On Hypervigilance Due to Bad Health IT: "Texting While Doctoring: A Patient Safety Hazard"
An Opinion piece "Texting While Doctoring: A Patient Safety Hazard" appeared in the Annals of Internal Medicine of 3 December 2013, authored by Christine A. Sinsky, MD and John W. Beasley, MD.  Dr. Sinsky is known to me to be what some would call a "heatlhcare IT iconoclast" (more accurately represented by the term "healthcare IT gadfly/realist" IMO).In the piece the authors comment on the distractions caused by the technology, leading to doctors missing important cues in the exam room and to and impaired problem-solving.  This is part of a larger phenomenon that has been called...
Source: Health Care Renewal - December 8, 2013 Category: Health Medicine and Bioethics Commentators Tags: Annals of Internal Medicine bad health IT Christine A. Sinsky deskilling healthcare IT distraction healthcare IT risks hypervigilance John W. Beasley Jon Patrick Source Type: blogs

How Many Straws? - Johnson and Johnson Settles Again, Again, Again...
ConclusionSo I get to say again, again again...  many of largest and once proud health care organizations now have recent records of repeated, egregious ethical lapses. Not only have their leaders have nearly all avoided penalties, but they have become extremely rich while their companies have so misbehaved. These leaders seem to have become like nobility, able to extract money from lesser folk, while remaining entirely unaccountable for bad results of their reigns. We can see from this case that health care organizations' leadership's nobility overlaps with the supposed "royalty" of the leaders of big finan...
Source: Health Care Renewal - December 6, 2013 Category: Health Medicine and Bioethics Commentators Tags: adverse effects diagnostic tests Ethicon Johnson and Johnson legal settlements Source Type: blogs

EHR Pastel Madness: Cognitive Overload in Critical Care
It's hard to find public postings that show the crazy and dangerous complexity of EHR interfaces, but I found a presentation at http://www.uiowa.edu/~medtest2/picis/vo_picis.pdf (PDF slide presentation) that demonstrates ths problem well.These are from a 2006 training presentation on an EHR for Critical Care , where doctors and nurses really don't have the time to wade through complexity like this.   I can honestly and in fact, with great vigor, opine I would not have wanted to use a tool like this when I was working in intensive care units.  And I'm a Medical Informatics specialist x 21 years...EHRs have no...
Source: Health Care Renewal - December 6, 2013 Category: Health Medicine and Bioethics Commentators Tags: cognitive overload healthcare IT risks human computer interaction PICIS Critical Care Manager Source Type: blogs

How Manipulated Clinical Evidence Could Distort Guidelines - the Case of Statins for Primary Prevention
This study excluded many patient for whom the statins were not contraindicated or warned against: uncontrolled hypertension; type 1 or type 2 diabetes mellitus on insulin or with a HgBA1C at least 10%; and body weight more than 50% "desirable limit for height."  (Based on the official contraindications and warnings for commonly used statins, e.g., see contraindications for Lipitor here, active liver disease, pregnancy for likely to become pregnant, nursing mothers, hypersensitivity to the medicine; and warnings: use of cyclosprine or strong CYP3A4 inhibitors, uncontrolled hypothyroidism, renal impairment.)&n...
Source: Health Care Renewal - December 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: American College of Cardiology American Heart Association clinical trials conflicts of interest evidence-based medicine guidelines manipulating clinical research review articles Source Type: blogs

There They Go Again, Again... - Johnson and Johnson Loses Two Civil Cases, Makes $2.5 Billion Settlement Based on Claims it Withheld Safety Data on its Products
There has been some talk by US government officials that any day now they will actually get tough on corporate executives whose organizations are involved in multiply unethical actions (perhaps using the legally valid, but massively neglected responsible corporate officer doctrine, look here).  However, the march of legal settlements by such corporations continue without any hints of negative consequences for the people who might have actually been involved in unethical activity.  So, we note another week, another multi-billion dollar settlement and another loss of a civil lawsuit by huge drug, device and biotech...
Source: Health Care Renewal - November 29, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception DePuy hip prostheses Janssen Johnson and Johnson legal settlements medical devices suppression of medical research Synthes Topamax Source Type: blogs

Confused Thinking about New Cholesterol Guidelines - Were Conflicts of Interest to Blame?
For years, clinical practice guidelines promulgated by prominent health care organizations have been hailed with accolades as received wisdom.  However, there is increasing reason to be skeptical of such guidelines.  Many guidelines are not based on rigorous application of the principles of evidence-based medicine, and often seem to arise from the personal opinions of their authors.  This is particularly troublesome when those authors  have conflicts of interest, and when the organizations that sponsor guideline development have institutional conflicts of interest.  Back in 2011, an Institute of Me...
Source: Health Care Renewal - November 22, 2013 Category: Health Medicine and Bioethics Commentators Tags: American College of Cardiology American Heart Association conflicts of interest evidence-based medicine guidelines logical fallacies Source Type: blogs

