). You see, unique identifiers are a challenge to healthcare databases. It’s tough to know you’ve got the right “John Smith” when databases are shared. The wrong “merge” and voila, you got a whole new set of preexisting conditions that the insurers can use to crank your premiums. Who will help rectify the situation? What about the other “John Smith’s” privacy? Oops.

Rankings Schmankings

True, Personal Health Records and informational websites can have answers to your questions. They have forums. They have information on your doctors and hospitals – like credentials and rankings. But these rankings are created by many, many sources: the government, marketing firms, and advertisers. Each of these ranking systems have significant limitations and use criteria that are non-uniform and only intermittently updated and almost never verified. (That, my friends, would take innumerable man-hours to maintain.) But they all claim they are the best at helping you choose your doctor or hospital with no proof as to their effectiveness. * Sigh *

Now is there a ranking that identifies the quality doctors based on the time they take with you, or if they answer your questions, or act as your advocate or evaluates your actual treatment outcomes? No. Instead, we are told that "quality doctors" are the ones that give aspirin 100% of the time after a heart attack, or prescribe beta blockers for heart failure. THAT, my friends, is just two of the ever-expanding 119 major measures that we should strive for! And these same rankings are often used for marketing of healthcare facilities. Heck, some hospitals with carefully collected quality assurance measures even pay to have their doctors “ranked” since their data always looks so good! All to help you, dear consumer, to make the right choice. After all, it is much easier (and politically correct) to implement e-health initiatives that hire more bureaucrats than to simplify the bureaucracy and redundancy by cutting unnecessary jobs!

Oh, and yes, they own all of the data. Your healthcare data.

That’s right, not you. Them.

And the Goliaths carry nary a liability concern regarding its accuracy – you saw that disclaimer, didn’t you? And don't forget, all of this data is no longer officially protected by the Health Insurance Portability and Accountability Act. Bits and bytes galore, all whirring this way and that for any number of eyes to see. All without any recourse or tracking capability and all at the speed of light. Because you, my friend, have authorized "sharing." But that’s not all. On some sights you’ll be targeted with advertisements to "empower" your healthcare choices. For many companies, this is the business model for their survival. So just how “secure” is your healthcare information if keywords you’ve entered are triggering the ads placed on your webpage? And although the Goliaths want to compare the security of banking transactions to healthcare transactions, are not the issues of identity theft real for both types of transactions? Correcting your widely disseminated “personal record” after it's been compromised is nearly impossible once the imprint of a preexisting conditions exists on your record. Good luck contacting Google to straighten that out.

The Goliaths, my friends, may soon become the Great and Powerful Oz of Healthcare, conveniently hiding their liability (and profit motives) behind a great electronic curtain called the Internet.

The PMR is not the EMR

But we mustn’t be too harsh. There are really good aspects to the personal health record and informational websites. Where else is there universal ability to transport your healthcare information between disparate institutions? Where else can you get a relatively unbiased search of information? Where else can you empower yourself with an avalanche of mostly reliable information and share experiences with total strangers who may have endured your same ordeal. But we mustn’t confuse the Personal Health Record, editable by all, as an Electronic Medical Record (EMR). The EMR contains the official transcript of your healthcare received. The EMR is the ultimate arbiter of healthcare delivery that is the undisputed king of records used in liability proceedings. As such, there is little incentive for physicians to maintain two sets of records. The Personal Health Record is just that: personal. It is NOT a health record. Sorry.

And if you want to have a Personal Health Record, you’d better not be too sick. If you can’t type or see, Personal Health Records and computer-driven healthcare might not be in your best interest, but there certainly might be a place for a caregiver to follow your healthcare delivery. Personal health sites leave a huge gap for services since they assume all "patient-consumers" use or have access to computers and will shop for “healthcare” like the latest dress or are physically and emotionally capable to use the sites as intended.

