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Thursday, April 30, 2009

Emergency on The Health Train Express???

The  H1N1 viral particle

Okay, what constitutes an emergency??  Our public health authorities now are linked to the Department of Homeland Security.  "Pandemic" is now being used to describe what is not even an epidemic in terms of numbers or morbidity or mortality.

Apparently our bureaucracy of federal and state administration requires the declaration of an 'emergency' to release funding for events such as this.  Let's be clear and scientific about all of this "political posturing' and bad science. We are not in the midst of, nor even approaching a 'pandemic' let alone an epidemic.

On a daily basis we are given figures as to how many deaths and/or reported cases of H1N1 Infuenza have been diagnosed. What we are not being told is how many non H1N1 cases are occuring concurrently.  How does this year's total for 'flu' compare with previous years. 

News travels now at the speed of light, whether true or false. 'Diseases such as flu now travel at the speed of flight.

Fear and panic should not replace caution and sensible behavior.

Public health officials need to inject some sanity into the equation, and media companies need to tone down their rhetoric about H1N1 (now more politically correct than Swine Flu)

Egypt slaughters 300,000 pigs. (Don't they have kosher dietary laws anyway?

Wednesday, April 29, 2009

Rob and Kevin on the Health Train Express

Kevin MD will be hosting Rob Lambert on a live Q&A at 10 PM EDT  Wednesday, April 29, 2009.  Join us.

Roxana Saberi on the Health Train Express

image From THCB,

Bloggers across the web are holding a blog rally in support of Roxana Saberi, who is spending her birthday on a hunger strike in Tehran's Evin Prison, where she has been incarcerated for espionage. According to NPR, "The Iranian Political Prisoners Association lists hundreds of people whose names you would be even less likely to recognize: students, bloggers, dissidents, and others who, in a society that lacks a free press, dare to practice free expression."


We here at Health Train Express have decided to join the Blue Ribbon campaign (Blue is for blogging) to honor and show support for those journalists, bloggers, students and writers imprisoned in Evin Prison, nicknamed "Evin University," and other prisons around the world, for speaking and writing their minds. 

Please consider placing a blue ribbon on your blog or website this week to show your support.  Also, please ask others to join this blog rally.

Monday, April 27, 2009

Pitfalls of PHR

from: THCB

Should You Keep Your Own Medical Records?

By RAHUL PARIKH, MD as written on "The Health Care Blog"


Personal Electronic health records raise doubt

Google service's inaccuracies may hold wide lesson

Dave deBronkart's records had wrong data.
Dave deBronkart's records had wrong data.

When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.

Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.

For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.

Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention."

DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment.


DeBronkart - who blogged about his Google Health experience on the website - has some simple advice for patients who use personal health records.

"Check it," he said. "See if it's accurate."

"Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has," said David Kibbe MD,  a senior technology adviser to the American Academy of Family Physicians

This fact negates the proposed effectivenss of a CMS' program of Pay for Performance, based upon claims data from physicians. For years Medicare has based cost containment on raw data regarding utilization from coding information on claims made without regard to the clinical data behind the claims.   Few of us are privy to their exact 'thought process'.

Sunday, April 26, 2009

11 Classic blog posts on EMR adoption

Our greatest glory is not in never failing, but in rising every time we fail."
~ Confucius


KevinMD posts a summary 11 classic posts since 2004 on electronic medical records.  Some of these are still valid. However, there seems to be a gradual but definite shift towards HIT adoption.

1. The low adoption rate of electronic records
2. Will physicians sacrifice for the future of health IT?
3. How to fund electronic medical records wisely
4. Medical students who are used to electronic records
5. Funding electronic medical records and bailing out the Big Three automakers
6. Do electronic medical records really reduce malpractice risk?
7. Do electronic medical records lead to fraudulent documentation?
8. Are hospitals the primary beneficiaries of the health IT stimulus?
9. How the widespread adoption of electronic medical records can raise health care costs
10. Are poor products to blame for the slow adoption of EMRs?
11. Op-ed: Why doctors still balk at electronic medical records

Now HIT funding and adoption seems inextricably woven into the fabric of the "stimulus package".  Healthcare now has additional responsibilities that go way beyond patient care.  Healthcare now accounts for a significant portion of the GDP, and is now the recipient of "stimulus" money at the taxpayer's largesse. Thus adds to the chaos and dysfunction of taking care of 'a patient'.

It now becomes more difficult for the doctor to make correct treatments for the patient, since he now has to worry about how his decisions and orders effect overall health budgets.  


Thursday, April 23, 2009

Health Train's New Track

Make everything as simple as possible, but not simpler.

Albert Einstein


Are they Listening? Apparently so. Providers now have an eager, and respected voice at one of the ‘decision making’ levels in the bureaucracy of those inside the “beltway”. David Blumenthal the new head of ONCHIT has made some public statements in regard to ‘haste makes waste’. In his recent statements in the April 9, 2009 edition of the NEJM Dr Blumenthal reiterates what most all providers already know. “Keep it simple”.

