Sovaldi, a Quantum Leap... Backwards to the Days Before Randomized Controlled Trials?
The Sovaldi (sofosbuvir - Gilead) media circus is continuing.  The New York Times just reported that sales of the new drug for hepatitis C were about $3.5 billion for the last quarter, which should intensify the kerfuffle over its US price ($1000 per pill, $84,000 for a 12 week course of medication).Meanwhile, reports of its wondrous properties continue to appear in medical journals.The latest was announced this way in Bloomberg, Gilead Science Inc Solvadi, controversial because of its price, helps cure hepatitis C in people with HIV, according to researchers who say the drug has the potential to limit a top cause of ...
Source: Health Care Renewal - July 24, 2014 Category: Health Management Tags: clinical trials evidence-based medicine Gilead Sovaldi Source Type: blogs

Sovaldi, a Quantum Leap? - Backwards to the Days Before Randomized Controlled Trials
The Sovaldi (sofosbuvir - Gilead) media circus is continuing.  The New York Times just reported that sales of the new drug for hepatitis C were about $3.5 billion for the last quarter, which should intensify the kerfuffle over its US price ($1000 per pill, $84,000 for a 12 week course of medication).Meanwhile, reports of its wondrous properties continue to appear in medical journals.The latest was announced this way in Bloomberg, Gilead Science Inc Solvadi, controversial because of its price, helps cure hepatitis C in people with HIV, according to researchers who say the drug has the potential to limit a top cause of ...
Source: Health Care Renewal - July 24, 2014 Category: Health Management Tags: clinical trials evidence-based medicine Gilead Sovaldi Source Type: blogs

Money vs Mission - How Generic Managers vs Physicians Think
On Health Care Renewal, we emphasize problems in leadership and governance in large health care organizations, and how they affect health care professionals' attempts to carry out their mission, and ultimately how they affect patients' and the public's health.  Large health care organizations are increasingly lead by people trained in business, not health care professionals, thus generic managers.  The stewards of these organizations, the members of their boards of directors or boards of trustees, are also increasingly current or former managers without direct health care experience. Yet all too often, healt...
Source: Health Care Renewal - July 22, 2014 Category: Health Management Tags: financialization generic managers ' coup d etat mission-hostile management mission-ignorant management pay for performance Source Type: blogs

For Hospital CEOs, Retirement May Mean Never Having to Lose Your Paycheck
 Dr Herbert Pardes was once one of the best paid CEOs of a US non-profit hospital system.  A new New York Times article reported that the hospital system continued to pay him millions after his retirement.  Introduction - the Best Paid Non-Profit Hospital System CEO in 2008In 2009, we first discussed the compensation given to Dr Herbert Pardes, the CEO of New York - Presbyterian Healthcare System, which appeared to make him one of the best paid, if not the best paid non-profit hospital system CEO in the US.  His total compensation for 2008 was $9.8 million, according to the NY Post.  While his comp...
Source: Health Care Renewal - July 17, 2014 Category: Health Management Tags: boards of trustees executive compensation Herbert Pardes New York - Presbyterian Hospital Uwe Reinhardt Source Type: blogs

When Money Talks, the Sick Will Walk, or Crawl - Three Illustrations of the Brave New World of Health Care
In the quaint days of yesteryear, there were those health professionals who thought of what they did as a calling.  The best care of the individual patient was supposed to come first, especially ahead of maximizing one's own income.  Now in the brave new world of neoliberalism, economism, unregulated, laissez faire capitalism - call it what you want - health care has become a business, an industry.  Protests that it still should be a calling are anechoic.For example, who noticed when a very famous person wrote this in 2012?Hospitals and other facilities 'must rethink their particular role in order to avoid h...
Source: Health Care Renewal - July 15, 2014 Category: Health Management Tags: core values economism medical ethics mission-hostile management neoliberalism perverse incentives Source Type: blogs

The Price of Compassion - Commercialized Hospices and the Mistreatment of Vulnerable Patients
Introduction - Commercialized Hospices We have occasionally written about the rise of the commercialized hospice industry, and concerns that commercialized hospices may not be providing the compassionate care they promise.  As we have discussed before, the hospice movement began with small, non-profit, community based organizations meant to provide compassionate palliative care to the terminally ill.  However, in the US, the hospice movement has been co-opted by commercial hospices, often run by large corporations, which may put profit ahead of compassion.Several long investigative articles have appeared this yea...
Source: Health Care Renewal - July 10, 2014 Category: Health Management Tags: Carlyle Group deception Fillmore Partners Gentiva Golden Living HCR ManorCare hospices marketing private equity Vitas Source Type: blogs

There They Go Again - Merck Threatened Legal Action Against Italian Doctor who Criticized Zetia
It seems that when confronted with unfavorable facts or opinions, Merck executives like to threaten legal action, rather than just argue their side of the case.  Last month we discussed how Merck officials used the US court system to try to prevent a physician from publicizing evidence uncovered in prior litigation that suggested Merck employees had concealed the risks of Vioxx from research subjects.Legal Threats to Shut Up a Critic Recently, a British Medical Journal news article explained how Merck tried to shut up an Italian physician who dared criticize another of its drugs, Zetia (ezetimibe).The Italian branch o...
Source: Health Care Renewal - July 8, 2014 Category: Health Management Tags: anechoic effect ezetimibe legal settlements Merck Source Type: blogs

