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 6, 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

Hospital Retaliation Against Outspoken Physician Reaches New Levels - La Cosa Nostra Levels, That Is
Physicians, take note: The Advisory Board CompanyFeb. 14, 2013  Hospital Framed Physician; Planted a Gun A jury has ordered a California hospital chain to pay physician Michael Fitzgibbons $5.7 million after its former CEO allegedly framed him by planting a gun in his car.In 2006, Fitzgibbons—an infectious disease specialist and former chief of staff at Western Medical Center—was arrested in the hospital parking lot after police found a pair of black gloves and a handgun in his car. Police questioned Fitzgibbons and searched his car after an anonymous 9-1-1 call claimed that the doctor had brandished the g...
Source: Health Care Renewal - February 28, 2013 Category: Health Medicine and Bioethics Commentators Tags: Mismanagement retaliation health care corruption Source Type: blogs

Peering Underneath the Iceberg's Water Level: AMNews on the New ECRI "Deep Dive" Study of Health IT "Events"
FDA's Center for Devices and Radiological Health director Jeffrey Shuren MD JD voiced the opinion a few years ago that what FDA knows about health IT risks is the "tip of the iceberg" due to systematic impediments to knowledge gathering and diffusion.   See links to source here and to the FDA Internal Memo on HIT risk - labeled "internal document not intended for public use" and unearthed by investigative reporter Fred Schulte several years ago - here (PDF).At my Feb. 9, 2013 post "A New ECRI Institute Study On Health Information Technology-Related Events" I opined that a new ECRI st...
Source: Health Care Renewal - February 28, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT risk AMNews Kevin O'Reilly jeffrey shuren Fred Schulte amednews.com ecri institute CDRH Source Type: blogs

Another Reason for Hope? - Concern about Excessive Executive Pay in Health Care Goes Mainstream
Another recent case suggested that the problem of excess, disproportionate compensation of health care executives is becoming more of a mainstream concern. The Case of Eastern Connecticut Health Network The case appeared in the Manchester (CT) Journal-Inquirer (link requires subscription).  Here are the basics:ECHN Inc., which owns Mancester Memorial and Rockville General hospitals, reported to the IRS last year that the company paid its president and CEO, Peter J Karl, a total of $1,042,200 in salary and fringe benefits.  That's a 30.7 percent increase over Karl's compensation reported in the previous year,...
Source: Health Care Renewal - February 27, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation government hospital systems politics Source Type: blogs

Reason for Hope? - Novartis Rescinds Vasella's Golden Parachute
Enormous compensation of hired health care executives, out of all proportion, if related at all to whether their work had any positive effect on patients' or the public's health, has long been a concern on Health Care Renewal.  For example, back in 2006, we posted repeatedly (look here for links) about the billion dollar plus fortune amassed by the then CEO of UnitedHealthcare which vividly contrasted with the company's avowal to "make health care more affordable."We have posted many such stories.  Yet maybe there is a whiff of change in the air.  For the first time that I can recall, a gigantic pa...
Source: Health Care Renewal - February 25, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation perverse incentives golden parachutes Switzerland Novartis Source Type: blogs

From another happy EHR user: automatic data "corrections" that alter the past
From another happy EHR user:One of my patients was married in late 2012.   Her name changed from XXXX to YYYY. Today I incidentally reviewed this patient's chart.Can you guess what name appears on all progress notes (on the LCD screen and in printed form)…going back to early 2007?You guessed it…YYYY…even though her name was XXXX until late 2012.I've also seen this happen with providers.  Example:  an RN received her NP.  When they updated her prof designation in the EHR, ALL of her notes were changed to NP…even though about 10 of those years she was an RN.That's data integrit...
Source: Health Care Renewal - February 21, 2013 Category: Health Medicine and Bioethics Commentators Tags: data integrity healthcare IT risk Source Type: blogs

