Executive Compensation as "Legal Corruption" - and the Continuing Example of the Troubles of Wake Forest Baptist
Conclusion So let me conclude with Prof Mintzer's conclusion,All this compensation madness is not about markets or talents or incentives, but rather about insiders hijacking established institutions for their personal benefit.Too many large corporations today are starved for leadership—true leadership, meaning engaged leadership embedded in concerned management. And the global economy desperately needs renewed enterprise, embedded in the belief that companies are communities. Getting rid of executive bonuses, and the gambling games that accompany them, is the place to start. (Source: Health Care Renewal)
Source: Health Care Renewal - May 21, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation perverse incentives Wake Forest Baptist Medical Center accountability Source Type: blogs

Marin General Hospital nurses warn that new computer system is causing errors, call for time out
- Posted on the Healthcare Renewal Blog May 17, 2013 -Of course, the ever-present euphemism for life-threatening EHR malfunctions and defects, i.e., "glitches" are the cause (http://hcrenewal.blogspot.com/search/label/glitch):Marin General Hospital nurses warn that new computer system is causing errors, call for time outBy Richard HalsteadMarin Independent JournalPosted:   05/15/2013 04:07:49 PM PDTNurses at Marin General Hospital have asked administrators to put implementation of a new computerized physician order entry system on hold until glitches can be worked out and more training provided to nurse...
Source: Health Care Renewal - May 17, 2013 Category: Health Medicine and Bioethics Commentators Tags: Lee Domanico glitch Patient care has not been compromised Marin General Hospital Marin Healthcare District gross negligence healthcare IT risks Source Type: blogs

American Medical Association finally on board with EHR views expressed on this blog since 2004
- Posted on the Healthcare Renewal Blog May 17, 2013 -It seems to have taken awhile, but organized medicine seems to finally be recognizing that today's commercial health IT is not quite the revolutionizing, transformative, plug-and-play panacea to healthcare's ills it is often touted as:AMA WireMay 15, 2013 AMA board chair: HHS should address EHR usability issues immediatelyThe government needs to act quickly to remedy the impaired usability of electronic health records (EHR) if the technology's touted benefits are to be realized, AMA Board of Trustees Chair Steven J. Stack, MD (left), told officials during a federal hear...
Source: Health Care Renewal - May 17, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT usability AMA Milt Freuedenheim healthcare IT safety MD Steven J. Stack Source Type: blogs

C R Bard Settles Allegations of Kickbacks to Promote Radiation Treatment for Prostate Cancer
Screening for and aggressive treatment of prostate cancer has become an enormously lucrative business, if not necessarily a life-saving medical strategy.  The minimal media coverage of a recent settlement suggests that at least to some degree, it has been fueled by some questionable practices.The CR Bard SettlementAs reported by the Atlanta Journal Constitution,A medical device company on Monday agreed to pay a $48.2 million settlement to resolve claims by a Georgia employee that it paid kickbacks to doctors and customers who bought radiation treatment for prostate cancer.C.R. Bard Inc., which is headquartered in New ...
Source: Health Care Renewal - May 16, 2013 Category: Health Medicine and Bioethics Commentators Tags: kickbacks impunity C R Bard prostate cancer whistle-blowers legal settlements deferred prosecution agreement Source Type: blogs

Six Years Later, Ranbaxy - Oops, Daiichi Sankyo - Pleads Guilty to Adulteration, Pays $500 Million
It only took until 2013, but the US Food and Drug Administration finally secured guilty pleas and fines.  The basics are in an Associated Press story (via the Washington Post): A subsidiary of India’s largest pharmaceutical company has agreed to pay a record $500 million in fines and penalties for selling adulterated drugs and lying to federal regulators in a case that is part of an ongoing crackdown on the quality of generic drugs flowing into the U.S.Federal prosecutors say the guilty plea by Ranbaxy USA Inc. represents the largest financial penalty against a generic drug company for violations of the Fed...
Source: Health Care Renewal - May 14, 2013 Category: Health Medicine and Bioethics Commentators Tags: FDA outsourcing crime adulterated drugs Ranbaxy adverse effects Daiichi Sankyo manufacturing problems Source Type: blogs

Clouded "Visionary" Leadership - Wake Forest Baptist Medical Center's EPIC "Business Cycle Disruptions"
A typical excuse for the multi-million dollar compensation now enjoyed by many leaders of health care organizations is these leaders' supposed brilliance.For example, in 2011 we noted  that the total compensation of Dr John McConnell, the CEO of Wake Forest Baptist Medical Center, a non-profit teaching hospital, rose from over $700,000 in 2008-2009 to over $1.6 million in 2009-2010.  Other top executives in the system made nearly one million a piece.  An official statement from the hospital system claimed that this level of compensation was needed to "retain skilled executives and visionary leaders for ...
Source: Health Care Renewal - May 10, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation healthcare IT difficulties manager-kings EPIC managers' coup d'etat Wake Forest University healthcare IT cost Wake Forest Baptist Medical Center public relations Source Type: blogs

