CPI investigation details health information technology sector’s lobbying efforts
Filed under: Conflicts of interest, Government, Health care reform, Health data, Public records
Writing for The Center for Public Integrity’s iWatch News, Josh Israel reports that, with billions of stimulus dollars still at stake, the number of health information technology lobbyists taking advantage of the lucrative “revolving door” between Capitol Hill and the private sector is sky-high, even by D.C. standards.
The Obama administration is still working to iron out the details of the “meaningful use” mandate expressed in the recovery act, and the big players in health IT are pulling out all the stops to ensure the rules are written to their advantage.
Healthcare Informatics magazine publishes an annual ranking of the 100 largest health IT companies by annual revenue. According to the Senate Office of Public Records, 15 of the companies in the 2010 ranking — most of them ranked in the top third by revenue — reported health IT-related lobbying activity in the first quarter of 2011 or the last quarter of 2010. Of the 90 lobbyists listed as having done health IT lobbying for those firms, at least 63 were former Congressional and/or executive branch staffers, many of whom worked for health-related agencies or committees.
For those interested in additional details on HIT’s lobbying efforts, Israel also included two sidebars:
- Only 15 of top 100 health information technology firms are lobbying on health IT
- Just 16 of top health IT firms maintain corporate PACs
Report explains doctors’ reluctance to adopt EMRs
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Writing for the Center for Public Integrity’s iWatch News, Susan Jaffe spent time in the trenches to better understand how government incentives toward the adoption of electronic medical records are (or aren’t) working. She spent time with Cleveland-area small practices and government agencies to understand the real obstacles faced by physicians on the ground. It offers a picture of the reality of EMR today. Some of my favorite tidbits:
- “570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the bonus.”
- “The systems are priced in a way that does not make comparison shopping ‘easy or necessarily valid,’ said Dottie Howe, a spokeswoman for the Ohio regional extension center. There is no basic price because each company offers different components, features, options, and level of technical support.”
- EMR systems can include more than a thousand sometimes-customizeable details, and that’s not including the myriad warnings and cross-checks.
- Compatibility with the systems in the area’s large hospitals is tough to guarantee, yet factors as a major concern for many small practices.
- How early adopters in the field were burned and are wary of getting fooled again.
- When practices adopt EMRs, they typically have to go through a “learning curve,” a period of weeks or months during which they can only see about half as many patients.
- Many major HIT companies don’t guarantee that physicians who adopt their systems will meet the standards for a government HIT bonus.
- The VA’s proven HIT system is available for free, but can’t handle billing and insurance.
- To get the maximum bonus payment, practices must adopt EMRs this year or next.
- Only certified systems can earn bonus payments, yet the second and third stages of certification haven’t even been finalized yet.
An accompanying piece by Emma Schwartz looks at one physician’s concerns.
Baby’s death illustrates how health IT can introduce complexity, error to system
Filed under: Health care reform, Hospitals, Hot Health Headline, Pharmaceuticals
Chicago Tribune reporters Judith Graham and Cynthia Dizikes explore the pitfalls of health information technology through the story of an infant boy who survived despite being born months early and weighing just 1.5 pounds, only to be killed by a sodium chloride overdose when a pharmacy tech entered information into the wrong field of his electronic medical record.
Photo by Christiana Care via Flickr
The tech’s fatal clerical error was compounded by disabled alarms on a compounding machine, incorrect labeling on an IV bag and an ignored lab test. The heart of the errors, the reporters write, seems to be that all the different systems involved don’t communicate.
Almost all medication requests at Advocate are transmitted by a doctor’s keystroke to the hospital pharmacy’s drug-dispensing system. But in this case, there was no electronic connection with the automated compounding system that prepared the IV bag for baby Burkett, a specialized device that handles low-volume, highly individualized orders.
So a technician transcribed the order by hand, and an error was introduced.
Electronic communication gaps are common at large hospitals, which typically use upward of 50 to 100 different information systems at their facilities, with different technologies used in emergency rooms, labs, pharmacies and other medical departments, said Ross Koppel, a sociologist at the University of Pennsylvania who studies health information technologies.
