Saturday, 21 September 2013

Use World Health Organisation standards when it comes to Health Screening and Wellness Programme Design.

Fantastic advances are being made in Health IT, Electronic Health Records and Mobile Health. This is not only to the benefit of patients in a medical setting, but also to the benefit of employees and the wider community to becoming empowered to be healthier. The ability to interpret medical data and convey it visually and accurately to the range of everyday devices such as smart phones, tablets and desktops is truly revolutionary in terms of communication. It is also a far more effective and efficient way of utilising medical professionals and drastically reducing overall costs.

The range of diagnostic tests coupled with medical advances in equipment at our disposal can make it difficult to decide on what the priorities should be for the population either in the local community or in the workforce when it comes to preventative health. The good news is that preventative health screening is guided by a series of basic principles that are now nearly 50 years old but are equally valid today. Use these to help you make decisions on the design of any wellness programme.

In 1968 the Wilson-Jungner criteria for appraising the validity of screening programmes was published by the World Health Organisation. The criteria set a series of basic rules to ensure that health screening and the test applied under the banner of health screening are necessary and beneficial for the individual.

1.    The condition being tested for should be an important health problem.
2.    There should be a treatment for the condition.
3.    Facilities for diagnosis and treatment should be available.
4.    There should be a latent stage of the disease.
5.    There should be a test or examination for the condition.
6.    The test should be acceptable to the population.
7.    The natural history of the disease should be adequately understood.
8.    There should be an agreed policy on whom to treat.
9.    The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole.
10. Case-finding should be a continuous process, not just a "once and for all" project.

World Health Organisation 1968

At Full Health, we use these principles to guide us to do the right thing by the end user we serve.  This helps us to design health screening and wellness programmes that are genuinely beneficial to both employees in the workplace and patients and end consumers in the community.

Furthermore, the aggregated anonymised data helps underpin that value. A tool such as Full Health that gives a consistency in approach regardless of the intermediary provider who delivers the service ensures that there is a clear return on investment for employers and wider commissioning groups versus just a box ticked and no clear return.

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Friday, 2 August 2013

Health Screening Software - Ten Key Questions to Consider

Health screening is a process with some unique challenges and software plays an increasingly important role. The evolution and choice of systems that can support screening is wide ranging from practice management to occupational health to bespoke software. Providers are increasingly investing in technology to grow and make their businesses more competitive.

Henry Ford "If I had asked people what they wanted, they would have said faster horses." 
Innovate to Deliver Real Competitive Advantage
Talking to a leading provider last week, I asked them if they had a working system for efficiently organising and running their entire process from participant self service to administration to decision support for the doctor through to online reports. The reply came that they had just made a very substantial investment in a new bespoke system which they were very excited about. I enquired further as to what this new system does and discovered that although it improved their administration and accounting, it was of no real extra benefit to the end customer they were serving
Are customers not looking for much more quantifiable benefits nowadays versus more of the same?

When reviewing or considering an investment in health screening software you should ask these 10 questions:

Will the Health Screening System:
  1. Automate the entire workflow?
  2. Enable online medical history, lifestyle questionnaires and information relevant to tests to be completed by participant?
  3. Provide instant analysis for the full battery of measurements and laboratory results and questionnaire data?
  4. Integrate fully with laboratories?
  5. Increase doctor productivity dramatically with engaging reports using the most up-to-date medical guidelines and content?
  6. Produce instant anonymous population reports?
  7. Provide a secure patient portal & report download?
  8. Enable scheduling and appointment booking for multiple locations?
  9. Give you financial control and ability for participants to pay online? 
  10. Continue to evolve and deliver value to you, your customers and empower end user participants to better health?

Today, you should look for a system that combines the best in prevention and is also leading the way in the new age of digital health.

* Paul Mc Carthy is CEO and Founder of Full Health and would love to hear your views.


Friday, 26 July 2013

Health Surveillance Screening or Health and Wellbeing Screening-Why Not Both?