Guest Post: A Physician Rebels Against Micromanagement by "'Leadership-Trained' Management Extenders"
Health Care Renewal presents a guest post by Dr Howard Brody, John P McGovern Centennial Chair of Family Medicine, Director of the Institute for Medical Humanities at University of Texas - Medical Branch at Galveston, and blogger at Hooked: Ethics, Medicine and Pharma. I recently heard from a physician whom I knew well in an earlier stage of her training—I’ll call her Pauline. She completed her training at one of the top children’s hospitals in the US, and served in several capacities in academic medical centers before her most recent job with a physician-owned for-profit practice. She called me to expres...
Source: Health Care Renewal - May 9, 2013 Category: Health Medicine and Bioethics Commentators Tags: generic managers corporate physician mission-hostile management financialization Source Type: blogs

Tales of the Wayfaring Generic Manager - from Ritz Carlton Hotels to Henry Ford West Bloomfield Hospital to Cancer Treatment Centers of America
In 2006, we wondered what a former hotel manager, Mr Gerard van Grinsven, admittedly known for putting the "wow" back in the Detroit Ritz-Carlton, would be doing as a hospital CEO.  This seemed at the time like a real "wow" example of how generic managers were taking over health care.  Mr Grinsven had extensive experience in the hospitality field, but no known background in health care. Organic Local Produce, "Wellbeing Centers," Gourmet Dining, Wedding Receptions, and Corporate FunctionsOver the next few years, Mr van Grinsven's Henry Ford West Bloomfield hospital did make a na...
Source: Health Care Renewal - May 8, 2013 Category: Health Medicine and Bioethics Commentators Tags: hospitals generic managers deception Henry Ford Health System Cancer Treatment Centers of America ill-informed management Source Type: blogs

BLOGSCAN - An Ex-Pharmaceutical Company CEO to Run the American College of Cardiology?
Marilyn Mann's blog discussed the appointment of a former pharmaceutical company executive, most recently at Actelion, and previously at Hoffman La Roche, Abbott Canada, Nordic Labs and Marion Merrill Dow (now known as Aventis), as president of the American College of Cardiology.  Although Mr Jacobovitz, who boasts a bachelor's degree in biology but no obvious experience in direct health care or biomedical science, was touted by the ACC as having "developed a strong patient- and customer-centered corporate strategy," Ms Mann provided documentation that his trajectory at Actelion seemed more money- than patie...
Source: Health Care Renewal - May 7, 2013 Category: Health Medicine and Bioethics Commentators Tags: generic managers American College of Cardiology medical societies Actelion Source Type: blogs

AMA says EHRs create 'appalling Catch-22' for docs - And just how many experts does it take to screw in a light bulb, anyway?
(NOTE:  this post, being about minor matters like death and financial mayhem, is particularly and unusually [even for me] biting and lacking in euphemisms and political correctness.  If you are easily offended and want the latter, and/or believe we all need to be 'nice' about banal issues like patient injury and death, fraud, and other minor matters, click here:  http://www.disney.com and skip the post below.) You were warned.--------------------------------------- At some point, so-called EHR "experts" and pundits need to stop being accommodated for their having ignored years of warnings, complain...
Source: Health Care Renewal - May 6, 2013 Category: Health Medicine and Bioethics Commentators Tags: Julie Creswell upcoding Reed Abelson AMA healthcare IT risks Fred Schulte fraud ecri institute Source Type: blogs

Financial woes at Maine Medical Center: Reading this blog might have saved them millions of dollars, and prevented massive "cost saving initiatives"
In this article, the euphemistic and almost endearing term "hiccup" is used instead of the more traditional "glitch" to describe obvious major information technology malfunctions.  It is likely the knowledge at this blog and at my health IT dysfunction teaching site could have helped prevent most of these problems:Financial woes at Maine Medical CenterNew England health system facing $13 million loss, initiates plan to save $15 millionNEW GLOUCESTER, ME | May 2, 2013 In a memo to its employees last week, one of Maine’s largest health systems said it has suffered an operating loss of $13.4 mil...
Source: Health Care Renewal - May 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: Maine Medical Center glitch Healthcare IT failure Edgecomb Selectman Stuart Smith EPIC healthcare IT cost hiccup Source Type: blogs

Health Information Technology: Blessings, Disasters, and Recommendations: An Interview with Scot M. Silverstein, MD
I was recently interviewed by Dr. Elizabeth Saenger for The Center for Rehabilitation and Recovery regarding use of healthcare information technology in provision of mental health services.  The Center, part of the Coalition of Behavorial Health Agencies Inc., provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.The interview is here:http://coalitionny.org/the_center/recovere-works/RECOVERe-worksApril2013.html#DrSilverstein The themes I discussed will be familiar to readers...
Source: Health Care Renewal - May 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: The Center for Rehabilitation and Recovery Dr. Elizabeth Saenger Coalition of Behavorial Health Agencies Inc. Source Type: blogs