Dr. Blumenthal, most recently director of the Institute for Health Policy at Massachusetts General Hospital/Partners HealthCare System in Boston, states in the NEJM article that one challenge for HITECH is a tight schedule. "The infrastructure to support HIT [health information technology] should be in place well before 2011 if physicians and hospitals are to be prepared to benefit from the most generous Medicare and Medicaid bonuses," he writes. Appointed last month as the national coordinator for health information technology in the Department of Health and Human Services, internist David Blumenthal, MD, will play a key role in implementing a portion of the American Recovery and Reinvestment Act dubbed the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Don't Force Physicians to Buy User-Unfriendly Systems

What those standards and policies will look like is Dr. Blumenthal's other big worry. According to HITECH, only a certified EHR system qualifies for a bonus, yet the law doesn't specify who will perform the certification. There's a contender in the wings — the Certification Commission for Healthcare Information Technology (CCHIT) — but Dr. Blumenthal writes that many CCHIT-certified programs "are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system."

Other “power players” in the advisory role for HIT, David Kibbe, Sam Karp, and Ben Park all summed it up by stating the following:

All the EHR authorities interviewed by Medscape Medical News agreed with Dr. Blumenthal's assertion that physicians will feel more motivated to use EHRs if third-party payers reimburse them for improving the quality and efficiency of healthcare. Family physician Ben Park, MD, an EHR user for 30 years and CEO of a 200-physician network in Indiana and Ohio, said more pay-for-performance programs and their reliance on data collection would hasten EHR adoption, assuming payers put more money on the table. "Right now, it's peanuts for performance," he said.

For many physicians and HIT advocates, the "meaningful use" requirements of HITECH represent another unsettling question mark because they have' not been fully spelled out. For example, physicians must use their EHRs to report how they perform on clinical quality measures that HHS has yet to select, but which will lean toward the management of high-cost, chronic diseases. Dr. Blumenthal warns in his NEJM article that the bar for meaningful use could be set too high, frustrating physicians and hospitals. Sam Karp recommends starting low, with quality measures as elemental as receiving lab results electronically, or reducing adverse drug interactions (made possible by automatic alerts that pop up during electronic prescribing).

Don't Force Physicians to Buy User-Unfriendly Systems

What those standards and policies will look like is Dr. Blumenthal's other big worry. According to HITECH, only a certified EHR system qualifies for a bonus, yet the law doesn't specify who will perform the certification. There's a contender in the wings — the Certification Commission for Healthcare Information Technology (CCHIT) — but Dr. Blumenthal writes that many CCHIT-certified programs "are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system."

Dr. Park's desire for higher pay also applies to the HITECH incentives, which he considers too low. Sharing his view is Micky Tripathi, president and CEO of the nonprofit Massachusetts eHealth Collaborative, which has helped some 600 physicians implement EHR systems. Based on his group's experience, Mr. Tripathi estimates that $44,000 in incentives under Medicare would cover only about two thirds of a physician's EHR costs over 5 years.

"The way this program is currently structured, the odds are quite low that EHRs will get high adoption," Mr. Tripathi said.

Monday, April 20, 2009

HIMMS REPORT from iHealthbeat

Federal Stimulus Package Hot Topic of This Month's Annual HIMSS Conference

This Audiocast  Special Report from iHealthbeat discusses the overall view of new funding of health IT.

New Stimulus package incentive payment estimates

Newly Named Health IT Chief Addresses Federal Stimulus Funding

And it just keeps getting better and better. "I'm from the government and I am here to help you."


Recovery Dialogue:

IT Solutions
For one week beginning April 27th, The Recovery Accountability and Transparency Board and the Office of Management and Budget in partnership with the National Academy of Public Administration, will host a national online dialogue to engage leading information technology (IT) vendors, thinkers, and consumers in answering a key question:

What ideas, tools, and approaches can make a place where all citizens can transparently monitor the expenditure and use of recovery funds?

Participants from across the IT community will be able to recommend, discuss, and vote on the best ideas, tools, and approaches. Your ideas can directly impact how operates and ensure that our economic recovery is the most transparent and accountable in history. Mark your calendars and check back for the web link and additional information.

See full size image

New NIH Recovery Act Opportunity Seeks to Fund High Impact, Large-Scale, Accelerated Research

Monday, April 13, 2009

Goal to Promote Growth and Investment in Biomedical R&D, Public Health and Health Care Delivery

The National Institutes of Health highlighted a new funding opportunity under the Recovery Act that will support approximately $200 million in large-scale research projects that have a high likelihood of enabling growth and investment in biomedical research and development, public health and health care delivery. The purpose of this new program, the Research and Research Infrastructure "Grand Opportunities" (GO), is to support high impact ideas that lend themselves to short-term funding and may lay the foundation for new fields of scientific inquiry.

Read More.