Many companies already engage in statutory health surveillance screening which is based on the risks in the workplace. Is there an opportunity for companies to upgrade these programmes to become an organisational wide health and wellbeing programme?

Health Surveillance Screening
Occupational health is concerned with the relationship between health and work. Health problems often impact on work and conversely work can impact on health.
The law requires employers to provide a safe place of work for their employees. They must identify workplace hazards and manage health risks that arise. Companies are also required by law to provide 'reasonable accommodation' for employees with illnesses or disabilities.

Health surveillance also frequently includes health screening of employees on an annual basis to ensure that the working environment is not having a negative impact on employee health. Typical health surveillance screenings include audiometry (hearing check) and spirometry (lung function check) and often blood tests too.

Health and Wellbeing Screening
Health and Wellbeing screening aims to promote health awareness and proactive risk management by identifying employee health risks and tailoring lifestyle recommendations accordingly. These health screenings offer the opportunity to identify previously undiagnosed illnesses and to address them before they become serious.

Health and wellbeing screening is primarily used as an employee benefit either as a stand-alone measure or as part of a wellness programme. Wellness programmes are usually tailored to suit the requirements of each individual company and include measures such as fitness programmes, dietary advice and mental wellbeing awareness.
A health and wellbeing screening can contain a combination of tests. A typical basic test profile could consist of Height, Weight & BMI, Blood Pressure, Cholesterol, Fasting Glucose or extend to a more advanced profile including Kidney Function Test, Liver Function Test, Full Blood Count, Thyroid Function, Urinalysis, Resting ECG & Advice on Cancer Awareness.

Why Not Both?
Health surveillance screening and health and wellness screening require a similar amount of administrative resources and planning and consume the same amount of employee time. So is there an opportunity for HR to effectively upgrade existing screening programmes to offer a real employee benefit?

We think so and innovation in health screening software can now provide the self service tools and automation to minimise costly process issues. This means that the substantial effort and resources invested in health surveillance in the workplace can be communicated to each employee in an engaging way so that is also seen as a company benefit. Ultimately, this can empower your employees to better health and productivity.

Paul Mc Carthy is the CEO and Founder of Full Health Medical.

Thursday, 18 July 2013

Little (miss) sunshine and the heart

These days, I always seem to be thinking about balance in medicine; a balance between risk and benefit, a balanced diet and so on. So as Ireland swelters in unusually hot weather conditions, I’ve found myself wondering about the balance between too little or too much sunlight and the health implications. I’m not alone in this. Over-exposure to sunlight and we need to think about skin cancers, for example. But what about too little? Well, one issue associated with too little sunshine is low vitamin D levels and it is suggested that a large number of the population of Ireland and the UK are currently deficient in said “sunshine” vitamin.

Research about vitamin D seems to be very popular at present and there seems to be an ever increasing body of evidence that vitamin D deficiency is associated with a multitude of illnesses. These range from the role of vitamin D in bone health, cancers, cardiovascular diseases and auto-immune diseases. There is even a vitamin D hypotheses in terms of explaining  the increased prevalence in northern latitude of multiple sclerosis. See Holick MF et al in the Am J Clin Nutr 2004 or Ascherio A. Ann Neurol 2007 for more.

Low vitamin D levels have been linked to increased coronary heart disease risk. However, frequently the findings were in small studies. In the last fortnight research was publish in JAMA regarding the MESA cohort. This was a large study of ethnically diverse patients who were free of clinical heart disease at time of enrollment. Amongst the findings it was noted that low serum levels of 25-hydroxy vitamin D independently predicted raised long-term risk of coronary heart disease events among white participants (as opposed to African American for example). This study was described by a JAMA editorial as being “robust” and it is interesting that outcomes were adjusted for a multitude of CHD risk factors: age, sex, BMI, smoking status, excercise, diabetes status, cholesterol for example, so it appears as if the evidence is getting stronger. See here for more.