“To some degree these systems talk to each other, but mostly they don’t, so hospitals have to design custom-made software ‘bridges’ to make this happen,” Koppel said. With each jury-rigged software solution comes the potential for new software bugs, transcription errors and other problems.
ER scribes handle EMRs, free up doctors
St. Louis Post-Dispatch reporter Michele Munz has found that some emergency rooms are easing the transition to electronic medical records by hiring “scribes” to enter information into the system, thus freeing up the doctor to focus on the actual patient.
Photo by MC4 Army via Flickr
Munz reports that scribes are often young, well-trained, tech-savvy pre-med types who get $8 to $10 an hour and plenty of real-world clinical observation for their trouble. The use of one California-based company’s scribes has grown sevenfold in the past two years, expansion its CEO called “exponential.”
Munz’ story shows that the growth is driven by the desire to ameliorate productivity hits that many hospitals have faced in the wake of EMR adoption.
After the switch to computer records, emergency departments have reported a loss in productivity. At DePaul, patient wait times initially increased 28 percent and patient satisfaction declined 40 percent despite additional staffing, said Dr. Stephen Larson, director of the hospital’s emergency department. St. John’s Mercy also reported a peak in wait times.
While both hospitals have seen wait times drop as doctors get past the learning curve, the emergency physicians group at DePaul decided to begin the scribe program in December “to allow us to continue to add to our gains,” Larson said.
New EHR error-reporting system to keep data confidential
Filed under: Government, Health care reform, Health data, Health journalism
EHRevent.org, a service that will allow health workers to report and track errors associated with electronic health records, has launched with broad support and no small amount of fanfare. In cooperation with the federal government, the new system will be run by the iHealth Alliance and the PDR network. The iHealth Alliance already runs the Health Care Notification Network, while the PDR Network, perhaps best known for their Physicians Desk Reference, already distributes FDA warnings and drug labeling information.
It shows promise, of course, but that promise comes with one hefty caveat for health journalists: The resulting data will be kept under wraps. Wall Street Journal health blogger Katherine Hobson has the details:
The aggregated data will be available to medical societies, liability carriers and agencies such as the FDA, but will remain confidential — and won’t be subject to legal discovery. (The mechanism for this type of information sharing is the patient safety organization, federally sanctioned groups formed by providers, nonprofit groups and other interested parties to analyze data about medical errors. Groups can get aggregated data if they agree to keep it out of the public domain.)
CPI to absorb Huffington Post Fund, health focus to continue
Filed under: Health journalism, Hot Health Headline
The New York Times‘ Tanzina Vega reports that two major news nonprofits, both regulars on this blog, are joining forces to create a heavyweight investigative unit with deep roots in the nation’s capital. The Center for Public Integrity, who we praised most recently for the wide-ranging asbestos investigation they did with the BBC, will absorb the Huffington Post Investigative Fund, which was founded last year. The HuffPo crew will bring with them $2 million in grant money, Vega reported.
Huffington Post Investigative Fund reporters Fred Schulte and Emma Schwartz have come up often in this space, thanks to their dogged coverage of health information technology and the ARRA. Editor Keith Epstein told AHCJ, via e-mail, that the combined organization will build on their efforts.
We’re going to have a strong emphasis on health reporting generally, and we’re excited that part of that emphasis will be continued and even enhanced examinations of the nation’s deployment of stimulus-fueled health information technology.
Who monitors pharmacies’ systems to curb pseudoephedrine sales?
CVS Pharmacy has been in the news recently after it agreed to pay $75 million in penalties and forfeit $2.6 million in profits made from illegally selling pseudoephedrine. Scott Hensley did a nice job of explaining why the retailer got in trouble, which boils down to a defect in the electronic system the chain used.
As most allergy sufferers know, federal laws (and some state laws) limit how much pseudoephedrine consumers can buy. Retailers are left with the chore of monitoring who buys how much of the drug, which also can be used to make methamphetamine.
