Don’t Say Stupid-Stupid… July 29, 2009
Posted by kirby8047 in Uncategorized.add a comment
ITS THE ECONOMY STUPID!
I didn’t invent the phrase “Its the economy, stupid”, that phrase was the brainchild of James Caraville, Bill Clinton’s campaign manager. It was used to unseat President George H W Bush. At the time it was popular and used in many forms such as “It’s the weather, stupid”, practically anything could be put into this simple expression. It’s an expression that we need to re-visit since it is so appropriate today. In documenting his fall from infallibility, President O’bama’s, biographers will have many opportunities to apply the phrase. But I would like to beat them to the punch and suggest a few uses at the end of July 2009.
ITS THE ECONOMY STUPID Part 2
Americans can plainly see that the economy is not fixed, or healed, or reversed yet. Too many people are out of work and the ARRA stimulus plan may or may not be helping. It is really too early to blame President Obama for problems in the economy. One thing however, is becoming clearer, and that is his putting too many programs that don’t create jobs immediately into the ARRA. Doing that was a big mistake. Programs such as Comparative Effectiveness Research, and Health Information Technology are perhaps marginally laudable programs but they would never have passed Congress without riding on the coat tails of a bigger spending package where their cost looked smaller in comparison to the total package. They have little if any chance of aiding the employment picture immediately. They were pork without even a clear definition of what their success would be. Some economists say that there wasn’t enough real stimulus in the stimulus package. Meanwhile, people are getting impatient. They want to see their President working hard on the economy first and foremost.
ITS NOT ABOUT HEALTH CARE, STUPID
Meanwhile Mr. Obama is off trying to re-do the health care systems or dilemmas, if you will. I use the words in the plural since we don’t have one simple problem to address, such as “cost”. We face a whole boatload of problems that are all intertwined and as hard to define as racial heritages in our melting pot society. Quality, Access, and Cost form the big three areas of health reform. And these three areas have problems in both the health care sense as well as the insurance sense. When one manipulates something in one or two places a third area becomes an intolerable new problem. It is clear that Mr. Obama in his good intentions failed to give the subject enough honor. Health reform may likely be the one issue that is too complex for us to undertake with a political process, let alone when there is too much debt and our economy overall is still weak. Besides, there is no major outcry for health care or health insurance reform. All agree reform is needed, but not the socialized medicine the Democrats on the left are proposing. Most, if not all of the current proposals are expensive and have already been shown in real life not to work. To be repetitive, I would suggest that health reform can come later, for now “It’s the economy-stupid.”
And what about the environment Cap and Trade and the financial regulatory system? Aren’t these topics ones that can wait until we make sure the economy is healed? One could legitimately ask Mr. Obama, did you forget the economy? It is clear that our President is not hard at work daily doing all he can do to stimulate the creation of new jobs. People want to know that their President is putting his hands on the items that need the most healing right now. And don’t forget that not even even you can get support for new programs and taxes and fees out of people who don’t have any money, don’t have a job or who are just hanging on to their little corner of the world.
ITS NOT ABOUT RACE STUPID
Meanwhile, Mr. Obama got diverted from the many subjects that need his full attention to give a short but clearly racist remark about a friend getting arrested. Not that one blames a black man from discussing racial profiling. But the President reacted without hearing both sides of the incident. So now he has to deal with the fact that he stated that some really good people “acted stupidly”. This ties in very conveniently with the theme of this little homily on the economy. The incident was about an upper class man with stubborn pride who thought he was above complying with the request of a police officer who was just doing his job. It is an incident unworthy of your attention.
DON’T SAY STUPID-STUPID
The “sharp” bright energetic Obama team currently at work in Washington are long on intelligence but short on common sense. They must think that the American people are stupid. There is now a long and growing litany of their saying things that are simply not true. Whether it be the truth of numbers or the truth of how a particular section of a health insurance proposal will affect a certain aspect of health care, the Obama administration can look right in the camera and promise and say things that will never become reality. Do they not think that their opponents will discover the tricky words and phrases they use and find the real truth that lies below the rhetoric? It is as if they all feel like Sen. Charles Schummer of New York who said the public didn’t care about the government dealings. It is as if they have signs hanging in their office that says “They’re all stupid”. But like the character Kevin Kline played in the movie “A Fish Called Wanda”, no one likes to be called stupid. So don’t say stupid-stupid.