When is disclosure not disclosure?
WHEN IS DISCLOSURE NOT DISCLOSURE? Hint: When it is made by the Chairman of the DSM-5 Task Force.Here is a case study in conflict of interest (COI). A remarkable confession has just appeared by a group of 5 prominent academics, writing in the journal JAMA Psychiatry. Having been outed to the Editors, they now admit to concealing pertinent financial information. One of the five is David J. Kupfer, MD, chairman of the DSM-5 Task Force and past chairman of the department of psychiatry at The University of Pittsburgh. The others are from Pittsburgh, Minnesota, and Chicago.With millions in funding from NIMH, these folks have be...
Source: Health Care Renewal - November 21, 2013 Category: Health Medicine and Bioethics Commentators Tags: Bernard Carroll conflicts of interest David Kupfer deception DSM-5 JAMA JAMA Psychiatry NIMH Robert Gibbons Thomas Insel Source Type: blogs

Another 'Survey' on EHRs - Affinity Medical Center (Ohio) Nurses Warn That Serious Patient Complications "Only a Matter of Time" in Open Letter
I've written previously about substantial problems nurses at medical centers including Affinity Medical Center, Ohio (http://www.affinitymedicalcenter.com/) and others are having with EHRs, and how hospital executives were ignoring their complaints.  The complaints have been made openly, I believe, in large part due to the protection afforded by nurses' unions.See for example my July 2013 post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals" at http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html, and my June 201...
Source: Health Care Renewal - November 17, 2013 Category: Health Medicine and Bioethics Commentators Tags: Affinity Medical Center cerner healthcare IT dangers healthcare IT risks labor unions Michelle Mahon RN National Nurses United Source Type: blogs

No Dogs to Bark - Failure to Connect the Events Foreshadowing the Fall of the Upstate President
In Silver Blaze, Sherlock Holmes noted the important clue of the watchdog that did not bark.  In health care, nowadays watchdogs are absent, so who is expected to bark?  So, when cases of failed leadership of health care organizations appear, in retrospect they often appear to have been foreshadowed by various events which caused no reaction..  Last week we posted about the president of the State University of New York (SUNY) - Upstate Medical University who resigned his job after revelations that he was receiving hundreds of thousands of dollars in income from outside organizations which he had not properly...
Source: Health Care Renewal - November 14, 2013 Category: Health Medicine and Bioethics Commentators Tags: intimidation SUNY SUNY - Upstate Medical University whistle-blowers Source Type: blogs

"We’ve resolved 6,036 issues and have 3,517 open issues": Extolling EPIC EHR Virtues at University of Arizona Health System
The public may believe that, in healthcare, only the Obamacare insurance exchange website has lots of bugs.  On those, see my Oct. 10. 2013 post "Drudge Report, Oct. 10, 2013, 9 AM EST: All that needs to be said about government, computing and healthcare" at http://hcrenewal.blogspot.com/2013/10/drudge-report-oct-10-2013-9-am-est-all.html.Another pillar of the Affordable Care Act, electronic medical records (promoted with incentives for adopters and with penalties for non-adopters via the HITECH section of the 2009 economic recovery act or ARRA) are pretty damn bad themselves.  Only, those systems don't...
Source: Health Care Renewal - November 9, 2013 Category: Health Medicine and Bioethics Commentators Tags: cerner ECRI Deep Dive Study ecri institute EPIC glitch healthcare IT dangers healthcare IT defects University of Arizona Health Network University of Arizona Medical Center Source Type: blogs

"Engaging Excellence" while Engaging Secret Paychecks - The Rise and Fall of the Upstate Medical University President
Yet another leader of a big health care organization seems to have acquired the excessively entitled CEO syndrome.Another Brilliant, Fearless Leader When Dr David R Smith was appointed President of Upstate Medical University, a part of the State University of New York (SUNY) system located in Syracuse, he got the usual rave reviews from the school's board of trustees, according to a university press release: 'David Smith rose to national prominence through his leadership ability, experience in children’s medicine, public health policy, and as the chancellor of the Texas Tech University system. We are very pleased to ...
Source: Health Care Renewal - November 8, 2013 Category: Health Medicine and Bioethics Commentators Tags: conflicts of interest executive compensation public relations SUNY Upstate Medical University Source Type: blogs

A New, and Huge ($2.2 Billion) Settlement for Johnson and Johnson, but "No Individuals were Charged with Wrongdoing"
The march of legal settlements made by big health care organizations has resumed with a bang.  As reported in most major media outlets, giant drug/ device/ biotechnology company Johnson and Johnson has made a big settlement with the US Department of Justice.The Basics of the SettlementAs reported by Bloomberg / Businessweek, Johnson & Johnson agreed to resolve criminal and civil probes into the marketing of Risperdal, an antipsychotic drug, and other medicines by paying more than $2.2 billion, one of the largest U.S. health-fraud penalties. J&J’s Janssen unit will plead guilty to a misdemeanor crimi...
Source: Health Care Renewal - November 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception kickbacks Johnson and Johnson impunity crime marketing legal settlements Source Type: blogs

What Me Worry? - American Legacy Foundation Executives' Relaxed Response to a $3 Million Plus Fraud
A Washington Post investigation into diversion of money from US not-for-profit organizations provided a striking case study showing the apparently relaxed approach taken by managers to apparent wrongdoing by one of their own.  Background: the American Legacy FoundationThe Post noted thatThe American Legacy Foundation is a revealing case study. While some challenges it faced were uncommon, fraud examiners said many resemble those they see time and again. Legacy was founded as a nonprofit organization in 1999 out of the Master Settlement Agreement that resolved health claims brought against cigarette companies on be...
Source: Health Care Renewal - November 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: American Legacy Foundation non-profit organizations managers' coup d'etat fraud Source Type: blogs