And what does this Goliathian healthcare look like on the ground? I'm just not sure yet. One only needs to look at the recent unfortunate recent circumstances of Senator Ted Kennedy to begin to comprehend the issues.

Imagine. Senator Kennedy comes into the ER with confusion, obtundation, and maybe not moving his right side very well. Did the doctors rush to Google and type in his symptoms? Oh, they could have. And they would have been met with a differential diagnosis of 870 different entries with AIDS, Creutzfeldt-Jakob disease, and inflammatory disease of the brain as the first three results after only 0.35-0.48 seconds. Hardly an accurate assessment, as we’ve seen.

And what about those hospital rankings to choose a hospital? Did the Kennedy's have a choice where he went first? Not really. He was appropriately taken to the closest facility. But more importantly as WhiteCoat has already pointed out, the family opted not to stay at that “Top 100” hospital, but rather elected to transfer him to an unranked hospital: Massachusetts General Hospital. So given all the different ranking systems out there, which ranking mechanism will you, dear “consumer,” use to make your choice of healthcare facility? Could it be that these marketing gimmicks called “rankings” might not have your best interests in mind?

And how about his diagnosis? Did a website help drill the hole in his skull and pass the biopsy needle in to his brain? Oh sure, I bet you could find pictures of how it’s done on the internet, but when it came to performing the procedure and delivering the care, where were Google, IBM, and Microsoft on this one?

Finally, when it came time to break the news of the diagnosis to Senator Kennedy and his family, were these corporate Goliaths in the room hold hands and lend support and nurturance? Hardly. Did the family consult the wellness bureaucrats to plan the next steps when anxiety was high and trust and respect are critical?

No, it was the Davids of healthcare – the doctors and their patients – that did the dirty, yet critically important, work together. It is the Davids that form the cellular basis of the healthcare system – the cornerstone upon which the entire dysfunctional system rests - not a computer, or a website, or a hospital, or an insurer.

And disease happens. It happens while doctors are filling out the 119 items on the EMR to keep their ranking. It happens while patients are typing in their website that redirects money and attention away from the front-line care. The doctor-patient relationship is threatened like never before. With fewer primary care physicians and more and more “physician” extenders, the word “doctor” has now been replaced with “provider.” Should we spend millions on information technology infrastructure while ignoring the resources required for the than the hands-on, “mano-a-mano,” aspects of healthcare that are so critically needed today? I guess the philosophical discussion comes down to what medicine is all about. Is it about the money? Or is it about the care of the patient?

Unfortunately, it’s probably about both, for if we run out of money, we can no longer care for patients. I acknowledge the Goliaths' potential to impose dramatic market forces to control costs if they could generate healthcare price transparency. But will the hospitals and insurers ever end their little profitable healthcare pricing collusion schemes and make their closely held data available for all to see?

But when I get sick, it’s going to be all about me. And I admit, when I get sick, I might turn to Google to show me some possible diagnoses, or to list side-effects or drug interactions that might occur with my medications, or to keep that list up to date, as long as my fingers will be able to pound on a keyboard. But despite how much information gets pumped to me, I will still need a doctor with experience to help guide me toward the best course of treatment for me – one who can cull through the morass and has seen and touched someone with my condition before. Knowledge, judgement, and experience trump mere information and marketing every time in healthcare.

While some information is important, websites won’t fill the patient care void in healthcare that exists today. Certainly, they'll fill a few gaps that exist. And perhaps our goal should be to strive for "concierge medicine at Wal-Mart prices" (h/t KevinMD). Will PMR's and EMR's and home monitoring services permit this? Where's the profit in that for all those Goliaths?

E-health initiatives, therefore, are one just one more tool for the patients, the doctors, and the marketers. And while Electronic Medical Records do improve efficiencies on many levels: data retrieval, billing and coding compliance, accounts receivable, etc., but they do not treat patients nor always have their best interests at heart. Does this Great and Powerful Oz really provide something that will save us? Or does he provide bells and whistles while medicine becomes less and less humanistic? For instance, do we really need daily complete blood counts and electrolyte measurements in our default admission order sets? Certainly the hospitals benefit with higher revenues. Or might less frequent labs suffice? How much has this single default order set cost our patients? How much has it saved in terms of earlier detection of infections? No one knows.

