Archive for March, 2015


March 17, 2015


The International Classification of Disease tenth revision (ICD-10) is a system of coding created by the World Health Organization that notes various medical records including diseases, symptoms, abnormal findings and external causes of injury. 10th Revision, Clinical Modification (ICD-10-CM) is a revision of the ICD-9-CM which the United States physicians and other providers are currently using to code all diagnoses, symptoms, and procedures recorded in hospitals and physician practices. United States is the only country that is still using ICD-9, and the move to ICD-10 will enable more accurate healthcare data comparison with the rest of the world. ICD-9 codes have been around for more than 30 years, therefor, uses outdated terminology, lack specificity, and is running out of room as new diagnosis codes are submitted annually.

The ICD-10-CM revision has more than 68,000 diagnostic compared to the 13,000 found in ICD-9-CM. The revision also includes twice as many categories, and is more specific in identifying treatment. For example, ICD-10 provides codes to distinguish between a left or right leg; ICD-9 does not. The U.S. Department of Health and Human Services had intended to require implementation by October 1, 2014. However, on April 1, 2014, Pres. Obama signed into law H.R. 3402 which prevents H.H.S. from establishing ICD-10 as the standard code set before October 1, 2015. Now some lobbies are back at it again –requesting that ICD 10 be delayed or even thrown out. The Taxes Medical Association has been urging physicians from across the United States to ask Congress for a two-year delay in ICD-10.

The American Health Information Management Association (AHIMA) and the Coalition for ICD-10 have launched its own advocacy efforts to keep the ICD-10 implementation date at October 1, 2015.
Why we need to move to ICD 10
1. Specific Information-ICD-9 lack of specificity, for example similar injuries on opposite limbs has the same code. ICD-10 will offer specific information in areas such as right versus left, initial or subsequent encounter. ICD-10 will have 68,000 available codes (with flexibility for adding new ones) in comparison to ICD-9’s 13,000 codes and limited space for additions.ICD-10 supports use of combined codes that can be used to classify multiple diagnoses or a diagnosis with a complication.

2. Public Helath-According to AHIMA, “The US is the only industrialized nation not using an ICD-10–based classification system for morbidity purposes. This makes it difficult to share disease data internationally at a time when such sharing is critical for public health. The US’s ability to track and respond to global threats in real time is thus limited.”

3. Technology-The transition is necessary no matter how one looks at it; the current coding system can’t meet the future needs of the healthcare system. ICD-9 is widely considered to be based on outdated technology, with codes unable to reflect the use of new equipment. ICD-10 offers integration with modern technology and meets Big Data need.

Several stakeholders have worked hard to prepare for ICD 10, School have taught their students on ICD 10 and certification exams have been prepared in anticipation on its adoption therefore to have the students go back to study ICD 9 would not only be a disappointment but a failure to our country’s educational system. Millions of dollars have been invested by organizations in an effort to meet the compliance deadline and do not want another ICD-10 delay. For most hospitals the IT team had to look at all systems and make sure there are compatible and ready to handle the different codes ICD 10 brings, the coding team had to be trained to understand how to code for reimbursement. There is t end-to-end testing between companies that also been done and still on going.
Bowman, a director for AHIMA coding policy argues that “pulling the plug now would mean additional cost for stakeholders.” Report from HHS shows that a one-year delay in the ICD-10 compliance date would increase providers’ costs by 10% to 30% relative to what organizations have already budgeted or spent for the transition, equaling a range of $1.1 billion to $6.8 billion for each additional one-year delay.
The American Hospital Association submitted a statement to the House subcommittee hearing expressing opposition to any further delay. AHA said, “Hospitals are actively preparing their information systems, affiliated physicians and coders to make the transition possible”

For most Americans the impact of the delay might not be felt right now but we need to recognize that as the U.S battles with indecision to update to ICD-10 coding system by the upcoming Oct. 1 deadline, work is being done elsewhere on the coding system’s next-generation product: ICD-11. Are we always going to be a step behind or its time to take a stand and move forward with ICD 10.