Australian Medical Association on EHR rollout: 'Hard to use, increases workload, hard to find data, we just don't seem to have got the outcome we were looking for.'
Some familiar themes from the Australian Medical Association on their attempt at a National Programme for Health IT:Electronic health records rollout has not met expectations, Australian Medical Association sayshttp://www.abc.net.au/news/2013-11-04/ama-says-rollout-of-electronic-health-records-needs-work/5066680 Updated Mon 4 Nov 2013, 8:59am AEDT The Australian Medical Association says the rollout of electronic health records has not met expectations.Federal Health Minister Peter Dutton has announced an independent review of the project to see how it can be improved.AMA national president Dr Steve Hambleton, one of the...
Source: Health Care Renewal - November 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT usability healthcare IT difficulties Australian Medical Association Peter Dutton Dr Steve Hambleton Source Type: blogs

More "anecdotes" of health IT-related errors - System errors with Victoria's trouble-plagued HIT program caused more than 100 medication mix-ups at two Melbourne hospitals
There are those in the field of health IT who see every health IT-related mishap as an "anecdote" - the "anecdotalists" - and every "positive" study, no matter how weak, as "solid evidence" of the technology's beneficence and efficacy. See "Anecdotes and Medicine, We are Actually Talking About Two Different Things" at http://hcrenewal.blogspot.com/2011/08/from-senior-clinician-down-under.html for more on the risk management/scientific method confusion it represents, from a clinician Down Under.More "anecdotes" from Down Under to make the anecdotalists' heads explo...
Source: Health Care Renewal - October 31, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT dangers healthcare IT risk Auditor-General John Doyle medication error Victoria Australia Source Type: blogs

Presto Chango - UPMC Tries to Make its Employees All Disappear
ConclusionI hope that the outlandish claims now being sanctioned by UPMC leadership may raise awareness of what is going wrong with the leadership of health care organizations in general.  As we have been saying for years, health care leadership that puts its self-interest ahead of patients and the public, and which disregards the truth in service of self-interest may be the biggest cause for ever increasing health care costs, and ever declining access and regard for the health of patients and the public.  True health care reform would encourage leadership that puts the mission ahead of self-interest, and values ...
Source: Health Care Renewal - October 29, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception non-profit organizations UPMC Source Type: blogs

Proof positive of government incompetence and recklessness in information technology - H.R.3303 - Bipartisan call for exemption of health IT from the FD&C Act
Here's proof positive of government incompetence and recklessness in information technology.A new proposed bill that would exempt health IT from the Food, Drug & Cosmetic Act and FDA regulation.Rep. Marsha Blackburn (R-TN) calls for exemption of healthcare software from FDA regulation with bipartisan co-sponsorship from Reps. Gene Green (D-TX), Phil Gingrey, M.D. (R-GA), Diana DeGette (D-CO), Greg Walden (R-OR) and G.K. Butterfield (D-NC). H.R.3303 - SOFTWARE Act of 2013 - referred to House Energy & Commerce on 10/22/2013http://beta.congress.gov/bill/113th/house-bill/3303/textThis remarkable and unprecedented regul...
Source: Health Care Renewal - October 29, 2013 Category: Health Medicine and Bioethics Commentators Tags: H.R.3303 healthcare IT regulation healthcare IT risk Rep. Diana DeGette REP. G.K. Butterfield Rep. Gene Green Rep. Greg Walden Rep. Marsha Blackburn Rep. Phil Gingrey SOFTWARE Act of 2013 Source Type: blogs

Over At The Health Care Blog, Aneesh Chopra Distorts IT Failure Reality
This article outlines the problems of enthusiasm and the problems of control, as well as the overwhelming complexity, that make the failure of large developments almost inevitable. Rather than the positive view found in much of the public administration literature, the author suggests a pessimism when it comes to information systems development. Aims for information technology should be modest ones, and in many cases, the risks, uncertainties, and probability of failure mean that new investments in technology are not justified. The author argues for a public official as a recalcitrant, suspicious, and skeptical adopter of ...
Source: Health Care Renewal - October 28, 2013 Category: Health Medicine and Bioethics Commentators Tags: IT failure Healthcare IT failure denialist Obamacare Health Care Blog Aneesh Chopra Source Type: blogs

There They Go Again - Omnicare to Settle for $120 Million
The march of legal settlements seems to be on its way again. The Latest Settlement The details, per Reuters,Omnicare, Inc, a leading U.S. provider of pharmacy services to the elderly, has agreed to pay the U.S. government $120 million to settle allegations the company gave nursing homes steep discounts on prescription drugs in exchange for patient referrals. Cincinnati-based Omnicare announced the settlement on Wednesday in a filing with the U.S. Securities and Exchange Commission, but denied any wrongdoing. The lawsuit, filed in 2010 by former Omnicare employee Donald Gale, had been scheduled to go to trial on October 28....
Source: Health Care Renewal - October 27, 2013 Category: Health Medicine and Bioethics Commentators Tags: Omnicare kickbacks legal settlements Source Type: blogs