EHRs and "Meaningful Use": Begging the Question in the New England Journal of Medicine
I used to have great respect for the New England Journal of Medicine.No more. That respect was reduced significantly in 2010 when I saw the following passage (as I wrote in my July 2010 post "Science or Politics? The New England Journal and The 'Meaningful Use Regulation for Electronic Health Records"): ... In the NEJM article "The 'Meaningful Use' Regulation for Electronic Health Records", David Blumenthal, M.D., M.P.P. (ONC Chair) and Marilyn Tavenner, R.N., M.H.A. (10.1056/NEJMp1006114, July 13, 2010) available at this link, the opening statement is (emphases mine):The widespread use of electronic he...
Source: Health Care Renewal - February 21, 2013 Category: Health Medicine and Bioethics Commentators Tags: meaningful use begging the question logical fallacies NEJM Source Type: blogs

It is Harder to Run a Small Public Hospital System than California? - Deep Seated Myths and Logical Fallacies Underpinning Health Care Executive Compensation
Hospital executive compensation, the gift that keeps on giving...  A Public Hospital CEO's Current Compensation A recent, somewhat obscure news article shows how deeply rooted is the current practice of paying top hired managers of health care organizations amounts that seem outlandish given the context.The article, in the Argus - San Jose (CA) Mercury News, discussed the compensation given the CEO of a small public hospital district.  It opened with, Amid a budget crunch that has forced sweeping cutbacks at its medical facilities, the Washington Township Health Care District board of directors on Wednesday ...
Source: Health Care Renewal - February 21, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation perverse incentives imperial CEO public hospitals hospital systems accountability Source Type: blogs

New York Times: "A Digital Shift on Health Data Swells Profits in an Industry"
This article highlights only one aspect of the "Failed Promise of Electronic Health Records". Through lobbying but also supported by a study from the RAND organization, the three final 2008 presidential candidates, Hillary Clinton, John McCain, and Barack Obama outbid each other with promises to spend billions to entice doctors to use electronic record systems. Unfortunately, because of unsolved documentation problems, such systems are often disliked and slow the process. Instead of creating interoperability, electronic medical record systems (EMRs) with limited functionality and benefits were created. In particu...
Source: Health Care Renewal - February 20, 2013 Category: Health Medicine and Bioethics Commentators Tags: New York Times Julie Creswell healthcare IT lobby healthcare IT risk healthcare IT difficulties Robert O'Harrow Jr. Fred Schulte Source Type: blogs

Are the health IT hyper-enthusiasts inept, or merely insane?
From a psychiatrist, partially in response to the article about me in Kaiser Health News, on the travails of health IT.They write:... In psychiatry we screen for certain medication side effects using a tool called "DISCUS."  [Dyskinesia Identification System Condensed User Scale - ed.] In a paper and pen world, we (1) reviewed a single page; (2) circled a score; (3) signed and (4) dated.In [redacted] EHR, we need to do the following to complete one DISCUS…     DISCUS Completion in [redacted] EHR:1.  Log in;2.  Acknowledge to do items by choosing “ok”;3.  ...
Source: Health Care Renewal - February 20, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT difficulties Source Type: blogs

Another Revolving Door Variant: From Academia with Millions in Medtronic Royalties, to the White House, to the Health Care Service Corp
The revolving door spins, and where it will stop, nobody knows... In October, 2010, we noted questions about how Dr Stephen Ondra got to be a Senior Policy Adviser for the US Department of Veterans Affairs. A veteran who was a neurosurgery professor at Northwestern University, Dr Ondra had received millions of dollars in royalties from device manufacturer Medtronic, whose CEO supported his appointment to the government position  (see this post).  As soon as he was appointed, he publicly opposed a nominee for US Surgeon General who had been critical of the medical device industry, and its financial ties to doctors...
Source: Health Care Renewal - February 19, 2013 Category: Health Medicine and Bioethics Commentators Tags: White House Medtronic revolving doors corporatism Veterans Affairs health insurance Source Type: blogs

