A Major Glitch for Digitized Health-Care Records

In two years, hundreds of thousands of American physicians and
thousands of hospitals that fail to buy and install costly health-care
information technologies-such as digital records for prescriptions and
patient histories-will face penalties through reduced Medicare and
Medicaid payments. At the same time, the government expects to pay out
tens of billions of dollars in subsidies and incentives to providers
who install these technology programs.

The mandate, part of the 2009 stimulus legislation, was a major goal
of health-care information technology lobbyists and their allies in
Congress and the White House. The lobbyists promised that these
technologies would make medical administration more efficient and
lower medical costs by up to $100 billion annually. Many doctors and
health-care administrators are wary of such claims-a wariness based on
their own experience. An extensive new study indicates that the
caution is justified: The savings turn out to be chimerical.

Since 2009, almost a third of health providers, a group that ranges
from small private practices to huge hospitals-have installed at least
some “health IT” technology. It wasn’t cheap. For a major hospital, a
full suite of technology products can cost $150 million to $200
million. Implementation-linking and integrating systems, training,
data entry and the like-can raise the total bill to $1 billion.

But the software-sold by hundreds of health IT firms-is generally
clunky, frustrating, user-unfriendly and inefficient. For instance, a
doctor looking for a patient’s current medications might have to click
and scroll through many different screens to find that essential
information. Depending on where and when information on a patient’s
prescriptions were entered, the complete list of medications may only
be found across five different screens.

Now, a comprehensive evaluation of the scientific literature has
confirmed what many researchers suspected: The savings claimed by
government agencies and vendors of health IT are little more than
hype.

To conduct the study, faculty at McMaster University in Hamilton,
Ontario, and its programs for assessment of technology in health-and
other research centers, including in the U.S.-sifted through almost
36,000 studies of health IT. The studies included information about
highly valued computerized alerts-when drugs are prescribed, for
instance-to prevent drug interactions and dosage errors. From among
those studies the researchers identified 31 that specifically examined
the outcomes in light of the technology’s cost-savings claims.

With a few isolated exceptions, the preponderance of evidence shows
that the systems had not improved health or saved money. For instance,
various studies found the percentage of alerts overridden by
doctors-because they knew that the alerted drug interactions were in
fact harmless-ranging from 50% to 97%.

The authors of “The Economics of Health Information Technology in
Medication Management: A Systematic Review of Economic Evaluations”
found no evidence from four to five decades of studies that health IT
reduces overall health costs. Three studies examined in that McMaster
review incorporated the gold standard of evidence: large randomized,
controlled trials. They provide the best measure of the effects of
health IT systems on total medical costs.

A study from Regenstrief, a leading health IT research center
associated with the Indiana University School of Medicine, found that
there were no savings, and another from the same center found a
significant increase in costs of $2,200 per doctor per year. The third
study measured a small and statistically questionable savings of $22
per patient each year.

In short, the most rigorous studies to date contradict the widely
broadcast claims that the national investment in health IT-some $1
trillion will be spent, by our estimate-will pay off in reducing
medical costs. Those studies that do claim savings rarely include the
full cost of installation, training and maintenance-a large chunk of
that trillion dollars-for the nation’s nearly 6,000 hospitals and more
than 600,000 physicians.

But by the time these health-care providers find out that the promised
cost savings are an illusion, it will be too late. Having spent
hundreds of millions on the technology, they won’t be able to afford
to throw it out like a defective toaster.

It is already common knowledge in the health-care industry that a
central component of the proposed health IT system-the ability to
share patients’ health records among doctors, hospitals and labs-has
largely failed. The industry could not agree on data standards-for
instance on how to record blood pressure or list patients’ problems.

Instead of demanding unified standards, the government has largely
left it to the vendors, who declined to cooperate, thereby ensuring
years of noncommunication and noncoordination. This likely means
billions of dollars for unnecessarily repeated tests and procedures,
double-dosing patients and avoidable suffering.

Why are we pushing ahead to digitize even more of the health-care
system, when the technology record so far is so disappointing? So
strong is the belief in health IT that skeptics and their science are
not always welcome. Studies published several years ago in the Journal
of the American Medical Association and the Annals of Internal
Medicine reported that health IT systems evaluated by their own
developers were far more likely to be judged “successful” than those
assessed by independent evaluators.

Government agencies like the Office of the National Coordinator of
Healthcare Information Technology (an agency of the Department of
Health and Human Services) serve as health IT industry boosters. ONC
routinely touts stories of the technology’s alleged benefits.