But we do know that a doctor sifting through pages and pages of Personal Medical Record information will have less time at the bedside. We do know that there will be legal exposures if that data presented is incomplete or incorrect. So the debate goes on. But one thing is for sure, before we spend millions and millions on websites that are still unproven to reduce costs or improve care, we better be damned sure that we’re spending our limited healthcare resources wisely in the name of “Computer-Driven Healthcare.”

-Wes

Choosing a Cardiologist

Pretty good suggestions offered here. But I'd add one more thing...

...do they blog? ;)

-Wes

EKG Du Jour - # 7

"Hey, Dr. Wes, I was reading EKGs and saw one of your patient's EKG today. The pacemaker was doing something funky and I was wondering if you could check it out:"

Click image to enlarge

So what's going on? Is this normal or not?

-Wes

Star Wars, Episode IV: A New Hope?

Upon returning from the Heart Rhythm Society Meeting, I strapped in.

User ID: * click click click click *
Password: * click click click click click click *

Good morning Master Luke.

In-basket: 250 e-mails, Order Cosign: 324; Results Review: 124…

Use the Force, Luke!

* click click click click click click click click click *

But I, I can’t, ugh, I’m trying… * click click click click click *

… Phone Calls: 2; ED Follow-up: 9, Overdue Results: 32…

Come on, Luke! Focus!. Use the Force!…

… Pre-surgery notification: 34; Staff message: 3; Review reports: 2...

Small chirping sounds are heard from behind my seat. Then a voice: “Master Luke, I think C3PO has been hit!”

Focusing now…
“Urology Grand Rounds will be held 5/15/2008 at…” * click *
“Employee Appreciation Day…” * click *
“New opportunities to learn Word, Excel…” * click *
“Link Update: …” * click *
“Canceled: Clinical Section Meeting 5/21/08…” * click *
“Epic Downtime Notice…” * click *

Yes, Luke, Yes!

* click click click click click click click *

Smoke clearly perceived from back of computer guidance system… “Master Luke, our engine! What are we going to do? You’re needed in the lab, then the ward! There’s just too many of them!”

* click click click click click *

The Force Luke! Use the Force!

“Leadership Conference to be held..." * click *

“Google Alert: Google Health launched to great acclaim. Patients now will have their own personal health records and soon they may be able to communicate directly with their doctor via e-mail…”

“Noooo! I'm not sure I can... There’s too many! Ugh!” * click * “Ugh! I’m… trying…” * click *

The Force, Luke!!!

* click *
* click *
.
.
.
* click *
.
.
.* click *

Would you like to Log Off?

Yes, Luke, that’s it!!!!! Now, Luke, N…O…W…!!!!!

Closing his eyes...

* click *

Then a moment later:

* Bbbbzzzaaaappppppp *

A large flash occurs, then the screen goes dark… then...

silence....
























Yes, Jedi Master. On to rounds now…

... and may the Force be with you.

-Wes

The Heart Organoid

It's kind of cool.

-Wes

Women's Heart Health: The Perils of Nonconformity

According to the American Heart Association, Minneapolis, MN, home of all three of the major medical device manufacturers (Medtronic, Boston Scientific, and St. Jude Medical) was the most "heart friendly" city in their recently-released ranking of the most Heart Friendly Cities for Women.*

Nashville, TN was heralded as the worst city. (St. Louis, Detroit, Pittsburgh, Dallas-Fort Worth-Arlington, Columbus, Cincinnati, Las Vegas, Cleveland and Indianapolis round out the loser list.)

Wow.

Now cities have rankings compiled by donation amounts to the American Heart Association! Go Red!