Kaiser Health News/Philadelphia Inquirer on InformaticsMD: "The flaws of electronic records"
At my Dec. 2012 post "How an interview for Kaiser Health News rekindled memories of health IT dysfunction in the 90's that persist in the 10's" I mentioned an interview by a reporter from the Kaiser Health Foundation interviewed me regarding health IT flaws.His article appeared in both the Philadelphia Inquirer and Kaiser Health News today under the title "The flaws of electronic records":Philadelphia Inquirer / Kaiser Health NewsFeb. 18, 2013Jay Hancock, KAISER HEALTH NEWSThe flaws of electronic recordsDrexel University's Scot Silverstein is a leading critic of the rapid switch to computerized medical ...
Source: Health Care Renewal - February 18, 2013 Category: Health Medicine and Bioethics Commentators Tags: Richard Cook Philadelphia Inquirer healthcare IT risk ross koppel David Blumenthal Kaiser Family Foundation Kaiser Health News george lundberg ONC matthew holt Jay Hancock IOM Source Type: blogs

A Right Royal Mess: EHRs and Royal Berkshire NHS Foundation Trust
Almost every theme I've written about for the past 15 years, at this blog and at my teaching site (link) regarding health IT mismanagement is present here:A Right Royal Mess     ehealth INSIDER12 February 2013 Newly released reports on Royal Berkshire NHS Foundation Trust’s implementation of Cerner Millennium show that many crucial issues were not addressed prior to go-live; and that the trust is continuing to face considerable operational and financial issues because of the system. Rebecca Todd reports.Read it at the link above.I feel this scenario is being repeated in many countries, including t...
Source: Health Care Renewal - February 16, 2013 Category: Health Medicine and Bioethics Commentators Tags: Mismanagement cerner millenium Royal Berkshire NHS Foundation Trust;cerner Healthcare IT Source Type: blogs

A Sewage-Laden Cruise Ship, Burning Aircraft Batteries, Neo-Nazi Factory Security - Will Jaw Dropping Cases Prompt the Public to Demand Better Leadership?
The dysfunction of modern health care likely arises from larger trends within the economy and the society.  We frequently discuss how poor leadership and governance within health care and other organizations exist in a context of focus on short-term revenue above all else (financialization); perverse incentives, particularly leading to excess executive compensation unrelated to leaders' actions or performance; deception, especially in marketing and public relations coupled to suppression of internal dissent and whistle blowing;  lax regulation and law enforcement, in a climate of regulatory capture and by governm...
Source: Health Care Renewal - February 15, 2013 Category: Health Medicine and Bioethics Commentators Tags: governance leadership Source Type: blogs

Carolinas Healthcare System Pays Executives Even More
In May, 2012, we discussed the contrast between the outsize compensation given to top executives of Carolinas Healthcare System, a large tax-exempt public hospital authority, and the apparent failure of the system to fulfill it promise to provide community care.  Now we can update that story.2012 Executive CompensationThe Charlotte Observer reported on the compensation given to top executives at the Carolinas Health Care System in 2012:The top executive at Carolinas HealthCare System received $4.76 million in 2012 compensation, a 12 percent increase over 2011, as the system celebrated a profitable year and met all of ...
Source: Health Care Renewal - February 14, 2013 Category: Health Medicine and Bioethics Commentators Tags: hospitals executive compensation perverse incentives Carolinas HealthCare public hospitals hospital systems Source Type: blogs

Bipartisan Policy Center's Health Innovation Initiative: Health IT Industry Officials Lying to Regulators With Impunity?
On Wednesday, February 13, 2013, The Bipartisan Policy Center's Health Innovation Initiative held a discussion on its new report: An Oversight Framework for Assuring Patient Safety in Health Information Technology.  The announcement is here:  https://bipartisanpolicy.org/news/press-releases/2013/02/bipartisan-policy-center-releases-recommendations-oversight-framework-paThe report is here (PDF):  "An Oversight Framework for Assuring Patient Safety in Health Information Technology."The "who's" of the Bipartisan Policy Center's Health Innovation Initiative included these people:Senator Tom D...
Source: Health Care Renewal - February 14, 2013 Category: Health Medicine and Bioethics Commentators Tags: Bipartisan Policy Center IOM Committee on Patient Safety and Health Information Technology health IT risk Tom Daschle Source Type: blogs