Justice Delayed - Two Device Companies Still Settling Cases from 10 Plus Years Ago
Here we go again.  After a hiatus during which the US media and perhaps parts of the government were preoccupied with such issues as the ongoing controversy over health care reform, and a government shutdown apparently arising out of this controversy, the march of legal settlements involving big health care organizations has resumed. In alphabetical order,...Boston ScientificFrom the Minneapolis Star-Tribune on 17 October, 2013, an account of a settlement arising from alleged misbehavior that started in 2002,A $30 million settlement between the U.S. Department of Justice and Boston Scientific will likely end a case in...
Source: Health Care Renewal - October 25, 2013 Category: Health Medicine and Bioethics Commentators Tags: BMP-2 Boston Scientific Guidant ICD impunity legal settlements medical devices Stryker Source Type: blogs

Former FDA Commissioner, CMS Administrator McClellan adds Johnson and Johnson Board Membership to Positions with General Atlantic LLC, Capital Royalty, Castlight Health, and AvivReit
Our latest example of the interchangeability of top insiders within corporate health care and the government agencies that are supposed to regulate corporate health care comes via an announcement from Johnson and Johnson,Johnson & Johnson (NYSE: JNJ) announced today that Mark B. McClellan, M.D., Ph.D., Senior Fellow in Economic Studies, and Director of the Initiative on Value and Innovation in Health Care, Brookings Institution, will join the Board of Directors on October 15, 2013.  Dr. McClellan will serve on the Regulatory, Compliance & Government Affairs Committee and the Science, Technology & Sustainab...
Source: Health Care Renewal - October 18, 2013 Category: Health Medicine and Bioethics Commentators Tags: CMS corporatism DHHS FDA Johnson and Johnson revolving doors Source Type: blogs

A new and very interesting EMR "glitch" - no warnings on stopping a medicine that diminishes the effects of a second medication
A new and very interesting EMR "glitch" from a report I received recently:... I found a glitch with my [name redacted] EMR. It probably happens with all EMRs. I had a patient on primidone (http://en.wikipedia.org/wiki/Primidone) for essential tremor. Later, his primary care put her on warfarin [a "blood thinner" - ed.] for atrial fibrillation. Some time after that, I took her off of primidone.  Her INR jumped to 7 or 8. [High - ed.] What happens is that the EMRs warn a physician pretty well if you START a medicine that interacts with warfarin, but fails to warn if you STOP a medicine that interacts...
Source: Health Care Renewal - October 16, 2013 Category: Health Medicine and Bioethics Commentators Tags: glitch primidone healthcare IT difficulties warfarin coumadin drug interaction EHR alerts Source Type: blogs

The Mystery of the Fugitive Founder (and Longterm President of an Offshore Medical School for US Students)
We recently wrote about for-profit medical schools located offshore from the US, but catering to American students, not students from the countries in which they operate.  Now some new media reports raise further questions, if not mysteries about another set of such schools.   Two Bloomberg articles on a trial underway focused on the alleged use of offshore accounts to avoid US taxes.  These accounts were connected to the former long-term President and founder of two offshore medical schools, and his spouse, a dean at one of the schools.   The first Bloomberg article opened thus:Patricia Hough, acc...
Source: Health Care Renewal - October 16, 2013 Category: Health Medicine and Bioethics Commentators Tags: offshore medical schools Saba University international medical graduates Source Type: blogs

Louise Schaper, PhD, CEO, Health Informatics Society of Australia: "What's Missing From the Health IT Investment? - Health Informatics"
Louise Schaper, PhD, CEO of the Health Informatics Society of Australia (HISA, http://www.hisa.org.au/), graciously extended an invitation in 2011 that I could not attend, and again in 2012 (that I accepted) to give a keynote presentation at HISA's annual convention, Healthcare Informatics Conference (HIC).  A writeup of my HIC2012 presentation in Sydney is at http://hcrenewal.blogspot.com/2012/08/my-presentation-to-health-informatics.html.I unfortunately could not make it Down Under for HIC2013 in Adelaide.  However, HISA has posted videos of a number of presenters.One of the presenters is Dr. Schaper.  Her...
Source: Health Care Renewal - October 10, 2013 Category: Health Medicine and Bioethics Commentators Tags: Health Informatics Society of Australia healthcare IT difficulties HISA Louise Schaper PhD Source Type: blogs

Drudge Report, Oct. 10, 2013, 9 AM EST: All that needs to be said about government, computing and healthcare
Per Drudge Report. Oct. 10, 2013, 9 AM EST:From the same people who brought us HITECH, the stimulus bill for rapid rollout of commercial electronic medical records, order entry, results reporting and other components of enterprise clinical "command and control" software for hospitals through which every transaction of care must pass.More IT malpractice.  The Drudge links, as they appear on the page: Obamacare website cost more than FACEBOOK, TWITTER, LINKEDIN, INSTAGRAM...'How can we tax people for not buying a product from a website that doesn't work?' Major insurers, Dem allies repeatedly warned Obama admi...
Source: Health Care Renewal - October 10, 2013 Category: Health Medicine and Bioethics Commentators Tags: Healthcare IT failure HITECH IT malpractice denialist healthcare IT anecdote Obamacare anecdotalist Drudge Report Source Type: blogs