What Does the Blumsohn - Procter and Gamble -Sheffield University Affair Say About the Fitness of the Latest VA Secretary Candidate?
Introduction - New Leadership for the US Department of Veterans Affairs After reports of problems with access, manipulation of data about waiting times, and most recently "a corrosive culture," the US Department of Veterans Affairs, the country's large government run health system, has had a massive leadership overhaul.  President Obama's nominee to head the agency is now Robert A McDonald, for CEO of Procter and Gamble. The choice of a former CEO or a large corporation was called "unorthodox" by the Boston Globe, but many saw merit in a business leader running the VA.  As reported by the...
Source: Health Care Renewal - July 2, 2014 Category: Health Management Tags: Actonel ghost writing leadership manipulating clinical research Procter and Gamble revolving doors suppression of medical research Veterans Affairs whistle-blowers Source Type: blogs

Health Care Corruption, "No Dirty Little Secret," but "An Open Sore" - Lessons from India for the US
Health care corruption is widely prevalent around the globe, but remains the great unmentionable.Introduction: Global Health Care Corruption We have discussed health care corruption whenever we have an opportunity, but rarely does the topic appear in the English language media or in English language medical and health care journals, particularly in the US.  Some might think that this is because health care corruption is not so prevalent in the US and other "developed" countries.  However, our most read post of all time was about a Transparency International global survey that found that fully 43% of Ame...
Source: Health Care Renewal - July 1, 2014 Category: Health Management Tags: conflicts of interest economism health care corruption kickbacks neoliberalism Source Type: blogs

Through a Glass Darkly - How Can So Many Health Care Executives Be Visionaries?
Visionary (noun) 1:  one whose ideas or projects are impractical :  dreamer 2:  one who sees visions :  seer 3:  one having unusual foresight and imagination Merriam-Webster Dictionary online The Visionary, or Messianic Health Care Executive In 1997, Sherif Abdelhak, the CEO of the then unusually large vertically integrated health care system based in Pennsylvania, the Allegheny Health Education and Research Foundation (AHERF) was described in an American College of Physicians publication as a "visionary." (See the summary beginning on p 5 here.) Abdelhak had previously been cal...
Source: Health Care Renewal - June 26, 2014 Category: Health Management Tags: AHERF CEO disease leadership public relations Source Type: blogs

A Real Example of Public Relations Talking Points to Justify Outsize Executive Compensation - and Why We Should No Longer be Fooled
We frequently discuss outsize executive compensation in health care organizations as both a symptom and a cause of these organizations' poor leadership and governance, and hence of widespread health care dysfunction.The Latest Stories of Huge CEO Pay Stories of gargantuan compensation appear almost daily.  For example, some headlines about pay at hospitals and hospital systems in the last few months included,Millionaire health care?With high costs and insurance premiums in Garfield County, focus falls on pay of a hospital’s chief executiveAudit faults UMass Medical School for improper documentation of $2 million...
Source: Health Care Renewal - June 25, 2014 Category: Health Management Tags: executive compensation logical fallacies public relations You heard it here first Source Type: blogs

GlaxoSmithKline's Marketing Firm Promised "Clinical Trials Could be Your Solution" to Poor Graduate Students
We have frequently raised concerns about the increasing domination of clinical research, particularly clinical trials, by those with vested in interests in the research producing particular results.  In particular, drug, biotechnology and device companies often sponsor trials meant to evaluate their own products.  Often it appears that commercial trial sponsors manipulate various aspects of research design, implementation, analysis, and dissemination to increase the likelihood of a result favorable to their interests.  Furthermore, when even such manipulation fails to produce the desired result, particular s...
Source: Health Care Renewal - June 24, 2014 Category: Health Management Tags: clinical trials GlaxoSmithKline manipulating clinical research marketing research subjects Source Type: blogs

$100 million Epic install dampens Lifespan Rhode Island Healthcare's credit
Lifespan Rhode Island Healthcare System's Siemens EHR was apparently causing thousands of electronically-generated prescriptions to become scrambled, as I posted in Nov. 2011 here: http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html.Due to this "glitch" - and other factors, I surmise - they switched to Epic.Here are the current results:$100 million Epic install dampens Lifespan's credithttp://www.modernhealthcare.com/article/20140606/NEWS/306069948By Bob HermanPosted: June 6, 2014 - 5:45 pm ETA multimillion-dollar electronic health-record system installation is eroding the cash flow, and ...
Source: Health Care Renewal - June 22, 2014 Category: Health Management Tags: EPIC Lifespan Source Type: blogs