ITS THE ECONOMY STUPID Part 3
So the President needs to be attending to the economy first, second, and third. He needs to be seen in committee meetings, talking with business leaders, Wall Street gurus, and the banking and finance folks. He needs to be toe to toe with critical aspects of our financial problems and he needs to do that uninterrupted until we are out of this deep recession. However politically inconvenient it is to have to deal with the economy instead of trotting out grand schemes for every other problem we face, this is what he really should be doing. It is a sad calculation that President Obama has made, that the people of this country can’t tell right from wrong when it comes to what the President should be doing. They know that “IT’S THE ECONOMY-STUPID”. Why doesn’t he?
Just a Note from the HIT Arena April 30, 2009
Posted by kirby8047 in HIT-Health Information Technology.add a comment
Challenging, unfriendly, time consuming, limited, communications, complications, frustrations, and HELP! I think all these describe the HIT implementation both from what I have witnessed, from what I have heard, and from what I have read. But all I really know is what I have seen firsthand from two very different physicians. Here are a few notes from the two encounters:
Dr. One
Dr. One has his own practice and is the sole physician in that practice. He strides into the room with his new laptop balanced precariously on his L arm my chart in his right hand. It was awkward for him but he finally got settled. The other thing that was very noticeable was that he had this microphone hanging from his tie which looked out of place. He sits down, hits a few keys and announces we are ready. “Hello” he announces, “I have this new medical record system” so bear with me since I am trying to figure out how it works. We start to talk a bit. He stops me and types a few things into the computer. “I’m sorry” he announces-”Go ahead-you were telling me about the nights you don’t sleep well”. On and on this goes, i.e. the starting and stopping, as we cover symptoms, medications, and what needs to be done. Talk, stop, talk, stop, it is irritating that he is mainly concentrating on the computer. He now has much less eye contact with me. I sort of feel like the odd man out-so to speak.
When we have finished our review and he made his recommendations, he stops again without saying a word to me, plugs his microphone into the computer and begins….”The patient is displaying signs of having………..” He dictates the notes from our meeting and when he finishes he stands up and says his nurse will be back with instructions. With that he stands up re-cradles the laptop on his L arm, grabs my chart with his R. hand and clumsily slips out the door. It all seemed very painful to him. To me, the tool got in the middle of the patient doctor relationship rather than helping it. But then again, I cut him some slack since it was a new system for him.
The followup visit about two months later was much the same as the first visit, only the paper chart was gone and the attention to the computer was just slightly diminished. Progress.
Dr. Two
Dr. Two is a member of a treatment team within a large University setting. I am signaled that something is new by the pretty balloons at the front desk. “Looks like someone had a birthday!” I declare. “On no” says the receptionist, “we just went on-line with our new Electronic Medical Records”. “How do you like it?” I ask. “It really good she replies, it is so much better than paper charts. But I do need your picture ID and insurance card so I can scan them into the new system” she declares. She goes on without prompts “But we are still going to keep the paper charts around even though everything has been scanned into the computer”.
I think to myself, never hurts to be safe although I personally don’t practice safe scanning, i.e. the policy of keeping papers around for awhile just in case something went wrong with the scan. I scan everything into my computer and promptly shred the original. My line of thinking is, if you are going digital, go digital, don’t mess around with halfway measures. But then again, I am not a big University.
Dr. Two come into the room and greets me with his usual friendly greeting, we are friends as a result of the painful hours we spent together trying to unwrap the mystery that is my health condition. I always sit at the foot of the examining table, he sits next to the examining table but facing me, and my wife sits across the room from us. She is there to remember what is said since I seem unable to accurately recall what I heard just two hours ago. It is an affliction that I understand is common to most men but in my case at least, short term memory loss is a verifyable part of my disease.