We fully share the hope that health IT will achieve the promised cost
and quality benefits. As applied researchers and evaluators, we
actively work to realize both goals. But this will require an accurate
appraisal of the technology’s successes and failures, not a mixture of
cheerleading and financial pressure by government agencies based on
unsubstantiated promises.

Mr. Soumerai is professor of population medicine at Harvard Medical
School and Harvard Pilgrim Health Care Institute. Mr. Koppel is a
professor of sociology and medicine at the University of Pennsylvania
and principal investigator of its Study of Hospital Workplace Culture

Sen. Schumer Press Release of BRAINS Act

FOR IMMEDIATE RELEASE: September 18, 2012

SCHUMER, COONS INTRODUCE VISA REFORM PLAN TO KEEP BEST AND BRIGHTEST IN U.S. TO FUEL VITAL INDUSTRY, CREATE JOBS AND BOOST ECONOMIC GROWTH

 

Current Immigration Policy Encourages Foreign Students With Advanced Degrees To Move Home, Despite Shortage of Engineers in U.S. “BRAINS Act” Would Make It Easier For Most Talented Foreign Students To Stay In U.S. After School And Fill High-Tech Jobs Vital To Emerging Start-ups and Tech Giants

Senate Plan Would Create 55K New STEM Visas In Each of Next Two Years

 

 

WASHINGTON, DC—U.S. Senators Charles E. Schumer (D-NY) and Chris Coons (D-DE) unveiled legislation on Tuesday to reform the U.S. visa system in order to encourage the world’s best and brightest to stay in the United States after receiving graduate degrees in the science, technology, engineering, and math (STEM) fields.

 

The “BRAINS Act” would fix a long-existing problem in our visa system that, despite the worsening shortage of highly-skilled tech workers based in the United States, forces many of the world’s brightest students to return to their country of origin, taking with them any economic growth and jobs that they might create.

 

The legislation creates a pilot program through which 55,000 new green cards per year will be available for foreign students who graduate from U.S. universities with advanced degrees in STEM fields. It also reduces the red tape to obtain a student visa, and allows high-tech workers currently in the United States on temporary visas to renew their visas without having to first return to their country of origin.

 

“It makes no sense that America is educating the world’s smartest and most talented students and then, once they are at their full potential, kicks them out the door,” said Schumer. “We should be encouraging every brilliant and well educated immigrant to stay here, build a business here, employ people here, and grow our economy.  Fixing our broken greencard system will help ensure that the next eBay, the next Google, the next Intel will be started in America, not in Shanghai.”

 

“American colleges and universities are educating some of the sharpest technical minds on the planet,” Coons said. “So why are we sending them away to pursue their ideas in other countries? We are fueling the economies that are trying to beat us in the global marketplace. The BRAINS Act clears a path for foreign-born, American-educated students with advanced degrees in science, technology, engineering and math to stay in the United States after graduation to pursue their ideas and create jobs here. This bill is a creative solution to a significant problem, and a smart way to inject new innovations into the American market. I’m proud to support these needed reforms to our immigration system, and to help unite families who are an integral part of the fabric of this country.”

 

Current immigration policy encourages foreign students to study and get their degrees from America’s top universities, but discourages those same students from remaining in the United States and starting new companies in America. Schumer and Coons noted that those students who wish to make America their permanent home must compete for very limited H1-B temporary visas that make it difficult to change jobs, earn a promotion, or travel abroad; or they must eventually give up and return home—wasting what is often up to a decade of educational investment by our American schools.

 

Minority-serving hospitals have problems with quality of care and patient satisfaction

Previous studies have shown disparities in the quality of care for blacks, including higher surgical mortality and complication rates. Patients treated in hospitals with high concentrations of black patients reported less satisfaction with their care and experienced several difficulties, reveals a new study. The researchers examined patient discharge data from 568 hospitals in California, Pennsylvania, New Jersey, and Florida. They also surveyed nurses on their work environments, staffing levels, patient/family complaints, and the occurrence of adverse events, such as infections. Hospitals with the largest percentages of black patients were large, urban, teaching hospitals. Nurses working at these institutions were more likely to report that they were not confident patients would be able to manage their care after discharge.

Nurses also reported more frequent complaints and infections at hospitals with the highest percentage of black patients. Nurse staffing was significantly associated with three outcomes: poor confidence in discharge care capabilities, frequent patient/family complaints, and ventilator-associated pneumonia. Overall, the concentration of black patients in a hospital was a significant predictor of poor satisfaction and nurse-assessed outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (HS18534).