As the CVS case seems to show, and my personal experience backs up, retailers apparently can set up their own systems for tracking the sale of pseudoephedrine as long as they meet some basic requirements:
Regulated sellers are required to maintain a logbook, written or electronic, to record sales of products containing ephedrine, pseudoephedrine, or phenylpropanolamine. The seller must enter into the logbook the name of the product, and quantity sold. The customer must write or enter into the logbook their name, address, date, and time of sale. The customer must also sign the logbook. You may not sell the product unless these requirements are met.
What isn’t clear is who is regulating those systems.
If a retailer’s system doesn’t prevent someone from making multiple pseudoephedrine buys and exceeding the federal limit – as happened at CVS – or if a retailer’s computer program mistakenly calculates the wrong amount of pseudoephedrine contained in a medication, then the system is failing. In the case of CVS, the problem happened for more than a year at multiple locations.
Now, for that personal experience I mentioned earlier …
After recently being told I had met my limit of pseudoephedrine at a neighborhood pharmacy, despite the fact that I take less than the maximum dosage to control my allergies, I asked to look at the store’s records.
A sympathetic pharmacist showed me the log of my purchases and I discovered that when I bought a package of 18 pills, the store’s computer recorded it as a package of 18 pills, but it calculated the amount of pseudoephedrine in that package to be the same as what would be in a 36-count package. That amount of pseudoephedrine was what triggered the computer to tell the pharmacy not to sell any more to me.
Once I pointed out the error, the pharmacist got out a calculator and eventually concluded I was right. He was rather incredulous that the error could happen. He tells me that he’s put in a request with the company’s help desk to fix the problem.
However, I’m left wondering whether my name is flagged in a computer database somewhere because of the store’s error and how many other innocent people are also flagged. Not to mention how many allergy sufferers have been left unable to breathe properly because computer systems show they’ve bought more pseudoephedrine than they actually have.
Perhaps more importantly, what about the methamphetamine criminal cases that have been brought as a result of authorities examining these records? There was recently a large raid on meth labs in my area based on pharmacy records and the pharmacist I talked to said he’d been in court testifying recently in meth cases. Could errors in pharmacy records be a defense attorney’s dream?
IBM storyteller creates idealized HIT present
IBM staff storyteller (really!) Chris Luongo shared his comprehensive vision for what I’d call the “ideal present” of health information technology on IBM’s Building a Smarter Planet blog. (See full-size image on Flickr.) Luongo’s vision takes the form of an analog-style comic.
The impact of Luongo’s illustration comes not from whiz-bang tech – it’s all stuff we’ve seen before, from teleconferencing to databases – but from the broader realization that, if we could figure out that whole implementation thing, our health system could match his ideal model right now.
It goes without saying, of course, that IBM’s got a dog or two in the HIT fight.
(Hat tip to ReadWriteWeb’s Marshall Kirkpatrick)
Health IT moves forward, regulation doesn’t
Filed under: Government, Health policy, Hot Health Headline
Fred Schulte and Emma Schwartz report that while the Obama administration plans to create a digital medical file for every American by 2014, “the administration has established no national mandatory monitoring procedure for the new devices and software. That no process exists to report and track errors, pinpoint their causes and prevent them from recurring is largely the result of two decades of resistance by the technology industry, a review of government records and interviews by the Huffington Post Investigative Fund shows.”
Major HIT malfunctions continue – they focus on one of 10 hospitals in the Trinity Health System in the upper Midwest – and nobody has a grip on their location or frequency. Meanwhile, the administration has issued regulations for HIT implementation that make no mention of safety and quality standards, standards the FDA has been considering for some time.
Text messages: health IT at its most basic
Amid the administration’s push for innovation in health information technology, the Associated Press’ Lauran Neergaard takes a broad look at the use of text messages to “nag” patients into following healthy behaviors on a daily basis.
It’s deceptively low-tech compared with electronic medical records and advanced devices, but the humble text message has shown impressive success rates thus far. Neergard says that, while novelty may be part of their power, personalized nagging texts appear to have a future beyond simple reminders to wear sunscreen on a sunny day.
For the record, those reminders increased sunscreen use by 40 percent in a six-week study.
Neergard’s story, taken as a whole, really drives home the realization that a simple health implementation of a mature technology is only now gaining traction in the health sphere is a testament to the formidable obstacles to HIT innovation.
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