Non-Profit Hospital Executive Salaries Continue to Defy Gravity and Logic
The old saying is that nothing is certain except death and taxes.  In health care, the other near certainty seems to be that compensation for health care leaders is big and always getting bigger.  Over the past few weeks several reports about the compensation of top executives of US non-profit hospitals and hospital systems have appeared.  So it is time to do our latest round-up of incessantly buoyant hospital executive compensation, and argumentative hot air that seems to fuel it.  I will first summarize the latest cases in alphabetical order by state, and then examine some common justifications for th...
Source: Health Care Renewal - February 13, 2013 Category: Health Medicine and Bioethics Commentators Tags: hospitals executive compensation academic medical centers logical fallacies Source Type: blogs

Texas Medical Association slams ONC Healthcare IT safety plan
The Texas Medical Association offers views similar to the views I have been writing about for a decade and a half on healthcare IT quality and patient care risks:FierceHealth IT todayTexas Medical Association slams ONC safety planBy Dan BowmanThe health IT safety action plan proposed by the Office of the National Coordinator for Health IT in December is not specific enough to succeed, according to recent comments made by the Texas Medical Association. In its letter to National Coordinator for Health IT Farzad Mostashari, TMA said that responsibility for the plan "lacks focus," and should be ov...
Source: Health Care Renewal - February 13, 2013 Category: Health Medicine and Bioethics Commentators Tags: HIMSS CHIME healthcare IT risks ONC Texas Medical Association Source Type: blogs

Guest post by Dr. Jon Patrick, U. of Sydney: On the ECRI Institute's recommendations following a "deep-dive" study of HIT-related events
At my Feb. 9, 2013 post "ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis", I wrote about an ECRI Institute study of well-defined client data submitted over a 9-week period (a "deep dive" study) on EHR problems.  Risk-creating events at a level that should be a significant concern to patients and clinicians fell into the following categories: inadequate data transfer from one HIT system to anotherdata entry in the wrong patient recordincorrect data entry in the patient recordfailure of the HIT system to function as intendedconfiguration of the system in...
Source: Health Care Renewal - February 13, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT risks Jon Patrick ecri institute Source Type: blogs

A New ECRI Institute Study On Health Information Technology-Related Events
As I wrote here, I was a reviewer of the report in the PA-based, ECRI Institute-conducted study "The Role of the Electronic Health Record in Patient Safety Events."  ECRI studied the Pennsylvania Patient Safety Reporting System database for HIT-related errors.   The ECRI Institute is an independent organization renowned for its safety testing of medical technologies and reporting on same, and that "researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care."  I've mentioned it and its bylaws in this blog in the past as a model for independ...
Source: Health Care Renewal - February 9, 2013 Category: Health Medicine and Bioethics Commentators Tags: You heard it here first healthcare IT anecdote healthcare IT risks PA-PSRS Pennsylvania Patient Safety Authority ecri institute Source Type: blogs

ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis
As I wrote here, I was a reviewer of the report in the PA-based, ECRI Institute-conducted study "The Role of the Electronic Health Record in Patient Safety Events."  ECRI studied the Pennsylvania Patient Safety Reporting System database for HIT-related errors.   The ECRI Institute is an independent organization renowned for its safety testing of medical technologies and reporting on same, and that "researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care."  I've mentioned it and its bylaws in this blog in the past as a model for independ...
Source: Health Care Renewal - February 9, 2013 Category: Health Medicine and Bioethics Commentators Tags: You heard it here first healthcare IT anecdote healthcare IT risks PA-PSRS Pennsylvania Patient Safety Authority ecri institute Source Type: blogs

New York Mayor Bloomberg: Gun Control - Yes, Bad Health IT Control - No?
The Mayor of New York, Bloomberg, calls for anti-gun legislation because accidents and unexpected events such as theft or use by a child can happen, even with legally owned guns (I don't think he believes law-abiding citizens who own them for defense or for sport would break the law with them).Yet the selfsame Mayor uncritically calls for spread of another technology that in its present state is prone to accidents and unintended consequences, and unlike guns, at a level that even the Institute of Medicine has admitted in unknown due to systematic impediments to transparency (see the middle of this post for source).From a r...
Source: Health Care Renewal - February 8, 2013 Category: Health Medicine and Bioethics Commentators Tags: gun control Mayor Bloomberg healthcare IT risks healthcare IT benefits Source Type: blogs