But this time things are different- the little data entry station that held the monitor, keyboard, and processor would not swivel far enough for the doctor to turn around and look at me! Oops, someone forgot to check with the doctors before installing the data entry station facing a wall. He asks if I would mind sitting by my wife since he can more comfortably turn to see me that way. This was my first clue that this was not going to be a model demonstration.
Pardon me for failing to mention the redshirts. These were IT staff people who hang around each department to help it get used to the new way of doing things. They are noticeable by their bright red shirts, their clipboards, and their general techie appearance. They lurk in the hallways waiting for a nurse or doctor to have a mental or technical breakdown. “How long are they in each department?” I ask. Two to three weeks depending on how many physician’s and staff there were to train. Cha Ching, that’s gotta cost big time.
My doctor friend is a young guy- maybe just 30 but already has landed a full time appointment at a Center of Excellence department in a major university. So he is about as bright as they come, a quality I recognized in him early on in our relationship and part of the reason I asked if he would oversee my care. He is no dummy. He struggles out loud with the categories for data entry-what do they mean? He mumbles to himself, then out loud. The drop down menus for the IDC code that he is required to enter does not contain my disease. What to do? He calls for a redshirt. There is no drop down menu to help him locate two of my medications’ names. He calls for a redshirt. He does a good job of keeping the dialogue regarding my health issues going while he types into the computer. It is clear he is from a different generation than Doctor One. But still, the appointment is interrupted 3 times by the need to bring in a redshirt to answer questions.
“Is it going to be good” I ask, “you know, when you get it all mastered?” He shakes his head negatively but doesn’t explain and we don’t have the time then to get into it, he has a whole day of patients already backing up and an even younger resident tagging along that day.
When we finished the appointment he asks me to hold on. He leaves and comes back with a copy of the notes he took during the appointment as well as a renewal Rx. The printed document was nice, but it was printed, and on a system that will likely be seen only by other physicians at the university, not by others who treat me. I will feel better when he makes his entries into my own personal EMR that is universally accesasable by anyone to whom I grant permission. But for now, I leave the appointment as I always do with this person, feeling that he has given me the very best medical care he can give.
Isn’t that the real point of it all?
Science Fairs Come to Medicine April 14, 2009
Posted by kirby8047 in CE-Comparative Effectiveness Research.add a comment
COMPARATIVE EFFECTIVENESS RESEARCH
Science Fairs Come To Medicine
March 2009
Comparative Effectiveness Research (CER) is a straightforward issue. We learned all about CER in middle school science projects when at least 10% of the class chose to do experiments on which paper towel was more absorbent Bounty or Brand X?. These simple head to head studies would often find that “Bounty” or some other brand was the better soaker upper. So if your buying decision was based on the question, “which paper towel is more effective at absorbing liquids” you had your answer and could act accordingly. Pure straightforward answers are assumed to happen as a result of Comparative Effectiveness Research (CER). Compare two treatments side by side and see which one does the job for the least amount of money.
But wait-there’s more! Which paper towel is best for the environment? Which has the prettiest designs so it looks nice on the kitchen dispenser? Which is best when used as a dust cloth? Other issues make the simple study on absorption now seem isolated and somewhat limited. This is what will happen to the CER as proposed in the ARRA legislation. One study simply leads to more questions and will not yield the cost savings holy grail we all would like to have. CER will end up being another Federal boondoggle.
CER as currently portrayed by many as a way to increase our knowledge base about what works and what doesn’t.(1) In theory the results of CER studies should tell us which medicine is the best for high blood pressure. Or which medication is the best for depression, and which one lowers cholesterol in the least expensive way? Proponents indicate that the new government entity that will carry out the billions of dollars in research can be nothing but positive and will answer many “which is best” questions. Unfortunately, or fortunately, whatever the case may be, medical research is much more complicated and involved than the proponents of CER would have you believe.
ARRA sets aside a large amount of money to create a new government research organization that would carry out CER which will then be used to help physicians use more scientific, evidence based or “effective” treatments. The idea not expressed in the language of the bill but verbally communicated during the writing of the bill was that this research would also form the basis of what the government would pay for in terms of treatments. The ultimate bottom line as seen by many is that CER is a way to control costs by rationing care.(2) Put another way, you and your physician would no longer decide what is best; a government agency would make the decisions by limiting what treatments would be covered.