Health 2.0

For you afficionados of SAS, and asp solutions,stay tuned to the imminent meeting of the new improved merger of Health 2.0  and Ix . Much  more information is available by clicking here or on the logo below.


Sunday, April 19, 2009

AMA joins the Health Train Express


Who said the American Medical Association is out of touch with today's rising provider stars under the age of 55? Not relevant? Does not represent the vast majority of physicians in regard to government regulations?  A group of Medical Politicians? Not so! The AMA now has a place on Twitter, and  "Twits" about all things medical.  Actually the correct term is   "Tweet".

Tweetie Pie is a 1947 Merrie Melodies cartoon directed by Friz Freleng and produced by Warner Bros. Cartoons, depicting the first pairing of Tweety and Sylvester.

I hope that my dues to the AMA are not being spent on this 'ridiculous' means of marketing and communications. The twits are limited to somewhere around 140 characters. Twit is actually meant for cell phone and smart messaging.  It is equivalent to your pager going off to tell you about some medical news or other item the AMA deems important to physician members.  (They ought to spend more time and money for information flowng at them, not from them.)

I started this particular entry several days ago......not much interest now in finishing it.

On to more challenging issues, such as how and why TARP is around and how we will be 'stimulated' and prodded to adopt EHR and HIT. There is much material to review and I will be back!!

Sunday, April 12, 2009

Misdirected Heat IT Funding Chapter II

I never think of the future. It comes soon enough.

Albert Einstein



....There are other ways to utilize HIT in direct patient care that would create enormous dividends and decrease medicare and private payments to hospitals.


The Silver Bullet Approach

A recent study revealed that a great number of medicare beneficiaries are re-admitted to hospital within 30 days of their discharge due to inadequate post discharge followup.

The study published by the New England Journal of Medicine   states,  "Twenty-two per cent of Medicare hospitalizations were followed by a readmission within 60 days of discharge. Medicare spent over $2.5 billion per year (24 per cent of Medicare inpatient expenditures) on such readmissions between 1974 and 1977.  This study  supercedes similar studies in 1994-1996, and 1984-1986.  The study cohorts are not similar in demographics or provider institutions and may not be comparable.

In this study, the cost of unplanned overcapitalization in 2004 was estimated to account for US$17.4 billion of the $102.6 billion in hospital payments from Medicare. A large percentage of bounce-back admissions appear to be related directly to poorly coordinated transitions of care. Given that a woeful percentage of patients attend follow-up visits, tremendous  improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge.

Other articles explain how medicare's prospective payment as well as  DRG reimbursement plan has created this image

difficulty and increased expenditures,and how improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge.  (Does a shorter hospital stay reduce costs and/or increase readmission rates. ) Are patients stable on discharge?

Would HIT spending in this area, applied in a systematic way reduce these expenditures?  Why spend it all on EMR and HIE?

Richard Reece MD, who writes in Medinnovation Blog elaborates on how these billions of dollars might well be apportioned more wisely.

Misdirected Health IT Funding

Let it be said that the Federal Government knows how to spend money on the wrong things in the wrong way.



One of the hypothesis (and yet to be proven) is that EMRs, and Health Information Exchanges will lower costs for medicare and private insurers.

The recent promises of using stimulus funds to promote health information technology while well intentioned has not been well thought out.

The financial structuring of the incentives is to 'rush' to implementation.  This will actually encourage the adoption of immature and inadequate electronic medical record systems. Interoperability and certifications do not ensure an efficient or  useful EMR.

Those providers who adopt this incentive thinking that the initial payoff in incentives will offset any possible penalties for delaying implementation.  Furthermore they may adopt a system that will actually cost them more in the long run, by being inadequate for their use.

This legislation for HIT funding is fueled by industry lobbyists (vendors), and organizations such as HIMMS which are largely directed by vendors themselves.

They wait at the doors of "public funding" for their take of stimulus funds. 





Saturday, April 11, 2009

Ask not what you can do for your Country, ask what your kids can do for you???


What did we ‘baby boomers’ do right?? How come almost everything we attempt to do, turns out to harm us more than help us??

Cover you A-s

I came across this on Matt Holt's ''The Health Care Blog" this AM during my usual scan of the health blogosphere.

Blogging has surely tapped into sources that most physicians have neither the access, nor time to analyze.

The health care situation" has now been posited for the iminent financial underpinning of the economy and it's rush toward doom. Numerous bean counters will bemoan the fact that the

health care portion of the economy is increasing in relation to the GDP to the point where it is unsustainable.


Will a "Universal Payor" (socialized, or privatized) do anything to reverse this trend??  Most providers recognized the inherent inefficiencies and redundant bureaucratic organizations operating in the healthcare sphere.

Health care has been labelled as 'the driving force' toward financial doom as it's financial underpinning and never ending demand for services. 

In the past, venture capital funding for health care has been meager when compared to the rest of the financial world.

Tim Mullaney in The Health Care Blog  discusses the Psilos Group's plan to raise 450 million dollars. The fund support Health Care Technology and Services.