Repost: Health IT Ten Commandments (1970) v. Health IT Truisms (2012)
I believe this Oct. 2012 post bears repeating, especially in view of the recent ECRI Deep Dive study of health IT risk (36 hospitals/9 weeks/volunteer reporting/171 health IT-related problems/8 incidents of harm/3 possible deaths):In 1970, health IT pioneer Dr. Octo Barnett at Harvard/MGH wrote his "Health IT Ten Commandments" (from Collen's "A history of Medical Informatics in the United States, 1950-1990"): 1. Thou shall know what you want to do2. Thou shall construct modular systems - given chaotic nature of hospitals3. Thou shall build a computer system that can evolve in a graceful fashion4. T...
Source: Health Care Renewal - May 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT difficulties Octo Barnett Source Type: blogs

UnitedHealth CEO Continues to Prosper While His Company's Behavior Appears to Contradict its Mission Statement
Tis spring, the season in the US for legal settlements, government findings, and proxy statements revealing executive compensation.  Therefore, maybe there should be no surprise that we are seeing a series of cases in which health care corporate leaders continue to enrich themselves while their organizations' behavior raises ethical questions.Following on the Amgen example, we now present the latest UnitedHealth example (in a post organized similarly.)The CEO Gets RicherLast week, the Associated Press (via the Washington Post) summarized UnitedHealth CEO Stephen J Hemsley's growing pile of money:UnitedHealth Group Inc...
Source: Health Care Renewal - May 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: UnitedHealth quality executive compensation managed care organizations mission-hostile management legal settlements Source Type: blogs

Amgen CEOs Prosper Despite (or Because of) Continuing Ethical Questions
This is becoming a familiar narrative on Health Care Renewal: top health care leaders continue to enrich themselves while their organizations' behavior continues to raise ethical questions.For our latest example we return to the ongoing adventures of biotechnology giant Amgen.CEOs Get Richer An AP story (via the LA Times) documented the continuing enrichment of its current CEO:Amgen Inc's new chief executive, Robert A. Bradway, received total compensation of $13.6 million in 2012, more than his predecessor, according to an analysis of a company regulatory filing.Bradway, who was promoted from chief operating officer to chi...
Source: Health Care Renewal - May 2, 2013 Category: Health Medicine and Bioethics Commentators Tags: Amgen executive compensation kickbacks legal settlements adverse effects Source Type: blogs

The Myth of the Tough Prosecutor as a Distraction from Health Care Corporate Executives' Impunity
The tragic case of the Boston Marathon bombing illustrates how myth making about tough law enforcement obscures the impunity enjoyed by top health care executives. A "Tough to a Fault" ProsecutorA recent Reuters article touted the toughness of the prosecutor who will take on the case of the surviving accused Boston terrorist:As the top federal law enforcer in Massachusetts, U.S. Attorney Carmen Ortiz has taken heat for being tough to a fault and coming down too hard on some defendants. But as she builds a possible death penalty case against suspected Boston Marathon bomber Dzhokhar Tsarnaev, 19, the unflinch...
Source: Health Care Renewal - April 25, 2013 Category: Health Medicine and Bioethics Commentators Tags: US Department of Justice impunity legal settlements public relations Source Type: blogs

Johns Hopkins: Thanks to EHRs, time with patients seems “squeezed out” of medical training, investigator says
Question:  Who would have thought it?  That there is yet another potentially deadly unintended consequence of bad health IT and health IT hyper-enthusiasm?Suggested answer:  anyone who truly understands the issues at the intersection of medicine, information science, information technology, and Social Informatics - which probably excludes 95% of the health IT "experts", pundits and opportunists.Which only goes to show how dense such people can be - as the medical trainees of today will be treating them, their families, and their children in the future:Johns Hopkins MedicineRelease Date: 04/23/2013 ...
Source: Health Care Renewal - April 24, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT unintended consequences social informatics healthcare IT risks Johns Hopkins University Source Type: blogs

WellPoint's Former Manager-Queen Got $20.6 Million and Its Nobility Got Millions
Score another for our new would be royalty, that is, for the hired managers who run big corporations.  Early this month a few scattered reports came out showing just how much even apparently failed executives of big health care organizations can make on their way out the door. A New Fortune for the Abdicating Queen of WellPoint Last year we discussed the abdication of Angela Braly, the former queen of giant insurance company WellPoint.  We then speculated about how much she might abscond with.  Now the Associated Press has reported: The compensation paid to outgoing Wellpoint Inc. CEO Angela Braly ...
Source: Health Care Renewal - April 23, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation manager-kings imperial CEO golden parachutes WellPoint managers' coup d'etat Source Type: blogs