Mental Health and Gun Ownership

March 8, 2015

Firearms can be used for multiple uses but can also be used to inflict harm to others and take the life of individuals. Currently the legal system of the United States of America holds different standard for individuals deemed mentally insane. These individuals are not equally responsible for serving the same punishment as a mentally stable individual and are exempt from the serving their time in the prison system by being deemed not guilty by reason of insanity. [1]

Fatal Gaps

Fatal Gaps


It is in our interest to protect the health and wellbeing of these individuals and those of the members of their communities by restricting the access of these individuals to firearms as it was mandated in the state of Washington.[2] By correctly implementing a system of medical professionals that diagnose an individual as mentally capable prior to gun purchase we can limit the liability that can come from having any single individual purchasing a firearm and causing harm to themselves or others.

By passing this bill we are equally protecting the rights and health of these individuals deemed medically as mentally unstable as well as protecting the rights of the community they reside in. Although the second a amendment is the right of bear arms, one has to consider that this can only be attained as long as the individual in question posses sound mind and clarity to make rational and informed decisions.

[1] Not Guilty By Reason of Insanity, Cornell Law

[2] Fundamental Rights to Keep and Bear Arms in Western Washington, Seattle Criminal Law


Other Supporting Documents:

National Conference of State Legislature

The workthreat group, LLC

Guns and Ammo, Magazine


Reducing maternal mortality in Kano, Nigeria

March 7, 2015

Momodu ng_children_mnchNigeria, the most populous country in Africa, accounts for about 13 percent of the global maternal death rates, with an estimated 36000 women dying in pregnancy or at childbirth each year. []. This is equivalent to about 630 maternal deaths for every 100000 live births [].

Most cases of maternal mortality are due to socio-economic and cultural factors. Poverty prevents women especially in the northern part of Nigeria, Kano from getting proper and adequate antenatal, natal and post-natal care.

In 2001, there was introduction of free maternal and child health services in Kano state by democratic rule in 1999. “The Nigerian State government showed a great commitment to substantially reduce maternal, newborn and child mortality as well as meeting the MDG targets” ( Policy for reducing maternal and mortality in Kano State Nigeria).

Kano state of Nigeria was the first state to introduce this official policy on free treatment of pregnant women. This led to reduction of maternal mortality in the state, but more recently maternal mortality ratio has increased in the state due to poor collateral services that will sustain the maternal mortality reduction ( This is a call to the state government of Kano and all stakeholders involved to look back into the policy to ensure sustainability of the program.

Breaking the Intergenerational Cycle of Under-nutrition: Community Based Interventional Approach in Bangladesh

March 7, 2015


Malnutrition has always been one of the major Public Health issues in Bangladesh. Malnutrition includes both under-nutrition and over-nutrition. However, Bangladesh is a highly under-nutrition (wasting, stunting and underweight) prevalent country which include macro and micro-nutrient deficiency. In Bangladesh, commonly children aged under 5 years and women suffer most from under-nutrition . Among the children under 5 years, the prevalence of chronic under-nutrition (stunting) is around 44% (7.8 million) and acute under-nutrition (wasting) is 14% (2 million) which is nearly the WHO “critical threshold” of 15%. More than one in five newborns (22%) have a low birth weight in Bangladesh due to maternal under-nutrition and early pregnancy. Early pregnancy contributes to the inter-generational cycle of under-nutrition. Although the prevalence of under-nutrition has reduced over the past few years, but progress has been slow due to poverty, lack of health education, natural disaster, food insecurity and caring practices.

Source: WFP Bangladesh Nutrition Strategy

Intergenerational cycle of under-nutrtion; Source- WFP Bangladesh Nutrition Strategy

Improvement of maternal and child nutritional status has been a priority of the government of Bangladesh for several decades. In 2012, to reduce maternal and child under-nutrition, along with World Food Programme (WFP) Bangladesh govt. introduced National Nutrition Service (NNS) strategy 2012-2016 which is multi-sectoral collaborative approach aiming on strengthening national and local capacities to adequately deliver nutrition services, and improving access to nutrition services through integrated community based interventionsThe policy specifically focused on the first 1000 days of a child from conception to two years when nutrition needs are the highest and nutrition intervention have the most long-term effect and contribute to breaking the inter-generational cycle of under-nutrition.

We believe, this short-term comprehensive approach will be very effective to reduce nutritional problem in Bangladesh. However, active coordination of all sectors, adequate training of health worker, uninterrupted supply of nutritional services and active involvement of community need to be ensured.

