healthy4u: Renee Ellmers

Several members of Congress have written HHS demanding meetings on health IT issues such as upcoding, test overutilization, misuse of incentive programs, and other factors as <a href="http://ihealthtran.com/wordpress/2012/10/senate-republicans-send-letter-to-sebelius-with-concerns-over-meaningful-use/" target="_blank">here</a>.<br /><br />However, what was largely left out was the issue of safety.<br /><br />I've written this letter to the congresspeople who've written to HHS secretary Sebelius (PDF available <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/EHR_congress_letter_oct24_2012_final.doc" target="_blank">at this link</a>):<br /><br /><blockquote class="tr_bq"><div class="MsoNormal"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">October 24, 2012</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">To:</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Sens. Coburn, Burr, Roberts and Thune</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Reps. Ellmers, Camp, Herger, Upton and Pitts</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">United States</span><span style="font-family: Arial; font-size: 10.0pt;"> Congress</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Washington</span><span style="font-family: Arial; font-size: 10.0pt;">, DC</span><span style="font-family: Arial; font-size: 10.0pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Re:<span style="mso-spacerun: yes;">  </span>HITECH and healthcare information technology</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Dear Senators and Representatives,</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">I applaud your recent inquiries to HHS regarding critical issues related to healthcare information technology (EHRs, physician order entry, decision supporting systems, etc.)  Issues such as the possible role of these systems in upcoding and Medicare overbilling, test overutilization, abuse of incentives, etc. must be addressed.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">However, you did not address an issue probably more important to the public, indeed to us all as patients – that of health information technology <i style="mso-bidi-font-style: normal;">safety.</i></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Congress must be made aware that health IT exists in two forms:  <b style="mso-bidi-font-weight: normal;">good health IT </b>and<b style="mso-bidi-font-weight: normal;"> bad health IT</b>.  <span style="mso-bidi-font-weight: bold;">Bad health IT reduces safety, creates close calls, injures, kills, raises costs, and sacrifices information privacy and confidentiality, among other ill effects</span>.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Congress must also be made aware that unfortunately due to systemic impediments to free flow of information about health IT systems and lack of FDA or other independent industry regulation, bad health IT is rarely removed from the marketplace or fixed.  </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">FDA and its director of the Center for Devices and Radiological Health (CDRH), Jeffrey Shuren MD JD, testified to HHS in Feb. 2010 that “under the Federal, Food, Drug, and Cosmetic Act, health information technology software is a medical device”, but that FDA has “largely refrained from enforcing our regulatory requirements with respect to HIT devices.”  </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">To clarify about the two types of health IT:</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><b><span style="font-family: Arial; font-size: 10.0pt;">Good Health IT</span></b><span style="font-family: Arial; font-size: 10.0pt;"> provides a good user experience, enhances cognitive function, puts essential information as effortlessly as possible into the physician’s hands, keeps eHealth information secure, protects patient privacy and facilitates better practice of medicine and better outcomes. </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><b><span style="font-family: Arial; font-size: 10.0pt;">Bad Health IT </span></b><span style="font-family: Arial; font-size: 10.0pt;">is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation. </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">The Agency for Healthcare Research and Quality (AHRQ) recently reported that the highest prevalence of medical technology safety issues was related to EHR systems.<span style="mso-spacerun: yes;">  </span>Even worse, there is a lack of reporting transparency. Harms are known of, but the magnitude admittedly unknown due to systematic impediments to reporting transparency, collection and analysis, as noted by FDA in a 2010 internal memo and IOM itself in its 2012 report on health IT safety.  This is unprecedented in modern medicine, violates patient’s rights, and under no circumstances should be considered acceptable.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">I personally know of adverse patient outcomes including death related to bad health IT that are unreported (even in a state that mandates reporting of medical incidents and serious events), as do numerous colleagues.