SILVERSTEIN v. ABINGTON MEMORIAL HOSPITAL: MOTION TO PROHIBIT COMMENTARY ABOUT THIS LITIGATION TO ANY PUBLIC CONTEXT: Do computers have more rights than patients?
Herein is an issue of potential Internet censorship and/or attempted prior restraint of the rights of a citizen to express him/herself freely:At my post "Hospital defense maliciousness, aided and abetted by attorneys who ignore the ABA and Pennsylvania's Ethical Rules of Conduct Regarding "Candor Towards the Tribunal" I wrote about how a defense attorney in a case I unfortunately am substitute plaintiff in, that involving EHRs and the injury and the death of my mother, violated the requirement under the Code of Conduct of lawyers to exhibit candor before the tribunal, and perhaps 18 Pa.C.S. §4904 relati...
Source: Health Care Renewal - April 19, 2013 Category: Health Medicine and Bioethics Commentators Tags: Marshall Dennehey Warner Coleman Goggin healthcare IT risk Internet censorship Abington Memorial Hospital prior restraint Stroud v. Abington Memorial Hospital Source Type: blogs

Healthcare computing 'glitch' time again: 15 patients possibly given wrong antibiotic after lab error at Regina General Hospital
Just another computer "glitch", that innocuous euphemism for a catastrophe-promoting IT defect, this time causing patients to receive the wrong antibiotics:Regina Leader-PostApril 17, 2013 15 patients possibly given wrong antibiotic after lab error at Regina General Hospital Fifteen patients in southern Saskatchewan were potentially treated with the wrong antibiotic stemming from a lab error at Regina General Hospital, the Regina Qu'Appelle Health Region announced Tuesday.According to the RQHR, lab reports between late January and late March erroneously deemed Clindamycin would effectively treat the patients...
Source: Health Care Renewal - April 19, 2013 Category: Health Medicine and Bioethics Commentators Tags: glitch healthcare IT risks Regina General Hospital Source Type: blogs

Guest Post: the Slow Grind of Justice
ConclusionOnce again we find the use of the legal system perverted by one party in an effort to gain a business advantage over another entity.Aultman has used its non-profit status to shield the activities of a for-profit insurance subsidiary.  Perhaps someone thought that no one would sue a large non-profit hospital for the actions of the subsidiary.Aultman used the tired old refrain that “we don’t do that anymore” as a defense for past business practices that garnered questionable profits. This after the fact admission does not absolve them of responsibility for those actions.When all else fails Au...
Source: Health Care Renewal - April 18, 2013 Category: Health Medicine and Bioethics Commentators Tags: legal settlements Mercy Health System hospital systems Aultman Hospital Source Type: blogs

Fred Schulte: "GOP senators call for overhaul of electronic health records program"
Fred Schulte, investigative reporter at the Center for Public Integrity (link to bio), has authored a new article worth reading in its entirety:GOP senators call for overhaul of electronic health records programLawmakers say Obama's $35 billion initiative pushing health information technology isn't working.Six U.S. Senators are calling for an overhaul of the federal government’s $35 billion plan for doctors and hospitals to switch from paper to electronic medical records, citing concerns from patient privacy to possible Medicare billing fraud.The report issued Tuesday by the half-dozen Republicans concedes that many ...
Source: Health Care Renewal - April 16, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT difficulties healthcare IT risks Center for Public Integrity Fred Schulte Source Type: blogs

Hospital defense maliciousness, aided and abetted by attorneys who ignore the ABA and Pennsylvania's Ethical Rules of Conduct Regarding "Candor Towards the Tribunal"
At Healthcare Renewal we've written of hospitals' deviations from the core mission of compassionate, ethical and safe patient care, towards profiteering at patient's and the community's expense.What we haven't written about is maliciousness.At my Feb. 2013 posts about my late mother's (now my) lawsuit regarding injury and death that involved EHR problems, namely "The lengths a hospital will go to in order to protect their EHR - Motion for Reconsideration of Denial of Motion for Reconsideration of Denial of Objections"   and   "More on the lengths a hospital will go through to protect thei...
Source: Health Care Renewal - April 11, 2013 Category: Health Medicine and Bioethics Commentators Tags: Marshall Dennehey Warner Coleman Goggin malicious abuse of process Candor Toward the Tribunal Abington Memorial Hospital Carolyn B. DiGiovanni Stroud v. Abington Memorial Hospital Source Type: blogs

Walk the walk
WALK THE WALKFor some time a jeremiad theme has been dominant in the psychiatric sector of the academic-industrial complex. Blockbuster psychiatric medications are going off patent, the pipeline is viewed as alarmingly empty, and several corporations are scaling back or even abandoning their research programs in this area. Analyses of the reasons range from the enlightened to the pragmatic to the pedantic to the foolish. Everyone predicts that things will turn bleak in academic clinical research if the corporate spigot is turned off.Lost in the wailing is a clear understanding that the defecting corporations are acting out...
Source: Health Care Renewal - April 6, 2013 Category: Health Medicine and Bioethics Commentators Tags: Steven Hyman Thomas Insel Charles Nemeroff Emory University 1boringoldman.com NIMH Helen Mayberg academic industrial complex GlaxoSmithKline Source Type: blogs

