Eagle’s syndrome represents a group of symptoms that includes recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. The medical history and physical and radiologic examinations are the main guides to the precise diagnosis. The radiologic diagnostic modality of choice is three-dimensional computed tomography (3-D CT). We describe a case of bilaterally symptomatic Eagle’s syndrome that was diagnosed by 3-D CT of the styloid processes and successfully treated with surgery via a transoral approach.

Symptoms of Eagle’s syndrome include recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain. Two possible causes of the syndrome are elongation of the styloid process and ossification of the stylohyoid or stylomandibular ligaments. (1-3) Eagle considered any styloid process greater than 25 mm–the approximate length of the normal styloid process in adults–to be elongated. (1-4) The reported prevalence of elongated styloid process ranges between 1.4 and 30%. (5-8)

The diagnosis is guided by the medical history, findings on physical examination (palpation of the lateral tonsillar fossa and infiltration of local anesthetics to the tonsillar fossa), and radiologic investigation. (7,8) X-rays are still used to diagnose Eagle’s syndrome, but a new and preferred modality is three-dimensional computed tomography (3-D CT), which can definitively measure the length of the styloid process. (9,10)

The primary treatment modality for Eagle’s syndrome is surgery. The elongated styloid process can be resected surgically via a transoral or extraoral approach. (11-13) The choice of surgical approach is usually based on the surgeon’s experience.

In this article, we present a case of Eagle’s syndrome that was caused by bilaterally elongated styloid processes. We describe our use of 3-D CT and surgery via the transoral approach.

Case report

A 46-year-old woman presented to us with a chief symptom of a foreign-body sensation in her throat. She also reported a sore throat and bilateral pain in the neck that was aggravated by swallowing. Earlier, she had been prescribed corticosteroid and analgesic treatment by a neurologist, and she had been subsequently referred to a gastroenterologist and a psychiatrist. Because a detailed gastroenterologic examination, including 24-hour pH monitoring, had detected no evidence of a gastrointestinal disease (gastroesophageal reflux or laryngopharyngeal reflux in particular), no medication had been recommended. The psychiatrist had prescribed an antidepressant drug, but the patient’s symptoms persisted.

The patient’s medical history was negative for recurrent tonsillitis, true foreign bodies, coexisting systemic diseases, and surgery, and her family history was negative for craniofacial syndromes. On routine physical examination, no otologic or rhinologic abnormality was found. No visible mass or true foreign body was observed during endoscopic examination of the nasopharynx, hypopharynx, larynx, and tongue base. No palpable mass was present in the neck. Suspecting an elongated styloid process, we palpated the tonsillar fossa bilaterally at the level of the anterior pillar, which elicited a very painful response. Lateral neck rotations to both sides also caused severe pain in the neck. The pain was relieved bilaterally by application of 1% lidocaine to both tonsillar fossae, a finding that suggested a diagnosis of Eagle’s syndrome.

Findings on a laboratory work-up–which included a complete blood count, measurements of the erythrocyte sedimentation rate and anti-streptolysin O titer, and hepatic and renal function tests–were all normal. No microorganism was demonstrated in cultures of sputum. However, a panoramic radiograph demonstrated bilateral radiopaque bodies extending from the origin of the styloid process to the angle of the mandible. We established a presumptive diagnosis of Eagle’s syndrome and initiated conservative treatment with the application of heat to the neck and analgesic and myorelaxant therapy. However, the patient’s symptoms failed to respond. We then obtained 3-D CT, which revealed that both styloid processes were elongated. The styloid process on the left was 41.5 mm (figure 1, A), and the styloid process on the right was 42.5 mm (figure 1, B). Based on these findings, the patient was scheduled for resection of the styloid processes via a transoral approach.

[FIGURE 1 OMITTED]

Following the administration of general anesthesia and intravenous antibiotics, we performed a bilateral tonsillectomy. Next, we located by digital palpation the protuberance of the styloid process at the superolateral corner of the tonsillar fossa. The styloid process was skeletonized, and the attaching ligaments were separated from it (figure 2). The naked and free styloid process was removed from the temporal bone at its origin. The same procedure was then performed on the other side. Intraoperatively, the length of both styloid processes was 40 mm.

* Number of wrong-site surgeries conducted on limbs or organs other than the spine occurred once in every 112,994 operations.

* Degree of harm was low in the instances found in the study.