Although it would seem that there is an increasing body of evidence linking low vitamin D to increased coronary heart disease, a word of warning. Perhaps it might be best to consider getting your levels checked rather than spending longer in the sun. Skin cancer has been increasing over the past decades. According to the World Health Organisation one in three cancers diagnosed is a skin cancer. Reducing exposure to sunlight’s UV rays really is our own resposibility. See here.

Good advice for the current strong sunlight is don’t forget the Australian mantra regarding adequate clothes, sun-cream and hats, “Slip-Slop-Slap” before heading out into the sun.

For Health Screening Software that gives personalised Vitamin D advice CLICK HERE

Friday, 12 July 2013

Does Health Screening have a role in General Practice today?

Most GPs have a strong belief in preventative health but the practice is often a time poor environment. From the doctor’s point of view, the root causes of many illnesses such as diet and exercise take too long to address.

Whilst providing written feedback on all results is desired, the work schedule simply doesn’t allow it. Time spent writing reports is an administrative and costly chore that nobody enjoys and this time is far better spent with patients. 

With the right tools, set-up and discipline, health screening can be an additional high value service to add to your practice without it eating your time. It can create a new revenue stream with good margins and attract new private clients. If something is picked up, these clients are likely to become patients with repeat visits to your practice.  A good set-up means having the process entirely nurse led and the patient doing more of the work in advance.

Here are 10 steps that outline the basics for running a health screening operation:
  1. Schedule specific monthly dates for your health screening service, it may only be one to two mornings per month.
  2. Contract one of your trusted nurses to lead the screening programme.
  3.  Decide what screening products you are offering. The combination of Height, Weight & BMI, Blood Pressure, Cholesterol, Fasting Glucose is a basic offering. Adding Resting Electrocardiogram, Lung Function Test, Kidney Function Test, Liver Function Test, and Full Blood Count is a more premium profile.
  4.   Create awareness. Decide the most appropriate way to promote your new health check service. It may include posters in your practice waiting room, a message on your prescription pads and awareness campaigns aimed at specific age groups.
  5. Take bookings and encourage your patients to book online, this reduces your admin time.
  6. Encourage patients to complete their questionnaire online, this reduces time required with the nurse, which is the major variable cost in running a health screening.
  7. Optimise your resources, perhaps there is a room that can be made available for the nurse on the set days e.g. when a doctor is out on call or off.
  8. As the GP you can set a specific time, for example 8 days post screening appointments to review and approve reports and to call any high priority cases.
  9. Enable your patients to download their own screening report securely, this reduces admin and printing costs. Hard copy reports cost money but can also be provided.
  10. Schedule times for follow-up consultations which should close out very quickly as the patient will have reviewed their report in advance.
Dr. Ann Shortt, Founder and Medical Director

Friday, 5 July 2013

What Qualities Really Influence Patient Satisfaction?

A survey by of 2917 patients has been analysed by a number of leading academics. 7 elements of the customer experience that patients use to rate their health service provision were identified.

1. Accessibility to Physician or healthcare services
2. Communication between the patient and the provider
3. The personality and demeanour of the provider
4. Quality of medical care processes such as diagnosis and treatment
5. Care continuity such as follow up conversations and referrals
6. Quality of healthcare facilities
7. Office staff – the link between the patient and the physician

Healthcare experiences that met each of these qualities were deemed to be ‘excellent.’ It is useful to take a moment to reflect on how your health screening service might be rated across each category.

At Full Health we have always maintained that better communication between the provider and the patient is the key to patient satisfaction, engagement and empowerment. Excellent communication at the point of consultation and of test results thereafter are crucial elements. 

In the words of Buddy Scalara “Engage your patients and move them along the journey.”

The study divides communication into 4 categories:

1. General communication,
2. Listening,
3. Treating the patient as a partner,
4. Giving information. 

Technical, medical information is often the focus of communication between the physician and the patient and the manner in which this is conveyed is crucial to ensure patient satisfaction. The method and delivery of this information must be accessible and presented in a people friendly manner.

