Held Hostage To Health IT? Here Is What Physicians Have To Put Up With Instead Of The Paper Chart...
MedInformaticsMD provided another amazing illustration of how typical commercial health care information technology systems may make physicians' work lives harder. It used to be that filling out discharge forms for a hospitalized patient was complex in proportion to the complexity of the patient's medical problems. Now to that complexity is added the complexity that requires a 30-page manual about just how to generate a discharge form. I cannot believe that anyone involved in the design of these convoluted processes ever even talked to a practicing hospital physician. We need to rethink the accepted dogma that policies to force physicians to adopt current commercial health care IT will improve patient care.Link: http://hcrenewal.blogspot.com/2010/01/here-is-what-physicians-have-to-put-up.html
What the November, 2009, Breast Cancer Screening Argument Obscured
Now that the dust has cleared after the rancorous dust-up over new US Preventive Services Task Force guidelines for breast cancer screening, I tried to reflect a little. What the sound and fury obscured was that after 30 years and 8 trials (only one, and the earliest done in the US), we still have no convincing evidence that mammographic screening for 40-49 year old women saves lives (which is different from reducing deaths due to breast cancer), or reduces morbidity, improves function, or improves quality of life in the screened population. In the absence of such evidence, how can anyone fault the USPSTF for recommending (not that women not be screened), but that decisions to screen individual people should be based on considered discussion between them and their physicians? Why aren't we rushing to remedy the evidence-gap with new clinical trials? Well, maybe the emotional arguments for screening uber alles were influenced by vested interests beyond the well-being of women who face the decision whether to undergo screening. We do our patients no favors when we let emotions, or our financial self-interest trump evidence and logic. I submit that the breast cancer screening kerfuffle demonstrates the need for better clinical and comparative effectiveness research independent from those with vested interests in selling products and services.Link: http://hcrenewal.blogspot.com/2009/12/what-november-2009-breast-cancer.html
On Automobile, and Health Care Companies Run by Finance People
More analysis of the great recession, aka global financial collapse focused on how manufacturing companies were laid low by leaders who were supposed experts in finance, rather than the products the companies manufactured, or the context in which they were used. A recent article showed how business schools have switched from training people interested in what companies may actually make to people interested in manipulating money. Since health care organizations are now mostly lead by people trained in the same schools, should we expect they will do a better job running hospitals or pharmaceutical companies? People really interested in improving health care outcomes and access while restraining costs ought to consider how we can increase the input of people who actually understand health care into its leadership.Link: http://hcrenewal.blogspot.com/2009/12/on-automobile-and-health-care-companies.html
The $20 Million Dollar Journal Editor
That's how much he made over a few years from royalties and consulting fees from a medical device company. Meanwhile, he was editing a journal (and leading an academic department) without disclosing the sources of his wealth. An investigative reporter's analysis showed that the journal seemed to include an unusual number of articles that were favorite to the companies' products, specifically those from whose sales the editor collected more royalties. So why should the public trust anyone in academic medicine any more? Is it any wonder that research done and disseminated by people who stand to make lots of money if the results favor certain products or services will lead to over-use of over-priced products and services. Again, to improve outcomes and access while restraining costs, we ought to consider how to separate clinical research from people with vested interests in promoting particular products and services.Link: http://hcrenewal.blogspot.com/2009/12/20-million-dollar-journal-editor.html
Finnish EHR's Clumsy, Mission Hostile, Consume Doctors' Precious Time
MedInformaticsMD showed how global is the problem of badly designed commercial health care information technology systems. (It's Finnish EHR's, not finished EHR's.) Why do hospitals and physicians' offices around the world continue pay good money to implement systems that make their lives harder? Again, we need to rethink the accepted dogma that policies to force physicians to adopt current commercial health care IT will improve patient care.Link: http://hcrenewal.blogspot.com/2009/12/it-seems-common-wisdom-in-u.html
Are Dismissive Industry and Government Reactions to Physician Concerns about EHR's and other Clinical IT Simply Perverse?