* Hospitals seem to be confused about processes JCAHO is recommending.

Wrong-site surgery is extremely rare and major injury from it even rarer, according to a study supported by the Agency for Healthcare Research and Quality and published in the April 2006 issue of Archives of Surgery. (1)

Researchers led by Mary R. Kwaan, MD, MPH, of Brigham and Women’s Hospital and Harvard School of Public Health in Boston, estimate that a wrong-site surgery serious enough to result in a report to insurance risk managers or in a lawsuit would occur approximately once every five to 10 years at a single large hospital.

The study assessed all wrong-site surgeries reported to a large medical malpractice insurer between 1985 and 2004 and found that the number of wrong-site surgeries conducted on limbs or organs other than the spine occurred once in every 112,994 operations. In addition, 40 cases of wrong-site surgery were identified among 1,153 malpractice claims and 259 instances of insurance loss related to surgical care. Of that total, 25 of the cases were non-spine wrong-site surgeries, with the remainder involving surgery of the spine.

Another interesting finding involved the universal protocols from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), which went into effect in July 2004. According to the researchers, available medical records for 13 of the 25 non-spine wrong-site surgery cases show that injury was temporary and minor in 10 of the cases, but that JCAHO’s “Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery” might have prevented eight of the cases.

An ‘uncommon’ event

“Our interest was in wrong-site surgery, how it happens, and what kinds of cases are at risk for wrong-site surgery events,” says Kwaan, a surgical research fellow at the Brigham & Women’s Center for Surgery & Public Health. “We also had some interest in finding out how hospitals reacted to the site verification protocol.”

The main point Kwaan would like to emphasize is that based on her findings, wrong-site surgery “is not a common adverse event.” Previously, she says, there had not been much data on the problem. “A lot of the discussion on this problem is based on case reports, so we do not have denominators,” she explains. “Also, we wanted to compare [the rate of wrong-site surgeries] with lots of other well-known errors, like a retained foreign body. We now have a number: one in 10,000. That is far more uncommon than leaving a sponge in the abdomen.”

The other key issue, says Kwaan, is degree of harm, which was low in the instances found in her study. “Retained foreign bodies mostly result in pretty serious harm,” she observes. “In our cases, most involved a scar requiring a second operation, but not a major disability–and none of the cases resulted in death,” she adds.

Structured protocols

“The final point it’s important to cite is that when we reviewed the medical records, the events appeared not to have been preventable by the [JCAHO] site preparation protocol,” adds Kwaan. “This is a very important finding: Despite this protocol being fairly extensive, unfortunately it is not expected to prevent every single case of wrong-site surgery. We found it prevented 62% with diligent enforcement.”

Kwaan describes the protocols as “fairly structured,” with three main components. “One is pre-op verification, with recommendations to check things like the consent document or having the histories and physical documents in the medical record,” she explains. “The second is marking the site, which has gotten a lot of attention, and the third is a time-out.”

While these are “fairly specific” components of what JCAHO would like a hospital to do, she says they don’t specify exactly how you actually bring these about.

“It seems [from discussions with hospitals] like there was some confusion about what procedures should be done,” Kwaan notes. “Even though the requirements are not rocket science, they could be quite cumbersome if not planned correctly.”

Given the fact that the protocols are not foolproof, what does Kwaan recommend? “For now, one of the things we think is important is to have a site verification protocol in your hospital that is simple; this will promote compliance,” she says. “Avoid cumbersome protocols and redundant checks, where everybody knows they are checking the same thing three other people checked. Although there is no data on this, we don’t feel it will increase compliance–in fact, we feel it will make it easier to violate the protocols.”

The pre-op verification process, she continues, should involve two health care professionals–and one should be the surgeon. The other should be the nurse or anesthesiologist, who will verify the documents. “The most relevant is the informed consent,” says Kwaan. “We also advocate that hospital policy have a very clear protocol for inconsistencies, so if something comes along that is not matching the OR schedule, a lot of emphasis should be placed on how that will be resolved.”

Bruce Bartlow writes out of decades of experience as a nephrologist and critical care physician. He begins with two thought-provoking statements to alert us that this book is about every person’s spiritual challenge to live and die as a person whose core self, or soul, knew and answered life’s essential questions.

His unsettling opening sentence states: “All of us will come to the end of our lives, but few of us will die well.” This is not what we expect a medical doctor to write about the American way of dying in an age of ever-increasing medical technological achievements!