There is a considerable amount of objection to the idea of another government body to do what is essentially the work already carried out in the private sector and by the FDA. There are no arguments against CER per se, CER produces valuable scientific information.(1) It is the use of CER data as a “gatekeeper” for introduction of new drugs, or as the standard used to approve payment for one procedure vs. another that brings out the red flags. The arguments against government sponsored CER fall into the following categories:
1. It is a waste of taxpayer money. These studies will not produce the information the government wants.
2. No CER study ever done has had any impact on clinical care (1). Medical protocols are developed over a series of studies each affirming a small discretely measurable aspect of a drug or a treatment procedure. What develops through the years is a mosaic of information from which physicians make their clinical treatment decisions.
3. CER can’t possibly answer all the questions that arise with any given disease and its treatment. There are just too many variables in real clinical practice. The two very large CER studies already completed by the government in recent years, one studying the use of blood pressure reducing medications and the other studying which medication was more effective for psychotics provided a large amount of useful information. In both studies the conclusions were that the older forms of medicine worked just as well as the new ones. But in both cases, follow-up studies proved the government research wrong. Again, it wasn’t that the studies weren’t useful and productive; they just failed to do what they set out to do, i.e. set the standard for which treatment is best, X or Y?
4. CER studies are often “systemic reviews” which simply summarize older studies and to make judgments based on a compilation of previous research. Critics point out that this type of CER doesn’t add any new clinical insight to the problem being studied.
5. The European models of CER are used to determine which treatments are used for which people. In short, it is their tool for rationing health care. All the single payer government run plans have budget limitations that mean they simply do not pay for certain kinds of care. CER is used to help rationalize these decisions when the citizens become angry about the lack of coverage. (3)
6. CER will stifle the creation of new medications. There is considerable reservation regarding the government studies being used to evaluate newer medications which have to be clinically tested over years to see how well they work and what impact they have at different dosage levels, and at different stages of a disease. To compare a new cancer medication with little or no widespread clinical use with an older mediation would end up stifling the creation of new drugs. Why would anyone make a new drug since it couldn’t possibly pass the CER test?
7. The FDA strictly prohibits CER. (1) Companies may not perform head to head research on their product vs. a competitors’ since the products are essentially the same and any differences are too small to make a real treatment difference. So what will happen when the FDA or the new agency both have to rule on a new medication? Will we see the end of the FDA in deference to the CER agency? As John Parker would say “Interesting Times”. Indeed.
It is clear that CER research can lead to helpful information. It is already a part of the ongoing mosaic of research findings that go into determining what treatments used in our health insurance system works best. Critics of Government run CER point out that when done by private entities, the research can be done more properly, I.e. without the government restricting the studies to studies based on the of cost. If cost becomes the only criteria for CER research, our health care system will suffer greatly, we will see a slowing of the advances in health care. And do we really want the Government to tell us what is best when it comes to health care? For myself I am still advocating the consumer driven approach which will put my doctor and I at the center of the process. Not some Government lackey.
PS A Bit About Government Decision Making Expertise
In my readings in preparation for this commentary, I came up with the fact that CMS has no Oncology expertise on its staff, no physician, no nurse specializing in oncology, no pharmacist. Despite having no medical staff, CMS has made 165 rulings in regards to Medicare payments for cancer services. These are not individual cases, they are 165 guidelines or rules. Just think what some Poly Sci major will do when setting up payment rules for open heart surgery!
(1) What Are the Promises and Pitfalls of a New Federal Effort?
