Yelp, California Health Care Foundation Partner To Improve Maternity Care

pregnant woman using computer for article, Yelp, California Health Care Foundation form partnership to improve maternity careMore than 500,000 births occur each year in the state of California, but deciding where to get care can often be a difficult process for consumers. That’s where a new partnership between Yelp and the California Health Care Foundation comes in.

Thanks to the partnership, maternity care measures are now being displayed for the roughly 250 hospitals that deliver babies in the state. These measures have the potential to be seen by millions of people who turn to Yelp in their daily life to help them make these types of decisions.

The data for the measures comes from, a hospital quality website founded by CHCF and operated by Cal Hospital Compare, a multistakeholder nonprofit organization.

Among the measures that are displayed on Yelp pages are the percentage of cesarean section deliveries in low-risk pregnancies to mothers having their first baby. Consumers can also check on a facility’s percentage of newborns fed only breast milk before discharge; how often episiotomies are performed; the availability of vaginal births after c-sections; and how often vaginal births among women with a prior c-section occur at a given hospital, or if it routinely provides them at all.

For its part, CHCF has operated a couple of data-centric websites for some time now. But it lacked the accessibility and reach of a site like Yelp.

Continue reading Yelp, California Health Care Foundation Partner To Improve Maternity Care

New Study Highlights The Importance Of Telemedicine

A recent study from Canada Health Infoway adds to the mounting evidence that telemedicine, specifically virtual visits and consults via video conferencing actually offer value to both the patient and the provider.

Infoway, a Canadian federal non-profit whose mission it is to advance mobile hillustration of telemedicine for article about Canadian study shows value of telemedicine visits to patients, cliniciansealth, worked with researchers from the University of British Columbia to conduct surveys and interviews with clinicians and patients participating in virtual visits.

Lead author of the study Kimberlyn McGrail stated:

“The patient survey results clearly show that virtual visits can be a way to offer patient-centered care. Whether we realize that potential depends critically on how these services are integrated into existing care delivery.”

They found that virtual visits increased access to care for patients with most saving travel time and avoiding work absence. Many may have reservation about online security, but 91 percent of participants of the study said that they were confident their information was secure. And 57 % stated that they avoided a physical trip to the doctor altogether.

iMedicalApps has covered other recent studies that support these findings, like one that showed e-consults improved access to infectious disease care and high satisfaction ratings in pediatric care.

While the study comes from Canada where access to care in remote parts of the country is a problem, access to care even in urban areas around the world is a problem and a good reason for more investment in telemedicine.


Let Posture Be Your Guide

07/20/17     Maureen Graves Anderson

I took up a new sport, speed skating. This is the short-track version where you wear long-bladed skates to speed around a hockey rink.

Think Apollo Ono and the Winter Olympics. I am not an elite athlete nor do I like dangerous activities, but something in the sport drew me in. In my mind’s eye, I am crouched over and flying around the corners. As I skate, the speed is exhilarating!

But when my coach showed me video of my skating, I was crestfallen. Surely, I was not that pokey person cruising along in an upright position? I tell this story to illustrate the fact that we don’t always have an accurate perception of our posture.

photo fo posture for article on Let Posture Be Your GuideDuring ergonomic evaluations, I take a photo of the person’s posture while he or she works. So often, the person is surprised by the photo. He or she may be twisted, slouched, stretched or reaching, and yet perceive himself as having picture-perfect posture.

Awkward posture is one of the biggest risk factors for ergonomic injuries. Awkward postures increase the forces on the body, especially in the low back. For example, a person picking up a pencil from the floor while bending at the waist has twice the amount of low back force as someone lifting a 40-pound load with good technique.

Awkward postures are often caused by a poorly designed workstation. Some examples are desks too high, chairs too low, overhead reaches to shelves, retrieving items from below-knee level, and constrained spaces. Unconscious behavior is another cause of awkward postures – crossing legs while sitting, slumping shoulders forward while standing, curling wrists inward while sleeping.

WellDoc BlueStar Diabetes App Gets FDA Nod For “Over the Counter” Use

screen shot of WellDoc BlueStar diabetes app gets FDA nod for “over the counter” useLast month, WellDoc, a leading mHealth company, announced that the U.S Food and Drug Administration (FDA) cleared their diabetes management   BlueStar for 510(k) Class II clearance for a non-prescription version.

BlueStar helps those with Type 2 diabetes get real-time guidance including instructions to get blood glucose in a safe range, tips, reminders, and calendars for dental appointments. It’s worth noting that for insulin-dependent patients, BlueStar doesn’t tell them how much insulin to administer. Rather, it focuses on providing personalized self-management guidance and helping manage extremes of blood glucose. There are also inputs for mood and diet which gives users a broad and comprehensive view of their health. The app also delivers reports to health care providers for continual monitoring by a professional.

BlueStar has been available by prescription for a few years, but now that it has over-the-counter status the company hopes that it will reach a wider audience and become more integrated with health care systems. The path WellDoc is following is similar to AliveCor who also brought their Kardia monitor to market as a prescription device first before seeking over-the-counter clearance. It does have some advantages for digital health devices by helping reassure regulators and others of safety with an initial period of more controlled, prescription-only use.