His second statement is that, “Nearly everyone who reads this book will someday care for a friend or family member as they die. Some of us will even make it a profession. Though we offer our help out of love, I believe we will also hope to be nourished by the transcendent experience of participating in the life well lived and released with grace.”

Bartlow maintains that illness and death, if we permit them, can teach us to reshape our lives. They can turn us, if we are willing, toward answering the meaning of life questions we were born to ask about who we are as a unique person, what is or ought to have been my primary goal in life? To what degree did I achieve it? What remains to be done? How can I use this illness and whatever time I have left in my life to achieve this goal?

Examining these questions, he believes, is crucial to every person in order to live and die well. For many of us, however, it is only illness or the approach of death that causes us to put aside other life events and to seriously reflect.

To lead us to do this reflection before or during an illness or as death approaches, Bartlow uses a metaphor of life as a river that is moving serenely through a forest of beauty. Suddenly the waters encounter a large stone and the peaceful flow is disrupted perhaps never to become again the gentle river it was. New adaptations to the environment must be made. However, though the river is different it need not cease to be what it was meant to be.

Bartlow sees our lives moving joyfully, with purpose through events as the original serene river. Unexpectedly, illness — perhaps terminal illness — enters and as the stone has changed the river, challenging it to adapt to a new environment and perhaps purposes.

In a similar way, illness becomes our teacher. As dashing against the stone causes the water to become murky and turbulent, so our illness causes us to ask questions we had long silenced within us. How will I live the remaining years of my life? What will I be able to do? How will my family and loved ones relate to me? Will I die peacefully or tied to machines, not being able to communicate my needs and/or desires?

Looking back over the river of his own medical career, Bartlow discovered that the questions he asked patients changed as he found that the medical technology he provided often failed to enable a patient to die well. Rather, 30 years of trying to “save” critically ill patients deprived them of the opportunity to complete the unfinished life goals that our core self needed to pursue in order to die healed.

His experiences taught him he could provide the opportunity for people to die well only if he moved from the technologically centered world into the post-modern world. He learned that rather than being a medical technician with answers about how to heal physical ills, he needed to become a healer, asking the patient to guide him to an understanding of what the patient in his/her deepest self needed so that he/she could die well.

As a technician, he had approached a patient thinking, “What do I need to do to offer this patient a physical cure?”

Today, as a healer, his queries are about the patient’s life goals, his/her hopes for the remainder of her/his life, the quality of life that would be acceptable if cure cannot be achieved.

Knowing the patient’s answers to these questions, as a healer he then outlines whether or not or to what degree the available medical procedures can provide sufficient time and energy for the patient to achieve these goals.

The essential questions become: What is your core self seeking to understand about itself through this illness? Are there unresolved issues that need to be addressed? Are there broken relationships that need to be healed if you are to die well?

The subtitle of this book, A Practical And Healing Guide to End-of-Life Issues for Families, Patients, and Healthcare Providers, can be misleading. A reader may expect a medical ethics book about how to use today’s techniques of medical science, such as pain medication and legal documents such as advance directives to provide for a dignified death.

Rather, the challenge of the book is either to use an existing illness or to imagine one’s dying days to ask questions about the type of person I want to be remembered as being. What have I achieved? What are the life goals that I have not yet accomplished? What is it that I was created to be? How can I achieve that in my remaining years?

Most medical research is empirical based on evidence rather than hunches or preferences. It follows a series of specific steps. There are no short cuts. Collection of evidence and its analysis should follow a carefully drawn protocol. Most of the modern medical research requires biostatistical tools to reach to a valid and reliable conclusion. Researcher must have an adequate knowledge and skill to be really effective. The endeavours should be consistent with the accepted medical and research ethics. Medical research can provide immense satisfaction when conducted on scientific lines, and can be occasionally frustrating when years of efforts fail to produce expected results. This article focuses on aspects that can increase the credibility of research. It is addressed to all interested in medical research, and seeking answers to questions such as what actually is research, what are its types, what specific steps should be followed, what a research protocol should contain, and what makes research credible etc.