Fourth Time is the (Anti)Charm? - UK NICE Highlights "Uncertainties in the Evidence Base" About Sovaldi
As we have discussed, (here, here and here), while anger continues to build about the $1000/ pill price sought by Gilead for its new antiviral drug for hepatitis C, Sovaldi (sofosbuvir), almost all public discussion still treats the drug as miraculous.  However, my reading of some key trials, and reviews by three groups of evidence-based medicine experts, suggested that the evidence supporting the drug is actually weak and unclear, and hardly suggests it is miraculous.NICE Weighs In Now, as first noted by the indomitable Ed Silverman in his revived PharmaLot blog, the National Institute for Health and Care Excellence ...
Source: Health Care Renewal - June 20, 2014 Category: Health Management Tags: anechoic effect clinical trials evidence-based medicine executive compensation Gilead health care prices manipulating clinical research Sovaldi Source Type: blogs

Yet another EHR "glitch" - insulin decreased per protocol, oops, I meant heparin
Yet another EHR "glitch" (http://hcrenewal.blogspot.com/search/label/glitch):http://www.labornotes.org/2013/07/electronic-medical-records-friend-or-foeAn emergency room nurse described her frustrating experience trying to accurately document a dose of heparin, a blood thinner for patients with chest pain. “The doctor stated he wanted 4000 units bolus [all at once] and then a 1000 unit per hour infusion,” she wrote. “The order in Paragon stated 5000 units of heparin. I was given the option to decrease the dose, which I manually changed.“However, I had to pick a reason why I decreased the do...
Source: Health Care Renewal - June 19, 2014 Category: Health Management Tags: glitch healthcare IT defects Source Type: blogs

Citizen's Council for Health Freedom: "The Truth about Electronic Health Records"
The Citizen's Council for Health Freedom (CCHF) is an independent 501(c)3 non-profit organization with a mission "to protect health care choices and patient privacy" (www.cchfreedom.org/about.php).Its president, Twila Brase, wrote this piece about Electronic Health Records in the CCHF newsletter of June 18, 2014, observing some "inconvenient truths" and highlighting one of the most asinine statements I've ever seen about computers made by (of course) a venture capital official who happened to play a significant role in formulating the Affordable Care Act a.k.a. "Obamacare":http://healthenews.c...
Source: Health Care Renewal - June 19, 2014 Category: Health Management Tags: CCHF Citizen ' s Council for Health Freedom conflict of interest healthcare IT risk HITECH Politico. Affordable Care Act Twila Brase Source Type: blogs

On the EHR-related term "cognitive overload"
I often use the term "cognitive overload" when writing about EHR and related information technology systems that present a needlessly complex user experience to clinicians.  This affects the care they deliver in negative ways.Physicians and nurses are presented with too much complexity for the hard, fast, unpredictable work they have to perform. This picture of a B36J cockpit illustrates the concept of cognitive overload instantly:(Click to enlarge)A 360-degree "virtual tour" is at http://www.nmusafvirtualtour.com/media/062/B-36J%20Engineer.htm.  Scroll around the cockpit to see more. Any ques...
Source: Health Care Renewal - June 18, 2014 Category: Health Management Tags: cognitive overload Source Type: blogs

At Merck's Urging, a Federal Judge Threatens to Sanction a Lone Professor for Trying to Reveal Evidence about Vioxx
We have written often, and most recently this week, about the limp posture taken by US law enforcement and regulatory agencies in the face of misbehavior by large health care organizations.  At best, official action often results in legal settlements which let companies pay fines, sometimes large, while the individuals who profited most from the alleged wrongdoing do not suffer any negative consequences.  Worse, the legal settlements often allow the companies to continue to deny any culpability, and the legal evidence underlying the settlement, which might let the public at least estimate culpability, is often ke...
Source: Health Care Renewal - June 18, 2014 Category: Health Management Tags: anechoic effect confidentiality clause legal settlements Merck Vioxx Source Type: blogs

Justice Delayed is Justice Denied? - Another Neurontin Settlement by Pfizer 20 Years After the Alleged Events
We have argued repeatedly against the strategy used by US government authorities to address allegations of bad behavior in health care (and elsewhere) by pursuing monetary settlements against the companies involved, rather than trying to impose penalties on the people who may have done wrong.  There are many apparent things wrong with this approach (which we will rant about again below), but one aspect that deserves more attention is its slowness.The Latest Pfizer Settlement For example, Bloomberg reported in early June about yet another settlement by Pfizer of allegations about the marketing of the drug Neurontin (ga...
Source: Health Care Renewal - June 16, 2014 Category: Health Management Tags: kickbacks legal settlements Neurontin Pfizer Source Type: blogs

Full Moon Friday the 13th: Computers down at Vermont's largest hospital
A health IT "glitch" hit in Vermont on Full Moon Friday the 13th (have some werewolf with your bad luck!)Dark Shadows' Quentin Collins (David Selby) in a foul full-moon mood.Note, however, that "bad luck" has little or nothing to do with mission-critical healthcare IT mass outages.  Mismanagement often does:http://www.wcax.com/story/25773022/computers-down-at-vermonts-largest-hospitalComputers down at Vermont's largest hospitalPosted: Jun 13, 2014 4:12 PM EST Updated: Jun 13, 2014 4:12 PM EST By WCAX NewsBURLINGTON, Vt. - A major, systemwide computer problem at Fletcher Allen Health Care in B...
Source: Health Care Renewal - June 16, 2014 Category: Health Management Tags: Fletcher Allen Health Care glitch healthcare IT crash healthcare IT risk Patient care has not been compromised Source Type: blogs