<span style="mso-spacerun: yes;">  </span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">The Institute of Medicine has just released a Discussion Paper written by experts in health information technology entitled “<b>Comparative User Experiences of Health IT Products: How User Experiences Would Be Reported and Used"  </b>(<a href="http://www.iom.edu/Global/Perspectives/2012/%7E/media/Files/Perspectives-Files/2012/Discussion-Papers/comparative-user-experiences.pdf" target="_blank">http://www.iom.edu/Global/Perspectives/2012/~/media/Files/Perspectives-Files/2012/Discussion-Papers/comparative-user-experiences.pdf</a>). The recommendations in this paper need to be put into place, and Congressional awareness of the issues and official inquiry as to when this will happen is essential.  </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">This paper’s recommendations will not happen without the oversight of Congress.  As stated in the paper itself, “Some medical and IT leaders have invested their reputations, and their organization’s time and money, in the software [implementation] program; complaints that expose large problems may not be appreciated or carried forward.” </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Some claim safeguards are already in place in the form of HHS certification of health IT.  </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Unfortunately, the HHS health IT certification guidelines do not have sufficient depth nor the correct focus to distinguish between bad health IT and good health IT.  Certification for MU does not look at real-world testing for safety, reliability and usability, for instance, under real loads, in actual clinical settings, and is not very thorough.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">On the other hand,  NASA, the pharmaceutical industry (via FDA's regulation of pharmaceutical research and manufacturing IT) and others dependent on mission-critical software have rigorous validation procedures to check for such factors, e.g., NASA’s "<a href="http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20040014965_2004000657.pdf" target="_blank">Certification Processes for Safety-Critical andMission-Critical Aerospace Software</a>" that includes rigorous testing to distinguish bad IT from good IT, and remediate or abandon the former.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">p. 6-7:  In order to meet most regulatory guidelines, developers <span style="mso-bidi-font-weight: bold;">must build a safety case</span> as a means of documenting the safety justification of a system. The safety case is a <span style="mso-bidi-font-weight: bold;">record of all safety activities</span> associated with a system throughout its life. Items contained in a safety case include the following:<br /><br />• Description of the system/software<br />• Evidence of <span style="mso-bidi-font-weight: bold;">competence of personnel</span>involved in development of safety-critical software and any safety activity<br />• Specification of <span style="mso-bidi-font-weight: bold;">safety requirements</span><br />• Results of <span style="mso-bidi-font-weight: bold;">hazard and risk analysis</span><br />• Details of <span style="mso-bidi-font-weight: bold;">risk reduction</span>techniques employed<br />• Results of design analysis showing that the <span style="mso-bidi-font-weight: bold;">system design</span> <span style="mso-bidi-font-weight: bold;">meets all required safety targets</span><br />• <span style="mso-bidi-font-weight: bold;">Verification and validation strategy</span><br />• Results of <span style="mso-bidi-font-weight: bold;">all verification and validation activities</span><br />• Records of<span style="mso-bidi-font-weight: bold;"> safety reviews</span><br />• Records of <span style="mso-bidi-font-weight: bold;">any incidents which occur throughout the life of the system</span><br />• Records of all changes to the system and<span style="mso-bidi-font-weight: bold;"> justification of its continued safety</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">These processes need to be put in place regarding healthcare IT as well, but will take much time and regulatory push on the industry to occur.  In the absence of truly rigorous testing, though, transparency is essential.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">The aforementioned IOM Discussion Paper outlines the creation of a nationwide post-marketing surveillance process and transparency on health IT usability problems, safety issues, billing fraud promotion, etc. is essential.  It recommends:</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 8.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">        </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">“Flight simulator”-like, thorough laboratory evaluation of test scenarios;</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 8.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">        </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">Point-of-use reporting by doctors and nurses on their experiences;</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 8.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">        </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">Third party–administered doctor and nurse surveys about their experiences with EHR systems;</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 8.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">        </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">Direct clinician-to-public reporting; and</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .75in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 8.