Research is a foray into the unknown. It is search for new information and knowledge. Research is either discovery of new facts, enunciation of new principles, or fresh interpretation of the known facts or principles. It is an attempt to reveal to the world something that was either never thought of, or was in the domain of the conjectures-at best being looked at with suspicion. It is a systematic investigation to develop or contribute to generalizable knowledge. The basic function of research is to answer why and how of a phenomenon, but searching answers to what, when, how much, etc., is also part of research efforts. all these questions have relevance to any discipline but medicine seems to have special appetite for such enquiries. The goal of medical research is to improve health, and the purpose is to learn how various systems in human body work, why we get sick, and how to get back to health and stay fit. Research is the very foundation of improved medical care. It can also provide evidence for policies and decisions on health and development.

Much of human biology is still speculative, and its interaction with environment is intricate. Thus medical science has enormous potential for useful research. At the same time it has its own risks as well. This is evident from some of the studies published in 2002. Popular breast cancer therapy tamoxifen was found to carry increased risk of endometrial cancer1. Menopausal women who took estrogen for long time were also found to be at higher risk of getting ovarian cancer2. Arthroscopic surgery for osteoarthritis of knee was found no better than placebo3.

Medicine is a delicate science. It is concerned with vitalities of life such as health, disease and death. Thus, it brooks no error. Ironically, no theories are available that can make it infalliable. There are no lemmas and no theorems. It must per force depend on evidence provided by observations and experience. Medicine is largely an inductive science and has very little space, if any, for deductive methods. The past experience and present evidence provide an insight in to the future. This empiricism is the backbone of medical science. Very often it works wonderfully well but sometimes it does not. There is no assurance. Miscues reported in the year 20021″3 are examples of such errors.

Empiricism has no conflict with rationalism. The observations must stand up to the reason, and should have adequate rational explanation. After all it is the logic of reasoning that separates humans from other species. Research results are more acceptable when the accompanying evidence is compelling and inspiring.

All scientific results are susceptible to error but uncertainty is an integral part of medical framework because of its empirical nature. The realization of enormity of uncertainty in medicine may be recent but the fact is age-old. No two biological entities have ever been exactly alike; neither would they be so in future (How about cloning!). Also our knowledge about biological processes still is extremely limited. These two aspects-first variation, and second limitation of knowledge-throw an apparently indomitable challenge. But the medical science has not only survived but is ticking with full vigour. The silver lining is the ability of some experts to learn quickly from their own and other’s experience, and to discern signals from noise, waves from turbulence, trend from chaos. Biostatistical methods play a key role in this endeavour. It is due to this learning that death rates have steeply declined and life expectancy is showing a relentless rise in almost all countries around the world. Burden of disease is steadily but surely declining across the nations per thousand population4.

Types of medical research

Medical research encompasses a whole gamut of endeavours that ultimately help to improve the health of people. Functionally, it can be divided into basic and applied types. Basic, also termed as ‘pure1, research involves advancing the knowledge base without any specific focus on its application. The results of such research are utilized somewhere in future when that new knowledge is required. Applied research, on the other hand, is problem-oriented, and is specifically directed to solve an existing problem. In medicine, basic research is generally at the cellular level for studying various biological processes. Applied medical research could be on the diagnostic and therapeutic modalities, on agent-host-environment interactions, or health assessments.

A private REIT is shopping a 1.7 million-square-foot portfolio of medical-office buildings valued at about $275 million.

The package consists of 24 buildings in nine clusters, each leased primarily to hospitals or doctors affiliated with hospitals.

The average occupancy rate is 90%. Given the nature of their tenants, medical offices are considered more stable than traditional office buildings, with about a 90% lease renewal rate.

The REIT, Lillibridge Health of Chicago, is backed by Prudential Financial, AEW Capital Management and private-equity player J.P. Morgan Partners. Granite Partners is handling the marketing, with assistance from Cain Brothers, a New York investment bank that specializes in the health-care industry.

At a $165/sf price tag, the buyer’s initial annual yield would be less than 8%.

The portfolio includes the 135,000-sf Saddleback Valley Medical Center in Laguna Hills, Calif., and four San Antonio buildings, encompassing 424,000 sf, that are closely tied to Santa Rosa Hospital/Medical Center. Lillibridge bought Saddleback from Lehman Brothers in 2002 for $30.5 million and bought the San Antonio buildings in 2001 for $22.5 million.

Other properties are located in Atlanta (351,000 sf), Daytona Beach, Fla. (91,000 sf), Indianapolis (95,000 sf), Knoxville, Tenn. (235,000 sf), Miami (148,000 sf), and Minneapolis (97,000 sf). There is also an 88,000-sf Phoenix development, called Banner Desert Medical Pavilion, that is 66% pre-leased.