A new working group to support malaria elimination in the Amazon region

March 7, 2015
Malaria Elimination Working Group, Iquitos-Peru, February 2014

Malaria Elimination Working Group, Iquitos-Peru, February 2014

In February 2014, the Malaria Elimination Working Group (MEWoG), in partnership with the Peruvian Ministry of Health (MoH), hosted its first international conference on malaria elimination in Iquitos, Peru. The two-day meeting gathered 85 malaria experts, including 18 international panelists, 23 stakeholders from different malaria endemic regions of Peru, and 11 MoH authorities.

Several key conclusions and points of consensus arose from this meeting. The most important one is that malaria elimination in the Peruvian Amazon is an achievable and nationally and internationally important goal. It will be important to develop a Comprehensive Regional Strategic Plan, which must satisfy several key characteristics. It was strongly recommended to first, pilot such strategy in suitable sites in the region to establish efficacy and acceptability. As such strategy is implemented, it will be important to monitor and evaluate progress through a variety of metrics and to set intermediate goals on the path to regional elimination. Targeted parasite elimination strategies that are appropriate to the region must be used, stressing active case detection using sufficiently sensitive and effective RDTs and species-specific treatment of the asymptomatic reservoir. This is particularly important in the case P. falciparum malaria, which must be treated with ACT and primaquine to interrupt transmission. The strategy must include and facilitate communication between key stakeholders from the region and political support at all levels of government, and the program should be incorporated into established health systems to improve acceptability and sustainability. The progression of such strategy should be flexible to allow new knowledge of the social determinants of malaria, the cultural acceptability of key interventions, and novel tests and treatments to be incorporated throughout the effort. With this conference, an agreement on the relevance of pursuing malaria elimination as goal has been reached, and the necessary components characteristics of this effort described. Moving forward, further detail should be elaborated as commitments from numerous key stakeholders are obtained

Not Free Anymore for Taipei City Ambulance? ——A Possible New Change

March 6, 2015

Emergency medical system (EMS) has always been the first-line help for citizens, particularly during emergencies, just like everyone knows ambulances are designed for people requiring immediate medical assistance. Instead of calling 9-1-1, people in Taiwan dial 1-1-9 while there’s an urgent medical condition, and the ambulance would come in minutes to transport the patient to medical facilities–free of charge. But problems exist because there’re individuals who tend to abuse the ambulance use, calling just for minor ailments even alcohol intoxication.
Emergency ambulance are NOT taxis.

Such calls have placed unnecessary burdens on EMS medical teams and affected the system’s providing service to those who are in genuine need. Although the whole Taipei City fire department is equipped with 78 ambulances and 200 ambulance corps members, there is an average of 400 emergency calls every day to handle. While there’s only one at most two ambulances in one precinct, if one ambulance is called out, the region would have to be supported by neighboring teams in the following one hour.
Taipei EMS Dispatches Statistics (Source: Taipei City Fire Department)

Taipei City government has long been considering implementation of charges for ambulance transportation on people who use the service for non-emergency conditions, a fee of NT$1,800 (about USD$60), including NT$800 for ambulance transport and NT$1,000 for the two accompanying paramedics, which is levied in accordance with the Emergency Medical Care Act. Yet it was not enforced except for some extreme cases until lately, the new Taipei City mayor has determined to extend the policy.

Based on the spirit of “users pay” and “leaving the resources to whoever in real need”, Dr. Wen-Je Ko—the current Taipei City mayor and also a former trauma surgeon as well as ER chief—believed that the charges should be applied on all patients that are not true emergencies, such as level 4 or 5 patients at ER triage. There are arguments and criticism from other sectors toward this policy, however, worrying the impact on the underprivileged or social vulnerable groups that could prevent them from seeking medical help. The city government promised that the measure would not affect people’s right to emergency medical services: the ambulance service would remain free if people call for real emergencies. Taipei City Fire Department has been working with Department of Health and the City EMS review committee, to organize and plan more comprehensive rules of ambulance charging, which are expected to be on the way recently.

Beyond the regulation by the FDA: Is the tobacco use effectively controlled in the United States?

March 6, 2015

Framework Convention on Tobacco Control (FCTC) is the first international treaty adopted by the World Health Assembly in Public Health field in 2003 with the aim of decreasing in the global tobacco consumption and exposure. This treaty provides some frameworks to help countries in regulating the tobacco use by policies including a prohibition of tobacco advertising, compulsory indication of the harmful effect of tobacco on its packaging, and heavy taxation on cigarettes.