From Parallel Universes? Dueling Accounts of VA/DoD EHR Integration
At a March 2010 post "VA / DoD EHR Interface Debacle: Will It Take the Luminosity Of A Dozen Supernovas To Shed Light On The Obvious About Healthcare IT?" I wrote about problems with ongoing efforts to integrate the Veteran Administration's EHR and the Dept. of Defense (active military) EHR.Now there appears to be two dueling accounts of the task's progress:Account One:DOD, VA to Speed Integration of Health RecordsBy Jim GaramoneAmerican Forces Press ServiceWASHINGTON, Feb. 5, 2013 – The secretaries of Defense and Veterans Affairs announced their departments will speed implementation of the Integrated Elect...
Source: Health Care Renewal - February 7, 2013 Category: Health Medicine and Bioethics Commentators Tags: Department of Defense DoD VA VistA AHLTA Source Type: blogs

Dueling Accounts of VA/DoD EHR integration
At a March 2010 post "VA / DoD EHR Interface Debacle: Will It Take the Luminosity Of A Dozen Supernovas To Shed Light On The Obvious About Healthcare IT?" I wrote about problems with ongoing efforts to integrate the Veteran Administration's EHR and the Dept. of Defense (active military) EHR.Now there appears to be two dueling accounts of the task's progress:Account One:DOD, VA to Speed Integration of Health RecordsBy Jim GaramoneAmerican Forces Press ServiceWASHINGTON, Feb. 5, 2013 – The secretaries of Defense and Veterans Affairs announced their departments will speed implementation of the Integrated Elect...
Source: Health Care Renewal - February 7, 2013 Category: Health Medicine and Bioethics Commentators Tags: Department of Defense DoD VA VistA AHLTA Source Type: blogs

More on the lengths a hospital will go through to protect their EHR from discovery
At "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" I wrote about obstruction of litigation by the defense regarding a case where an EHR contributed to patient injury and death.The major basis for the new "Motion for Reconsideration" (a request for the court to reconsider its prior denial of an earlier Motion for Reconsideration of an initial court decision to dismiss defense objections to the Complaint) is this.  From the actual filing (emphases mine):(click to enlarge) Here is likely why ...
Source: Health Care Renewal - February 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: lawsuit motion for reconsideration healthcare IT risks Source Type: blogs

CPRIT, Part 7 (Conclusion): Reflections
The story of CPRIT is not over. Revelations and reactions come out almost daily as the power struggles continue. It is ultimately in the legislature's hands what will occur.But the situation is not encouraging. There is no reason to believe that there is a way to put Humpty Dumpty back together again after this fiasco. Nothing I've seen looks at all hopeful about change even though the new CPRIT officials are making compliant noises. The vigorous pro-rapid-commercialization defenses being made are not reassuring. Those who promote a "business" or "engineering" approach to cancer drugs while disdaining s...
Source: Health Care Renewal - February 5, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs

The Story of CPRIT, Part 6: Reactions
There has been a lot of dismay in Texas as all this has become public (with the word "cronyism" being mentioned very frequently). As the Houston Chronicle asked in May: Why is CPRIT even funding commercial enterprises? Didn't voters expect the bond money to support research?[Answer: Voters did, and there was no mention of commercialization in the ballot measure. Legislators did get language about commercialization into the enabling legislation, however.] Newspapers and bloggers have not been happy with what is going on. Nor have some former supporters. Cathy Bonner, a cancer survivor and activist who had worked h...
Source: Health Care Renewal - February 5, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs

The Story of CPRIT, Part 5: A Can of Worms
The publicity engendered by the walkout caused more attention to various aspects of the Cancer Prevention & Research Institute of Texas (CPRIT). This turned up a number of other real or potential issues, as a compliance officer reviewed all past commercialization grants and a state audit was done. (As well, investigations by the Travis County DA and the Attorney General of Texas are ongoing.)The Dallas Morning News discovered that commercialization awards had been going to companies with connections to Perry and Dewhurst campaign contributors. A CPRIT commercialization award had gone to a firm, Caliber Biotherapeutics,...
Source: Health Care Renewal - February 5, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs

