Princess Health and Government getting serious on EMR. Princessiccia

Princess Health and Government getting serious on EMR. Princessiccia

Gusty 07:56 Add Comment

This press release shows our government is starting to get serious about computerized patient records (I am steering away from the term "electronic medical records." My ham radio transceivers are electronic in nature; medical records don't contain vacuum tubes, transistors, resistors or capacitors as far as I know.)

Let's hope that included in the bipartisan call for addressing "systemic obstacles and misaligned incentives that have hindered health information technology adoption" are the sociotechnical (people and skills) issues that are a direct cause of healthcare IT failure.

My support of this initiative will include pointing out that one poorly-addressed but critically important benefit of widespread computerized patient records will be better real-time societal health surveillance, for example, detecting harmful pharmaceuticals via improved postmarketing surveillance before things get out of hand. Better health surveillance is also more than just a handy capability to have in times of potential bioterrorism or other epidemics.

CAUCUS CO-CHAIRS TO INTRODUCE MAJOR HEALTH I.T.
LEGISLATION
Your Action Needed to Support Legislation to Bring Health Care
into the Information Age

On Wednesday, May 11, 21st Century Health Care Caucus co-chairmen Rep. Tim Murphy (R-PA) and Rep. Patrick Kennedy (D-RI) will introduce legislation to dramatically increase the use of information technology to improve the quality, safety, efficiency, and coordination of health care. They need your help to pass this bill this year.

Health IT offers the promise of better health outcomes for patients, by catching conflicting prescriptions, providing reminders to improve timely prevention and other recommended care, and better public health monitoring. It can streamline doctors' practices by easing compliance with reporting requirements, simplifying billing and eligibility checks, and providing more patient information at the point of care. It can eliminate wasteful duplication of testing and provide new research capabilities. But despite the promise, health care has been slow to move into the information age due to a number of systemic obstacles.

The 21st Century Health Information Act will be the first bipartisan bill to address the systemic obstacles and misaligned incentives that have hindered health information technology adoption. It is of pragmatic scope in these tight budgetary times but maximizes limited federal dollars to bring about real systems change. It appeals across the political spectrum, from Newt Gingrich to Hillary Clinton.

There is enormous interest in health IT in Washington, but until now there has not been anything around which support could coalesce. With the introduction of the 21st Century Health Information Act, meaningful action on health IT is possible this year, but it will take concerted effort.

What You Can Do:
1. Send a Letter of Support. The cosponsors are trying to get as many letters of support from organizations across the health care spectrum, including patients, physicians, hospitals, other providers, health plans, employers, vendors, and others. You can email letters to michael.zamore@mail.house.gov (Kennedy) and michael.baxter@mail.house.gov (Murphy).

2. Issue a Press Release. Help get word out about the bill and the importance of health IT by issuing a press release on May 11. By applauding introduction of the bill and explaining how health IT will impact your organization or your organization's role in rolling out health IT, you can amplify the importance of this legislation while potentially working your organization into media coverage of the bill introduction.

3. Call or Email Members of Congress. Immediately after introduction, we will begin seeking cosponsors to demonstrate that this is legislation with broad, bipartisan support. Phone calls and emails to Members of Congress and their health staffers encouraging cosponsorship of the 21st Century Health Information Act are critical. There can never be too many phone calls or emails.

4. Write a Letter to the Editor or an Op-Ed. By following up May 11 with a letter to the editor or op-ed to your local newspaper about the importance of health IT and the 21st Century Health Information Act, you can help create an echo effect that amplifies the message and helps build support.

Thank you for your efforts to make health care ever better, safer, and more efficient. We look forward to passing the 21st Century Health Information Act with your help.

Addendum - I sent this letter to the congressmen:

Dear Congressman Murphy and Congressman Kennedy,

I sincerely applaud The 21st Century Health Information Act that you are co-chairing.

As a Medical Informatics (clinical IT) specialist who has designed and implemented clinical IT in hospitals domestically and in overseas settings, I can assure you this initiative will have a return on investment in future years in greatly improved quality of care, increased efficiency, reduced waste, and reduced costs.

I have promoted this issue since the mid 1990's and have written extensively on systemic obstacles and misaligned incentives that have hindered health information technology adoption ("sociotechnologic issues"), e.g., at my website "Sociotechnologic Issues in Clinical Computing: Common Examples of Healthcare IT Failure" at http://home.aol.com/medinformaticsmd/failurecases.htm .

