Princess Health and CPOE cybernetic miracles not yet achieved. Princessiccia

Princess Health and CPOE cybernetic miracles not yet achieved. Princessiccia

Gusty 06:28 Add Comment

Lest hospital executives believe that computers are going to be a cure-all for all that ails medicine, here's another sobering report on computerized physician order entry (CPOE):

Medical errors kill nearly 100,000 American each year, with lethal drug interactions accounting for most of these deaths. Computerization -- which hospitals have been slow to embrace -- was supposed to eliminate most problems, but new research published Wednesday indicates that even the best computer system can�t save you from a doctor�s catastrophic screw-up. Harmful medication-related mishaps cropped up in a quarter of all patients at the Veterans Affairs Medical Center in Salt Lake City, one of the most high-tech hospitals in the country, according to a study published in Archives of Internal Medicine.

"If you were on an airplane and a quarter of the time it crashed, that would be a problem," said study co-author Dr. Jonathan Nebeker, a physician at the VA Medical Center.

Even though the hospital's computers were supposed to protect against dangerous drug interactions, illegible prescriptions and bedside mix-ups, nine of the 937 patients studied died as a result of medication problems, the study found.

As a medical informaticist, I have always been somewhat skeptical about the "syndrome of inappropriate confidence in computers" and related beliefs in "computational alchemy." While clinical IT progress in undeniable and must proceed, one must temper expectations about the technology to realistic levels. This is especially true for those involved in clinical operations. (Similar issues occur in the pharmaceutical R&D sector, as I have observed). We are still in an era when, paraphrasing Chuck Yeager, who shot down a faster German jet in his propeller-driven P51 Mustang, "it's the [person], not the machine."

This study also suggests that when implementing clinical IT, it best be done right by those with experience in both medicine and computing, because if it's done wrong, even worse problems can result.

Princess Health and CPOE cybernetic miracles not yet achieved.Princessiccia

Princess Health and CPOE cybernetic miracles not yet achieved.Princessiccia

Gusty 06:28 Add Comment

Lest hospital executives believe that computers are going to be a cure-all for all that ails medicine, here's another sobering report on computerized physician order entry (CPOE):

Medical errors kill nearly 100,000 American each year, with lethal drug interactions accounting for most of these deaths. Computerization -- which hospitals have been slow to embrace -- was supposed to eliminate most problems, but new research published Wednesday indicates that even the best computer system can�t save you from a doctor�s catastrophic screw-up. Harmful medication-related mishaps cropped up in a quarter of all patients at the Veterans Affairs Medical Center in Salt Lake City, one of the most high-tech hospitals in the country, according to a study published in Archives of Internal Medicine.

"If you were on an airplane and a quarter of the time it crashed, that would be a problem," said study co-author Dr. Jonathan Nebeker, a physician at the VA Medical Center.

Even though the hospital's computers were supposed to protect against dangerous drug interactions, illegible prescriptions and bedside mix-ups, nine of the 937 patients studied died as a result of medication problems, the study found.

As a medical informaticist, I have always been somewhat skeptical about the "syndrome of inappropriate confidence in computers" and related beliefs in "computational alchemy." While clinical IT progress in undeniable and must proceed, one must temper expectations about the technology to realistic levels. This is especially true for those involved in clinical operations. (Similar issues occur in the pharmaceutical R&D sector, as I have observed). We are still in an era when, paraphrasing Chuck Yeager, who shot down a faster German jet in his propeller-driven P51 Mustang, "it's the [person], not the machine."

This study also suggests that when implementing clinical IT, it best be done right by those with experience in both medicine and computing, because if it's done wrong, even worse problems can result.

Princess Health and More Accusations of Harsh Bill Collecting Tactics: Intermountain Health Care. Princessiccia

Princess Health and More Accusations of Harsh Bill Collecting Tactics: Intermountain Health Care. Princessiccia

health care prices hospitals Intermountain Health Care

Gusty 12:46 Add Comment

Intermountain Health Care (IHC, in Utah) is another large health care system that has been accused of employing harsh collection tactics against poor patients who don't pay their bills. Earlier this month it announced kinder, gentler collection processes. It is unclear if these were a response to charges heard in the state legislature last year that the system operates like a for-profit company, and threats that it then should be taxed like one. (See news articles here and here.)
Nonetheless, a state legislative tax force will be investigating IHC, prompted by "recurring perceptions of monopolistic practices, ... of heavy-handed collection practices." (News article here.)
Ironically, a tiny news item appearing early in May suggested that this apparently tough-minded organization could not prevent Ralph Jay Hansen, its former retirement account fund director, from embezzling $2.6 million between 1996 and 2004. (See article here.)