Quality and Safety Implications of Emergency Department Information Systems: ED EHR Systems Pose Serious Concerns, Report Says
A report "Quality and Safety Implications of Emergency Department Information Systems"appeared in the Oct. 2013 issue of "Annals of Emergency Medicine."  It is available fulltext at http://www.annemergmed.com/article/S0196-0644%2813%2900506-4/fulltext, or in PDF via the tab, free as of this writing.First, a preamble:  I once tried to alert a hospital where I'd trained decades before, Abington Memorial Hospital (http://www.amh.org/), of impediments to safe care I'd noted in their EHR's, predominantly their ED EHR.  They did not listen.  In fact, their response to my concerns was chara...
Source: Health Care Renewal - October 8, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT risk Abington Memorial Hospital postmarketing surveillance EDIS healthcare IT regulation healthcare IT safety Chris Jay Hoofnagle emergency department Source Type: blogs

Marketing Bad Health Care Decisions as a New Form of Stealth Health Policy Advocacy
A remarkable set of video advertisements appeared a few weeks ago that seem designed to frighten people into making bad health care decisions.The "Bad Uncle Sam" Advertisements As described by Businessweek,In the first ad, dubbed 'The Exam,' a young woman who has signed up for Obamacare arrives at a medical facility and changes out of her clothes and into a flimsy hospital gown. Following the instructions of a doctor, she reclines on a hospital bed and spreads her legs into a pair of stirrups. The doctor leaves the room. Then, suddenly a mascot wearing a plastic Uncle Sam mask and sporting an unwavering grin&mdas...
Source: Health Care Renewal - October 7, 2013 Category: Health Medicine and Bioethics Commentators Tags: health care reform stealth health policy advocacy health insurance disinformation Source Type: blogs

Use of Psychological Manipulation of Physicians to Sell Pharmaceuticals: The Drug Representative as "Den Mother"
We have discussed, most recently here, how marketers of health care goods and services use deception and psychological manipulation to sell their goods.  Physicians, of course, are particular targets of marketers of drugs and devices. A vivid anecdote showing how this works just appeared on a New York Times blog.  It may be easier to recall that psychological theories:In the social and culinary wasteland that was residency training, it had been easy for Cheryl, a bubbly brunette in her mid-30s, to become our den mother. She never tired of listening to our grousing, had unerring taste in take-out, made it a p...
Source: Health Care Renewal - October 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception pharmaceuticals marketing Source Type: blogs

Words that Work: Singing Only Positive - And Often Unsubstantiated - EHR Praise As "Advised" At The University Of Arizona Health Network
When clinicians are told to promote a technology in no uncertain terms, that puts a chilling effect on critical thinking and discourse.  In effect, when under orders to only speak positively about a hospital or its technology, saying anything bad could very likely get clinicians labeled as 'troublemakers' or 'disruptive clinicians.'  Sometimes - in a sadly real example at Affinity Health - it may even get threats of having complaints plastered to one's forehead (see http://hcrenewal.blogspot.com/2013/07/hows-this-for-patient-rights-affinity.html), a threat answered to by a judge.The 'disruptive' label usually doe...
Source: Health Care Renewal - October 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception healthcare IT difficulties marketing University of Arizona Health Network EPIC sham peer review intimidation healthcare IT exceptionalism Source Type: blogs

Round and Round Spins the Revolving Door, Unimpeded by "Obamacare," Nor By Those Protesting "Obamacare"
On this day of government dysfunction in the US, it is time for our latest installment on the "revolving door," the interchange of insiders among government legislative offices that affect health policy and agencies that implement it, and large health care corporations and the lobbyists and attorneys who represent them.  While we have been discussing this issue since March, 2011 (look here),  it got major media attention in the form of a New York Times article two weeks ago.We have accumulated several other relevant stories since late August, 2013, which we will group by the type of government offices a...
Source: Health Care Renewal - October 2, 2013 Category: Health Medicine and Bioethics Commentators Tags: health care reform Department of Health and Human Services revolving doors ppaca Source Type: blogs

Another in the "Health IT Crashed, But Patient Care Was Not Compromised" Series - NHS Greater Glasgow and Clyde
We must have health IT to prevent stupid doctors and nurses from making mistakes.  Without it, patients are at the mercy of dreaded Paper Records, which by definition cannot ever be used to provide quality care.But when the IT goes down, Patient Care Has Not Been Compromised.  This line should be trademarked, as it's seen so often.  (I even have an indexing tag for it, see this query link: http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised.)Care is never, never compromised when the IT goes belly up en masse due to information technology malpractice.  Care is only ...
Source: Health Care Renewal - October 2, 2013 Category: Health Medicine and Bioethics Commentators Tags: Patient care has not been compromised healthcare IT crash IT malpractice NHS Greater Glasgow and Clyde Source Type: blogs