In addition, as Merck's former Director of Scientific Information Resources, I would also like to point out that a national computerized patient records infrastructure will enable large-scale health surveillance. This capability will enable much more rapid post-marketing surveillance of new drugs, helping avoid debacles such as the VIOXX and Phen-fen accidents, as well as earlier detection of natural or man-made (i.e., bioterrorism) epidemics.

If I can assist this initiative in any way, please let me know.

-- SS

Princess Health and Government getting serious on EMR.Princessiccia

Princess Health and Government getting serious on EMR.Princessiccia

Gusty 07:56 Add Comment

This press release shows our government is starting to get serious about computerized patient records (I am steering away from the term "electronic medical records." My ham radio transceivers are electronic in nature; medical records don't contain vacuum tubes, transistors, resistors or capacitors as far as I know.)

Let's hope that included in the bipartisan call for addressing "systemic obstacles and misaligned incentives that have hindered health information technology adoption" are the sociotechnical (people and skills) issues that are a direct cause of healthcare IT failure.

My support of this initiative will include pointing out that one poorly-addressed but critically important benefit of widespread computerized patient records will be better real-time societal health surveillance, for example, detecting harmful pharmaceuticals via improved postmarketing surveillance before things get out of hand. Better health surveillance is also more than just a handy capability to have in times of potential bioterrorism or other epidemics.

CAUCUS CO-CHAIRS TO INTRODUCE MAJOR HEALTH I.T.
LEGISLATION
Your Action Needed to Support Legislation to Bring Health Care
into the Information Age

On Wednesday, May 11, 21st Century Health Care Caucus co-chairmen Rep. Tim Murphy (R-PA) and Rep. Patrick Kennedy (D-RI) will introduce legislation to dramatically increase the use of information technology to improve the quality, safety, efficiency, and coordination of health care. They need your help to pass this bill this year.

Health IT offers the promise of better health outcomes for patients, by catching conflicting prescriptions, providing reminders to improve timely prevention and other recommended care, and better public health monitoring. It can streamline doctors' practices by easing compliance with reporting requirements, simplifying billing and eligibility checks, and providing more patient information at the point of care. It can eliminate wasteful duplication of testing and provide new research capabilities. But despite the promise, health care has been slow to move into the information age due to a number of systemic obstacles.

The 21st Century Health Information Act will be the first bipartisan bill to address the systemic obstacles and misaligned incentives that have hindered health information technology adoption. It is of pragmatic scope in these tight budgetary times but maximizes limited federal dollars to bring about real systems change. It appeals across the political spectrum, from Newt Gingrich to Hillary Clinton.

There is enormous interest in health IT in Washington, but until now there has not been anything around which support could coalesce. With the introduction of the 21st Century Health Information Act, meaningful action on health IT is possible this year, but it will take concerted effort.

What You Can Do:
1. Send a Letter of Support. The cosponsors are trying to get as many letters of support from organizations across the health care spectrum, including patients, physicians, hospitals, other providers, health plans, employers, vendors, and others. You can email letters to michael.zamore@mail.house.gov (Kennedy) and michael.baxter@mail.house.gov (Murphy).

2. Issue a Press Release. Help get word out about the bill and the importance of health IT by issuing a press release on May 11. By applauding introduction of the bill and explaining how health IT will impact your organization or your organization's role in rolling out health IT, you can amplify the importance of this legislation while potentially working your organization into media coverage of the bill introduction.

3. Call or Email Members of Congress. Immediately after introduction, we will begin seeking cosponsors to demonstrate that this is legislation with broad, bipartisan support. Phone calls and emails to Members of Congress and their health staffers encouraging cosponsorship of the 21st Century Health Information Act are critical. There can never be too many phone calls or emails.

4. Write a Letter to the Editor or an Op-Ed. By following up May 11 with a letter to the editor or op-ed to your local newspaper about the importance of health IT and the 21st Century Health Information Act, you can help create an echo effect that amplifies the message and helps build support.

Thank you for your efforts to make health care ever better, safer, and more efficient. We look forward to passing the 21st Century Health Information Act with your help.

Addendum - I sent this letter to the congressmen:

Dear Congressman Murphy and Congressman Kennedy,

I sincerely applaud The 21st Century Health Information Act that you are co-chairing.

As a Medical Informatics (clinical IT) specialist who has designed and implemented clinical IT in hospitals domestically and in overseas settings, I can assure you this initiative will have a return on investment in future years in greatly improved quality of care, increased efficiency, reduced waste, and reduced costs.

