The Week in Review - April 30, 2009

In a report to the SAS Healthcare and Life Science Executive Conference, John Halamka contends that there are many challenges for the implementation and use of the EHR's nationally. "First, there is not a single set of standards for identifying medical information, meaning physicians, insurers, pharmacists and others involved would have trouble communicating with each other electronically... At the same time, technology needs to be developed to maximize ease of use for physicians... 'Putting servers and exchanges into doctors offices is not going to work,' Halamka said, suggesting a better model is using regional health-care information technology centers that use cloud computing systems to work with doctors."

Nothing like the threat of a pandemic... The Senate (finally) confirms Kathleen Sebelius for Secretary of Health and Human Services. The Wall Street Journal reports that "she was sworn in hours later and quickly went to work on the swine-flu outbreak... She'll also guide a health-care overhaul that the White House and Congress are pledging to enact this year."

Joseph Conn reports on the NCVHS hearing on meaningful use. "The NCVHS got a lot more to chew on—a daylong discourse on the ills of the nation’s healthcare system and a broad overview of what role health information technology might play in healthcare reform." Article at Modern Healthcare (subscription required).

NPR's On Point features the push for e-Health records, the concerns about doctor-patient privacy and the costs to implement these systems.

Business Week features the Dubious Promise of Digitial Medicine. Business Week reports that "industry leaders are pushing expensive systems with serious shortcomings, some doctors say. The high cost and questionable quality of products currently on the market are important reasons why barely 1 in 50 hospitals has a comprehensive electronic records system..."

Diagnosis: Inaccuracy - - Boston Globe editorial on the use of billing codes as clinical content in the PHR. And a summary of editorials on electronic health records from the AMA.

The Week in Review - April 23, 2009

Fox News medical contributor and NYU Professor of Medicine Marc Siegel delivers a thumbs down to universal health insurance in a Wall Street Journal Op-ed. He contends that universal health coverage won't necessarily deliver health care. Siegel cites the Medicare Payment Advisory Commission finding that an increasing percentage (28%) of Medicare patients couldn't find a primary care doc. Siegel considers dropping Aetna and Blue Cross following the lead of 11% of his fellow NYU physicians due to the increasing paperwork and decreasing payments. When Doctors Opt Out suggests that this vicious cycle means physicians left behind will have even worse workloads for less money - all to the detriment of the patients. Editor's Note: For an alternative view, see the seventh paragraph of the Hippocratic Oath.

New England Journal of Medicine reports on the struggle for health care reform. "The result might be a phasing in of a less comprehensive reform plan with more modest benefits than many liberal Democrats favor and tighter controls on costs. But given the party's current power, public majorities favoring government intervention to ensure coverage, and private interests that recognize the system's unsustainability, the odds remain with Obama and his allies. If their reform affects the entire medical economy, it will represent a paradigm shift away from the incrementalism that has long dominated U.S. health policymaking."


The Economist's special report on "Medicine Goes Digital" looks at the deployment of healthcare technology in the US, the impact of EHR's on medical care, a "new Moore's law" for personalized medicine (genomics), mobile health technology for the developing world, portable personal health technology, and Health 2.0.

A good piece from Software Advice on the "odd couple" - - Sam's Club and eClnicalWorks. "Competing EMR companies ... will enter the fray one way or another, and the economics of software will allow them to match the Wal-Mart price."

It's the penalites that will drive the investments in Health IT, not the incentives. For a 500 bed hospital these penalties can rise to as much as $3 million per year by 2017, while total incentives are $6 million. PWC's report is one of the few articles correctly reporting the $36 billion in incentives that will be doled out between 2011 and 2015. (It's the benefits that push the net to $20 billion.)

Improving Medication Use and Outcomes with Clinical Decision Support (CDS) is published. It documents the five rights for CDS. "The CDS Five Rights model states that we can achieve CDS-supported improvements in desired healthcare outcomes if we communicate:

1. The right information: evidence-based, suitable to guide action, pertinent to the circumstance
2. To the right person: considering all members of the care team, including clinicians, patients, and their caretakers
3. In the right CDS intervention format: such as an alert, order set, or reference information to answer a clinical question
4. Through the right channel: for example, a clinical information system (CIS) such as an electronic medical record (EMR), personal health record (PHR), or a more general channel such as the Internet or a mobile device
5. At the right time in workflow: for example, at time of decision/action/need"

Soon-to-be-confirmed HHS Secretary Kathleen Sebelius in written testimony to the Senate Finance Committee says that “a nationwide interoperable health IT infrastructure is a fundamental building block for broader health reform" and that the systems should be "interoperable and that patient privacy ... assured.” When asked about management of chronically ill patients, she referred to Health IT as a part of the solution for provider communication and care coordination.

New position announcements from the White House targeting government efficiency and effectiveness include Jeffrey Zients, Chief Performance Officer and Aneesh Chopra, Chief Technology Officer. They join new Chief Information Officer Vivek Kundra.

Telemedicine improves treatment and outcomes for stroke victims. The hub at Millard Fillmore hospital's stroke center connects to 10 other hospitals. "Early evidence from Buffalo and elsewhere suggests that telemedicine links improve the chances that patients will survive a stroke and avoid paralysis and other major problems."

Wall Street Journal reports on the big challenges facing David Blumenthal as he guides the transition to electronic health records.

Obama to Name Kathleen Sebelius to HHS

Kansas Governor Kathleen Sebelius will be tapped on Monday to be Secretary of Health and Human Services (HHS).

Barack Obama will highlight her bipartisanship, executive experience and independent-minded insurance experience. Unlike the previous nominee, Sebelius has not worked in Washington which will test her capacity to guide plans to overhaul the US health care system. And unlike the previous nominee, Sebelius will be nominated for Secretary of HHS only and not the health care role within the White House which is thought to be reserved for someone with the Washington background needed to drive Obama's health care legislation.

Sebelius has a Masters in Public Administration at the University of Kansas. For 8 years she served as a Kansas legislator. In 1994 she won election as Insurance Commissioner where she worked for the next 8 years. Sebelius developed a reputation for staying independent from the insurance companies and even halted a planned merger of the powerful Kansas Blue Cross and Blue Shield.

In 2002 Sebelius became the Democractic governor of a very red state. Her bipartisan appeal contributed to her re-election in 2006 by a wide margin. She remains a highly popular governor.