Except for six of the 10 Knoxville buildings, all of the properties are located on hospital campuses. Many are connected to the hospitals via sky bridges, walkways or underground corridors.

Six of the properties are leasehold interests. The ground leases run through 2041 to 2056, with renewal options of at least 25 years. The portfolio includes six garages that can hold 2,300 cars.

The offering comes on the heels of Orlando-based CNL Retirement Properties’ $256 million acquisition last month of a 1.3 million-sf portfolio from Medical Office Properties of Chevy Chase, Md.

Lillibridge was founded some 25 years ago by Todd Lillibridge, who still heads the firm, which owns or manages some 9 million sf in 20 markets. The company buys, develops and manages medical-office buildings and outpatient healthcare facilities.

Hong Kong’s health authorities said Tuesday that they are on high alert and have taken necessary preventive measures against severe acute respiratory syndrome (SARS) following Singapore’s report of its first probable case in four months.

The Hong Kong government said it has enhanced health checks on incoming travelers from Singapore at Hong Kong International Airport.

”Existing health screening measures, including health declaration and temperature screening at border control points, will remain in place. It is imperative that everybody, the community and the visitors alike, must be put on high alert,” Secretary for Health, Welfare and Food Yeoh Eng-kiong said.

The territory’s public hospitals, private hospitals and private medical practitioners have been alerted of the Singapore incident and told to be prepared for any possible reemergence of SARS.

Hong Kong was one of the areas hit worst by the highly contagious disease, which originated in southern China and triggered off a global health alarm early this year.

SARS infected 1,755 people in the former British colony with 300 deaths.

Hong Kong was removed from the World Health Organization’s (WHO) list of SARS-affected areas in late June.

Hong Kong’s Health Department said it has contacted Singapore’s Health Ministry and the WHO to learn more about the background of the case in the city-state.

The territory has also established a mechanism with neighboring Guangdong Province in mainland China for alerting each other on unusual infections.

”Certainly, we are much better prepared now than we were at the start of the previous outbreak. We should have sufficient facilities and manpower to deal with any possible outbreak. We are all on high alert,” Yeoh said.

He called on the public to continue with the good hygiene practices developed during the SARS epidemic.

Various government departments have also been told to continue preventive measures including requiring students to take their temperature every day before attending school, providing enhanced outreach support to elderly homes, strictly enforcing temperature checking of passengers at border control points, and maintaining active surveillance at clinics, schools, childcare centers and elderly homes.

OCEANSIDE, N.Y. — American Medical Alert Corp. (NASDAQ:AMAC) a developer and provider of healthcare communication services and advanced home health monitoring technologies, announced today that it has increased the size of its Board of Directors from seven to eight members. Concurrently, the Board has appointed Greg Fortunoff to fill the newly created position.

Howard M. Siegel, Chief Executive Officer commented, “Mr. Fortunoff has more than a decade of investment management experience with a specific focus on small cap healthcare and biotech companies. Mr. Fortunoff is a significant shareholder and over the years has demonstrated a strong interest in working with management. We believe as a Board member, Mr. Fortunoff will be able to provide additional expertise to assist the Company with its relations with the investment community.”

Mr. Fortunoff commented, “I have been a long time investor in AMAC and believe that now is the time for me to work with the Company in order to help them build on the significant value they have created. AMAC management has put the Company in a strong position to capitalize on major trends in the healthcare industry, particularly the movement to augment healthcare facility communication capabilities and the increasing reliance on disease management and remote patient monitoring as a more cost effective treatment modality. I would like to thank the Board for inviting me to join them and look forward to working together to enhance the value of our company for all stakeholders.”

About American Medical Alert Corp.

AMAC is a healthcare communications company dedicated to the provision of support services to the healthcare community. AMAC’s product and service portfolio includes Personal Emergency Response Systems (PERS) and emergency response monitoring, electronic medication reminder devices, disease management monitoring appliances and healthcare communication solutions services. AMAC operates seven communication centers under local trade names: HLINK OnCall, Long Island City, NY, North Shore TAS, Port Jefferson, NY, Live Message America, Audubon, NJ, Answer Connecticut, Newington, CT and Springfield, MA, MD OnCall, Cranston RI and Capitol Medical Bureau Rockville, MD to support the delivery of high quality, healthcare communications.