So come on now, Nashville and other bastions of womanly insensitivity. Stop being so policitally incorrect! Get your act straight, for goodness sake! Take it from us guys. Conform.

Or else you're going to keep getting, er, well, um, publically bitch-slapped by the American Heart Association.

-Wes

* Please note Minnesota's obesity ranking.

Best Trick from the HRS Meeting

For all the electrophysiologists out there, the best trick for crossing the interatrial septum that is resistant to transseptal puncture came from the group in Pessac Bordeaux, France.

Although rare, these authors found that 6 of 280 (2%) of transseptal crossings were difficult. They proposed a simple solution: After they ensured accurate positioning of the transseptal sheath and needle on the interactrial septum, they applied unipolar radiofrequency electrocautery energy at 20W (using it's "cut" setting) to the needle within the sheath and advanced the needle slightly against the septum to cross. The contact was achieved outside the patient at the proximal end of the needle with the energy transmitted to its tip. RF energy was effective at perforating the septum in all 6 patient's in 4 +/- 4 seconds and no complications occurred.

Nice.

-Wes

Reference: A Straightforward Solution for Interatrial Septae Resistant to Transseptal Punctures. Knecht S, Matsuo S, Wright M, et al. Hopital cardiologique du Haut L'Eveque, Pessac Bordeaux, France. Poster PO5-41, Heart Rhythm VolL 5, Issue 5S, May 2008.

New Technologies for Atrial Fibrillation Ablation

One of the highlights of the Heart Rhythm Society 2008 meeting in San Francisco was the “EP TV” live cases performed today. In the morning were two ventricular tachycardia cases, and the afternoon, two atrial fibrillation ablation cases. They were professional and very well-attended.

One of the more interesting interactions occurred in the afternoon atrial fibrillation case discussions which included doctors Warren M. “Sonny” Jackman, MD (Oklahoma City, OK), Fred Morady, MD (Ann Arbor, MI), Andrea Natale, MD (his lab was operating – Austin, TX), Douglas Packer, MD (Rochester, MN), and Koonlawee N. Nademanee, MD (Inglewood, CA) as panelists and John D. Day, MD (Salt Lake City, UT) as moderator. There were two paroxysmal atrial fibrillation cases being performed – one with manual catheter manipulation and CartoSound ultrasound image development, and the other using the Hansen robotic mapping system coupled with the ESI Nav-X 3D mapping system that used their new “Fusion” software to superimpose a pre-procedural-obtained CT volume rendered image over the Nav-X geometry.

I have attempted to paraphrase the commentary (taken from notes taken) in response to a question e-mailed to the participants from the audience:

“What does the image overlay and all of this technology add to doing this procedure?”

Jackman: Well, with the known limitations of registration with these systems, I am cautious when using them. CartoSound is okay, because you’re imaging the surface of the heart directly. And certainly pre-operative CT imaging is helpful to understand the anatomy. But I would have wanted to get a feeling for this arrhythmia first (the patient was in sinus rhythm at the time) – I would want to initiate the rhythm first to see if there might be something I might understand to ablate before proceeding with the whole afib ablation. I might not find anything else most of the time, but if I did it’d be helpful.

Nademanee: I just use Carto to create a very simple map – you know, the His, CS, and pulmonary veins and use about 6-7 minutes of fluoro for the whole case after the geometry is developed – I don’t think Stereotaxis would help reduce that time very much. I use image guidance with fluoro, because my technique uses electrograms and I’m going to move that catheter because my technique relies on proper electrograms.

Morady: I don’t think there is a dispute over the role for 3D mapping of the left atrium – it cuts down on fluoro, and registering the locations of the ablation points is helpful. The extra imaging with “Merge” and CartoSound is nice but it could be that a mistake if 1-2 mm will be the difference between thinking you’re in the left atrial appendage or the ridge outside the left superior pulmonary vein. We still need a cost-benefit evaluation. Will outcomes be better? I don’t know. In the top labs around the world, they’ve ben doing a pretty good job already – it’s hard for me to think it’ll be improved with this technology.