Masters of the Obvious at Athens Regional Medical Center: Lack of clinician input, training, common sense created problems with Athens Regional electronic records system - but mostly lack of common sense
(Note: also see my earlier May 26, 2014 post at http://hcrenewal.blogspot.com/2014/05/i-could-not-make-this-up-if-i-tried.html)My early medical mentor, Dr. Victor P. Satinsky, had disdain for those whom he called "Masters of the Obvious", who proffered profound words of wisdom that were in fact common-sensical or well-accepted, as if they'd invented those words personally.I think it's fair to say that after countless publications dating back decades, pointing out the essential role of clinical leadership in the development of clinical tools such as healthcare information technology systems, that such involvement ...
Source: Health Care Renewal - June 16, 2014 Category: Health Management Tags: Athens Regional Medical Center cerner healthcare IT risk master of the obvious Mismanagement Patient care has not been compromised Source Type: blogs

Masters of the Obvious at Athens Regional Medical Center: Lack of input, training, common sense created problems with Athens Regional electronic records system - but mostly lack of common sense
My early medical mentor, Dr. Victor P. Satinsky, had disdain for those whom he called "Masters of the Obvious", who proffered profound words of wisdom that were in fact common-sensical or well-accepted, as if they'd invented those words personally.I think it's fair to say that after countless publications dating back decades, pointing out the essential role of clinical leadership in the development of clinical tools such as healthcare information technology systems, that such involvement is now a standard of care that reasonable hospital leadership would mandate when spending tens of millions of dollars on potent...
Source: Health Care Renewal - June 16, 2014 Category: Health Management Tags: Athens Regional Medical Center cerner healthcare IT risk master of the obvious Mismanagement Patient care has not been compromised Source Type: blogs

Sham Peer Review Issue Goes Mainstream. WaPo: VA Physicians Fear Sham Peer Review
The paper's words this time, not mine:From the Washington Post, "VA docs concerned about retaliation", June 12, 2014, http://www.washingtonpost.com/blogs/federal-eye/wp/2014/06/12/va-docs-concerned-about-retaliation/:Retaliation from management is a real concern among Department of Veteran Affairs (VA)  employees ...  James Martin, a physician and a representative of the American Federation of Government Employees National VA Council, told the gathering  that sham peer reviews are a problem in the department. In a later interview, he elaborated, saying, “orchestration of facts” related ...
Source: Health Care Renewal - June 13, 2014 Category: Health Management Tags: bad health IT sham peer review Veterans Administration medical scandal Veterans Affairs Source Type: blogs

Canada: Province-wide electronic medical record computer system 'glitch' causing patients to be turned away from care
This story describes a very bad scenario for sick Canadians.  I offer just a few pithy comments, as not much more than that is needed:http://medicinehatnews.com/news/local-news/2014/06/10/system-failure-has-docs-patients-upset/System failure has docs, patients upsetBy Gillian Slade on June 10, 2014Many patients were turned away from their doctor’s office Monday because a province-wide electronic medical record computer system had collapsed.Province-wide.  Stunning.  A very big argument against centralization of EHR resources.“This is the third straight week of issues with the TELUS Wolf system,&r...
Source: Health Care Renewal - June 11, 2014 Category: Health Management Tags: Alberta Canada healthcare IT crash healthcare IT dangers healthcare IT difficulties TELUS Wolf Source Type: blogs

The Return of PharmaLot
After an unfortunate hiatus (see this post), PharmaLot is back.  PharmaLot was one of the premier sources of incisive information on the pharmaceutical industry, is back.  PharmaLot was and now is run by Ed Silverman, and is known for publishing important, but sometimes unpleasant truths.Ed Silverman provided unbiased, insightful reporting.  Notably for the Health Care Renewal audience, he was not afraid to report on the good, the bad, and the ugly. He was no friend of marketing and public relations smarm.  Often he was first to break stories involving legal settlements, guilty pleas, and miscellaneous ...
Source: Health Care Renewal - June 6, 2014 Category: Health Management Tags: blogs free speech pharmaceuticals Source Type: blogs

Another Sign The EHR Experiment is Producing Undesired (But Predictable) Results: ED EHRs Produce No Efficiency Gains
Adverse results that run counter to the industry meme of healthcare IT exceptionalism are coming fast and furious.  It's hard for me to keep up with it all.In addition to my post today "EHR Exceptionalism Debunked: Care Quality Variances Among VA Hospitals Suggest the True Value of Health IT Has Been Grossly Exaggerated" (http://hcrenewal.blogspot.com/2014/06/ehr-exceptionalism-debunked-care.html), here's another.I won't comment on this very much:http://www.jwatch.org/na34646/2014/05/30/electronic-charting-less-efficient-paper-chartingMay 30, 2014 Is Electronic Charting Less Efficient Than Paper Chartin...
Source: Health Care Renewal - June 5, 2014 Category: Health Management Tags: healthcare IT difficulties healthcare IT exceptionalism healthcare IT oversell Source Type: blogs