By Scott Gottlieb, M.D. American Enterprise Institute (AEI)
http://www.aei.org/publications/pubID.29310/pub_detail.asp
(2) Comparative Effectiveness’ Research Sparks Concerns over Access to Health Care;
By Mary Agnes Carey and Alex Wayne, CQ Staff. The Commonwealth Fund
(3) Comparative Effectiveness in Health Care Reform: Lessons from Abroad
by Helen Evans, Ph.D. Backgrounder #2239 The Heritage Foundation
http://www.heritage.org/Research/HealthCare/bg2239.cfm
Kirby V. Nielsen
Delaware, Ohio
Babylonian Lessons Part 2 April 8, 2009
Posted by kirby8047 in HIT-Health Information Technology.add a comment
HEALTH INFORMATION TECHNOLOGY: NO PLACE FOR UNCLE SAM
Perhaps the greatest difference between those in favor of the insertion of money into the ARRA for government run HIT and those of us that don’t see a thing wrong with what is happening in the Health IT domain. It is currently struggling to find its core values and then its core program language. With time, the proper HIT solutions will be implemented. There are many who are saying on the other hand that this is the rightful domain of the Federal Government and that private enterprise has fiddled around long enough.
HURRY UP AND SPEND
The context of the HIT debate, centers partly on how it was brought about. I see it as being jammed into a pork laden spending bill. Along with CE, it was put in with little or no debate. If HIT and CE were studied on their own merits, they would likely never have been funded at the astronomical levels they received. Like so many other parts of the stimulus bill that really didn’t involve stimulus spending, it was an all or nothing offer on the part of Democrats and the President. They conceded issues only to the extent that they could get the three needed votes. This made a lot of people angry right from the start, it is hardly the Obama promised “new way of doing things in Washington”.
CONSERVATIVE IDEALS
The second context is that HIT and CE are issues that might best be handled by organizations who have more expertise in this area. For the National Association of Health Underwriters to advocate for something because it sounds good or has some face validity is the wrong reason to support the issue. I hope to show here that the HIT issue is a can of worms with little hope of having positive outcome as a result the ARRA. I realize that who represent health insurance agents inside the beltway must realize that the majority of the membership is probably more conservative than what is popular inside the beltway. Many of us see a country deep in the financial hole and would not support the notion that spending for spending sake is the way to get out of this financial crisis.
HIT SAVES MONEY AND REDUCES MEDICAL ERRORS
There are many things right with HIT but there is a great many problems as well. I searched the internet and found a large number of articles that were both supportive as well as critical of HIT. Let me begin by focusing in on two articles I found on Health Affairs (1) (2). Both articles question to some extent, the overly optimistic opinions that HIT will make for better health care and will save us money. There has been a growing body of evidence that HIT not only does not save money, it does not necessarily reduce errors. In fact, one study showed that medical errors increased using HIT. Although all the things often bantered about as HIT positives are potential benefits of a properly implemented HIT program, we are years away from that ever happening.
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The group Connecting for Health presented evidence to the Office of the National Coordinator for Health Information Technology (A body that is supposed to make HIT standards) and the Certification Commission for Health Information Technology (the body that is supposed to certify that the standards have been met) that three years of work has resulted in none as in 0 standards being met.
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Another report by the Merkle Foundation suggested that there were no clear goals in HIT. Nor were there were “incentives to implement HIT”. The point being perhaps that although there are potential savings, the cost of implementation is too high.
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Sidrov (1) reported that using Electronic Health Records (EHR) increased cost and that there was no indication that it would ever save money. She also reported that documentation time increased by 17% in facilities that implemented HIT. Those that implemented Computerized Physician Order Entry (CPOE) saw a 98% in documentation time. Even more critical in physicians’ offices that implemented EMR’s there was no decrease in staffing after implementing EMR’s. The time that was saved by having EMR’s was offset by the staff inputting into the EHR’s.
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The Agency of Healthcare Research and Quality (AHRQ) does support the idea of HIT measures but does not list HIT as EHR’s as a way to increase safety or reduce errors.
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The United States has already spent $900,000,000 on all of the above via money appropriated in 2004. The purpose of that money was to prove that HIT could work. Obviously, it has failed to ensure its widespread adoption.