AMA News: Dangers of "EHR Sloppy and Paste" - And Why Was An Informatics Expert Apparently For "Anecdotes" Before He Was Against Them?
In the AMA News an article by Kevin O'Reilly appeared entitled "EHRs: “Sloppy and paste” endures despite patient safety risk."It addresses the dangers of a common feature of EHR's used recklessly:  copy-and-paste. EHRs: “Sloppy and paste” endures despite patient safety riskCopying and pasting information is common within EHRs, but the practice sometimes can lead to confusion and endanger patient care. By Kevin B. O'Reilly, amednews staff. Posted Feb. 4, 2013.During the winter holidays, a patient at Yale-New Haven Hospital in Connecticut had a large pressure ulcer with an abscess. A su...
Source: Health Care Renewal - February 4, 2013 Category: Health Medicine and Bioethics Commentators Tags: AMA News healthcare IT note cloning healthcare IT note copying Kevin O'Reilly healthcare IT anecdote Bill Hersh healthcare IT risks Source Type: blogs

The Story of CPRIT Continued, Part 4: The Walkout
Gilman’s resignation, though tendered in May, was effective in October. He wanted to shepherd grants that had already been through peer review but which were not yet actually funded through funding if possible, particularly as they had been delayed in the spring at the same time as the IACS grant was approved. He asked his peer reviewers to hang in with him through October. It is clear that he really tried his hardest to get a change in the new revised course of CPRIT – but he lost, and completely. He tried to get agreement that future commercialization projects would be subject to scientific review – and...
Source: Health Care Renewal - February 4, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs

Not the Story of CPRIT - Part 3: A Tangentially-Related Detour
I take a brief hiatus from relating the story of CPRIT to tell another story. This one is about a company that – please note – has no connection to CPRIT: Celltex Therapeutics. The tangential connection is that they are both in Texas and both are related to the mindset of some business folk and of our governor, Rick Perry, the man who recently stated that[CPRIT was] . . . intended . . . to get cures into the public's arena as soon as possible and at the same time create economic avenues (from) which wealth can be created. Basic research takes a long time and may or may not ever create wealth.A recent and excell...
Source: Health Care Renewal - February 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: stem cells Celltex CPRIT Source Type: blogs

The Story of CPRIT, Part 2: A Problematic Grant
The grant that upset Dr. Gilman so much that he chose to resign was an award of $22 million dollars for one year. The award had been presented to the Oversight Committeee and approved without going through any scientific review. It was a combination award to Rice and to an organization, IACS (Institute for Applied Cancer Science), associated with Lynda Chin, a scientist and wife of the president of M.D. Anderson, Ronald DePinho. Remarkably, the IACS portion of the award had not been reviewed by the provost of either Rice or M.D. Anderson, and after reaching CPRIT, it was rushed through the CPRIT approval process in a very ...
Source: Health Care Renewal - February 3, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs

The Story of CPRIT, Part 1: A Promising Start
HC Renewal readers who don’t live in Texas may not have followed the saga of the Cancer Prevention & Research Institute of Texas (CPRIT). It’s a fascinating story which will take me more than one post to tell even a partial version of, especially since a wealth of information is available because of FOIA requests and the superb reporting of the Houston Chronicle and The Cancer Letter.A constitutional amendment authorizing CPRIT was proposed to the voters in November 2007. (In Texas, lots of things that could be passed legislatively elsewhere require amending the constitution, so that it’s now a very l...
Source: Health Care Renewal - February 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: Cancer Prevention and Research Institute of Texas Alfred Gilman CPRIT Source Type: blogs

A Condemnation of Suppression of Medical Research... by Ben Goldacre in the New York Times
Amazingly, this topic now seems to be in the mainstream.The Goldacre Version in the New York Times in 2013 In his op-ed, Ben Goldacre introduced it thus:the entire evidence base for medicine has been undermined by a casual lack of transparency. Sometimes this is through a failure to report concerns raised by doctors and internal analyses, as was the case with Johnson & Johnson. More commonly, it involves the suppression of clinical trial results, especially when they show a drug is no good.He noted that this problems was supposed to be fixed by the registration of clinical trials, and by changes in editorial policies a...
Source: Health Care Renewal - February 2, 2013 Category: Health Medicine and Bioethics Commentators Tags: perverse incentives impunity You heard it here first transparency anechoic effect suppression of medical research Source Type: blogs