Another Sign of Resistance? - Doctors Sue Hospital Systems Alleged to Put Money Ahead of Mission
This article also described how money allegedly came before patient care:The court papers include email exchanges between Henderson and the other doctors in the ER group. In a November 2010 email, he discusses ways to punish doctors who do fewer patient transfers and reward those who tally more transfers:'(T)op quarter $1,000, next quarter $500. Bottom quarter up or out talk at annual evaluation.' In other words, according to doctors who received the email, Henderson proposed that doctors would be divided into strata based on who recommended the most transfers, with the top group winning bonus money while those who perform...
Source: Health Care Renewal - April 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: Prime Healthcare organized resistance Dignity Health lawsuit mission-hostile management Catholic Healthcare West Source Type: blogs

More Signs of Organized Resistance? - Proposed Legislation for More Hospital Leadership Accountability
This year we note the beginning of action against the power of large health care organizations lead by hired executives and cronies who seem to put their self-interest and self-enrichment ahead of patients' and the people's health.  In 2013 we noted no confidence votes by medical school faculty (here), and university faculty (here) against academic leaders perceived as putting their power and wealth ahead of core values, actions by a state governor (here) and a big city mayor (here) against local health care systems perceived as putting their executives' enrichment ahead of their services to patients, and a union labo...
Source: Health Care Renewal - April 1, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation organized resistance logical fallacies non-profit organizations public relations Providence Health Systems hospital systems Source Type: blogs

The Market Made Us Do It: Increasing Low Level Employees' Health Plan Deductible While Paying Executives Millions
A small news item from the Seattle public radio station, KUOW, provides our latest example of the contrasts between how hired executives and "regular" employees are treated even at non-profit health care organizations, and between these organizations' actions and their stated missions.  Hospital Employees Strike Against Reductions in their Health InsuranceThe report was about a small job action going on at a single hospital.  Ironically, the strike is over the employees' own health insurance.  Along with housekeepers, nursing assistants and other staff, surgical technologist Bob Wilson is a member ...
Source: Health Care Renewal - March 28, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation mission-hostile management health insurance Providence Health Systems Source Type: blogs

The Push Back Continues: the Mayor of Pittsburgh Sues UPMC Claiming it is No "Public Charity"
There is another indication that push back against the power of large health care organizations is getting more significant.In February, 2013, we noted that the Governor of the state of Connecticut publicly criticized lavish executive compensation at a small regional hospital system, compensation partially fueled by government funded health insurance payments, and in contrast to hospitals' claims that insufficient reimbursement was driving them to poverty.    The Suit Challenging the Charitable Status of UPMCNow the outgoing Mayor of Pittsburgh has launched a lawsuit challenging the status of huge, nominally non-...
Source: Health Care Renewal - March 26, 2013 Category: Health Medicine and Bioethics Commentators Tags: UPMC oligopoly concentration of power logical fallacies non-profit organizations public relations Source Type: blogs

Boulder Community Hospital computer records back on line - but something does not add up
This post is in followup to my March 20, 2013 post "Boulder Community Hospital computer system crash: Either you're in control of your information systems, or they're in control of you".At a March 24, 2013 Denver Post article "Boulder Community Hospital computer records back on line" the following statements are made:The computer system that Boulder Community Hospital uses to manage patient records, which had been down for almost two weeks, is now up and running again, hospital officials said Saturday.Meditech, the system used by the hospital to manage patient records, went down March 12 and affected t...
Source: Health Care Renewal - March 26, 2013 Category: Health Medicine and Bioethics Commentators Tags: glitch Meditech Joint Commission healthcare IT crash Boulder Community Hospital Rich Sheehan healthcare IT risks Source Type: blogs

EHR Advertising Obscenity ... Is This An Emergency Department, or a Bar Mitzvah?
Regarding unregulated, unvetted information technology installed in acute care environments such as ED's, that slows physicians down and increases risk, this video is perhaps typical of the cavalier attitudes of hospital executives and IT hyper-enthusiasts. I have personally observed potentially serious malfunctions involving allergy lists and med lists exhibited by particular system, in fact.Click the image below to play the video.  Have nausea bag nearby:Click on this image or here to see a charmingly disgusting song & dance.ED's are all about dancing:If you change your mind, I'm the first in lineHoney I'm still...
Source: Health Care Renewal - March 25, 2013 Category: Health Medicine and Bioethics Commentators Tags: hospital advertising PICIS Pulsecheck Source Type: blogs

NYU Faculty Vote No Confidence in their President
Faculty at large American universities, in which most of the country's medical schools and teaching hospitals are embedded, are becoming increasingly concerned about the leadership and governance of their organizations, and whether the universities are putting their academic (and clinical) missions ahead of other concerns, like making money and rewarding top executives.In January, 2013, we discussed a an informal, anonymous vote faculty at the University of Miami medical school expressing no confidence in their dean and his chief lieutenant.The NYU No Confidence Vote The faculty of a major component of another big US unive...
Source: Health Care Renewal - March 21, 2013 Category: Health Medicine and Bioethics Commentators Tags: New York University executive compensation boards of trustees free speech academic freedom transparency accountability Source Type: blogs