I have promoted this issue since the mid 1990's and have written extensively on systemic obstacles and misaligned incentives that have hindered health information technology adoption ("sociotechnologic issues"), e.g., at my website "Sociotechnologic Issues in Clinical Computing: Common Examples of Healthcare IT Failure" at http://home.aol.com/medinformaticsmd/failurecases.htm .

In addition, as Merck's former Director of Scientific Information Resources, I would also like to point out that a national computerized patient records infrastructure will enable large-scale health surveillance. This capability will enable much more rapid post-marketing surveillance of new drugs, helping avoid debacles such as the VIOXX and Phen-fen accidents, as well as earlier detection of natural or man-made (i.e., bioterrorism) epidemics.

If I can assist this initiative in any way, please let me know.

-- SS

Princess Health and Hospitals need better security. Princessiccia

Princess Health and Hospitals need better security. Princessiccia

Gusty 17:04 Add Comment

Another strain on limited hospital budgets is in the making, in a very concerning way:

Intruders try to gain access to hospitals' off-limit areas

In Indianapolis and elsewhere, authorities have reported cases, uncertain of motives.

Associated Press

VALPARAISO, Ind. -- Cases of unauthorized people trying to gain access to restricted areas of hospitals in Indiana and across the country puzzle federal authorities and security officials.

Recently, on the same day an Indianapolis hospital reported suspicious people trying to enter its emergency department, two professionally dressed people carrying clipboards walked into the outpatient campus of Porter hospital in Valparaiso, saying they wanted to tour the facility. The two left when challenged.

Earlier, during a two-week period starting Feb. 26, people claiming to be inspectors from the Joint Commission on Accreditation of Healthcare Organizations tried to enter hospitals in Boston, Los Angeles and Detroit. The three incidents had no apparent relationship beyond the tactics of the intruders.

Indiana Department of Health spokesman Andy Zirkle confirmed that one Indianapolis hospital had reported an incident but would not elaborate. He directed further questions to the U.S. Department of Homeland Security and to the FBI, but neither agency confirmed the incident.

A day after the March 22 incident, a former safety officer at St. Vincent Hospital and Health Services in Indianapolis, Thomas Huser, sent an e-mail to health care security officials across the state saying men had tried to gain access to the emergency departments at three separate hospitals, which were not named, The Times of Northwest Indiana reported in a story Sunday.

Huser's e-mail also said that information found in a car at one of the hospitals indicated one of the men was on the FBI Terror Watch List. He said he received the information from another hospital.

FBI Special Agent Wendy Osborne said information regarding the watch list would not be shared with the hospitals.

Porter hospital Security Director Jim McClanahan said any hospital has to balance security against the public's need for access. Porter has 28 security workers filling about 17 full-time jobs. They patrol outside and respond to reports of people wandering into areas where they do not need to be.

But the first line of security over such a sprawling institution is often the doctors, nurses and volunteer auxiliary members. A member of a hospital auxiliary had cornered the pair that walked into the Valparaiso Outpatient Campus and forced them to leave, The Times reported.

Mark Forstneger, spokesman for the Joint Commission on Accreditation of Healthcare Organizations, said the intruders masquerading as inspectors more likely were looking for drugs or privileged information about patients than pursuing any plot against national security.

"There are a lot of things that hospitals have that are desirable," Forstneger said.

The joint commission is a nonprofit organization that judges the quality and safety of care at 15,000 hospitals and health care institutions around the country. It receives one or two reports each year of people claiming to be inspectors, the newspaper said.

Princess Health and Hospitals need better security.Princessiccia

Princess Health and Hospitals need better security.Princessiccia

Gusty 17:04 Add Comment

Another strain on limited hospital budgets is in the making, in a very concerning way:

Intruders try to gain access to hospitals' off-limit areas

In Indianapolis and elsewhere, authorities have reported cases, uncertain of motives.

Associated Press

VALPARAISO, Ind. -- Cases of unauthorized people trying to gain access to restricted areas of hospitals in Indiana and across the country puzzle federal authorities and security officials.

Recently, on the same day an Indianapolis hospital reported suspicious people trying to enter its emergency department, two professionally dressed people carrying clipboards walked into the outpatient campus of Porter hospital in Valparaiso, saying they wanted to tour the facility. The two left when challenged.

Earlier, during a two-week period starting Feb. 26, people claiming to be inspectors from the Joint Commission on Accreditation of Healthcare Organizations tried to enter hospitals in Boston, Los Angeles and Detroit. The three incidents had no apparent relationship beyond the tactics of the intruders.