Grand Jury: Ventura County, Calif., Mishandled Electronic Health Records Transition
In Ventura County, California, "the function of the Grand Jury is to act as a civil oversight of county and city government, special districts, governing boards, personnel commissions, school districts, and humane officers. It is their responsibility to insure that government is serving the best interests of Ventura County's citizens" (http://www.ventura.org/grand-jury).Even under such a grand jury, the need for true Health IT experts (instead of amateurs) seems to have gone unnoticed.A 2013-2014 Ventura County Grand Jury conducted an investigation in response to information received regarding the implementation ...
Source: Health Care Renewal - June 5, 2014 Category: Health Management Tags: Healthcare IT failure ill-informed management Ventura County Source Type: blogs

EHR Exceptionalism Debunked: Care Quality Variances Among VA Hospitals, Perhaps The Most Wired Hospitals in the World, Suggest the True Value of Information Technology in Healthcare Has Been Grossly Exaggerated
The Wall Street Journal somehow managed to get access to internal VA patient care quality data and published the following article:http://online.wsj.com/articles/veterans-affairs-hospitals-vary-widely-in-patient-care-1401753437Veterans Affairs Hospitals Vary Widely in Patient CareInternal Records Show Facilities Such as Phoenix Have Far Higher Death Rates Than PeersThomas M. Burton and Damian PalettaJune 3, 2014 The Phoenix facility at the heart of the crisis at the Department of Veterans Affairs is among a number of VA hospitals that show significantly higher rates of mortality and dangerous infections than the agency's t...
Source: Health Care Renewal - June 5, 2014 Category: Health Management Tags: Donald Lindberg healthcare IT exceptionalism healthcare IT oversell Veterans Administration medical scandal Veterans Affairs Source Type: blogs

Fool Me Twice? - Boehringer Ingelheim, Medtronic Settle Lawsuits Alleging Deceptive Marketing
It seems like it has been really quiet on the legal settlement front in the US, but maybe corporate executives wanted to wait until things calmed down after the unofficial start of summer to let out news that some people might not think reflected well on them.  So this week it was time to announce two new legal settlements of allegations of bad behavior by corporate health were announced, as we will list in alphabetical order....Boehringer Ingelheim Settles Suits Alleging it Hid Data About Pradaxa HarmsAs per Bloomberg,Boehringer Ingelheim GmbH, the German family-owned drugmaker, agreed to pay $650 million to settle t...
Source: Health Care Renewal - June 3, 2014 Category: Health Management Tags: Boehringer Ingelheim deception kickbacks legal settlements manipulating clinical research marketing Medtronic Pradaxa Source Type: blogs

In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red
At my Nov. 9, 2013 post H3 { margin-bottom: 0.08in; }H3.cjk { font-family: "Droid Sans Fallback"; }H3.ctl { font-family: "Lohit Hindi"; }P { margin-bottom: 0.08in;"We’ve resolved 6,036 issues and have 3,517 open issues" (http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html) I wrote about "issues" (i.e., "glitches" including potentially injurious or deadly bugs and malfunctions) the organization was having with a new EHR at University of Arizona Health System.Now we know part of the cost of resolving those 9,553 "issues."http...
Source: Health Care Renewal - June 2, 2014 Category: Health Management Tags: EPIC glitch healthcare IT benefits healthcare IT cost healthcare IT risks University of Arizona Health Network words that work Source Type: blogs

Sovaldi - a "Revolution" in Clinical Care, or in Marketing and Public Relations?
DiscussionWashington Post/ Kaiser Health NewsOn May 12, 2014, in an article on the dilemma the drug's US price of $1000/ pill presents to Medicare, Richard Knox wrote this about a patient with the infection:Previous drug treatments didn't clear the virus from Bianco's system. But it's almost certain that potent new drugs for hep-C could cure him. In other words, the article asserted that Sovaldi and similar drugs cure nearly everyone with hepatitis C, even those not cured by previous treatment.  ReutersOn May 20, 2014, in an article about how US health insurers are balking at the price of Sovaldi, was this statement b...
Source: Health Care Renewal - May 28, 2014 Category: Health Management Tags: evidence-based medicine Gilead health care prices manipulating clinical research Sovaldi You heard it here first Source Type: blogs

"Texas VA Run Like a ‘Crime Syndicate,’ Whistleblower Says" - Can Reports About the Benefits of EHRs at the VA Healthcare System Be Trusted?
This article just appeared:Texas VA Run Like a ‘Crime Syndicate,’ Whistleblower SaysMay 27, 2014http://www.thedailybeast.com/articles/2014/05/27/exclusive-texas-va-run-like-a-crime-syndicate-whistleblower-says.htmlFor years, employees at a Texas VA complained that their bosses were cooking the books. For years, the VA insisted there was no widespread wrongdoing. New whistleblower testimony and internal documents implicate an award-winning VA hospital in Texas in widespread wrongdoing—and what appears to be systemic fraud.Emails and VA memos obtained exclusively by The Daily Beast provide what is among the...
Source: Health Care Renewal - May 28, 2014 Category: Health Management Tags: CPRS health care corruption healthcare IT unintended consequences Veterans Administration medical scandal Veterans Affairs VistA Source Type: blogs