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 10.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">¨<span style="font: 7.0pt "Times New Roman";">        </span></span></span><span style="font-family: Arial; font-size: 10.0pt;">A formalized system of hazards reporting from EHR systems.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">These measures are essential if the technology is to achieve the benefits of which it is theoretically capable, but not presently achieving despite the hundreds of billions of dollars being spent.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">In conclusion, I ask you to add to your inquiries the subject of health information technology safety.  That includes the need for HHS to develop a robust, transparent national reporting system for safety problems created by the technology, and a system to ensure that bad health IT is either fixed in a timely manner or removed from the marketplace.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Sincerely,</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Scot Silverstein, MD</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">-----------------------------------------------------------------</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Scot M. Silverstein, MD</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Adjunct faculty in Healthcare Informatics and IT (Sept. 2007-present)</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Assistant Professor of Healthcare Informatics and IT, and Director, Institute for Healthcare Informatics (2005-7)</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Drexel</span><span style="font-family: Arial; font-size: 10.0pt;"> University</span><span style="font-family: Arial; font-size: 10.0pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">College</span><span style="font-family: Arial; font-size: 10.0pt;"> of Information   Science</span><span style="font-family: Arial; font-size: 10.0pt;"> and Technology</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">3141 Chestnut St.</span><span style="font-family: Arial; font-size: 10.0pt;">, Philadelphia,  PA 19104-2875</span><span style="font-family: Arial; font-size: 10.0pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Email:<span style="mso-spacerun: yes;">  </span>sms88 AT drexel DOT edu </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;">Bio:<span style="mso-spacerun: yes;">  </span><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/biography.htm">http://www.ischool.drexel.edu/faculty/ssilverstein/biography.htm</a> </span></div></blockquote><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Arial; font-size: 10.0pt;"></span></div><br /><br />I hope this letter has some beneficial effect.<br /><br />-- SS

Letter To U.S. Senators and Representatives Who've Sought HHS Input On EHR Problems

Several members of Congress have written HHS demanding meetings on health IT issues such as upcoding, test overutilization, misuse of incent...

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A letter on Health IT from Congresswoman <a href="http://ellmers.house.gov/index.cfm?sectionid=94&sectiontree=2,94">Renee Ellmers</a>, (R) NC, Chairwoman of the U.S. House of Representative's Committee on Small Business, Subcommittee on Healthcare and Technology was just sent to Secretary of the Dept. of Health and Human Services Kathleen Sebelius.<br /><br />The themes in the letter will be familiar to readers of Healthcare Renewal.<br /><br />A PDF copy of the letter can be downloaded by clicking below, and the text follows.<br /><br /><br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_2qirVMyivJO381vV0HLJ5llEXSAZTVTTq38vhgR-RkUBW0XIKs_CJQR43Sxm1tjdVyB8YkT_9FcRqSwIU02xHFgfYVe4TnyG4852AOTTRfq0U1PbZEmb8qgX06yZPn2b4IDfipISDnDD/s1600/ellmers.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5639969911782066050" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_2qirVMyivJO381vV0HLJ5llEXSAZTVTTq38vhgR-RkUBW0XIKs_CJQR43Sxm1tjdVyB8YkT_9FcRqSwIU02xHFgfYVe4TnyG4852AOTTRfq0U1PbZEmb8qgX06yZPn2b4IDfipISDnDD/s320/ellmers.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 246px; height: 320px;" /></a><span style="font-size:85%;">(<a style="font-weight: bold;" href="http://smbiz.house.gov/UploadedFiles/Health_IT_Concerns_Sebelius_8.11.11.pdf">click here</a> to download PDF)</span><br /></div><br /><br />Here is the text, along with several comments:<br /><blockquote><br />August 11, 2011<br /><br />The Honorable Kathleen Sebelius<br />Secretary<br />U.S. Department of Health and Human Services<br />200 lndependence Avenue, S.W.<br />Washington, DC 20201<br />Via Facsimile: 202. 690.7380<br /><br />Dear Secretary Sebelius:<br /><br />The House Small Business Committee, on which I serve, is required by the Rules of the House to study and investigate the problems of all types of small businesses. This jurisdiction extends to matters concerning small businesses and health care. I chair the Committee’s Subcommittee on Healthcare and Technology.