Indiana Department of Health spokesman Andy Zirkle confirmed that one Indianapolis hospital had reported an incident but would not elaborate. He directed further questions to the U.S. Department of Homeland Security and to the FBI, but neither agency confirmed the incident.

A day after the March 22 incident, a former safety officer at St. Vincent Hospital and Health Services in Indianapolis, Thomas Huser, sent an e-mail to health care security officials across the state saying men had tried to gain access to the emergency departments at three separate hospitals, which were not named, The Times of Northwest Indiana reported in a story Sunday.

Huser's e-mail also said that information found in a car at one of the hospitals indicated one of the men was on the FBI Terror Watch List. He said he received the information from another hospital.

FBI Special Agent Wendy Osborne said information regarding the watch list would not be shared with the hospitals.

Porter hospital Security Director Jim McClanahan said any hospital has to balance security against the public's need for access. Porter has 28 security workers filling about 17 full-time jobs. They patrol outside and respond to reports of people wandering into areas where they do not need to be.

But the first line of security over such a sprawling institution is often the doctors, nurses and volunteer auxiliary members. A member of a hospital auxiliary had cornered the pair that walked into the Valparaiso Outpatient Campus and forced them to leave, The Times reported.

Mark Forstneger, spokesman for the Joint Commission on Accreditation of Healthcare Organizations, said the intruders masquerading as inspectors more likely were looking for drugs or privileged information about patients than pursuing any plot against national security.

"There are a lot of things that hospitals have that are desirable," Forstneger said.

The joint commission is a nonprofit organization that judges the quality and safety of care at 15,000 hospitals and health care institutions around the country. It receives one or two reports each year of people claiming to be inspectors, the newspaper said.

Princess Health and University of Pennsylvania Allies with Tai Sophia Institute. Princessiccia

Princess Health and University of Pennsylvania Allies with Tai Sophia Institute. Princessiccia

complementary/ alternative medicine University of Pennsylvania

Gusty 12:59 Add Comment

The Philadelphia Inquirer reports that the prestigious University of Pennsylvania Medical School has announced a partnership with a local center for complementary and alternative medicine (CAM), the Tai Sophia Institute, and in parternship will begin to offer a masters degree in CAM.
The article quotes 86 year old Arnold Fishman, a pulmonologist, who has "enjoyed a long, achievement filled career in evidence-based medicine," advocating for the alliance, "my interest is: what are the new frontiers?" He further noted, "The message from consumers is quite clear." "Medicine cannot supply all that consumers feel they want."
But Robert Baratz, a skeptic about CAM, challenged this, saying the University is "attempting to capitalize on the so-called dynamics of the marketplace."
The Tai Institute's Institutional Values include

• "Operate from a declaration of oneness, a unity with all creation."
• "Make all judgments and decisions in the context and light of the seven (past 3, future 3, and present) generations."

The Tai Institute offers acupuncture and herbalist services. Its web-site states

• "Individuals using traditional acupuncture treatments often find relief from concerns including headaches, chronic fatigue, depression, allergies, back pain, digestive disorders, joint pain, sleeping problems, infertility, menstrual disorders and other symptoms."
• "Acupuncture is helpful for many concerns from headaches to joint pain. It has also been found effective for severe chronic conditions where pinpointing the cause has been difficult to determine. Those who receive ongoing treatment for maintenance and the promotion of good health have told us that they: � Tend to get sick less often and recover more quickly� Have improved stamina and vitality� Are better managers of their own health� See reductions in long-term health care costs and tend to visit physicians less often� Enjoy deepened more harmonious relationships with others "

The web-site presents no evidence to support these claims. I doubt they are well supported by data from well-designed randomized controlled trials. For a more skeptical view of acupuncture, see this page from Quackwatch.
Regarding herbal therapies, the Tai Sophia web-site states:

• "Botanical healing, used for thousands of years, is used specifically to support the healthy structure and function of the body. It works to promote vitality, balance, and longevity. "

Again, The Institute does not present evidence that, in particular, using herbs causes people to live longer. Although I will allow that some CAM remedies may turn out to have benefits that outweigh their harms, I see no reason to believe that this is true for any particular such remedy until it has been tested in well-designed controlled studies. I can see value in medical schools teaching students about patients' use of CAM, and performing well-designed research on CAM. However, the University of Pennsylvania's alliance with an Institute that seems to be a fervent, uncritical promoter of CAM seems at odds with the the scientific basis of medicine that medical schools, of all institutions, should uphold. I hope the University will come up with a clearer explanation for what it is doing than the purely consumerist approach described in the Inquirer's article.
[Full disclosure: I did a Kaiser Fellowship in General Internal Medicine at the University of Pennsylvania, where I got training in, among other subjects, clinical epidemiology.]