PRIVACY AND DATA SECURITY
I am concerned about those who setting aside concerns about “big brother” having access to our personal health information. I am sorry to hear that many people can set aside these concerns so quickly. Apparently they are a big fans and supporter of my “Big Brother” but I do not trust him or like him. Nor do I like or trust Microsoft and Google or Intel. I love them all, don’t get me wrong, they provide me with the best place in the world to live and give me magnificent products and services, but I do not trust them. I do trust my wife, my children, and God and that is about all. My point is that liberals often run right past the very issue that concerns everyone the most “trust”. It is wise to stop and consider one of the very most basic concerns people have before spending a few Billion or Trillion dollars on HIT.
Speaking of privacy, ARRA’s expansion of HIPAA privacy regulations ARRA did receive good comments from two consumer based watchdog groups. They were the Electronic Privacy Information Center (EPIC) (3) and the Patient Privacy Rights (4) group. Notwithstanding these endorsements it is interesting to note the following facts (5).
Since 2003:
1. There have been 35,000 HIPAA violations reported to CMS
2. There have been zero as in none civil fine.
3. Approximately 200 cases were referred to the Department of Justice of which the status is unknown.
Which leads us to the simple question of whether or not, HIPAA privacy standards are worth the millions of tons of paper they have been printed on? The best of regulations mean zero if there is not enforcement. This is not necessarily good news if you are asking people to “Trust Uncle Sam”.
Or, how about the secret military files that recently showed up on a MP3 player? Maybe the company that was taking 83,000 Johns Hopkins Hospital patient files to storage but instead left them on the loading dock of a flower company could explain how our electronic medical records are safe. Finally, closer to home here in Ohio, we had a college intern student instructed to take the backup tape of files of 500,000 Ohioans (which included their name, address, Social Security numbers, and DOB) home with him. He threw the tape in the back seat of his car from where it was stolen. I believe we taxpayers got a $10,000,000 bill for that mistake. I don’t think I need to go on although I could. Security is not necessarily assured whether you are with the government or a private enterprise. These things are a big concern to many of us.
THE FUTURE IS BRIGHT FOR HIT
I am one of the biggest advocates of HIT. But as you can tell, not such a big fan of Government run HIT. I believe in all of the positive outcomes as a result of implementing a sound HIT policy. However, I believe that there are some principles that need to apply before we can reach HIT Nirvana:
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The first principal is that HIT must implemented in conjunction with a reform of the health care delivery system. The key is that the system must be reformed before HIT can produce the results we all desire.
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The second is that there must be clear goals for what HIT is to do and what information it is to provide. Questions such as what do we want out of it are critical. In one article I read, the author bemoans the fact that 4 medical doctors stood at the doorway of a patients’ room talking about the patient. Not one of them referred to the information in their computer. To this person, the conversation was not documented, the decisions were not based on empirical evidence, and therefore the HIT implementation had failed. Apparently, this person’s goal is to replace talking to each other with a digital medium. To me, 4 MD’s talking about a patient’s health care is a miracle in this day and age. It is people being people, doctors using their minds instead of being robots directed by some computer “best practices” flow chart. My point is if we want techs to do MD’s work then go to the hilt on HIT and live or die literally by “best practices”. But if we want doctors to do doctors work, we should build the HIT to support the physician, not replace the physician or make more work.
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The third is that the goals in HIT should be measurable. Like “best practices” in medicine, it will be important to monitor what digital tools work and which ones don’t.
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The fourth is that the machine language or computer software must be open source in both senses, i.e. in terms of the operating language as well as implementation programming. This does not replace private enterprise but is developed by private companies seeking profits and efficiencies around which to build better digital tools.
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The fifth is that HIT should be consumer centered, not institutional or physician centered. EHR’s should be completely owned by individuals who then grant access to the records to physicians, hospitals, or other care providers. Each provider is welcome to keep what they need in their files, but all treatments, medications, and other medical information must be placed in the individuals’ EHR. This is the only way to streamline the system down to a workable level. It is also the only way to guarantee the privacy of the each individual’s EHR. .