MedInformaticsMD pointed out how the responses to the sorts of problems with health care information technology systems (like those mentioned above) by system developers, system vendors, and health care executives include blaming the victims and attacking the messengers. That may be now par for the course in our current amoral business culture, but it is perverse in health care. Is there any question that suppressing data and discussion critical of health care products and services will lead to over-use of over-priced products and services? Those interested in improving health care outcomes and access while restraining costs need to consider how to protect free speech about health care products and services.Link: http://hcrenewal.blogspot.com/2009/12/are-dissmissive-industry-and-government.html
And still on the main page from the weeks before are:
Boston Scientific (Again) Settles - This Time, Charges of Kickbacks Disguised as Clinical Studies
Here is our latest demonstration why the current civil fines/ corporate integrity agreement approach to bad behavior by large health care organizations used by US law enforcement does not work. Boston Scientific is on its third major settlement since 2007, this time for allegations that payments made to physicians in conjunction with what appears to be a "seeding trial" of a medical device were actually kickbacks. I again submit that until there are negative consequences for the people who actually approve, direct and implement bad behavior, that behavior will continue. And while bad behavior continues, costs will continue to rise, access will continue to fall, and quality will continue to degrade.Link: http://hcrenewal.blogspot.com/2009/12/boston-scientific-again-settles-this.html
ONC Defines a Taxonomy of Robust Healthcare IT Leadership
MedInformaticsMD noted that the US Office of the National Coordinator for health care information technology now seems to recognize that health care IT leaders should actually know something about health care. This is news, because he and the other HCR bloggers have posted about numerous instances in which there were no requirements for health care leaders to know something about health care. I again submit that health care dysfunction will continue until we have health care leaders who know something about health care, and care something about its values.Link: http://hcrenewal.blogspot.com/2009/12/onc-defines-taxonomy-of-health-it.html
How to Give a Course on Corruption in the Health Sector
A useful paper on the basics of providing such a course just appeared (published by a Norwegian organization that provides anti-corruption resources.) Although the course seems directed at developing countries, the content would likely be just as applicable to developed countries, including the US. In fact, the author of the paper teaches a version of the course in the US (at Boston University), although again it seems aimed at people who will go into international public health. I believe that it is the only such course taught in the US. One wonders why courses like this are not available at medical and public health schools throughout the world.Link: http://hcrenewal.blogspot.com/2009/12/how-to-give-course-on-corruption-in.html
Spun Silly: Academic Medical Center Cancer Treatment Advertising in the Era of Hype and Flim-Flam
A NY Times report surveyed some advertisements for cancer care at leading US academic medical centers, whose common ingredients seemed to be hype and spin. For example, one, sans data, advertised a particular surgeon at that academic medical center as having the best results (in the world?) In each case, the marketing geniuses who devised the advertisements had some excuse. (For that example, it was that the advertisements were somehow not meant for actual cancer patients, but merely to enhance the reputation of the hospital.) This demonstrates what has happened to health care in an era of hype, flim-flam, (and you may substitute your preferred terms.)Link: http://hcrenewal.blogspot.com/2009/12/spun-silly-academic-medical-center.html
Addressing Drug, Biotechnology, and Device Companies' Payments to Physicians: the Thai National Health Assembly
Thailand has a better idea - to have a national health assembly yearly which allows actual people, not just corporate CEOs, PR people, and lobbyists, to have some input into health policy. It's interesting that one priority of this year's assembly were the sorts of payments that regularly are discussed on Health Care Renewal (and which discussion has lead to industry supporters to label us "pharmascolds.") Maybe they will need to label the population of Thailand "pharmascolds."Link: http://hcrenewal.blogspot.com/2009/12/addressing-drug-biotechnology-and.html
Arguments for Maintaining the Health IT Status Quo on Defects Nondisclosure Clauses
MedInformaticsMD commented on arguments against his electronic petition to end contractual clauses that prohibit disclosure of defects in and problems and adverse events associated with electronic health records. He classified the objections as legal, semantic, corporatist, statist, and logically fallacious or irrational. However, no one has apparently raised any substantive or logical objections. I would suggest such non-disclosure clauses mainly benefit health IT corporate insiders, while they place patients, and doctors at risk. Please consider signing the petition.Link: http://hcrenewal.blogspot.com/2009/12/arguments-for-maintaining-health-it.html
With Leaders Like These...
How did four of most notorious leaders of failed financial firms all end up on the board of the same academic hospital system? Did this sort of stewardship have to do with the outsized compensation paid the system CEO (see below)? Did it have to do with an academic leadership culture that emphasized the importance of faculty as "taxpayers," (bringers of external funding) rather than good teachers, researchers or clinicians? This is another reminder that bringing the ethos of business in the "greed is good" era to academic medicine has not been good for patient care, teaching or research.Link: http://hcrenewal.blogspot.com/2009/12/with-leaders-like-these.html
Teaching Would-be Health Care Leaders About Health Care: Why Is This News?
A five-day course on health care for health care MBA candidates, run by doctors, merited a NY Times article. Should it be news when future business leaders of health care learn a tiny amount about health care? This again suggests how little many of the business people who run health care organizations know or care about how health care is actually provided. Maybe organizations lead by people who understand and uphold their missions would provide more, better and cheaper health care.Link: http://hcrenewal.blogspot.com/2009/12/teaching-would-be-health-care-leaders.html
Roy M. Poses MD
Clinical Associate Professor
Brown University School of Medicine
Roy_Poses@brown.edu
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