Athens Regional Medical Center: Hospital management is "addressing computer problems" AFTER patients are put at bodily risk, not before, only in response to irate clinicians; then claiming everything will be fixed soon while doctors resign.
Maybe hospital management gurus could address these computer problems BEFORE turning them loose on patients?Physicians in Georgia seem to have more guts than their colleagues elsewhere.  Rather than letting patients be guinea pigs for the naive fantasies of hospital executives about health IT, these physicians said "get these [expletive] computer systems out of our hospital"...Then they started resigning their appointments: Athens Regional addressing new computer system problems encountered by doctorsBy Donnie Z. FetterFriday, May 23, 2014http://onlineathens.com/health/2014-05-22/athens-regional-addressing-n...
Source: Health Care Renewal - May 26, 2014 Category: Health Management Tags: Athens Regional Medical Center Gretchen Tegerhoff Healthcare IT failure healthcare IT risks healthcare IT safety ill-informed management James G. Thaw patient safety Source Type: blogs

Big Door Keep Revolving - Our Latest Roundup About the Blurred Lines Between the Health Care Industry and the Government Bodies that are Supposed to Regulate and Make Policy Affecting It
The revolving door continues to turn connecting US government bodies that make health policy or regulate health care and the health care industry.  Sometimes these transitions are obvious, sometimes they are obscure.  The press sometimes makes the revolving door the subject, but more often it is just an aside.The latest roundup of transitions through the door includes, in chronological order of media attention...Former White House Press Secretary to Consultancy Serving Health Care Corporations As reported by the Washington Post in April, 2014, Robert Gibbs was White House Press Secretary until he departed for the...
Source: Health Care Renewal - May 22, 2014 Category: Health Management Tags: FDA health care reform revolving doors US Congress White House Source Type: blogs

A very short observation on EHRs and the Veterans Administration healthcare scandal
As has been in the news lately, it has been revealed that U.S. veterans' medical care was being delayed at a number of Veteran's Administration-run hospitals, perhaps many others as well not yet known.A timeline for the Veterans Administration medical scandal is here:  http://www.usatoday.com/story/news/politics/2014/05/21/veterans-healthcare-scandal-shinseki-timeline/9373227/The Obama administration is facing a serious scandal in which government officials are alleged to have falsified data to hide how long veterans were waiting to see doctors at VA hospitals. The controversy has led to calls for the resignation of V...
Source: Health Care Renewal - May 22, 2014 Category: Health Management Tags: CPRS Veterans Administration medical scandal Veterans Affairs VistA Source Type: blogs

More Stories of Million Dollar Plus Hospital Executives, but Now the NY Times Challenges the Talking Points
It is spring, time for birds to sing, flowers to bloom, and hospital executives to get more money.  As we do periodically, we have amassed a series of media accounts of the big to enormous compensation paid to top non-profit hospital leaders.  These reports follow a certain pattern, but this year's spring crop included something different.The PatternIn the groundbreaking science fiction series "Fringe," "The Pattern" was a series of apparently inexplicable events which eventually pointed to the existence of a parallel universe. In non-profit hospitals, The Pattern of the discussion of executiv...
Source: Health Care Renewal - May 20, 2014 Category: Health Management Tags: executive compensation hospital systems hospitals perverse incentives UPMC Wake Forest Baptist Medical Center Source Type: blogs

Is this Any Way to Discuss Health Care Policy? - Television Advertising about US Health Care Reform Cost $445 Million from 2010 -2014
Every now and then, we get an anonymous comment criticizing our "lack of balance" or words to that effect, maybe because we criticized some action by a big, often but not always for-profit, health care organization.  We usually respond that we have no obligation to be balanced, since- We publish opinion, not hard news-  It is questionable that even hard news reporters must report all opinions on an issue, if some of those opinions are demonstrably less credible-  There are far more voices extolling the wonderful "innovations" provided by our current "best health care system in the wo...
Source: Health Care Renewal - May 16, 2014 Category: Health Management Tags: anechoic effect health care reform health policy marketing public relations Source Type: blogs

The Continuing Mystery of the Fugitive Founder and Missing Money - What it Says About the Opacity of Offshore Medical Schools
The next chapter in the bizarre tale of the fugitive founder of an off-shore (from the US and Canada) Caribbean medical school, and his now convicted spouse, do not solve any mysteries, but raise larger concerns about the accountability, or lack thereof, of leaders of important health care organizations.Introduction: the Fugitive Founder and Convicted SpouseAs we posted in October, 2013, drawing an amazing for us number of comments, the couple who founded two Caribbean medical schools which catered almost entirely to US and Canadian students ran into significant legal trouble.  Founder David Leon Fredrick and his wife...
Source: Health Care Renewal - May 13, 2014 Category: Health Management Tags: accountability crime Equinox Capital fraud governance leadership offshore medical schools private equity Saba University Source Type: blogs