Day: Andrea, tool or toy?

Natale: In the hands of people who do this everyday, it might not be that helpful, but for people who don’t do it everyday, I think it will be useful.

Packer: I agree with Fred’s (Morady) comments. In the more complicated cases, the utility of 3D images increases our success we think. We’ve done validation (on accuracy) with CT images. CT’s are yesterday’s news, ultrasound is today’s. Ultrasound gives about a 2mm error, vs. 3D mapping systems that give 6-8 mm error. How fast can we do it? How much does it cost. We’ve found we’re doing less pre-procedure CT’s with ultrasound now… The utility of all of this will need to be sorted out in prospective randomized trials…

Hopefully this will give a flavor for their enthusiasm. Consider purchasing the actual CD for the actual conversations from the Heart Rhythm Society if you’d like to hear more…

-Wes

Addendum: The funniest moment of the whole event was when Rodney P. Horton, M.D was introducing his atrial fibrillation case. Imagine, a room the size of two or three football fields full of cardiac electrophysiologists from around the world, analysts from every major venture capital firm in this space, and tons of industry personnel - all whom have collectively performed thousands upon thousands of catheter ablation procedures for atrial fibrillation. Then Dr. Horton says:

"...atrial fibrillation is an experimental procedure and is not approved by the FDA..."

and there, lying on the table is a patient with a Hansen robot in their leg (approved by the FDA) and an ESI mapping system (approved by the FDA) mapping their heart.

The whole room started quietly chuckling...

...like anyone cared. Now, it seems, every operation performed in the US will have to be "approved by the FDA" before it can occur.

-Wes

Heart Rhythm Society Meeting 2008: A Conversation Overheard

“I always enjoy meeting old friends at this meeting.”

“Me, too.”

“Learned anything?”

“A few things, but there doesn’t seem to be much new.”

“I know what you mean.”

“It just seems to be the same old researchers and companies. But there's just so much more over-the-top marketing going on. God, if I see one more 256-color mapping system with little dots all over the left atrium, all claiming to be better than the next system, I'm gonna puke! There must be huge budgets to promote this stuff – most of which does help a rat’s ass at fixin’ the frickin’ afib – it looks more like a radiology meeting than an EP meeting. And did you see? Boston Scientific miraculously got their new devices approved by the FDA three to four months earlier than expected they said and yet, boy, somehow they had all the displays up already – like they “knew” all along! What a crock...."

* * * Laughing * * *

“Hey, do you know what that (Medtronic) ‘Vision 3D’ on that go-cart over there means?”

“No. Do you?”

“No clue. But man, did you see it’s plastered on the sides of the buildings and the stairs and frickin’ everywhere?. I heard someone say they got pissed that they were out-marketed by the other guys at last year’s conference, so they decided to go all out this year. I do kind of like those little go-cart thingies... maybe they should use those as shuttles to the hotels..."

“The commercialism just seems over-the-top. The *&#$*# poster sessions were like an afterthought – HRS gave more convention floor space to the companies than the poster display areas. There were so many people, I couldn’t even walk between the rows of posters! All that work – overshadowed by corporate displays.”

“Yeah, I know what you mean. The abstract sessions today – you know, the good, stuff – I heard there were 23 different sessions running concurrently. How could we even see a small portion of that?”

“You know what I think?”

“What?”

“I think that if they keep this up, that lots of folks will stop coming and just wait to see the presentations online.”

-Wes

The Next Pacemaker Re-Charger

Could it be a solar-powered bra manufactured by Triumph?

-Wes

Ref: More on Video.