Vested Interests and Their Influence on Physicians- New Understanding from Cognitive and Social Psychology
Evidence-based medicine proposes patient care decisions based on the best evidence from critically reviewed clinical research, knowledge of biology and the biopsychosocial context, and patients' values and preferences.  Yet physicians often fail to make evidence-based decisions, despite many efforts to educate, or incentivize them to do so.  We used to think that the main reason was physicians' lack of knowledge and understanding of EBM, and human cognitive limitations that make such evidence-based thinking difficult.  However, now we realize that physicians are deluged by  attempts to influence their d...
Source: Health Care Renewal - September 26, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception key opinion leaders marketing logical fallacies evidence-based medicine judgment and decision psychology conflicts of interest Source Type: blogs

A Plague of Bureaucrats - Now 10 Per Physician in US Health Care
There seems to be a reasonable argument that the US health care system is more dependent on the private sector, and in particular the for-profit private sector, than systems in other developed countries.  Advocates of private, for-profit health care often tout the private sector as more efficient and less bureaucratic than government.   However, a post by Robert Kocher in the Harvard Business Review blog, of all places, noted that US health care is increasingly inflicted by a proliferation - perhaps a plague - of bureaucrats.Dr Kocher looked at employment of physicians, other health care professionals and clinica...
Source: Health Care Renewal - September 24, 2013 Category: Health Medicine and Bioethics Commentators Tags: bureaucracy generic management managers ' coup d etat Source Type: blogs

Should "Diagnosing While Texting" Be Illegal?
I saw an interesting comment at Medscape in the comment thread of the article "Do Your EHR Manners Turn Patients Off?" (MedScape subscription required).Dr. [redacted] | NeurologyI live in a town that has passed legislation criminalizing texting and driving. A driver is more impaired and distracted when texting than when intoxicated.  EHR's and the practice of medicine should be no different. Do you really believe that your physician is actually concentrating on the patient in front of them while their attention is primarily focused on entering data on a computer? The reality is that EHR's true value is data ...
Source: Health Care Renewal - September 23, 2013 Category: Health Medicine and Bioethics Commentators Tags: Medscape healthcare IT difficulties Ddulite healthcare IT distraction healthcare IT risks Source Type: blogs

The Adventures of the Purloined Bequest, the Resident Heiress, and the Hidden Hospital System
The game is afoot again.  A series of recent articles in the media described a series of cases whose mysterious interrelationships Sherlock Holmes might have appreciated.The Purloined BequestA singular article in the Wall Street Journal, entitled "Judge Rules in Case of Fortune Tied to Buffett," first made this case explicit, but some background is required to understand it.The story focused on Long Island College Hospital, in Cobble Hill, Brooklyn, New York.  [Full disclosure: this story got my attention particularly because I grew up nearby in Brooklyn, and was born at that hospital, which was also th...
Source: Health Care Renewal - September 19, 2013 Category: Health Medicine and Bioethics Commentators Tags: accountability anechoic effect concentration of power Continuum Health Partners hospital systems mergers Mismanagement Source Type: blogs

UnitedHealth's Latest Blunders Include Lax Fraud Detection, Recalled EHRs - So Why is its CEO Worth $13.9 Million, or is it $34.7 Million?
We managed to go four months since our last post about UnitedHealth, but sure enough, the company that keeps on giving... examples of poor management to contrast with ridiculous management pay... has done so again.There were two obvious examples of poor management that recently appeared in the media.Lax Fraud DectionThe background, as noted in a Kaiser Health News article published in September, is that it is now fashionable for American states to outsource some or most of their Medicaid health insurance programs to managed care organizations, often for-profit, as is UnitedHealth.  These programs are meant to provide ...
Source: Health Care Renewal - September 17, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation fraud healthcare IT risks managed care organizations Medicaid out-sourcing UnitedHealth Source Type: blogs

An Open Letter to David Bates, MD, Chair, ONC FDASIA Health IT Policy Committee on Recommendations Against Premarket Testing and Validation of Health IT
From http://www.healthit.gov/policy-researchers-implementers/federal-advisory-committees-facas/fdasia:The Food and Drug Administration Safety Innovation Act (FDASIA) Health IT Policy Committee Workgroup is charged with providing expert input on issues and concepts identified by the Food and Drug Administration (FDA), Office of the National Coordinator for Health IT (ONC), and the Federal Communications Commission (FCC) to inform the development of a report on an appropriate, risk-based regulatory framework pertaining to health information technology including mobile medical applications that promotes innovation, protects p...
Source: Health Care Renewal - September 16, 2013 Category: Health Medicine and Bioethics Commentators Tags: David Bates ECRI Deep Dive Study FDA FDASIA Health IT Policy Committee Workgroup healthcare IT dangers healthcare IT deaths healthcare IT defects healthcare IT risk ONC premarket approval Source Type: blogs

Quality vs Costs of US Corporate Owned but Offshore Medical Schools
Background: Off-Shore Medical Schools for US Students Owned by US Corporations While US health care appears to be more corporate than health care in any other developed country, one part of health care that has remained a bit less corporate is medical education.  In particular, no US medical school is a for-profit venture, to my knowledge.  (This just makes US medical education a bit less corporate than the rest of health care because, as we have discussed endlessly, academic medical institutions in the country have frequent institutional conflicts of interest, and their boards of trustees, administration, and fa...
Source: Health Care Renewal - September 13, 2013 Category: Health Medicine and Bioethics Commentators Tags: medical schools Ross University DeVry Inc off shore medical schools Source Type: blogs