Although the effectiveness of policies was proven in many countries where the FCTC was adopted earlier, the U.S. has not ratified the FCTC yet. There might be several factors that have delayed ratification, but the Family Smoking Prevention and Tobacco Control Act (FSPTCA) could be the main reason, which actually complies with the FCTC. The FSPTCA authorized the FDA to regulate the manufacture, distribution, and marketing of tobacco products. However, this act was criticized because “the law offers the tobacco industry an opportunity to rehabilitate its image and products as they are now FDA regulated.


Stephen F. Sener, MD, national volunteer president at the American Cancer Society said that the U.S has a critical role in ratifying the FCTC, especially for low-income countries. Rationale of his critiques is mainly based on the fact that the U.S., as the fourth biggest tobacco producer in the world, has an huge international impact since it is the home country of multinational tobacco companies, such as Philip Morris.

Although President Obama promised his strong commitment for FCTC before he was elected, he has not shown his presence in this field. In order to promote more effective domestic tobacco control as well as international norms in the U.S., understanding the discrepancies between the FSPTCA and the FCTC is essential. Therefore, we strongly urge senators to set the agenda again so that Obama addresses this gap as the first step to ratify FCTC.

Why a New Transparency Policy is Effective in Tackling MERS in Saudi Arabia

March 6, 2015

In 2012, a novel coronavirus was isolated from an old man in Saudi Arabia who arrived to the hospital suffering from shortness of breath, fever, and chest pain. While efforts were made to characterize and understand the nature of this virus, several cases of acute to severe respiratory illness continued to appear in hospitals throughout the Kingdom, and transmission between patients and hospital workers added to the burden of the outbreak. The pathogen was later classified as Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and by early 2013; this deadly virus had already spread through the Arabian Peninsula, resulting in 9 countries with lab-confirmed cases. As of February 5, 2015, 971 laboratory-confirmed cases of human infection with MERS-CoV have been reported to WHO, including at least 356 deaths.

There are many who have condemned the Ministry of Health on its lack of containment measures in response to the MERS outbreak. However, Tariq Madani, the head of the scientific advisory board at the Saudi Ministry of Health, emphasizes that most positive confirmed results of MERS, which were tested in government hospitals and laboratories, have simply not been passed by those institutions to the ministry. The ministry’s policy regarding discrepancies between two test results meant that only the government laboratory result would be considered, whether positive or negative. Adel Fakieh, the new health minister, has changed that policy and implemented a new policy, which requires positive MERS test results from any laboratory accredited by the health ministry, and not just government laboratories, to be considered as a confirmed cases and immediately reported to the ministry.

This new policy allows for more laboratory testing to be done in hospitals, which means more confirmed cases could be identified and isolated. A policy requiring laboratories, whether private or public, to report all positive confirmed cases of MERS to the ministry allows for better communication between hospitals and ministry officials.

The slowing rate of MERS infection indicates that such a policy of transparency in tackling this epidemic is clearly effective and should be enforced with complete cooperation by healthcare providers and laboratory technicians.

Adopt the 2014 bill SBP 7028, the “Florida Telemedicine Act”

March 6, 2015

For the past two years, there has been a heated debate on legislature surrounding the adoption of telehealth technology in the state of Florida. Telemedicine has been shown to be a cost-saving benefit by leveraging technology to provide more effective and efficient systems of care. blog pic 1Florida currently has a higher ratio of patients to primary care providers when compared to the national average and is projected to have an increasing shortage of physicians over the next 10 to 15 years. The reasons cited for these projections include a growth in the population, increased use of medical services due to an aging population and an increased number in the insured due to the mandated 2010 Affordable Care Act (ACA). Another major benefit to facilitating telemedicine in the state is rural health care coverage. The Florida Department of Health reports ten of Florida’s 30 rural counties currently lack a rural hospital which continue to be the primary and focal point of care for these areas.

SBP 7028 would seek to “create licensure and registration requirements; provide health insurer and health plan reimbursement requirements for telemedicine; and provide requirements for reimbursement of telemedicine services under the Medicaid program, etc.” Telemedicine in Florida is supported by independent groups such as Florida TaxWatch and Florida Partnership for Teleheath. This bill has been met with most resistance from the Florida Medical Association specifically due to concerns of accountability, physician licensure, certification process to provide telemedicine services and potential abuse or misuse of such technology by out of state providers.