Boulder Community Hospital computer system crash: Either you're in control of your information systems, or they're in control of you
Yet another health IT crash, "prolonged" this time, from some unspecified "glitch":Boulder Community Hospital computer system crash frustrates patientsOfficials say it could take until Friday for outage to be resolvedBy Brittany AnasCamera Staff WriterPosted:   03/18/2013 07:23:23 PM MDTUpdated:   03/18/2013 07:24:16 PM MDTA prolonged computer system outage is preventing Boulder Community Hospital from accessing patient records -- making it difficult for people to schedule surgeries, get test results and make appointments for routine blood work.Meditech, the system used by the hospit...
Source: Health Care Renewal - March 20, 2013 Category: Health Medicine and Bioethics Commentators Tags: glitch Meditech healthcare IT crash Boulder Community Hospital Rich Sheehan healthcare IT risks Source Type: blogs

Doctors' Dubious Excuses for Taking Pharmaceutical Companies' Money
This report, and its recommendations have gotten scant attention, maybe because they would threaten a status quo that enriches conflicted health professionals and the companies that create these conflicts.  However, in my humble opinion, implementing all the report's recommendations would only be a beginning down the road of restoring the integrity of clinical care, teaching, and research.   (Source: Health Care Renewal)
Source: Health Care Renewal - March 19, 2013 Category: Health Medicine and Bioethics Commentators Tags: stealth marketing key opinion leaders pharmaceuticals logical fallacies conflicts of interest Source Type: blogs

Bad Science (and Perhaps Conflict of Interest) At ONC / HHS
This article recently appeared, quoting Jacob Reider, M.D., chief medical officer at ONC on an upcoming Health IT Safety Plan:Health Data Managementhttp://www.healthdatamanagement.com/news/HIMSS13-ONC-HIT-safety-plan-45809-1.html ONC Sets Early Summer for Release of HIT Safety PlanThe Office of the National Coordinator for Health Information Technology anticipates releasing a final health information technology safety plan by early summer, officials announced on March 5 at HIMSS13 in New Orleans.ONC released a draft plan in December and accepted public comment until February 4. The draft followed an Institute of Medic...
Source: Health Care Renewal - March 16, 2013 Category: Health Medicine and Bioethics Commentators Tags: bad science Jacob Reider MD ONC Health IT Safety Plan Allscripts Source Type: blogs

IRS faces class action lawsuit over theft of 60 million medical records
Try this with paper records.  This is spectacular (as in, spectacularly alarming) if true:IRS faces class action lawsuit over theft of 60 million medical recordsThe Internal Revenue Services is now facing a class action lawsuit over allegations that it improperly accessed and stole the health records of some 10 million Americans, including medical records of all California state judges.According to a report by Courthousenews.com, an unnamed HIPAA-covered entity in California is suing the IRS, alleging that some 60 million medical records from 10 million patients were stolen by 15 IRS agents. The personal health inform...
Source: Health Care Renewal - March 15, 2013 Category: Health Medicine and Bioethics Commentators Tags: electronic medical records IRS medical record privacy medical record confidentiality Source Type: blogs

Minimizing Legal Liability or Upholding the Mission? - the Markingson Case Redux
There are new, and troubling developments in the long running case of Dan Markingson, the psychiatric patient and research subject who committed suicide while enrolled in a trial of anti-psychotic drugs at the University of Minnesota nearly 10 years ago.Summary of the Case A good quick summary of this case just appeared in the Center for Law and Bioscience blob out of the Stanford Law School.  Dan Markingson – a vulnerable, psychotic young man – was forced to choose between enrolling in a Pharma-funded drug study or being involuntarily committed (in other words, locked up).  A UMN [University of Minne...
Source: Health Care Renewal - March 15, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception atypical anti-psychotics AstraZeneca manipulating clinical research mission-hostile management University of Minnesota research subjects accountability conflicts of interest Source Type: blogs

JAMA: "Improving the Electronic Health Record—Are Clinicians Getting What They Wished For?" - No, But Utopia Arrives Soon
At a new JAMA piece "Improving the Electronic Health Record—Are Clinicians Getting What They Wished For?", former Columbia U. and now NIH medical informaticist James J. Cimino, MD points out issues with the documentation that results from health IT systems.A preview of the first page of this short Viewpoint piece is available free at this link.  It includes the observation that:... There is no question that computerization has made patients’ records more available and legible. With respect to completeness, however, there are now complaints that the record is too complete: electronic notes are dee...
Source: Health Care Renewal - March 14, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT difficulties James Cimino MD JAMA healthcare IT utopianism Source Type: blogs