A Nurse's Union, National Nurses United, Takes On Bad Health IT
National Nurses United (http://www.nationalnursesunited.org/), a nurse's union, takes on bad health IT with both satire and seriousness:Hey dude!  I'm your highly-cost effective computer technician Steve.  Tell me what's hurtin' and I'll program it into Frank, our computerized doctor and nurse replacement. (YouTube video at https://www.youtube.com/watch?feature=player_embedded&v=YthF86QDOXY.)See their page at http://www.nationalnursesunited.org/site/entry/insist-on-an-rnI note that nature abhors a vacuum, and since medicine's watchdogs (e.g., FDA), physicians and their organizations, the Medical Informatics c...
Source: Health Care Renewal - May 12, 2014 Category: Health Management Tags: bad health IT healthcare IT risks National Nurses United Source Type: blogs

Cerner: "It’s in the DNA of our company to have the vision and passion to fix what’s broken in health care." Maybe they should fix their software first?
I point out this hyper-exuberant piece on health IT in the St. Louis Post-Dispatch.Clearly someone at Cerner thinks they're going to cure the world with "population health" and their computer software:With its Healthy Nevada initiative, Cerner Corp. cultivates a culture of healthSt. Louis Post-DispatchDiane Stafford,  Kansas City StarMay 11, 2014http://www.stltoday.com/news/special-reports/mohealth/updates/with-its-healthy-nevada-initiative-cerner-corp-cultivates-a-culture/article_8cc3168f-fd9f-5e7e-ba80-cc05dd6a35f9.htmlCerner Corp. employees started visiting Nevada, Mo., in 2011, looking to adopt a communi...
Source: Health Care Renewal - May 12, 2014 Category: Health Management Tags: cerner Cerner FirstNet cerner millenium healthcare IT defects Source Type: blogs

EHR Story for Mother's Day 2014: Even The Formerly Simple Act Of Giving IV Fluids in ICU's Can Kill Babies. But's Let's Be Objective and Happy!
[Note to the humorless:  this post is satirical and sardonic to make a very serious point about the perversity of downplaying/ignoring health IT risks, issues too often ignored by those who know better.  If you don't like satire, don't read it.] I've been critiqued for posting in too gloomy a manner for some's taste, even those who like me are in the Medical Informatics field.  For example, in the Feb. 2013 Kaiser Health News article "Health Technology’s ‘Essential Critic’ Warns Of Medical Mistakes" at http://www.kaiserhealthnews.org/stories/2013/february/18/scot-silverstein-healt...
Source: Health Care Renewal - May 9, 2014 Category: Health Management Tags: #EHR #EMR #HCIT #HITsm bad health IT blame the user cerner cerner powerchart FDA healthcare IT risks medication error satire use error Source Type: blogs

Some Authoritative Skepticism about the "Triumph" of Sovaldi to Add to Outrage about "Blood Money"
This report just appeared online in JAMA Internal Medicine [Ollendorf DA, Tice JA et al.  The comparative clinical effectiveness and value of simeprevir and sofosbuvir in chronic hepatitis C viral infection.  JAMA Inte Med 2014.  Link here.] The review found again that there were major limitations in the available data, and so much of it was based on a network meta-analysis and simulation studies,The review was limited to patients with genotype 1, 2, and 3 infections, which account for most HCV cases in the United States. At the time of the review, no head-to-head trials of the direct-acting antiviral d...
Source: Health Care Renewal - May 7, 2014 Category: Health Management Tags: evidence-based medicine Gilead health care prices manipulating clinical research pharmaceuticals Sovaldi Source Type: blogs

Abort, Retry, Fail? - Lancet Avoided Much Recent Unpleasantness in Reporting on New Gates Foundation CEO (Including Her Defense of $55,000 a Year for Bevacizumab)
The April 26, 2014 issue of the prestigious journal Lancet used two full pages and two separate articles by the same author to discuss the ascension of the Gates Foundation new CEO, Dr Susan Desmond-Hellmann.(1-2)Two Somewhat Redundant Lancet Articles Dr Desmond-Hellmann trained as an oncologist, spent time working on AIDS and Kaposi's Sarcoma in Uganda, but then spent much of her career as a pharmaceutical/ biotechnology executive, as described in the first article,(1)After returning from Uganda, Desmond-Hellmann joined the nascent Taxol development programme at Bristol-Myers Squibb, before being poached by Arthur Levinso...
Source: Health Care Renewal - May 5, 2014 Category: Health Management Tags: anechoic effect boards of directors conflicts of interest Gates Foundation Genentech health care foundations health care prices Lancet medical journals Procter and Gamble UCSF Source Type: blogs

The Pervasiveness of Health Care Corruption as Shown by Another Roundup of Legal Settlements
Legal settlements are one way to document unethical and even corrupt behavior by large health care organizations, even if they may not deter bad behavior in the future.  It is time for another roundup of settlements by large pharmaceutical and device companies, presented in alphabetical orderAbbott LaboratoriesThis one goes back to late December, 2013.  As described in the Chattanoogan (from Tennessee):Abbott Laboratories, a global healthcare company, has agreed to pay $5.475 million to settle alleged violations of the False Claims Act, and other federal laws and regulations in connection with the operation of it...
Source: Health Care Renewal - April 30, 2014 Category: Health Management Tags: Abbott antitrust Baxter Endo Health Solutions fraud Hospira kickbacks legal settlements Neurontin Pfizer restraint of competition RICO Source Type: blogs