This press release contains forward-looking statements that involve a number of risks and uncertainties. Forward-looking statements may be identified by the use of forward-looking terminology such as “may,” “will,” “expect,” “believe,” “estimate,” “anticipate,” “continue,” or similar terms, variations of those terms or the negative of those terms. Important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are set forth in the Company’s filings with the Securities and Exchange Commission (SEC), including the Company’s Annual Report on Form 10-KSB, the Company’s Quarterly Reports on Forms 10-QSB, and other filings and releases. These include uncertainties relating to government regulation, technological changes, costs relating to ongoing FCC remediation efforts, our expansion plans, our contract with the City of New York and product liability risks.

“My brother-in-law Tex has been told he has, maybe, one week to live with Stage IV liver cancer. Do you have any suggestions?” The question was posed in late November, 2002, to an American who has established an expertise in tracking down breakthrough medical technologies, and then getting them to doctors who want to use them. The American replied: “There’s just one chance. You need to get Tex to Hermosillo, Mexico, today and take him to Dr. Hector Romero.” The brother-in-law rented a plane in his Texas city and flew Tex that very day to Hermosillo. When Tex got to Dr. Romero’s, he could not hold down even a glass of water. Immediately upon arrival at the clinic, that afternoon, there were two treatment sessions that ran until about midnight. The next morning, before 10 am, he ate a boiled egg and potato, and held it down! Within two days, he was up and walking, as this starved and dehydrated man regained energy. Within 3 weeks, he was walking a mile per day. On 11 January, he went home, via commercial airliner, his liver tumor reduced by over 50%! You can contact Tex by telephone at: 512-556-3424 and he can tell you the details of his experience.

What’s going on? How could this happen? That’s what I wanted to know when I traveled to Hermosillo the week of February 16-22 to attend a small Congress put on by Dr. Romero for people interested in his cases.

Hermosillo, capital of the Mexican state of Sonora, bordering the Gulf of California, is a city of 800,000 about 250 miles south of Tucson, Arizona, Pleasantly modern, it has a handsome, well-preserved 400-year-old cathedral downtown.

There are always lots of little events that lead up to any story. This one started a few years ago when Dean Graves, a big-hearted Arizona businessman, founded an organization called Amigos de las Americas, dedicated to helping where help is needed. The next winter, learning that an’Indian tribe in northern Mexico was near starvation after their crops had failed because of no rain, he and his group loaded up a semi with wheat, corn and beans, which was distributed to the Indian tribes in the mountains.

Dean Graves got acquainted with Dr. Hector Romero, a doctor assigned to work with small town medical groups. Dean learned that Dr. Romero was buying medicine for the poor people, who had no money, but his pay was low, and sometimes he ran out of money. One day, he told Graves: “I won’t have enough medicine to treat all of these children, so I’m only going to be able to treat some of them.” A few days later, Dean learned one of the children who didn’t get treated had died. The news “hit me like a ton of bricks,” he says, and from then on, his Amigos tried to assist Dr. Romero in his needs to take care of his patients.

That is how a remarkable American met a remarkable Mexican doctor, who would buy medicine for his poor patients until his own funds ran out.

Fast forward to January 2002, when Dean Graves met the American who tracks down new medical technologies, who quickly put an end to his wife’s migraines and her need to take half-dozen prescription drugs every day. He did this with just one treatment of the Rife “Blue Light” device, so-called because its bulb glows blue while it dispenses healing frequencies. “Now,” jokes Dean, “it’s an open question which my wife would be most willing to give up: me or the Blue Light.” The American had another device, the Quantum or QXI, which has the capability of diagnosing and then treating to reverse whatever condition it finds. Graves told the American: “I want you to drive down to Hermosillo with me to meet Dr. Hector Romero,” and so the contact was made.

The American wasn’t salesman but just someone who wanted to help others, so he offered to leave with Dr. Romero on indefinite loan: 1) the Rife Blue Light device, 2) a Plexus Venus Pulsar, which stimulates the lymph system and the flow of venous blood and 3) the Quantum QXI. The latter is a very complicated computerized device, but Dr. Romero’s bright, bilingual, 22-year-old son, Hector Jr., quickly learned how to operate it, and taught his father.

That is the background of how a small group of people were invited to spend February 16-22 in Hermosillo to learn what results Dr. Romero had achieved with these technologies, all forbidden in the US, where we have the benefit of being “protected” from such breakthroughs, by the FDA.