Why Trust Drug Company Executives After One Admits Commercially Sponsored Clinical Research Is All About "Competitive Advantage?"
Mickey, the semi-anonymous blogger on 1BoringOldMan, wrote a righteously angry post in support of transparent clinical research.  As we have noted frequently, clinical trials done on human subjects are often manipulated to increase the likelihood of results favorable to commercial sponsors, or suppressed when even such manipulation does not produce the desired results.Note that such suppression and manipulation degrade the scientific value of the studies, impede the evidence-based medicine process to rationally apply clinical research evidence to improve the health of patients and the public, and violate the trust of ...
Source: Health Care Renewal - September 12, 2013 Category: Health Medicine and Bioethics Commentators Tags: secrecy deception Abbott InterMune AbbeVie mission-hostile management suppression of medical research Source Type: blogs

A New And Quite Perverse Hospital Ploy to Defend Medical Malpractice - Blame the Dead Patient? Two Examples
I did not think hospitals would ever get to the level of perversity, in defense of EHRs and EHR-related malpractice, seen herein.Just a few days ago I came across the following article on a web search.It is an astonishing story of a 49 year old man who died in part because an ED physician in a Suffern, NY hospital did not know how to use the EHR that had life saving diagnostic information within, and the hospital attempted to BLAME THE PATIENT for not "explaining his medical history thoroughly enough" to the ED doctor.You read that correctly.Ironically and sickeningly, yesterday my dead mother and I just had some...
Source: Health Care Renewal - September 11, 2013 Category: Health Medicine and Bioethics Commentators Tags: blame the patient Good Samaritan Hospital Suffern NY Aaron Kase Abington Memorial Hospital Regina Sturgis Michael McKenzie healthcare IT risks perverse defense of health IT Michael Kane Source Type: blogs

A New And Quite Perverse Hospital Ploy to Defend Medical Malpractice - Blame the Patient? Two Examples
I did not think hospitals would ever get to the level of perversity, in defense of EHRs and EHR-related malpractice, seen herein.Just a few days ago I came across the following article on a web search.It is an astonishing story of a 49 year old man who died in part because an ED physician in a Suffern, NY hospital did not know how to use the EHR that had life saving diagnostic information within, and the hospital attempted to BLAME THE PATIENT for not "explaining his medical history thoroughly enough" to the ED doctor.You read that correctly.Ironically and sickeningly, yesterday my dead mother and I just had some...
Source: Health Care Renewal - September 11, 2013 Category: Health Medicine and Bioethics Commentators Tags: blame the patient Good Samaritan Hospital Suffern NY Aaron Kase Abington Memorial Hospital Regina Sturgis Michael McKenzie healthcare IT risks perverse defense of health IT Michael Kane Source Type: blogs

N.S.A. Able to Foil Basic Safeguards of Privacy on Web, Including Medical Records - Yet Another Reason To Be Concerned About What You Tell Your Physician
There's already a major issue with privacy and protection of medical records in electronic form.  See the multiple blog posts at this query link:  http://hcrenewal.blogspot.com/search/label/medical%20record%20privacyNow this from the New York Times:N.S.A. Able to Foil Basic Safeguards of Privacy on WebBy NICOLE PERLROTH, JEFF LARSON and SCOTT SHANESeptember 5, 2013The National Security Agency is winning its long-running secret war on encryption, using supercomputers, technical trickery, court orders and behind-the-scenes persuasion to undermine the major tools protecting the privacy of everyday communications in ...
Source: Health Care Renewal - September 6, 2013 Category: Health Medicine and Bioethics Commentators Tags: New York Times medical record privacy medical record confidentiality GCHQ computer security techdirt.com email privacy NSA Source Type: blogs

Market Fundamentalism and the Denial of Conflicts of Interest, and of Worse Offenses
While we often point out the pervasiveness of conflicts of interest in medicine and health care, and the likely ill effects of this state of affairs, it seems that the powers that be in health care tend to airily dismiss conflicts of interest as at most a minor problem that needs management (e.g., look here.)  How Market Fundamentalist Ideology Nullifies the Concept of Conflicts of InterestOn the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody discussed how application of the reigning orthodoxy in economics, sometimes called neoliberalism, market fundamentalism, or economism, can be used to dismiss the conce...
Source: Health Care Renewal - September 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: market fundamentalism economism conflicts of interest Source Type: blogs

Study Explains Errors Caused by EHR Default Values - With Only Four Reports of "Temporary" (By the Grace of God) Patient Harm
From Health Data Management and the Pennsylvania Patient Safety Authority:Study Explains Errors Caused by EHR Default ValueJoseph Goedert Sept. 5, 2013 A new study analyzes errors related to “default values” which are standardized medication order sets in electronic health records and computerized physician order entry systems.The Pennsylvania Patient Safety Authority, an independent state agency, conducted the study. “Default values are often used to add standardization and efficiency to hospital information systems,” says Erin Sparnon, an analyst with the authority and study author. “For e...
Source: Health Care Renewal - September 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: Erin Sparnon healthcare IT risk Health Data Management default values Pennsylvania Patient Safety Authority HIT Policy Committee Source Type: blogs