Modern Healthcare: "Health IT Iconoclasts"
The healthcare executive-targeted journal "Modern Healthcare" has named Dr. Ross Koppel, Dr. Deborah Peel, Dr. Larry Weed, and yours truly as "healthcare IT iconoclasts."  Dr. William Bria corroborated the importance of iconoclasty in this domain.(I would rather see the term "defender of patient's rights" rather then "iconoclast", but I'll settle for the latter if it gets the message out.)Author Joe Conn writes:... health IT has long had its critics, even among its pioneers and proponents, as these four prominent health IT iconoclasts will attest. All four consider themselves to...
Source: Health Care Renewal - February 2, 2013 Category: Health Medicine and Bioethics Commentators Tags: Lawrence Weed ross koppel Scot Silverstein Joseph Conn Modern Healthcare Deborah Peel Health IT Iconoclast William Bria AMDIS Source Type: blogs

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
My mother was injured and then died as a result of an EHR foul-up.  She sued the hospital where the mid-2010 accident occurred while she was still lucid, and I am now substitute plaintiff.  Yet the case has been held up through the defense (mis)using court process to stall.It seems the lengths a hospital will go to in order to protect their EHRs (i.e., from Discovery by an expert such as myself, which could show many problems) are amazing.To wit, their latest filing, in an attempt to throw a monkey wrench into the gears of the legal discovery process:2/1/2013MotionBY [redacted] HOSPITAL MOTION FOR RECONSIDERATION...
Source: Health Care Renewal - February 2, 2013 Category: Health Medicine and Bioethics Commentators Tags: lawsuit motion for reconsideration healthcare IT risks Source Type: blogs

US Senate Subcommittee Asks What the RUC is About
It has been a long time coming, but the issue of how the US Medicare and Medicaid system sets the fees it pays doctors, and hence sets the incentives on doctors that drive their health care decisions, finally got some public attention again. The background is complex, and may glaze the eyes of readers hoping for simple solutions to simple problems.  One wonders if the complexity was deliberately created to discourage solutions.  Yet we have created a complex, obscure, opaque health care system.  If we want to meaningfully improve it, we must address its "inside baseball" qualities.  Those...
Source: Health Care Renewal - January 31, 2013 Category: Health Medicine and Bioethics Commentators Tags: perverse incentives primary care RUC anechoic effect conflicts of interest Source Type: blogs

AMIA: Enhancing patient safety and quality of care by improving the usability of EHR systems, but ... no sympathy for victims of bad health IT?
A panel of experts from the American Medical Informatics Association have written a paper "Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA."The paper is publicly available at this link in PDF. The authors are  Blackford Middleton (Harvard Medical School),  Meryl Bloomrosen (AMIA),  Mark A Dente (GE Healthare IT),  Bill Hashmat (CureMD Corp.), Ross Koppel (Dept. of Socology, Univ, of Pennsylvania), J Marc Overhage (Siemens Health Services), Thomas H Payne (U. Washington IT Services),  S Trent Rosenbloom ...
Source: Health Care Renewal - January 30, 2013 Category: Health Medicine and Bioethics Commentators Tags: ross koppel AMIA healthcare IT usability Thomas H Payne Jiajie Zhang J Marc Overhage Bill Hashmat Blackford Middleton S Trent Rosenbloom Charlotte Weaver Meryl Bloomrosen Mark Dente Source Type: blogs

Broken Promises: Latest HCA Settlement Suggests Skepticism about the Next Big Thing in Health Care
A long time ago in the US, most people got care from physicians who were self-employed, or part of physician partnerships.  If they had to be hospitalized, it was at hospitals that were community or academic non-profit organizations.   If they had health insurance, it was likely from a non-profit Blue Cross Blue Shield affiliate.  However, with the rise of market fundamentalism, we have heard the promises of increased efficiency and innovation from for-profit health care.  So hospitals, insurance companies, and now increasingly physicians' practices have been bought up by for profit corporations.Ma...
Source: Health Care Renewal - January 29, 2013 Category: Health Medicine and Bioethics Commentators Tags: deception HCA mission-hostile management mergers public relations hospital systems broken promises Source Type: blogs