But don't worry, your EHR information is secure
My last reminder of this issue was almost a half-year ago, but I think a repeat is in order. More bugs squashed: Microsoft fixes critical Windows, IE flaws for Patch TuesdayMicrosoft has released four critical security updates for Windows and Internet Explorer, along with a bevy of other products, in order to protect against at least 19 vulnerabilities identified in its software.On deck this month, there are four "critical" vulnerabilities that affect Windows, Internet Explorer, Office, and Windows Server, including one for Silverlight that affects both Windows and Mac machines.The most severe Internet Explorer f...
Source: Health Care Renewal - March 13, 2013 Category: Health Medicine and Bioethics Commentators Tags: medical record privacy medical record confidentiality computer security Source Type: blogs

The Dangers of Big Corporate Health Care: Deceptive Marketing of Cancer Treatments
A series of articles over the last few months, culminating in an investigative report by Reuters, provided the newest example of what can go wrong when corporations provide direct care to vulnerable patients.  In this case, the vulnerable patients had cancer, and the corporation that provided them care was the Cancer Treatment Centers of America (CTCA).  I will try to go through the case chronologically.As Rueters reported, CTCA "was founded in 1988 by Richard J. Stephenson, who has been chairman ever since."The Founder's Checkered PastA Misdemeanor As Reuters noted,A graduate of Northwestern University...
Source: Health Care Renewal - March 11, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception crime marketing Cancer Treatment Centers of America hospital systems complementary/ alternative medicine Source Type: blogs

When "Human Error" Causes EHR Downtime, Who is Liable For Patient Injuries That Result?
In the Pittsburgh Post-Gazette was this story of yet another EHR "glitch":March 9, 2013 12:17 am Human error the cause of UPMC electronic issueA systemwide problem with UPMC's information systems Wednesday left electronic patient records and other data inaccessible for about three hours. A UPMC spokeswoman said the hospitals "immediately went to manual backup systems, and we quickly identified and fixed the problem." She said there was no indication that patient care was compromised by the incident, which was due to human error.I will presume the "human error" was not a physician or nurse...
Source: Health Care Renewal - March 11, 2013 Category: Health Medicine and Bioethics Commentators Tags: glitch UPMC Patient care has not been compromised healthcare IT difficulties healthcare IT crash Source Type: blogs

Far more concern about Linux user experience than the EHR user experience, and your life does not depend on the former
I find this ironic and striking:During my informatics postdoc I used a SparcStation-2 running UNIX and an old X Windows user interface.  Then a few years later, in the Windows 95 days, I installed Linux (an open-source UNIX-like operating system) on a PC and used various X Windows user interfaces on that, too.  There was a lot of debate on which features of which user interface made for the best usability, and more broadly, user experience.This debate continues as Linux in its multiple versions continues to be extremely popular.If the health IT sellers put as much time into considering the user experience present...
Source: Health Care Renewal - March 10, 2013 Category: Health Medicine and Bioethics Commentators Tags: user experience healthcare IT usability Linux Ubuntu Source Type: blogs

Twitter EHR "revolt": #EHRbacklash
As noted at the new IEEE Spectrum piece "U. S. Electronic Health Record Initiative: A Backlash Growing?"  (worth reading in its entirety along with its hyperlinks), the following is noted:There seems to be a slow but steady backlash growing among healthcare providers against the U.S. government’s $30 billion initiative to get all its citizens an electronic health record, initially set to happen by 2014 but now looking at 2020 or beyond. The backlash isn’t so much about the need for, or eventual benefits of, electronic health records but more about the perceived (and real) difficulties caused by t...
Source: Health Care Renewal - March 9, 2013 Category: Health Medicine and Bioethics Commentators Tags: #EHRbacklash IEEE healthcare IT difficulties Twitter Source Type: blogs

On EHR's: See No Evil, Hear No Evil, Speak No Evil: Part 2
Part 1 is here.This is the second a series of posts I plan on the issue of "See No Evil, Hear No Evil, Speak No Evil" regarding EHR's.Frequent reminders are needed by all stakeholders, I believe, to think critically about, and take with a big grain of salt, effusive praise by key opinion leaders, politicians, etc. about health IT, and accompanying attempts to deride those critical of the technology, to counterbalance ongoing HIT hyperenthusiasm.The following quote comes from a May 2010 post "David Blumenthal on health IT safety: nothing to see here, move along":Blumenthal, at the time Director of ONC at...
Source: Health Care Renewal - March 8, 2013 Category: Health Medicine and Bioethics Commentators Tags: ONC= healthcare IT risks David Blumenthal bad health IT See No Evil Hear No Evil Speak No Evil Source Type: blogs

Deadly Over-Doses and Private Equity - the Case of Bain Capital's Methadone Clinics
Some reporting by Bloomberg provides more evidence about what happens when direct care of the most vulnerable patients is commercialized.  The vulnerable patients in this case were narcotic addicts.By way of introduction, one method of treating narcotic addiction is the use of methadone.  Methadone is a narcotic that may block the "high" produced by other narcotics and thus may lead to the abuse of these drugs.  Because methadone is long-acting and can be given orally in liquid form, methadone clinics traditionally provided patients one dose a day which they swallowed on the spot.  The methado...
Source: Health Care Renewal - March 7, 2013 Category: Health Medicine and Bioethics Commentators Tags: Bain Capital narcotics adverse effects private equity CRC Health Source Type: blogs