While there, I asked the American who had brought the technologies if he knew of something that would help a brain tumor. “The Blue Light,” he replied, “has already reversed 5 brain tumors.” He added that two years ago, an asthmatic ten-year-old who was treated just once with the Blue Light became asthma free, and remains so two years later. This, of course, is the Rife device, discovered in the 1920’s and 30’s in San Diego by the brilliant scientist Royal Rife. Chapter four of Politics in Healing tells of its suppression in the US.

Everyone wanted to know how Dr. Romero had treated the by-now famous Tex. The first thing he did, he explained, was simple, down-to-earth, old fashioned doctoring: he had his nurse give Tex an enema. He followed that with two hour treatments with the Blue Light, then two hours of the Quantum, and an hour on the Venus Pulsar. Two treatments the first day, then next day the same protocol was followed. Eating and being able to hold down food quickly increased his energy, and within less than twelve days he was off all drug medications, without negative consequence. A pleasant house in a fine neighborhood was found for the 80 year-old Tex and his wife and son, who had accompanied him. Remember, when he arrived, he had been given up for dead by American doctors, who had declared he had not more than one week to live. He went home the end of January, well.

Manual provider credentials processing can create hours of data entry work and build mountains of paperwork. An Arkansas medical group learned that lesson quickly–and responded by implementing a credentialing software program that has helped staff save both time and money.

Scaling Paper Mountains

Cooper Clinic is a large multispecialty medical group headquartered in Fort Smith, Ark. The clinic employs 830 workers, including 130 physicians. Debbie Heimark, assistant director of human resources, heads the clinic’s provider enrollment and credentials verification process.

When Heimark joined Cooper Clinic five years ago, there was no credentialing software in place. When a new provider came on board, she had to manually complete as many as 13 different enrollment forms, get the provider’s signature and then mail the completed documents to each insurance carrier. She followed a similar process each time a staff provider’s license or credentialing information needed to be updated. The process amounted to hours of data entry work and piles of paper. Filling out forms by hand was not complicated, she says, but the process was redundant and left room for errors.

“I knew there had to be a better way to do provider enrollment,” Heimark says. About a year later, the medical group bought its first credentialing software. But she felt the headaches soon afterward. Within months, the software was obsolete, Heimark says. Vendor staff lacked medical background and failed to understand end-user needs. “The only thing that system did was warehouse information for us,” Heimark says. “We still had to manually complete many provider forms for various insurance companies.”

Heimark needed to find a more efficient option–and fast. As a member of the human resources department, she could not dedicate the majority of her time to provider credentials. After considering several vendors, Cooper Clinic focused on Brentwood, Tenn.-based Sy.Med Development Inc. and its OneApp healthcare credentialing software.

The software offered Cooper Clinic a user-friendly provider database, a one-click electronic application completion process, data tracking and reporting, and the ability to scan and store images of virtually any license, certificate or other paper document. It also gave Heimark the capability to electronically scan and update provider applications and forms in-house–Heimark’s “biggest must-have.” Sy.Med’s staff possessed a medical background and a solid understanding of Cooper Clinic’s needs. Additionally, OneApp allowed Cooper Clinic to import provider data it had warehoused in the old credentialing software, eliminating the need for hours’ worth of data re-entry.

Automated Credentialing

The medical group went live with OneApp in January 2002. The vendor assisted Cooper Clinic’s in-house IT staff with loading the software onto the clinic’s mainframe and converting provider information to the OneApp database. A Sy.Med representative conducted a typical single-day training, spending time one-on-one with Heimark to train her how to use OneApp’s database to populate required credentialing applications and forms. By the time the vendor staff left, Heimark had most of her provider forms loaded into OneApp and could navigate through the program easily.

Now, instead of filling out each form manually, Heimark needs only to enter a provider’s information once, and OneApp automatically completes subsequent credentialing applications. The completed applications and all required attachments are then printed and sent to the provider for approval and signature in a process that takes hours rather than days; often, forms are ready for provider signature the same day the information is entered. The printed documents are then forwarded to the appropriate healthcare organization for verification and acceptance. Why the hurry? The faster a provider is enrolled, the faster he or she receives his Medicare, Medicaid and other insurance reimbursements–and the faster that funds are brought into the clinic, Heimark says.

The most labor-intensive part of the process was bringing a new provider on board, Heimark says. “I would cringe,” she recalls. “For one provider to get all of his or her initial provider credentialing paperwork done took at least three days. It was worse when several providers started at the same time.”