Fear and Pain

07/14/17      Mark Pew

Have you ever feared uncertainty? Unpredictability? Difficulties? Of not being able to control your circumstances? The indefinite? What doesn’t make sense? Have you even feared fear?

Word cloud graphic for fear of chronic pain studyHas the anticipation of those feelings ever caused you to avoid circumstances that could potentially create them?

Welcome to the intersection of fear and pain. Especially chronic pain. An interminable, “will it ever go away”, hopeless feeling often accompanies chronic pain. Which creates anxiety. And depression. And potentially surrender and sub-optimal behavior (for example, isolation). And fear. Which can make it all worse.

This Australian Spinal Research Foundation article discusses not only the problem but ways to deal with those fears.

First, the problem. It was reaffirmed in a 2015 study “Beliefs underlying pain-related fear and how they evolve: a qualitative investigation in people with chronic back pain and high pain-related fear.” Their study included three different cohorts:

  1. Those who were fearful due to “diagnostic uncertainty” ;
  2. Those who “feared their pain symptoms were a sign of damage or impending damage” and experienced confusion as to how to fix the problem ;
  3. Those who had consulted healthcare providers due to the loss of function their pain caused, but whose treatments had failed to restore full function.

“The overarching theme was a LBP [low back pain] experience that did not make sense. For all participants, the experience of LBP as unpredictable, uncontrollable and/or intense made it threatening to them.So, to summarize, something they could not control actually ended up controlling them – regardless of the cohort to which they belonged. That threat instilled fear. And that fear can “further feed the catastrophic appraisal of pain, avoidance activity, and disability.” Which can make it all worse.

Fear can be paralyzing. As President Franklin Delano Roosevelt said in his first inaugural address in 1933 …


Top 10 California Workers’ Comp Topics: First Half of 2017

07/13/17   Julius Young

graphic for Top 10 California Workers' Comp Topics: First Half of 2017Months race by, so now it is time to take stock of California workers’ comp after the 2017 half-way mark. What stands out?

Below, in no particular order, are my picks for the most significant topics in California workers’ comp during the first half of 2017. Most of these were discussed in my blog as the year went along.

1. Adoption of a formulary was delayed

Proposed formulary regs were unveiled, with a 45-day comment period ending with a public hearing on May 1, 2017. AB 1124, passed in 2015, amended Labor Code section 5307.27 to require the Administrative Director to adopt and incorporate an evidence-based drug formulary into the MTUS by July 1, 2017.

Many stakeholders expressed concern over the July 1, 2017 deadline, urging the DWC to take more time to “get it right”. As of early 2017 the DWC has not issued revised regs with a 15 day comment period.

The DWC moved forward on regs required to implement the two anti-fraud measures enacted in 2016. Emergency provider suspension regs were adopted as required by AB 1244, as were WCAB lien claims filing rules, required by SB 1160.

WCIS (Workers’ Compensation Information System) regs were also adopted.

Still undone are home health care provider fee schedule regs and an interpreter fee schedule.

It should be noted that the DWC is not required to go through the Administrative Procedures Act for treatment guideline updates and OFMS (treatment fees) updates.

2. The issue of apportionment to genetic causation rose in prominence

A case decided by the California Court of Appeal Third District, City of Jackson v. WCAB (Christopher Rice) 11 Cal. App. 5th 109, addressed whether the courts would uphold a QME’s determination that a portion of the disability should be apportioned due to genetic causation. The Court of Appeal determined that this was allowable. However, the Court refused to consider arguments that this was prohibited by the California anti-discrimination statues (Government Code 11135(a) and 12940(a)) since that issue was not raised previously. Likewise, City of Jackson v. WCAB did not consider potential issues as to whether genetic apportionment was a violation of GINA, the federal Genetic Information Nondiscrimination Act of 2008.


911 AED Drone Delivery!

Drones to the rescue: Improved delivery of AEDs to remote patients with cardiac arrest

For patients experiencing cardiac arrest, having quick access to defibrillation is crucial for survival. However, due to access limitations, many patients suffer due to delayed defibrillation.

Drones to the rescue: Improved delivery of AEDs to remote patients with cardiac arrestPreviously, the power of crowd-sourcing first-aid CPR skills in the community to provide care to patients with cardiac arrest in non-hospital settings has been well-demonstrated. In a recent study by Claesson A et al, the concept of using drones to deliver automated external defibrillators (AEDs) was put to the test at locations where previous, real cases occurred within a 10-km radius of the fire station in Stockholm.

The time needed for drones to fly AEDs to patients experiencing cardiac arrest outside of hospital settings was compared with that of conventional emergency medical services (EMS). Based on 18 cases within a 72-hour period, the median dispatch time for EMS was 3 minutes and the median time from dispatch to arrival with EMS was 22 minutes. In comparison, dispatch and arrival times with drones was much quicker, at a median of 3 seconds and 5:21 minutes, respectively (95% CI 13:48–20:12 minutes compared with EMS; P<0.001).