Medtronic's Sprint Fidelis Performance Lead Update

It's now been six months since Medtronic's lead recall of their 7-French Model 6949 Sprint Fidelis defibrillator lead in October 2007. The first update of the lead performance arrived in my office this week, dated 7 May 2008 (you can view it here). With this letter came the first trending data of the failure rates as determined by evaluation of Medtronic's Carelink follow-up database and Returned Product Analysis (RPA) reports as well.

While the number of lead failures remains relatively small and current follow-up recommendations have not changed, the failure trends, albeit early, remain concerning. It appears that a continued number of failures throughout the life of the lead can be expected. By Medtronic's analysis of a typical 1000-patient ICD clinic, over the next 12 months, nine (9) patients can be expected to have an anode or cathode failure and half of those patient's will have little warning of an impending fracture.

The implications of these recommendations are far-reaching, for it now seems the fault with the lead was not a physician implant technique problem as originally surmised, but rather a design flaw. Further, when it comes to replacing these patient's defibrillator batteries over the next four or five years, electrophysiologists will likely be advised to replace the 6949 lead with a more reliable defibrillator lead model, like the 6947, increasing the difficulty of a typical device battery change procedure.

-Wes

Physician Gain-Sharing: What a Tangled Web We Weave

In an effort to control costs, it seems the Department of Health and Human Services is exploring physician gain-sharing programs:

The Health and Human Services Office of Inspector General has approved a handful of gainsharing arrangements in which physicians receive cash payments for reducing hospital spending. Gainsharing might reduce costs by aligning hospital and physician incentives, but concerns remain about quality and access.

But there are significant concerns with this approach:

Although the approved programs incorporated safeguards, questions remain regarding whether such narrowly structured programs can effectively reduce costs without harming access and quality. Specific concerns focus on whether physicians respond to gainsharing by limiting their use of quality-improving but costly devices ("stinting") or by treating only healthier patients ("cherry-picking") and avoiding sicker patients ("steering") at their gainsharing hospitals. Because of concerns about cherry-picking and steering, the OIG prohibits payouts to physicians with changes in their patient mix, measured by the prevalence of high-cost, high-risk patients. The OIG also has expressed concern that physicians would increase their caseloads within gainsharing programs, essentially receiving payments for referrals. To limit this, the OIG has required that any savings generated by an increased volume of patients insured by Medicare or Medicaid could not be included in physicians’ payouts. Others have expressed concern that gainsharing might limit patients’ access to new, beneficial drugs and devices.

Note that the "savings" are passed on to the hospital and doctor, but not the patient (nor their insurer).

Are we potentially robbing the poor to pay the rich with this approach?

-Wes

Radiologists Have All the Fun

I found this from this week's Grand Rounds over at Health Business Blog. Very funny.

Damn radiologists have all the best party gags...

-Wes

HRS: Be Sure to Bring Your Lomotil

I'll be heading to the Heart Rhythm Society Meeting in San Francisco tomorrow, and just received this e-mail:

Dear Heart Rhythm 2008 Attendees and Exhibitors,

The Heart Rhythm Society has learned from the San Francisco Department of Public Health that there have been reported cases of what is suspected to be norovirus in the San Francisco area. A number of those affected were attending an earlier event at the Moscone Convention Center.

As you know, Heart Rhythm 2008 is scheduled to take place at the Moscone Center, May 14-17. The Convention Center and city health officials have put measures in place to disinfect the facility and are continuing with the current schedule of events. Therefore, Heart Rhythm 2008 is scheduled to continue as planned.

We will continue to update all attendees and exhibitors via e-mail and ww.HRSonline.org should new information become available.

For more information on norovirus, please visit the CDC website at http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus.htm.

We look forward to seeing you in San Francisco.

The Heart Rhythm Society

Gee, I can't wait...

-Wes

Underpenetration of Implantable Defibrillators

One wonders if this whole mess could have been avoided if this man had had an implantable defibrillator installed before this occurred. I mean, there's such a false sense of security thinking that it's been 10 years since your heart attack, so you must not need a defibrillator.

Well, think again.

-Wes