Kirby V. Nielsen
Delaware, Ohio
(1) Health Affairs, Joan Sidrov Market Watch “It Ain’t Necessarily So..EHR and the unlikely prospect of saving money”. Volume 25 Number 4
(2) Health Affairs Carol C Diammond and Clay Shirky Web Exclusive “HIT: A few Years of Magical Thinking”
(3) www.epic.org
(4)Patient Privacy Rights http://www.patientprivacyrights.org
(5) Wall Street Journal 08.08
(6) CNN http://edition.cnn.com/2009/TECH/01/27/confidential.mp3.player/
OTHER REFERENCES:
www.openehr.org for information on a group of people developing open source HIT.
www.eheathinitiative.org has a list of studies and other efforts to demonstrate the effectiveness of HIT.
http://www.health2blog.com Health 2.0 is a rapidly growing group of corporations and individuals interested in developing bottom up technologies that support consumer friendly services. Many believe Health 2.0 like its cousin Web 2.0 is the future of health care delivery in America.
https://openhie.projects.openhealthtools.org is another organization working on open source programs for HIT
http://www.connectingforhealth.org/decisionmakers/index.html An excellent site sponsored by the Markle Foundation. Resources and planning information for HIT.
Babylonian Lessons Part 1 April 8, 2009
Posted by kirby8047 in HIT-Health Information Technology.add a comment
March 2009
Babylonian Lessons: Healthy Information Technology and The ARRA
There has been a lot of attention in the media recently regarding the passage of the ARRA stimulus plan in regards to two major cost items, Health Information Technology (HIT) and Comparative Effectiveness Research (CER)
The Senate Finance Committee released for public use a number of Qs & A’s which were inadequate to deal with these issues. Those who simply brush off the very real problem of the government overseeing the development and implementation of HIT is a gross error in my opinion. So lets’ look at the HIT issue first and deal with Comparative Effectiveness Research in a separate commentary.
There is a lesson in the Old Testament in regards to the building of the tower of Babel. In so much as God was angry with the people of Babylonia, he caused them all to speak different languages during the building of their monument. Consequently the tower couldn’t be built. Confusion and disarray resulted from the language mess. A poor analogy to today’s HIT status, but in many ways, not that far off.
CONFLICTING PRIORITIES
Today’s equivalent are the many technologies and more specifically, programs that make up HIT. Each provider of HIT uses a proprietary system, so a perfectly workable program for a chain of 15 hospitals may not be compatible with the Center for Medicare/Medicaid Services CMS for billing purposes, or with physicians’ offices for the exchange of critical patient information. Everyone is on their own system. There are conflicting proprietary interests and billions of dollars at stake. Everyone thinks they have the best answer. Everyone is speaking a different language and using different computer systems in their own worlds.
The result, according to authors Carol Diamond and Clay Shirky writing in Health Affairs in the August 18th 2008 issue…Health Information Technology…A few years of magical thinking..is that health planners must stop the magical thinking that HIT is going to improve health care. There is simply no evidence to support that by pouring Billions of dollars into this field the US will save any money, let alone improve care.
REFORM HEALTH CARE FIRST
What seems like an intuitively good idea, i.e. computerizing records and data, is only part of the solution to our health care problems. What is needed of course is a major reform in the way health care is delivered and how it is financed. Simply working on IT does nothing to solve the underlying problems with our health care system.
One of the most critical errors made by many is that they seem willing to accept that the government as a perfectly harmless entity to carry out the mission of building and implementing HIT. Nothing could be further from the truth. What if the government developed the Internet? Would it be as free and open as it is today? I am sure politicians would have figured out a way to put a fee on each e-mail or web visit as is often the subject of unsubstantiated web folk lore.
OPEN SOURCE SOFTWARE
The HIT system that we do need and can benefit from must come from private enterprise working on open source software that is free to all wish to use it. The second consideration must involve control of key standards by a non-profit board comprised of HIT specialists, physicians, hospitals, the pharmacy industry, government representatives, and most importantly, CONSUMERS. Consumers should be the focus of the entire system and have complete ownership and control of all their Electronic Medical Records (EMR) or what is often referred to as Personal Health Information or PHI. Without the strictest of systems built by a non-governmental agency, people will be reluctant to engage new government sponsored technologies that post and track personal information.