See “Quality of care and patient satisfaction in hospitals with high concentrations of black patients,” by J. Margo Brooks-Carthon, Ph.D., R.N., Ann Kutney-Lee, Ph.D., R.N., Douglas M. Sloane, Ph.D., and others in the Journal of Nursing Scholarship 43(3), pp. 301-310, 2011.


Obama or Romney: Who Will Address Today’s Healthcare Problems?

Obama or Romney: Who Will Address Today’s Healthcare Problems?
By Martin Merritt, JD | September 9, 2012
Now that flags have been waived, the confetti has been … (not sure there is a verb for confetti) and the two party convention halls have grown quiet, it is time to refocus on the major issue facing the healthcare industry — an affordable healthcare plan for everyone. The President’s plan under the Affordable Care Act (ACA) calls for universal coverage through an “individual mandate.” People with no insurance must purchase it. Insurance companies may not deny coverage on a “newly discovered policy defense,” after the beneficiary falls ill.

The Republican plan seems to involve balancing the budget through some form of voucher system, which would reduce the government’s obligation to pay for Medicare and Medicaid. It is unclear, however, if the Republican plan intends to addresses the problems created by the masses of uninsured, or protect those who thought they were insured, until they needed benefits. This is simply a problem too great to ignore.

Any capitalistic free market is supposed to act according to the laws of supply and demand, which should hold down costs, and increase efficiency. This is the heart of conservative ideology. But American healthcare is no more capitalistic than China’s economy is purely communistic. What we have is a mixture of social programs and free enterprise. While this works well in many cases, in the healthcare context, the laws of supply and demand get out of balance. This is because of the unique health-related behavior of three primary groups.

In the first group, are those whose very intense efforts affect market availability, cost, and utilization. This group includes both the supply side — doctors, hospitals — and the demand side, those who must purchase services — employers, individuals, and insurers. A second group consists of the consuming public, who are not in the market, and feel the goings on in the market do not matter to them. Then, the third group is comprised of those consumers who thought they were in the second group, and therefore did not choose to be in the market. Instead, members of this group were thrust into the market – either by unhappy (illness) or happy (a new baby) circumstance — with no ability to pay for their needs and no advance thought to what they might do I when the bill comes due. Obviously, this is going to create a problem (and a national embarrassment) if Americans are allowed to die from lack of life-saving care.

What can’t happen usually won’t, but what we did in response to the “uninsured” problem is nothing short of absurd. Think of a Rubik’s Cube. The problem facing you is that one of the colored squares doesn’t fit. Rather than make the problem go away, you could simply turn the problem to make it face someone else. This is exactly what the government did with the unfunded mandate, the Emergency Medical Treatment and Active Labor Act (EMTALA), in which hospitals with emergency rooms cannot turn away patients suffering from an “emergency medical condition” (42 U.S.C. 1395dd).. This gift to the masses might have been defensible in the early and middle years of Medicare and Medicaid. During the halcyon days of fee-for-service and reasonable hospital reimbursement rates, it seemed not too much to ask those making a fortune from government programs to pitch in. The problem came from the “dog pile” which followed.

Once everyone figured out the government would not let us die from lack of care, there was no need to plan for that contingency. A mass migration of sorts occurred in which it was suddenly safe to be in the second or even third group of Americans who made no plan whatsoever to pay for illness. Economically, this has been devastating. Hospitals struggle to meet obligations, by raising the sticker price on everyone, which leads insurance companies to engage in post-claims underwriting (wait until an insured needs coverage, then find a flaw in the application to justify denial of coverage.) We are left with a non-functioning system described in hyperbole, as a “war of all-against-all,” in which “[i]nsurers cheat patients and doctors; patients cheat doctors and insurers; doctors cheat insurers and patients; and all cheat the federal governments.” See, Bartlett, Donald; Steele, James, “Critical Condition– How Health Care in America Became Big Business and Bad Medicine,” New York: Doubleday (2004)

If we do not start demanding real solutions from our candidates to the problems created by EMTALA and the masses of uninsured, it seems clear we will not be able to avoid an eventual government takeover of the healthcare industry. This is because currently, there is nothing motivating people to take care of themselves. In fact, those who try to take care of their own needs, are often thrown back into the pile of uninsured, because they failed to disclose a sore throat, 10 years before a diagnosis of cancer.

This is a crisis of financing which transcends politics and traditional conservative and liberal ideology. This is our problem. Everyone needs care, and no one wants care delivered with the same enthusiasm as government employees at a department of motor vehicles. The best thing you can do is become active in your state’s medical association.

No matter who you vote for in November, find out what your association is doing, and how you can help ensure the survival of your industry.