Patients who rated physicians as excellent in this category made comments such as:

“Very easy to approach and communicate with”

“Excellent communicator”

“Plain spoken, straightforward in his approach.”

“Explains everything to me so that I can understand it.”

It is obvious that every physician should strive to provide this level of service. Yet increasing resource constraints caused by pressures such as aging population, narrowing budgets and margins and regulatory changes have led to multiple projections of demand outstripping supply. 

In this challenging environment how can an ‘excellent’ level of service provision and communication be ensured for every patient?

Wednesday, 26 June 2013


I’m new to this blogging concept so you may have to forgive me if this seems a little flat – perhaps it’s because I’ve been cutting back on my morning coffee. But thankfully there is light at the end of the tunnel, and it’s all down to the French. Merci mes amis!

Last week I blogged on blood pressure and possible lifestyle choices that people can make to lessen their blood pressure and thus improve their cardiovascular risk profile. I hadn’t expected to return to that subject quite so quickly but you see coffee is dear to my heart and recently people have been asking me about coffee intake and blood pressure; so I couldn’t turn down this opportunity to comment on new research from our colleagues in France. See F. Thomas-Jean, B. Pannier, et al.

Years ago during a health screening it was noted that my blood pressure was high. Since then I’ve surprised my inner skeptic by reducing my readings to an acceptable level by changing my diet, decreasing my salt intake, losing weight and exercising more. The sceptic in me was not surprised that my blood pressure fell as there is ample evidence to support this. What surprised is that it fell by so much. In spite of this my intake of coffee has been questioned.

Now to some, my consumption of coffee is a tad excessive; to me every drop is a glorious moment so it is possible that I’ve been over-doing it. But thankfully I might now be in a position to justify taking another cup.
Presented this week during the European Society of Hypertension (ESH) 2013 Scientific Sessions, research showed a small but statistically significant reduction in both systolic and diastolic blood pressure for individuals who drank tea or coffee. Granted this research was retrospective and based on a self reported questionnaire and indeed was unable to define the exact caffeine content of the beverages consumed, so it will probably be challenged.

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However there is a paucity of good evidence in relation to links between coffee and high blood pressure. The most recent ESH/ESC guidelines back this up, as summarised by the following quote. “With regard to coffee consumption, a recent systematic review found that most of the available studies (10 RCTs and 5 cohort studies) were of insufficient quality to allow a firm recommendation to be given for or against coffee consumption as related to hypertension.”

Given this lack of clarity overall I think I’m going to embrace the new findings for the time being. Now for a quick trip to the patisserie and a small espresso.

Friday, 21 June 2013

Lifestyle Changes for Patients with High Blood Pressure

This week, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published new guidelines in relation to the diagnosis and management of high blood pressure. This welcome development comes out before the long awaited US guidelines which are being produced by the Joint National Committee (JNC) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-8), which are expected later this year.

Targets for those patients with high blood pressure have been simplified. For most people with high blood pressure the recommendations are now to treat to keep systolic blood pressure below 140mmHg. Although certain subgroups have different recommendations: e.g. the elderly, those with existing heart or kidney problems and those with diabetes for example.

However, the European societies have been clear to state that these guidelines are just that, guidelines. They are not expected to apply in every case and they are not meant to be restrictive to physicians’ management practice. Indeed whilst encouraging a holistic approach, the new guidelines are clear that management options need to be in line with cardiovascular disease risk analysis.

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Interestingly, lifestyle changes for lowering blood pressure have been addressed in the new guidelines. This will likely be of interest to those individuals who have undergone a health screening program. The guidelines have this to say about lifestyle changes: “Appropriate lifestyle changes are the cornerstone for the prevention of hypertension. “and “lifestyle modifications can be equivalent to drug monotherapy”. In addition, “Beside the BP-lowering effect, lifestyle changes contribute to the control of other CV risk factors and clinical conditions.”