Princess Health and University of Pennsylvania Allies with Tai Sophia Institute.Princessiccia

Princess Health and University of Pennsylvania Allies with Tai Sophia Institute.Princessiccia

complementary/ alternative medicine University of Pennsylvania

Gusty 12:59 Add Comment

The Philadelphia Inquirer reports that the prestigious University of Pennsylvania Medical School has announced a partnership with a local center for complementary and alternative medicine (CAM), the Tai Sophia Institute, and in parternship will begin to offer a masters degree in CAM.
The article quotes 86 year old Arnold Fishman, a pulmonologist, who has "enjoyed a long, achievement filled career in evidence-based medicine," advocating for the alliance, "my interest is: what are the new frontiers?" He further noted, "The message from consumers is quite clear." "Medicine cannot supply all that consumers feel they want."
But Robert Baratz, a skeptic about CAM, challenged this, saying the University is "attempting to capitalize on the so-called dynamics of the marketplace."
The Tai Institute's Institutional Values include

• "Operate from a declaration of oneness, a unity with all creation."
• "Make all judgments and decisions in the context and light of the seven (past 3, future 3, and present) generations."

The Tai Institute offers acupuncture and herbalist services. Its web-site states

• "Individuals using traditional acupuncture treatments often find relief from concerns including headaches, chronic fatigue, depression, allergies, back pain, digestive disorders, joint pain, sleeping problems, infertility, menstrual disorders and other symptoms."
• "Acupuncture is helpful for many concerns from headaches to joint pain. It has also been found effective for severe chronic conditions where pinpointing the cause has been difficult to determine. Those who receive ongoing treatment for maintenance and the promotion of good health have told us that they: � Tend to get sick less often and recover more quickly� Have improved stamina and vitality� Are better managers of their own health� See reductions in long-term health care costs and tend to visit physicians less often� Enjoy deepened more harmonious relationships with others "

The web-site presents no evidence to support these claims. I doubt they are well supported by data from well-designed randomized controlled trials. For a more skeptical view of acupuncture, see this page from Quackwatch.
Regarding herbal therapies, the Tai Sophia web-site states:

• "Botanical healing, used for thousands of years, is used specifically to support the healthy structure and function of the body. It works to promote vitality, balance, and longevity. "

Again, The Institute does not present evidence that, in particular, using herbs causes people to live longer. Although I will allow that some CAM remedies may turn out to have benefits that outweigh their harms, I see no reason to believe that this is true for any particular such remedy until it has been tested in well-designed controlled studies. I can see value in medical schools teaching students about patients' use of CAM, and performing well-designed research on CAM. However, the University of Pennsylvania's alliance with an Institute that seems to be a fervent, uncritical promoter of CAM seems at odds with the the scientific basis of medicine that medical schools, of all institutions, should uphold. I hope the University will come up with a clearer explanation for what it is doing than the purely consumerist approach described in the Inquirer's article.
[Full disclosure: I did a Kaiser Fellowship in General Internal Medicine at the University of Pennsylvania, where I got training in, among other subjects, clinical epidemiology.]

Princess Health and Do Living Wills Save the Government Money?. Princessiccia

Princess Health and Do Living Wills Save the Government Money?. Princessiccia

Gusty 12:40 Add Comment

The Washington Post ran a follow-up on the story of how US Health and Human Services Secretary Leavitt appeared to be encouraging people to sign living wills in order to save Medicare money. (See our previous post here.)
The follow-up includes comments from several experts, including the National Institutes of Health Bioethics Chair Ezekiel Emanuel, denying that living wills in fact would save much money. Ezekiel said, "I'm a big advocate of living wills because they give people the power to make decisions." However, "I am not a big advocate of living wills because they save money." (We have mentioned Emanuel before, in his role as an advocate for relaxing the proposed NIH conflict of interest rules.)
Leavitt appeared to retreat a bit too. A spokesperson said that he "regrets if the comment was inaccurate. He did not intend to link living wills to the issue of costs."
Fair enough. There may be little evidence that living wills save money.
What is lacking in these responses is any concern that the highest ranking US health official apparently urged the elderly to accept less health care because he thought it would save the US government money. One editorialist did allow that Leavitt's speech sounded "ghoulish." Worse, it seems on the slippery slope towards the government labeling certain citizens as undeserving of health care.