How the HIT zealots and profiteers have harmed physicians and nurses, not to mention patients, taxpayers, and the government
Any new technology introduced into a complex system, especially when introduced recklessly, has the potential to produce unexpected consequences, and the problems introduced can be worse than the problems the technology was attempting to solve.  This is a fundamental precept and empirical observation in the field of social informatics, a domain that studies information and communication tools in their cultural or institutional contexts.Idealism combined with zealotry (excess of zeal; fanatical devotion) and/or hyper-enthusiasm that ignores the downsides of an intervention, and silences credible critique,  has als...
Source: Health Care Renewal - January 29, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT unintended consequences healthcare IT risks Source Type: blogs

Senator Stephen H. Martin of Virginia: proposed limitations on use, storage, sharing, & processing of electronic medical record data
Here's a politician who certainly seems concerned with the privacy and confidentiality and flawed-analysis downsides of electronic health records -  Senator Stephen H. Martin of Virginia:SB 1275 Medical data in an electronic or digital format; limitations on use, storage, sharing, & processing. SUMMARY AS INTRODUCED:Medical data. Prohibits any person that regularly stores medical data in an electronic or digital format from (i) participating in the establishment or implementation of the Nationwide Health Information Network; (ii) performing any analytic or statistical processing with regard to any medical records ...
Source: Health Care Renewal - January 26, 2013 Category: Health Medicine and Bioethics Commentators Tags: HITECH medical record privacy medical record confidentiality Senator Stephen H. Martin Source Type: blogs

How the "Revolving Door" and Other Aspects of Corporatism Benefited Amgen Just After its Settlement and Guilty Plea
At least here in these United States, our health care corporatism is bipartisan.  Here we present a sorry story of how a company that should have been shamed by dishonest behavior that likely harmed patients instead apparently was awarded special treatment through its cozy relationships with top government leaders   Accusations of Kickbacks and Deceptive Marketing of Aranesp  Last month, biotechnology giant pleaded guilty to a charge of misbranding and settled civil charges with the US government for $762 million (look here).  Soon after, New York Times article described the unethical practices the comp...
Source: Health Care Renewal - January 23, 2013 Category: Health Medicine and Bioethics Commentators Tags: Amgen deception kickbacks stealth health policy advocacy crime revolving doors corporatism adverse effects Source Type: blogs

The HIT Scam
Worth a read -The HIT Scam By Greg ScandlenNotable in the piece are these observations:  ... even the editors of the Washington Post have come to agree the whole [national health IT] project was a fiasco — but only after we wasted $27 billion of taxpayer money. Yet, those who are enriching themselves on the $27 billion are just happy as clams over the program. John Hoyt, the Executive Vice President of the Healthcare Information and Management Systems Society (HIMSS) was quoted in a recent Health Change Bulletin as saying −This data suggests that the HITECH portion of the 2009 stimulus law is achieving its...
Source: Health Care Renewal - January 23, 2013 Category: Health Medicine and Bioethics Commentators Tags: HIMSS Healthcare IT failure Greg Scandlen HITECH healthcare IT cost Source Type: blogs

GUEST BLOG - What Can Doctors Do to Combat Business Malfeasance in Health Care?
Dr Gene Dorio is a an internist and geriatrician in California, described in the Los Angeles Times as an "old school physician."  He would welcome discussion with anyone interested in his proposal.  Please email him directly at grd51 at aol dot com, or email me for forwarding.     As a Health Care Renewal reader, learning of medical business malfeasance irritates my moral conscience, yet lack of legal intervention frustrates my inner core.I am chairman of the Department of Medicine at a small community hospital in Southern California, and as I battle the Administration during Medical Executive...
Source: Health Care Renewal - January 22, 2013 Category: Health Medicine and Bioethics Commentators Tags: learned helplessness corporate physician anechoic effect Source Type: blogs