Setback for Sutter after $1B EHR crashes (in followup to post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals")
At my July 12, 2013 post "RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals" (http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html) I reproduced a California Nurses Association warning about rollout of an EHR at Sutter:RNs Say Sutter’s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay HospitalsIntroduction of a new electronic medical records system at Sutter corporation East Bay hospitals has produced multiple problems with safe care delivery that has put patients at risk, charged t...
Source: Health Care Renewal - August 28, 2013 Category: Health Medicine and Bioethics Commentators Tags: glitch Patient care has not been compromised healthcare IT crash Sutter East Bay Hospitals EPIC healthcare IT risks California Nurses Association Sutter Health Alta Bates Summit Medical Center Source Type: blogs

Calling Dr. Moe, Dr. Larry and Dr. Curly: Advocate Medical Breach of Four Million Patient Records, and No Encryption
At my Oct. 2011 post "Still More Electronic Medical Data Chaos, Pandemonium, Bedlam, Tumult and Maelstrom: But Don't Worry, Your Data is Secure" (http://hcrenewal.blogspot.com/2011/10/still-more-ehr-chaos-pandemonium-bedlam.html) I thought I'd seen the worst.Yet another post to add to the category of medical record privacy/confidentiality/security (http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy), however:Advocate Medical Breach: No Encryption?Computer Theft Raises Questions About Unencrypted DevicesBy Marianne Kolbasuk McGee, August 27, 2013.The recent theft of four unencrypted desktop comp...
Source: Health Care Renewal - August 28, 2013 Category: Health Medicine and Bioethics Commentators Tags: Mismanagement healthcare IT risk Bitlocker FileVault medical record privacy medical record confidentiality computer security Advocate Health Care Source Type: blogs

What Sorts of People are "Most Influential in Healthcare?"
Modern Healthcare just put out their list of the "100 Most Influential People in Healthcare" for 2013.  A look at what sorts of people are on this list says a lot about who runs US health care, and raises questions about who should.Some Health Care Professionals, Lots of Hired ManagersI did some quick descriptive categorizations. (Counts were double checked but I am not guaranteeing accuracy.  Categorizations were sometimes difficult for highly diversified organizations.)First, less than one third of list members are physicians (31% by my count).  I did not see any other health professionals on it ...
Source: Health Care Renewal - August 27, 2013 Category: Health Medicine and Bioethics Commentators Tags: health care reform generic managers executive compensation health policy Source Type: blogs

A Good Way to Cybernetically Harm or Kill Emergency Department Patients ... Via An ED EHR "Glitch" That Mangles Prescriptions
Yet another healthcare IT "glitch" - that banal little word used for potentially life-threatening software defects.An EHR/command and control system (including ordering, results reporting, etc.)  for hospital Emergency Departments, Picis Pulsecheck, was recalled by FDA.Reason?  "Notes associated with prescriptions are not printed to the prescription or to the patient chart."This is reminiscent of the truncation of prescription drug "long acting" suffixes, apparently by a Siemens system, that led to thousands of prescription errors (perhaps tens of thousands) over more than a year's t...
Source: Health Care Renewal - August 23, 2013 Category: Health Medicine and Bioethics Commentators Tags: glitch healthcare IT risk FDA recall ED EHR PICIS Pulsecheck healthcare IT defects Source Type: blogs

The Long Con - "Charitable" Hospitals Make Multimillionaires out of Their CEOs
The CEOs of ostensibly charitable hospitals founded to serve the poor continue to become rich.   The latest reminders are in two articles from Maryland, from DelMarVaNow, and from the Baltimore Sun,.and one from the Boston Globe.All this diligent reporting showed multimillion dollar executive compensation,  as usual not justified by evidence or logic, but also how executive compensation is becoming divorced from the ostensible charitable mission of non-profit hospitals.   Most Hospital CEOs are Paid a LotSo jin Maryland, we found via DelMarVaNow,Peninsula Regional Medical Center paid its top executive and he...
Source: Health Care Renewal - August 23, 2013 Category: Health Medicine and Bioethics Commentators Tags: hospitals executive compensation deception perverse incentives mission-hostile management non-profit organizations hospital systems Source Type: blogs

The Mystery of the Northwestern Settlement - the Plot Thickens
This article includes even more curiosities that raise even more questions.Dr Bennett Found Irregularities, Sangoleye Pleaded Guilty, Nobody Noticed In the original media coverage, Dr Bennett was accused based on complaints by a whistle blower.  For example, in an article in the Chicago Sun-Times, A whistleblower suit filed under seal in 2009 by former Lurie Cancer Center worker Melissa Theis first alleged the wrongdoing by Bennett. However, the story in the Cancer Letter suggests Dr Bennett had tried to blow the whistle himself.  First,Bennett said the allegations that he spent NCI money on dinners and vaca...
Source: Health Care Renewal - August 20, 2013 Category: Health Medicine and Bioethics Commentators Tags: Amgen whistle-blowers Northwestern University legal settlements cancer anechoic effect Source Type: blogs