Twenty-two states are facing proposed legislature related to adopting telehealth technologies while others are expanding these to meet a growing need. One year and several amendments later, it is time to vote on this bill for telemedicine across the state of Florida.

Child Trafficking in Nepal

March 6, 2015

About the only thing the Government of Nepal has gotten right since passing the Human Trafficking and Transportation (control) Act of 2007 is that they’ve started prosecuting public officials accused of complicity in fraudulent recruitment of underage labor and sex trafficking even if the numbers of prosecutions is a drop in the bucket to how much corruption really exists in Nepal around child trafficking. However, at least this new law brought them in line with International Trafficking laws (which make them look good, right?) But, The GoN has no national anti-trafficking plan in place, nor is it a party to the 2000 UN Trafficking in Persons (TIP) Protocol.

Child trafficking in Nepal is unfortunately on the rise, with between 7,000 and 12,000 children being trafficked from Nepal each year to countries such as Bangladesh, India and the United Arab Emirates where they will face exploitation, predominantly in the commercial sex industry but also being sold into forced labor. There are many factors that help perpetuate this complex problem of human trafficking especially in children including; political instability, transition into peacetime (post-conflict), high poverty levels, high illiteracy, unemployment and the patriarchal social norm. Nepal has all of this in abundance.

According to the US Department of State 2014 Trafficking in Persons report, “Nepal is a source, transit, and destination country for men, women, and children who are subjected to forced labor and sex trafficking.”[i] Let’s take a closer look at what the government hasn’t done yet:

  • The GoN has been developing and anti-trafficking plan, but not yet completed or voted on.
  • No publicity surrounding the policy change of Human Trafficking in 2007 to raise awareness of the stand the GoN has finally taken.
  • There still exists a ban on women under 30 from travelling to foreign countries to work as domestic labor, which forces migration through illegal and dangerous channels.
  • There has been no sign of increased law enforcement against all forms of trafficking including girls and women.
  • Punishment of those trafficked without proper ID continues as usual (typically stolen by their captors), or those forced into prostitution.
  • Very little, if any police training on trafficking as well as prosecutors and judiciary (for the handling of human  trafficking prosecution)
  • No formal procedures put into place to recognize victims and protect them once taken away from trafficked environment (especially by police conducting raids).
  • There is very little provision of and/or a referral to protection services, immediate healthcare, legal services etc.
  • Finally, among the most heinous of these insults to trafficked victims is returning them to their captors after raids. (because the captors paid bribes to the police).

When you have societal norms of bribery among the local police, prosecutors, judiciary etc. much of what the government may try to do is undone by this corruption. According to the US State Dept., there are reports of all this and since some of those in authority own dance bars, or businesses that force child labor and slavery from trafficked children (i.e. brick kilns) it is entrenched in their society. Additionally, the huge, thriving networks of manpower agencies which lure children from their homes with promises of real jobs are powerful, have been around for centuries and bribery has always been a part of it – it’s called organized crime.

In 2013, according to the Government of Nepal’s (GoN) Report on Anti-Human Trafficking Initiatives[ii] they allocated a budget of 3 times as much to Nepal Embassies in other countries for trafficked Nepali citizens than they did for awareness programs, protection, rescue missions etc. within 75 districts in Nepal. (NRs 8 million vs. 3.7 million). Is this because the GoN will get more international coverage for what it is doing to ‘protect its citizens’ in other countries? They were the recipients of an international award for this.

The most important work is being done by local, national and international nongovernmental agencies and the communities they serve. The NGOs working in rural and urban areas develop awareness, create protection and shelters, provide legal aid and education include: Change Nepal and The Himalayan Foundation (). Since 1980, Bachpan Bachao Andolan (BBA) which has been at the forefront in the fight against slavery, has conducted rescues of over 82,800 children and the withdrawal of over 200,000 bonded and child laborers. The organization Global March is a collaboration among child rights’ organizations, trade unions and teachers’ organizations. It is the largest and most established active global coalition that specifically targets child labour elimination. Their belief is ”child labour can never be eliminated as long as hard-to-reach children continue to remain out of school”[IChild_labour_Nepalii].

The work these organizations are doing by saving children’s lives, putting them into schools and providing life after slavery ultimately creates the slow process of social change.