(Contact Info: larry at larryblakeley.com)

Important Note: You will need to click this icon to download the free needed to view most of the images on this Web site - just a couple of clicks and you're "good to go." For reasons why - go here.

A listing and access link to all:
song lyrics and mp3 audio files http://www.royblakeley.name/larry_blakeley/songs/ (all of which are a part of this Web site) can be accessed simply by selecting the "htm" file for the song you want;

poetry http://www.royblakeley.name/larry_blakeley/poetry.htm;

quotations http://www.royblakeley.name/larry_blakeley/quotations.htm; and

essays written by Larry Blakeley http://www.royblakeley.name/larry_blakeley/articles/articles_larry_blakeley.htm,

all of which are used to tell the story in this Web site, can be accessed by going to each respective link set out above.

My son, Larry Blakeley http://www.royblakeley.name/larry_blakeley/larryblakeley_photos_jpeg.htm manages this Web site.

Major Roy James Blakeley (December 10, 1928 - July 22, 1965) - USAF (KIA)

When I was young my dad would say
Come on son let's go out and play

No matter how hard I try
No matter how many tears I cry
No matter how many years go by
I still can't say goodbye

- "I Still Can't Say Goodbye," Performer: Chet Atkins

MP3 audio file/lyrics http://www.royblakeley.name/larry_blakeley/songs/still_cant_say_goodbye.htm

For a larger image click on the photograph.

Medical technology was supposed to remove problems caused by fallible humans: inaccurate prescriptions, wrong diagnoses and inappropriate therapies. But recent studies have shown that some technologies have caused more problems than they've solved.

Nevertheless, the Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/default.asp?, or CMS, which provides health insurance to seniors and the poor, is giving a few technologies a shot at improving the government organization's dismal track record managing patients with chronic conditions.

Medicare's history of not adequately covering preventive health services has created a culture of patients waiting until things get really bad before they'll head to the hospital. Such acute care is far more expensive than the ongoing maintenance that can fend off emergencies in the first place.

As part of the Medicare Modernization Act of 2003 http://www.cms.hhs.gov/medicarereform, CMS is sponsoring nine pilot projects involving 180,000 patients and using technologies administrators hope will improve preventive care. Officials anticipate that the program could, for example, help a diabetes patient get to the doctor before she requires a leg amputation, or allow a doctor to begin a new prescription or diet before his patient suffers heart failure.

How expensive is chronic care? Two-thirds of Medicare money ($236.5 billion in 2001) is spent on just 20 percent of those enrolled, according to a 2002 report (.pdf report here) http://www.partnershipforsolutions.org/DMS/files/Medicare_fact_sheet.pdf from Partnership for Solutions, a group that studies chronic health conditions. Everyone in that 20 percent is coping with five or more chronic conditions. The first of the baby boomers officially become seniors in 2011, and it is clear Medicare needs help, particularly in its chronic-care approach.

"This needs to happen anyway," said Sandy Foote, senior adviser for the Chronic Care Improvement Program http://www.cms.hhs.gov/medicarereform/ccip/ at CMS.

CMS has chosen patients with chronic-care needs to participate in pilot projects that will implement technologies ranging from automated phone reminder systems and interactive in-home devices that ask patients questions about their health to hospital technologies for physicians.

CMS is paying health-management organizations like McKesson http://healthsolutions.mckesson.com/wt/hsol.php and Health Dialog http://www.healthdialog.com/ to deliver technologies http://tinyurl.com/3lgkv to those patients. But if after three years Medicare doesn't see a substantial improvement in health benefits and costs compared to a randomly selected group of about 100,000 control patients, CMS will ask for an unspecified portion of the fees back.

"We're not going to lock into a technology that may very well be outdated soon," Foote said. "We're paying organizations to help people in very individualized, very personalized ways to reduce their health risks, and they can keep refining how they do that."

That means, for example, McKesson is also not bound by the technologies it has chosen to implement. If something looks like it's not benefiting -- or actually is hindering -- patients or physicians, McKesson or any of the other management organizations can nix a technology for one that might work better.

The program sets up an exceptional potential for change and innovation in a hefty, bureaucratic government organization. And recent studies showing the failure of some medical technologies suggest that flexibility might be a good thing.

Two studies published in the March 9 issue of the Journal of the American Medical Association http://jama.ama-assn.org/content/vol293/issue10/index.dtl found that technologies designed to make physicians' jobs easier sometimes didn't, and in some cases the tools actually made the doctors' work more difficult.

"The system should not control the process of doing medicine but respond to how the hospital works," said the University of Pennsylvania's Dr. Ross Koppel, the lead author of the JAMA study. "Very often the software designers expect the users to wrap themselves like pretzels around the software, rather than making it respond to the hospital's needs."

The other study looked at systems that help doctors make treatment decisions. It found that the technology can sometimes improve a physician's performance, but it wasn't clear whether patients fared any better thanks to the technologies.

Health Hero Network http://www.healthhero.com/, a company that makes an in-home communication device called Health Buddy, believes its technology will make the cut. The device's simple design is meant to be easy for seniors to understand. The Health Buddy has a large screen that poses questions about patients' daily health: How do you feel today? Did you take your medicine today? Did you weigh yourself today? (A 3-pound weight gain can indicate heart failure.)

Health Buddy transmits the patients' answers through a phone line to the hospital, where a nurse can scan the output. Patients whose answers indicate they might be on the verge of a health problem appear in red, and the nurse can check up on them.

In a study involving 5,000 Veterans Affairs patients, Health Buddy reduced emergency room visits by 40 percent, reduced hospital admissions by 63 percent and significantly reduced days of care in both hospitals and nursing homes. The company asked the Information Technology Association of America http://www.itaa.org/ to place a dollar amount on how much Medicare might save per year if it adopted Health Buddy. ITAA's estimate was $30 billion.

For now, Health Buddy is being tested in just two states: Mississippi and Pennsylvania.

Using the device every day can have a huge impact on a patient's health as well his or her outlook on life, said Health Hero president and CEO Steve Brown.

"They know they're not out there on their own," Brown said. "It changes the patients' whole experience with health care, and their behavior changes. They are less depressed about their disease."

Results for the first phase of Medicare's pilot project are expected in three years.

- "Medicare: Bring on the Tech," Kristen Philipkoski, Wired News http://www.wired.com/, March 16, 2005 http://www.wired.com/news/medtech/0,1286,66903,00.html