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.
NEHI maps out future of comparative effectiveness
Filed under: Government, Health care reform, Health policy, Studies, Tools
NEHI, a nonprofit research group that was known as the New England Heathcare Institute, has released a white paper mapping out a potential near future for comparative effectiveness research in the United States. We first noticed the report on the Kaiser Family Foundation’s Health Reform Source site.
The white paper’s authors, Tom Hubbard, Shin Daimyo and Karan Desai, make a strong case that proper dissemination will be the real key to the success of CER. Their argument hinges on the observation that, even today, good medical research rarely makes it into clinical practice without a hefty nudge. 
When it comes to delivering this nudge to all that stimulus-funded comparative effectiveness research, the paper’s authors have singled out the newly created Patient-Centered Outcomes Research Institute. PCORI’s stated role is to help all stakeholders make informed health care decisions. It’s also, the authors write, uniquely positioned to become a key force in CER dissemination alongside the AHRQ’s Office of Communications and Knowledge Transfer. Unlike AHRQ, PCORI is an independent organization that’s free to form relationships and build consensus across the spectrum.
All in all, the report’s a quick and handy read. There are only 9 pages of text, and you’ll come out with a better understanding of the practical problems facing those who seek to apply comparative effectiveness research. If you’re looking for examples of successful implementation programs, head to pages 8 through 10.
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.
FDA to regulate health information technology?
Fred Schulte and Emma Schwartz, the Huffington Post Investigative Fund duo who have made it their business to stay in front of all stories related to the federal push for the adoption of health information technology, now look at the possibility of federal regulation of health IT.
Schulte and Schwartz write that “In the past two years, the agency has received reports of six patient deaths and several dozen injuries linked to malfunctions in the systems,” and officials say those voluntary reports represent just the tip of the iceberg. In case you’re interested, here are the transcripts from the relevant government hearing.
… digital medical systems are not risk-free. Over the past two years, the FDA’s voluntary notification system logged a total of 260 reports of “malfunctions with the potential for patient harm,” including 44 injuries and the six deaths. Among other things the systems have mixed up patients, put test results in the wrong person’s file and lost vital medical information.
Schulte and Scwartz summarize the three possible regulatory approaches outlined by officials:
- Option 1: FDA requires HIT makers to register, submit safety reports and correct problems.
- Option 2: FDA requires HIT makers to report safety concerns and sets minimum quality guidelines.
- Option 3: FDA makes HIT “subject to the broader regulatory actions that new medical products must face before they ever reach the market.”
Many manufacturers argue that such regulation could be counterproductive.
The manufacturers of the systems generally have opposed regulation by the FDA, arguing in part that imposing strict controls would slow down the government’s campaign to spur widespread adoption of the technology.
Regulation will not necessarily create a “safer” electronic medical record “and might actually limit innovation and responsiveness when it is needed most,” Carl Dvorak, executive vice president of Epic Systems Corporation, a Wisconsin-based company that builds the systems mainly for hospitals and large medical practices, said in his prepared testimony for Thursday’s hearing. The hearing is being held by an advisory group created by the stimulus law.
Government Health IT also is following the issue and points to some problems the Veterans Health Administration has run into and how it dealt with the lapses.
FCC’s broadband plan includes wireless health tech
The Federal Communications Commission will release a report next month outlining a national broadband plan that is expected to include measures for promoting and facilitating the use of mobile devices in health care, Mary Mosquera of Goverment Health IT reports. The plan was mandated as part of the stimulus package.
The FCC plan will describe “where government has a role to reduce some of the hurdles to these technologies both in connectivity and to promote innovation in applications,” said Dr. Mohit Kaushal, digital healthcare director of the FCC’s Omnibus Broadband Initiative.
The American Recovery and Reinvestment Act called for the FCC to develop a plan for establishing broadband connections to the Internet as a way to spur business development, job creation and improvements in healthcare.
To demonstrate a few possible uses of such technology, Mosquera also talks to organizations, hospitals and doctors who are taking advantage of current resources.
NIH updates stimulus grant info, releases database
Filed under: Health data, Health journalism, Public records, Tools
We’ve been waiting for this one. The National Institutes of Health have followed through on their promise to release a comprehensive database of NIH grants funded with stimulus money. The new data is up-to-date as of yesterday, you can find it on this page or go directly to the 13mb Excel file. The NIH’s stimulus transparency site has been quite good, in general, but inexplicably lacked key data fields and a way to export more than 500 (of 12,000+) grants at a time. The new database solves those issues.
For a quick picture of where the stimulus cash was headed, we grabbed data for all 50 states as well as D.C. and Puerto Rico, added some recent census estimates, and put together a few top 10 lists. Massachusetts, D.C. and California lead most categories, and per-capita numbers differ pretty significantly from absolute totals.
Which states (etc.) are getting the most NIH grant money?
And how does all of that money break down on a per-person basis?
What about individual NIH grants?
And what’s the per-capita on those?
These are just scratching the surface, the database has a separate entry for each grant, and it’s pretty easy to break it down by institution, research area and a number of other categories.
Does stimulus-funded research stimulate?
Filed under: Government, Hot Health Headline, Studies
Reporter Michelle Breidenbach of the Syracuse, N.Y., Post-Standard considers local academic research being funded by stimulus money and wonders just how much these projects – many of which were turned down previously and selected for stimulus money based partly on timing considerations – are really stimulating the economy. There were no job-creation or buy-American strings attached and, while ostensibly health-related, studies covered such esoteric topics as wild ticks on lab mice and the interaction between marijuana and malt liquor consumption.
With a story localization model that can be applied across the country, Breidenbach used the NIH’s grant-tracking site to check in on stimulus-funded projects getting underway at a number of nearby universities, then contacted researchers and assessed their work’s impact on the local economy and on human knowledge in general.
About 45,000 docs qualify for HIT stimulus money
Researchers at George Washington University have found that approximately 45,000 physicians nationwide qualify for as much as $63,750 each in federal stimulus money to be used for the adoption and maintenance of health information technology beginning in 2011.
According to the press release, the following groups of physicians will qualify for as much as $63,750 as long as they demonstrate meaningful use of HIT:
- Office-based physicians whose patients are made up of at least 30 percent Medicaid beneficiaries.
- Office-based pediatricians who have a patient mix including 20 percent medicare beneficiaries will qualify for the same incentives.
- Physicians who practice at federally qualified health centers and other settings can qualify if 30 percent of their patient base is characterized as “needy,” including those covered by Medicaid, those who receive uncompensated care and patients who are charged income-related sliding scale fees.
Reporters may be able to localize this by finding qualified doctors in their area or by checking with community health centers and rural clinics. Page 10 of the report lists how many qualifying physicians there are in each state.
Find the full study here (14-page pdf).
Stimulus boosts health care for poor Americans
The Associated Press’s Kristen Wyatt looks at one category of stimulus spending that’s already making an impact: funding for clinics serving the poor and disadvantaged.
From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.
The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it - about $500 million - is already being spent. The White House has promised another burst of money this summer.
Wyatt quotes grateful patients and providers, but also tempers the enthusiasm with a reminder that the money comes in the form of one-time grants that aren’t designed to fix the systemic problems behind the lack of health services for America’s poorest residents.
For a full list of Health and Human Services programs receiving stimulus money, visit the HHS page at recovery.gov or use this map to find programs benefiting from the stimulus in your area.
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