For those who have a once-off elevated blood pressure reading during their health screen it may not be appropriate to diagnose hypertension depending on the blood pressure result. However as there is little down side to changing lifestyle, then here is a quick recap on some recommendations from the new ESH/ESC guidelines:

1.       Moderate salt intake: typical figures in the European context are a daily intake of 9 to 12g per day of salt. Ideally this should be limited to 5-6g/day.

2.       Moderate alcohol intake: a few days alcohol free and less alcohol if possible. Limit consumption to 21 units for men and 14 for women.

3.       High consumption of vegetables and fruits and other low-fat foods and diets.
Two diets have been in the news a lot recently: these are the Mediterranean diet and the DASH diet. Both have similar recommendations. For example to eat more vegetables, use low-fat dairy products, eat more dietary and soluble fibre, whole-grains, fruit and protein from plant sources. Fish, eaten twice per week, is also recommended.

4.       Optimise weight: This is tricky. Currently two measures are used to give an indication of whether a person is over-weight, these are BMI and waist circumference. Both are frequently used in health assessment although there are limitations with both measures. Nonetheless the new guidelines would advise getting the BMI to below 25kg/m2 and for waist circumference the recommendation is <102cm for men and <88cm in woman. These are the targets but getting there will involve a mixture of dietary and exercise changes.

5.       Increase in regular physical exercise: the ESH/ESC guidelines recommend at least 30 minutes of moderate intensity dynamic aerobic exercise on 5-7 days per week.

6.       Smoking cessation: Smoking causes an acute increase in BP and if stopped has multiple good effects in lowering overall cardiovascular risk. The recommendation is to advise to stop and for physicians to offer assistance where possible.

If you have had a health check recently and your blood pressure was up, you should try to implement some of the above recommendations. They will likely help and it would surely be better than having a heart attack or stroke.

Monday, 17 June 2013

5 Tips to Maximise Health Screening Programme Uptake

Health and wellness screening is an incredible way to empower employees to avoid serious illness.

To ensure uptake is maximised, here are 5 simple tips:

1. Promote Online
Circulate details of screening programmes internally. Email is a simple and trusted form of internal communication for HR to clearly explain the advantages of health screening and why it is being offered as an employee benefit.

Email is also an effective method of reminding employees of their appointment time and specific requirements such as fasting prior to blood tests. Making the process as smooth and easy as possible for the employee increases satisfaction and engagement.

2. Promote Offline
Health screening is an opportunity to build a strong relationship offline and to build recognition of your company. Hosting lunchtime information sessions and simple pop-up banners and posters can help create awareness to drive engagement. Empower local points of contact to become ambassadors for the event by providing them with the tools and support they require.

3. Ensure Consistency
Health screening has multiple steps. Initial emails, booking, promotion, screening and reporting all offer the opportunity to build a relationship with the employee through consistent messaging and branding. This is a simple concept but with the frequency of touch points in screening it is essential to maintain the trust and confidence of the employee.

If you’re sending great emails with your branding then make sure you back it up friendly medical staff and high quality engaging reports that explain results in plain english and graphically.
The most personable aspect of health screening is generally the appointment. By creating a high level of awareness a friendly nurse can engage with informed employees and really drive employee satisfaction.

4. Data Protection
Health screening is a great way to show employees that they are valued yet many may be hesitant to participate if they think their employer or insurer will have access to the data. This is a very valid concern. Be clear and transparent and explain how personal details will be kept in total confidence. Share your privacy statement and make it clear that no personal identifiable details will be shared with the employer or that any group data could invariablly identify them. The heart of data protection is being transparent.

5. Ask for Feedback

Any company that engages with health and wellness screening values their staff. Always ask and encourage feedback as each individual has a different perspective that can help you to continually improve and refine your health screening.

Doctor Time Spent Analysing Results and Creating Personalised Reports can be Reduced to 2 Minutes