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.
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.
Beacon programs offer hope for health IT
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Emma Schwartz and Fred Schulte, the HIT specialists at the Huffington Post Investigative Fund, examine the 15 “beacon” programs involved in a $220 million federal effort designed to demonstrate how health tech can bring better treatment at a lower cost. Twelve of the programs will focus, at least in part, on diabetes in order to explore how much of an impact HIT can have on chronic (and under-treated) diseases.
For more on each program, visit this interactive map.
The grants also offer an early test of a $27 billion gamble by the Obama administration that medical records technology can achieve specific cost reductions and health improvements, critical tenets of health reform.
Hopes are high. In Mississippi, the alliance aims to reduce blood sugar levels in at least one of four patients with diabetes, increase the numbers of people who take their medications as directed and cut the cost of their care by 10 percent – all within the next three years. In Tulsa, Okla., which has the nation’s highest rate of heart disease, another group is hoping that its $12 million grant will reduce preventable hospital visits by 10 percent while saving patients and taxpayers $11 million a year.
Schwartz and Schulte write hopefully of the potential shown by the beacon programs, but temper it with cautionary tales from Florida and various auditor’s offices.
Schulte, Schwartz look for help investigating HIT
Filed under: Health data, Health journalism, Hot Health Headline
Regular readers know that we always keep an eye out for updates from Fred Schulte and Emma Schwartz, the duo from the Huffington Post Investigative fund that refuses to let the Obama administration’s push for health information technology proceed without scrutiny. This time, they’re following up on past work with stories on HIT-related errors and the FDA’s role (or lack thereof) in the policing of HIT.
Their most interesting update, however, concerns their effort to get HIT-related “adverse events” data from the FDA. Schwartz describes the difficulties they’ve run into, how they’ve overcome them, and how readers can help them put the whole puzzle together. It’s an interesting strategy, and an equally interesting primer on the FDA’s tricky “Manufacturer and User Facility Device Experience,” or MAUDE, database. You can also find their own version of the data here, courtesy of Amanda Zamora.
Attending Health Journalism 2010?
Schulte will be speaking about “Tracking health-related stimulus money” during a panel at 4:15 p.m. on Friday. His co-panelists will be ProPublica reporter Michael Grabell and Phil Galewitz, a Kaiser Health News reporter and AHCJ board member.
On Sunday morning, don’t miss the panel “Personal electronic medical records: What will consumers need to know?” featuring:
- Steve Gray, partner, Affiliated Computer Services Healthcare Solutions
- Bala Hota, M.D., M.P.H., chief medical information officer, Cook County Health and Hospital System
- Thomas Layden, M.D., chief, Department of Internal Medicine; professor of medicine, University of Illinois at Chicago
- Moderator: Prerna Mona Khanna, M.D., M.P.H.. visiting clinical associate professor, University of Illinois College of Medicine
Report: Smart phones are changing health care
For the California HealthCare Foundation, Jane Sarasohn-Kahn created a 23-page report titled “How Smartphones Are Changing Health Care For Consumers And Providers (PDF).” The report’s key message is that, while doctors have been slow to adopt EMRs and other forms of HIT, they’ve been quick to adopt smart phones. And thus it would seem smart phone apps could hold the most promise of practical HIT implementation in the coming years. Especially since, Sarasohn-Kahn writes, Manhattan Research has found that “the number of physicians who own smart phones will increase from 64 percent in 2009 to 81 percent by 2012.”
The speed of the uptake has been remarkable for a nation that has been traditionally slow to adopt HIT, as Figure 1 shows. Two-thirds of physicians used smartphones in 2009. About 6 percent of these were using a fully functional electronic medical record or electronic health record system — while only 1.5 percent of hospitals had a comprehensive electronic health record system as of 2008.
And the promise and popularity of health on smart phones has led to a corresponding boom in apps, Sarasohn-Kahn writes. Right now, she says, “Some of the most widely used mobile applications by physicians are drug and clinical references, and clinical tools such as dosage calculators.”
For clinicians, the smartphone offers an alternative to many health IT formats that have been cumbersome and costly to adopt, and that may interrupt their workflow. As of February 2010, there were 5,805 health, medical, and fitness applications within the Apple AppStore. Of these, 73 percent were intended for use by consumer or patient end-users, while 27 percent were targeted to health care professionals. It should be noted that, although developers usually have a principal audience in mind, all users can and do download the apps. In the “medical” category, 33 percent of apps are meant for consumers/patients, 32 percent for physicians, 17 percent for medical students, 4 percent for other health professionals, and 2 percent for nurses.
In addition to her market statistics, Sarasohn-Kahn breaks the applications down into key categories, the most interesting of which are:
- Linking physicians to up-to-the-minute safety alerts on a local and national scale
- Delivering instant lab results
- Remote monitoring of patients and their vital statistics, as well as the issuance of related alerts
- Consulting with other physicians remotely
- Monitoring patient compliance with treatment recommendations and guidelines
Tracking medical errors amid health tech push
Filed under: Government, Health policy, Hot Health Headline
Fred Schulte and Emma Schwartz are still hot on the trail of health information technology at the Huffington Post Investigative Fund, now exploring the timeline and tactics involved in tracking medical errors as part of widespread stimulus-funded HIT adoption. Colleague Amanda Zamora’s companion graphic helps provide both an at-a-glance overview and in-depth understanding of how errors are tracked now and how they will be monitored in the future.
Schulte and Schwarz write that a federal panel hopes to create a national database of HIT-related errors, but that it won’t be functional until 2013, a date many experts fear is unnecessarily distant.
The draft proposal would require doctors and hospitals to report problems as a condition of receiving stimulus money, starting in 2013. The panel, which is expected to finalize the plan next month, also wants to require that manufacturers alert customers when software glitches are discovered and require all users of the systems to undergo safety training
…
But many early adopters, who often have spent a decade or more and tens of millions of dollars working out kinks, say that even additional oversight can’t stave off every potential hazard. And they are becoming increasingly vocal about the downside of rushing into buying the highly complex technology.
“There is a great fear among many people that we are asking organizations to go too far too fast,” said Justin Starren, who directs health technology at the Marshfield Clinic in Wisconsin. “It’s a foregone conclusion that with this many installations that some people will make some mistakes.”
Schulte will be taking part in a panel about “Tracking health-related stimulus money” at Health Journalism 2010. Joining him on the panel will be ProPublica reporter Michael Grabell and Phil Galewitz, a reporter for Kaiser Health News and member of AHCJ’s board of directors.
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