Now, if Heimark receives the provider’s file in the morning, she uses OneApp to scan all appropriate documents and enters the provider’s personal and educational information only once. She can automatically complete and print all of the necessary applications and forms, flag them for signature and get them into the provider’s hands by that afternoon.

When Heimark needs to confirm an individual provider number to a hospital, radiology department or group insurance plan, she can do so with a few keystrokes, obtaining all the information she needs at the desktop. If an insurance carrier or a hospital needs verification of a provider’s education or certification, Cooper Clinic staff can print out a copy of the scanned document and fax it, or attach it to an e-mail, rather than run to the file cabinet to retrieve another piece of paper.

mIn an age when people frequently use their computers to review bank statements and pay car insurance and utility bills, it may seem like it’s only a matter of time before such technological capabilities are fully realized within health care. Yet with on-line payment solutions running about $10,000, key concerns for providers considering adopting the technology are whether widespread use truly will occur and if benefits will be sufficient to justify cost.

Munson Healthcare, a six-hospital system located in northern Michigan, had the same concerns before introducing its system for providing on-line access to patient billing information in August 2001. To help minimize risk, the provider based its systems selection on market research and paid close attention to functionality and design. Since introducing a combined on-line and enhanced paper billing system, the provider has seen significant increases in cash flow and a 50 percent reduction in patient phone inquiries for billing information.

Program Development

Munson’s on-line patient billing program was conceived during general research into ways the provider could enhance technology use. Amid broad discussions of on-line capabilities, such as class registration and preregistration for appointments, focus groups gave very favorable responses to the idea of introducing various billing applications. Specifically, participants requested technology that would allow patients to view updated account information check on the status of insurance or a claim, and access information to better understand the healthcare billing process.

For additional insight into needs, Munson conducted two more focus groups. The groups reviewed the health system’s ideas for the content, format, and functionality of the on-line statement. Many respondents suggested keeping the design simple and the information consolidated and organized. At the same time, the statement needed to have a great deal of content, including information on insurance appeals.

Munson considered these perspectives when redesigning its billing statement. Updates included placing a clear division between payment activity and amounts pending with insurers. Also, a snap shot summary was included before account information, and a consistent format was used on all accounts for payment activity and indication of balance due.

To develop the appropriate technology for use with the statements, the health system decided to use an outside firm. When discussing priorities with the firm, Munson requested an application that would be customizable, would be integrated with its existing systems, and could be deployed without having to reengineer legacy and web systems. Other key areas of interest were systems’ functionality and ease of use for patients. Munson also needed to ensure compliance with HIPAA. The billing system selected provided appropriate data security with intrusion-detection technology and firewalls to keep users out of unauthorized areas. To further maintain the privacy of patients’ medical histories, Munson ensured clinical information would be absent from the on-line billing statement.

Munson’s On-Line Patient Billing System

Total time for the system’s development from focus group research to launch was about six months. The system selected includes a variety of features.

E-mail notification. Munson sends patients e-mail messages whenever their account experiences activity. For example, patients are alerted when an insurance payment has been made, a new balance is due, or a charge for a new service has been received. The notice also includes a link to Munson’s web site, providing patients with convenient access to their account.

Comprehensive account information. Munson’s on-line patient billing system contains clear, comprehensive information for the patient. An account summary shows all charges, insurance payments, balances, and amounts the patient owes. Information is updated daily, allowing patients to identify quickly when an insurance claim has been paid or when their payment has been received. Also, the on-line account has room for customized marketing messages from the health system, such as announcements for wellness classes.

Payment options. Patients can make credit-card payments to the account electronically. They also can use the site to print a payment stub to attach to payments sent by mail.

Interactivity. Patients can communicate with billing staff using the Internet. Munson’s system allows patients to update their insurance information on-line. (Because its legacy system is not able to display insurance information on paper statements, this feature has been particularly useful.) Also, patients can seek guidance from Munson’s customer-service department through e-mail.

Bill-tracking assistance. Because paperwork is generated by multiple providers and payers, patients often have difficulty tracking medical bills and payments. To assist patients, Munson’s web site devotes a section to ways patients can organize medical bills. The section includes a spreadsheet that patients can download to track how much a particular service costs, how much the insurance company paid, and how much the patient must pay Also featured are Munson’s billing policies and a glossary of frequently used terms.