Princess Health and More Accusations of Harsh Bill Collecting Tactics: Intermountain Health Care.Princessiccia

Princess Health and More Accusations of Harsh Bill Collecting Tactics: Intermountain Health Care.Princessiccia

health care prices hospitals Intermountain Health Care

Gusty 12:46 Add Comment

Intermountain Health Care (IHC, in Utah) is another large health care system that has been accused of employing harsh collection tactics against poor patients who don't pay their bills. Earlier this month it announced kinder, gentler collection processes. It is unclear if these were a response to charges heard in the state legislature last year that the system operates like a for-profit company, and threats that it then should be taxed like one. (See news articles here and here.)
Nonetheless, a state legislative tax force will be investigating IHC, prompted by "recurring perceptions of monopolistic practices, ... of heavy-handed collection practices." (News article here.)
Ironically, a tiny news item appearing early in May suggested that this apparently tough-minded organization could not prevent Ralph Jay Hansen, its former retirement account fund director, from embezzling $2.6 million between 1996 and 2004. (See article here.)

Princess Health and Drug Studies Required by FDA Fast Track Process Never Completed. Princessiccia

Princess Health and Drug Studies Required by FDA Fast Track Process Never Completed. Princessiccia

FDA

Gusty 12:29 Add Comment

Help, help, there is so much going on I a can't keep up with it anymore....
The Los Angeles Times just revealed a report by the staff of US Rep. Edward J Markey (D-Mass) about the US Food and Drug Administration (FDA) fast-track drug approval process. This process, created in part as a response to demonstrations by AIDS activists in the late 1980's (see previous post here), allows rapid marketing of drugs after a limited number of studies, contingent on manufacturers' willingness to perform future studies.
Apparently, many of these studies are never finished.
Markey's report said that of 91 studies promised since 1992, 42, almost half, were not completed, and 21 were never started.
Markey is calling for new legislation to impose penalties on pharmaceutical companies that do not complete promised studies.

Princess Health and Drug Studies Required by FDA Fast Track Process Never Completed.Princessiccia

Princess Health and Drug Studies Required by FDA Fast Track Process Never Completed.Princessiccia

FDA

Gusty 12:29 Add Comment

Help, help, there is so much going on I a can't keep up with it anymore....
The Los Angeles Times just revealed a report by the staff of US Rep. Edward J Markey (D-Mass) about the US Food and Drug Administration (FDA) fast-track drug approval process. This process, created in part as a response to demonstrations by AIDS activists in the late 1980's (see previous post here), allows rapid marketing of drugs after a limited number of studies, contingent on manufacturers' willingness to perform future studies.
Apparently, many of these studies are never finished.
Markey's report said that of 91 studies promised since 1992, 42, almost half, were not completed, and 21 were never started.
Markey is calling for new legislation to impose penalties on pharmaceutical companies that do not complete promised studies.

Princess Health and Medical Whistleblowers' Roundtable. Princessiccia

Princess Health and Medical Whistleblowers' Roundtable. Princessiccia

data manipulation ghost writing mission-hostile management whistle-blowers

Gusty 11:48 Add Comment

PLoS Medicine just published a summary of a round-table discussion by notable whistleblowers about pharmaceutical companies' research and marketing practices, with an accompanying editorial. (The on-line journal stepped in as a sponsor 10 days before the conference, after the unnamed journal that originally was going to sponsor the meeting pulled out on its lawyers' advice.)
The conference underlined some of the issues that have appeared on Health Care Renewal. Some notable quotes:

• Betrayal of Mission: According to David Graham (who raised concerns about the safety of Vioxx), The US Food and Drug Administration (FDA) is in a "collaborative relationship" with pharmaceutical companies. A senior FDA official told Graham, "industry is our client." The public may be excused for thinking that they are supposed to be the FDA's clients.
• Tactics to Increase Likelihood of Favorable Results: Several participants talked about specific tactics used by some pharmaceutical companies to increase the likelihood that research results will be favorable to their products. An anonymous industry scientist noted that it takes only two positive studies to get FDA approval. But if a study has bad results, "typically a company is not going to publish the study at all." Furthermore, he said "drug companies assiduously avoid acquiring information about side effects." Patients who have increased risks of side-effects "are excluded from studies deliberately, even though, when the drug is approved, these patients will be targeted for sales." He also charged that studies are deliberately designed to be too small, or be over too quickly to detect serious adverse effects.
• Conflicts of Interest: Several participants suggested how drug companies convey money to public officials to influnce state level decisions about drugs. One charged that officials who were responsible for writing state guidelines about psychiatric treatments could access a secret account financed by drug companies. He was told, "Look, drug companies write checks to politicians, they write checks to politicians on both sides of the aisle - back off." He was then advised, "quit being a salmon, swimming against a stream."
• Ghost-Writing: The anonymous industry scientist described the process of ghost-writing, "When studies are published, they are frequently written not by the trained research scientist, who might have designed and analyzed the study, but by a designated medical writer with little if any backgroun in research, but who is trained instead to craft the findings of the study in the best possible way for the company."

This is important additional evidence about how deep these problems run. Solving them will take a lot of salmon.