From a physician and former USAF air traffic controller/pilot on the state of healthcare IT
From a colleague, a physician and blogger and fellow AMIA member with an eclectic background, on the state of healthcare information technology.  Reposted with his permission.Emphases in bold are mine:To restate the old joke, the nice things about medical informatics standards, are their are so many of them too chose from… don’t think we necessarily need to invest even more time and energy on ever more sophisticated data models or ever more exhaustive standards (which are then largely ignored).  The fact of the matter is that the EMR remains in the United States a tool for maximization of reimburseme...
Source: Health Care Renewal - April 27, 2014 Category: Health Management Tags: AMIA F16 Frank Meissner healthcare IT difficulties human computer interaction Source Type: blogs

In ECRI Institute's new 2014 "Top 10 Patient Safety Concerns for Healthcare Organizations", Healthcare IT is #1. (FDA: E-cigarettes are REALLY dangerous.)
The ECRI Institute in Pennsylvania (https://www.ecri.org/About/Pages/default.aspx) has had health IT as among the "Top Ten Healthcare Technology Risks" for several years running.  Search this blog on "ECRI" for mention of those reports.Just off the press, though, is ECRI's "Top Ten patient safety concerns for 2014".  The PDF report is available at https://www.ecri.org/EmailResources/PSRQ/Top10/Top10PSRQ.pdf.Health IT is number one, perhaps as a result of the ECRI Deep Dive study of Health IT risk with its hair-raising numbers of 171 "IT incidents", 8 resultant injuries, and...
Source: Health Care Renewal - April 27, 2014 Category: Health Management Tags: #ecigarettes #ecigs #EHR #EMR #HITsm E-cigarettes ecri institute Top Ten patient safety concerns for 2014 Source Type: blogs

Followup to "CMS does not have any information that supports or refutes claims that a broader adoption of EHRs can save lives"
At my April 16, 2014 post "CMS does not have any information that supports or refutes claims that a broader adoption of EHRs can save lives" (http://hcrenewal.blogspot.com/2014/04/cms-does-not-have-any-information-that.html) I noted that the American Association of Physicians and Surgeons (AAPS) had received a reply from CMS to a FOIA request that:"We [CMS] do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives." Put another way, the country is embarking on a $1 trillion healthcare experiment, and blindly.I mentioned I'd post the letter when received f...
Source: Health Care Renewal - April 26, 2014 Category: Health Management Tags: arra Centers for Medicare and Medicaid Services CMS foia Freedom of Information Act healthcare IT benefits healthcare IT risk #EHR #EMR #HCIT #HITsm Source Type: blogs

Hypocrisy at the FDA: Let's regulate E-cigarettes ... E-medical records, E-medical ordering and related Bad Health IT? They get a gentleman's pass.
Bad health IT is defined at my Medical Informatics academic site (http://cci.drexel.edu/faculty/ssilverstein/cases/) as follows:Bad Health IT ("BHIT") is health IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, is difficult and/or prohibitively expensive to customize to the needs of different medical specialists and subspecialists, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient p...
Source: Health Care Renewal - April 26, 2014 Category: Health Management Tags: #ecigarettes #ecigs bad health IT E-cigarettes FDA healthcare IT regulation Source Type: blogs

EHR recall: Use of this affected product may cause serious adverse health consequences, including death
Here is another example of a grossly defective health IT product, this from last year but only posted by FDA publicly on 3/14/2014 at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm389356.htm: "There was an occurrence where the patient case data did not match the patient data when the case was recalled in the Anesthesia Care Record (ACR) in that it included data from another case. Use of this affected product may cause serious adverse health consequences, including death."One wonders why problems like this are found in the field when real patients are involved, not in ...
Source: Health Care Renewal - March 24, 2014 Category: Health Medicine and Bioethics Commentators Tags: FDA recall healthcare IT defects healthcare IT risk McKesson McKesson Anesthesia Care Source Type: blogs

Better Late than Never - JAMA Article Advocates Banning Academic Medical Leaders from Serving on Many Health Care Corporate Boards
Conclusion So it is very nice to see that the issue of what we once called a new species of conflict of interest finally has made the big time.  Whether it now gets any traction remains to be seen.  Unfortunately, since conflicts of interest can be so profitable for the directly affected parties, I fully expect they will continue to oppose any restrictions.  The money they have made will likely be used to deploy marketing and public relations personnel and legal counsel to counter any attempts to try to make this aspect of health care more honest.As we have said again and again, the web of conflicts of inter...
Source: Health Care Renewal - March 20, 2014 Category: Health Medicine and Bioethics Commentators Tags: academic medical centers boards of directors boards of trustees conflicts of interest leadership medical schools You heard it here first Source Type: blogs