A difference of 16 minutes in defibrillation delivery is quite substantial. According to the American Heart Association (AHA) Guidelines 2000, every minute that passes between collapse and defibrillation is associated with a 7–10% decrease in survival rates.

CPR, first-aid, cardiac arrest, heart attack, AED Of course, this is assuming that the patient is accompanied by someone who is capable of following the instructions on the AED to deliver care to the patient, but this is a fairly safe assumption as the AED is designed to provide simple instructions that anyone should be able to follow. Nevertheless, the rescue rate in light of improved care delivery will have to be evaluated, in detail, in future studies.


Your Workers Travel Where?

07/07/17 Julius Young

A recent California Court of Appeals decision deals with the issue of how and when an insurance carrier can rescind a workers’ compensation policy.

fraud alert road sign for Californai Workers' Compensation insurance fraud articleStudies prepared for CHSWC have shown that California is plagued with a large amount of employer premium fraud (see link at the end of this post). Sometimes it may be the hiding and misrepresentation of payroll data. Or it may be misrepresentations of the nature of work done by employees.

So clarity about how and when a policy may be rescinded is critical.

In Southern Insurance Co. v. WCAB (note that the case is designated as an unpublished opinion), the misrepresentation was about the distances trucking employees would be driving.

The employer, EJ Distribution (“EJ”), filed an online application with Southern Insurance Company in December 2008. Interestingly, the application was prepared by EJ’s insurance agent. The application listed the business as “local hauling” and also that EJ’s employees did not travel out of state or in excess of a radius of 200 miles.

However, the insurance policy itself did not have an exclusion based on location of injury.

Southern was not pleased when it received a claim that an EJ trucker had hurt his back while on a trip to Tennessee for EJ.

So Southern sent a letter to EJ rescinding the policy on the grounds of material misrepresentation or concealment of material facts in the application for insurance. Southern returned the policy premium paid by EJ.

A later investigation by EJ determined that EJ had been doing trucking operations beyond 200 miles for some time, but there was a lack of specific data uncovered as to when those out of state operations actually started. So Southern apparently did not have direct proof that out of state service was underway at the time of the January 1, 2009 policy inception.


It’s Road Construction Season Again

 07/05/17   Randy Klatt

While many areas of the country experience road construction year-round, summer generally means an uptick in highway projects.

Summer also brings an increase in traffic as people head out on vacations. This is especially true this year with the lowest July gas prices since 2005. Combined increases in both traffic and construction poses obvious challenges for both motorists and construction crews.

According to the Bureau of Labor Statistics, there were 2,054 workplace fatalities in 2015 involving transportation (42% of all workplace fatalities in 2015). Roadway incidents involving motor vehicles and pedestrians struck by vehicles accounted for 1,553 of those fatalities, and 130 of those fatalities occurred at road construction sites.

Total fatalities in work zones, including pedestrians and motorists not at work, totaled 700. Needless to say, more focus is needed in an industry where workers on foot are intentionally placed in close proximity to moving traffic.

Info graphic showing Total fatalities in work zones

Source here.

Each year speeding is found to be the most common cause of traffic crashes. Since nearly half of roadway fatalities result from employees being struck by moving vehicles a reasonable recommendation is to slow down! Highway work zones often have reduced speed limits posted, and many states double the fine amount for exceeding those limits.

Motorists must be more vigilant when approaching construction sites. Expect workers and heavy equipment to be moving around the site frequently and adjust speed accordingly. Driving more conservatively will get you to your destination, and avoid the frustration and increased risk of a crash that comes with driving faster. By the way, it will also save money in fuel and car


Controlling Work Comp Transportation Expense Is More Than Ordering an Uber

Monitoring and managing workers’ comp transportation expenses can drastically improve the claim expense cost, especially on larger work comp claims. Unfortunately, claims adjusters and/or nurse case managers often overlook this important expense, thinking to save money by not using a transportation service.

Attempting to cut costs in this category is not an option, and here’s why.

Controlling transportation expense is more than ordering an Uber for the employee to get to the doctor or writing the employee a check for personal automobile mileage.

When the employee is physically unable to travel unassisted or does not have access to transportation and will have multiple visits to the treating physician or other medical providers, a transportation company specializing in workers’ compensation claims is needed. Services of a transportation company are arranged by the adjuster or nurse case manager, not by the employee.   The selection of a transportation company is based on the company’s ability to provide safe and reliable transport service whenever needed.

A full service transportation company saves the claims office a significant amount of time, since the adjuster or the nurse case manager can spend many calls and emails coordinating employee transportation needs. Often employees reschedule doctor appointments for their own convenience and the transportation must be scheduled all over again. Or worse, employees “forget” their medical appointment and are not ready to go when the transportation arrives, knowing the doctor will not see them if they are very late arriving. Continue reading Controlling Work Comp Transportation Expense Is More Than Ordering an Uber