The nature of a government designed HIT system seem clearly nothing more than a method to pursue ownership of the entire health care delivery and payment system. Once the Federal Government has forced all the medical providers into their system of HIT, it is only a matter of time before they will control what doctors and hospitals do, or put more clearly, they will control what health care you and I receive.
I hope that those who support the Obama administrations’ incursion into this arena will step back from the precipice on this issue and get into the problems that are related to health care first such as how to serve more people at a lower cost, how to keep access to health care open and fluid, and how to keep Americans covered by the private insurance plan of their choice.
Kirby V. Nielsen, M.A. CLU
Delaware, Ohio
Say “No Way” to IO-way April 7, 2009
Posted by kirby8047 in The Lighter Side.add a comment
I am from Iowa so I can say this. Thank God their caucus’ are over tonight. The average Iowan has been subjected to more pounds of hot air per person than anywhere else in the United States. It is a wonder there is any air left in Iowa. And the rest of us have been forced into being witnesses to the prolific misuse of hot hot air.
Regular folks in Iowa can’t even eat their lunch in peace. A story in the Wall Street Journal told about a life long Republican, a senior citizen who was eating his lunch in his favorite restaurant and in walks Hillary Clinton and a bevy of media and secret service folks and who knows who else. He has never liked either of the Clintons and has to slink down low so she doesn’t see him and come over to him. Now that is a situation no American should have to be subjected to. When faced with being cornered by a politician, every American should be guaranteed the right to be able to duck down a side street of their choice. Perhaps campaigns should be required to send out a runner ahead of the candidate warning everyone that they are approaching. That way people who don’t want to be bothered could get out of the way.
Imagine being bombarded by TV ads for months and months on end, getting piles of glossy junk mail you don’t want, and listening to those annoying canned phone messages all hours of the day. I wouldn’t blame Iowans for demanding a special privacy law where one could “opt out” of the political ad blizzard. Of course, all this hoopla brings in millions of dollars to the state and of course one has to take that into consideration before being too critical of the whole process.
In fact, perhaps Iowans could create a whole new industry called POLITICALOPINIONATING. Since politicians are apparently willing to spend millions of dollars just to curry the favor of otherwise sensible people, why not make Politicalopinionating a full time industry? Instead of bothering with having a Congress, whenever the country is facing a major issue, just have the pros and cons of the issue presented to Iowans for them to “Caucus” on it. Paid volunteers could be sent swarming over every corner of the state to badger the citizens into sharing their opinions. Individual Iowans who “cacus” could be paid a fee for their participation. It would probably be more entertaining and cheaper than having a Congress where people are paid for doing nothing.
Iowans have to put up with alot these days. Not only do innocent people have to dodge political zealots, but suppose they want to get stay in Des Moines over the Christmas Holidays. Why they couldn’t do it because every room has been taken up with TV talking heads who can spend hours explaining that a race is too close to call. I just hope they charge plenty to all those New Yawk and Warshington experts to stay at the Best Western out in Clive.
To top things off, Iowans have had to suffer the indignaty of having their own politicians put a tax on pumpkins if they are used for decorations, but not if they are used for making pies. Who is gonna follow Eldon Farmsmith home to see if his grandkids carve them up or if his wife bakes pies with them? I tell you it is going to teach a whole generation of God fearing people to learn to lie. Like Meridith Wilson said in the famous song Music Man song, trouble starts with the letter P except it isn’t P for pool, it is P for Pumpkins. I think if any of these presidential candidates wanted to do some good, they would take a strong position on the pumpkin tax. Better yet, maybe the whole state could have a pumpkin party just like the Boston Tea party only they could throw all the pumpkins they can gather together into Spirit Lake or the Mississippi River.
For the sake of the country lets all just say “No Way” to the IOwa-way. No more cornering innocent senior citizens who are just trying to eat their lunch in peace. No more annoying junk mail. Lets support Iowa moving their cacus day back to November 2, long after both parties have held their nominating convention. I like the guy who was interviewed on TV tonight when he said ” I will vote for any politician who leaves me alone”. Finally, a voice of reason in the media wilderness we know and love as Iowa.
Kirby V. Nielsen January 3, 2007