Medscape re: Class Action suit: "Doctors Who Sued EHR Company Win First Round"
Interesting article about a Class-Action lawsuit against a health IT seller, Allscripts, see Medscape link below (the story is copyrighted so I cannot repost it here).Relevant excerpts:On Monday, March 4, a group of doctors who are suing their electronic health record (EHR) manufacturer for selling them a "buggy" product and then discontinuing it learned that the defendant's motion to block the lawsuit and compel them to accept binding arbitration was overruled by a judge in Miami, the first step in getting a court date in what is believed to be a first-of-its-kind case.... In December 2012, 4 physician practices...
Source: Health Care Renewal - March 7, 2013 Category: Health Medicine and Bioethics Commentators Tags: Medscape class action lawsuit Allscripts healthcare IT defects Source Type: blogs

On EHR's: See No Evil, Hear No Evil, Speak No Evil: Part 1
This is the first of a series of posts I plan on the issue of "See No Evil, Hear No Evil, Speak No Evil" regarding EHR's.  Frequent reminders are needed by all stakeholders, I believe, to think critically about, and take with a big grain of salt, effusive praise by key opinion leaders, politicians, etc. about health IT, and accompanying attempts to deride those critical of the technology, to counterbalance ongoing HIT hyperenthusiasm (e.g., link).In face of growing evidence of risk and adverse outcomes of bad health IT from multiple sources and organizations (such as this, as just one example), growing advic...
Source: Health Care Renewal - March 6, 2013 Category: Health Medicine and Bioethics Commentators Tags: CCHIT solutionism bad health IT healthcare IT risks See No Evil Hear No Evil Speak No Evil Mark Leavitt Source Type: blogs

Solutionism: are all healthcare issues transparent and self-evident processes that can be easily optimized, if only the right algorithms are in place?
I've ordered this book:  "To Save Everything, Click Here: The Folly of Technological Solutionism" by Evgeny Morozov.I've read some excerpts prior to its delivery and find them fascinating.  Emphases mine:... Alas, all too often, this never-ending quest to ameliorate—or what the Canadian anthropologist Tania Murray Li, writing in a very different context, has called “the will to improve”—is shortsighted and only perfunctorily interested in the activity for which improvement is sought. Recasting all complex social situations either as neatly defined problems with definite, computab...
Source: Health Care Renewal - March 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: Ddulite solutionism Evgeny Morozov Source Type: blogs

JAMIA: Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems
A new article appeared online 20 February 2013 in the Journal of the American Medical Informatics Association entitled "Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems" (link to fulltext) by David C Radley, Melanie R Wasserman, Lauren EW Olsho, Sarah J Shoemaker, Mark D Spranca and Bethany Bradshaw.The authors performed a meta-analysis of the literature on Computerized Practitioner Order Entry (CPOE) systems in inpatient settings and concluded:"Processing a prescription drug order through a CPOE system decreases the likelihood of error ...
Source: Health Care Renewal - March 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: Mark D Spranca AMIA Melanie R Wasserman medication error Lauren EW Olsho David C Radley healthcare IT risks Sarah J Shoemaker Bethany Bradshaw JAMIA healthcare IT benefits CPOE Source Type: blogs

Dr. Richard Cook on the Health IT Sector's Ills
This explanation of the health IT sector's ills comes from Dr. Richard Cook, a physician, educator, researcher, and patient safety expert formerly at the University of Chicago and now Professor of Healthcare System Safety at the Royal Institute of Technology, Stockholm, Sweden.Dr. Cook was also a member of the U.S. Institute of Medicine panel that studied health IT safety, leading to the 2012 IOM report ("Health IT and Patient Safety: Building Safer Systems for Better Care").He was also co-author of an article I consider a must-read for anyone in the health IT sector, Hiding in plain sight: What Koppel et al. Tel...
Source: Health Care Renewal - March 1, 2013 Category: Health Medicine and Bioethics Commentators Tags: Richard Cook healthcare IT lobby healthcare IT difficulties Source Type: blogs

Arguments with Pavlov's Dogs: Health IT Regulation Will "Harm Innovation"? How, exactly?
Health IT hyper-enthusiasts, when faced with the prospect of government regulations, react like Pavlov's dogs with the response "regulation of health IT will harm innovation."Here's a soliloquy of critical questions that need be asked:----------------------- Now, Mr. (or Dr.)  Hyper-Enthusiast, you state HIT regulation will harm innovation.What aspects of regulation, specifically, will harm innovation?Good manufacturing processes (GMPs)?Building a safety case for review and inspection?Pre-market safety/fitness/quality/reliability testing?Post-marketing surveillance?What?Innovations happen before regulatory e...
Source: Health Care Renewal - February 28, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT regulation Source Type: blogs