<br /><br />On June 2, 2011, the Subcommittee held a hearing on the barriers to health information technology that are encountered by physicians and other providers in small practices. At the hearing, physicians testified that the cost to purchase and maintain a health IT system, is addition to staff training and downtime during the transition to health IT, are significant burdens for small practices. These barriers mere mentioned even by physicians who believe health IT would ultimately benefit their practices. Providers at the hearing also stated their concern about the Medicare reimbursement penalties that will be assessed against providers who do not demonstrate “meaningful use” of health IT by 2015.<br /><br />One of the frequently mentioned benefits of health IT has been a reduction in medical errors.  However, recent news reports have noted incidents of health IT errors. An article in Sunday’s <span style="font-style: italic;">Pittsburgh Post-Gazette</span> <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[a series, actually, </span><a style="font-weight: bold; font-style: italic;" href="http://hcrenewal.blogspot.com/2011/05/healthcare-renewal-cited-in-pittsburgh.html">here</a><span style="font-weight: bold; font-style: italic;"> <span style="color: rgb(255, 0, 0);">and</span> </span><a style="font-weight: bold; font-style: italic;" href="http://www.post-gazette.com/pg/11219/1165767-114-0.stm?cmpid=nationworld.xml">here</a><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">- ed.] </span>cited a baby who was killed while computerized IV equipment prepared a lethal dose of an intravenous sodium chloride solution. The machine did not catch the pharmacy technician’s error. The article also noted that when a hepatitis C-positive kidney was accidentally transplanted from a live donor into a recipient, the physician team missed the electronic records alert, and the physicians complained that their electronic records system is cumbersome and difficult to adjust to any one physician’s needs.<br /><br /><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[You can be sure that my writings on health IT mission hostility, poor quality, lack of regulation, etc. as well as the cases of health IT-related injury and death I know of, including that of my own relative, will find their way to Rep. Ellmer's office - ed.]</span><br /><br />The Journal of the American Medical Association recently published a study of almost 4,000 computer-generated prescriptions that were received by a pharmacy chain. The report found that 12 percent of the prescriptions contained errors, which, the report said, is consistent with error rates with handwritten prescriptions.  <span style="font-weight: bold; font-style: italic;"><span style="color: rgb(255, 0, 0);">[I wrote about that</span> </span><a style="font-weight: bold; font-style: italic;" href="http://hcrenewal.blogspot.com/2011/06/electronic-medication-prescribing-magic.html">here</a><span style="font-weight: bold; font-style: italic;"> <span style="color: rgb(255, 0, 0);">- ed.]</span></span><br /><br />A modern, well-equipped office is critical to the practice of medicine, and <span style="font-weight: bold;">health IT offers promise to all medical professionals.</span> <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[But only when done well - and there is massive complexity behind those simple two words "done well" that is poorly recognized and/or ignored - ed.] </span>Health IT has the potential to improve health care delivery, decrease medical errors, increase clinical and administration efficiency, and reduce paperwork.<br /><br />We most do all we can to ensure a commitment to our health care system and patient care. As technology rapidly evolves, <span style="font-weight: bold;">I ask that you consider a study of health IT’s adoption, benefits and cost effectiveness.</span>  <span style="font-weight: bold; font-style: italic;"><span style="color: rgb(255, 0, 0);"><br /><br />[Cart before the horse when being done AFTER a national multi-billion dollar rollout is put into law,</span> <a href="http://hcrenewal.blogspot.com/2010/10/cart-before-horse-again-institute-of.html">as I wrote here</a>, <span style="color: rgb(255, 0, 0);">but better late than never - ed.]</span> </span><br /><br />As part of the study, I hope you will also consider medical error rates — both human and technological --so that all errors can he better assessed and prevented.<br /><br /><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[I have been calling for this for years now - ed.]</span><br /><br />Sincerely,<br />Renee Ellmers<br /><br />Chairwoman<br />Subcommittee on Healthcare and Technology<br />House Committee on Small Business </blockquote><br />I find this letter from a leading member of the House of Representatives remarkable.    Importantly, Chairwoman Ellmers has a medical background (HHS Secretary Sebelius, to my knowledge, does not). Here is part of Chairwoman Ellmer's <a href="http://en.wikipedia.org/wiki/Renee_Ellmers">background</a> from Wikipedia:<br /><br /><blockquote>In 1990, she graduated with a <span style="font-weight: bold;">Bachelor of Science degree in Nursing</span>.  Ellmers worked as a nurse in Beaumont Hospital's surgical intensive care unit. In North Carolina, she was clinical director of the Trinity Wound Care Center in Dunn.</blockquote><br />The only other letters like it asking questions like this that I know of came from a Republican Senator to the HIT vendors, Sen. Grassley of Iowa (see <a href="http://hcrenewal.blogspot.com/2009/10/washington-post-emrs-no-cure-all-sen.html">here</a> and <a href="http://hcrenewal.blogspot.com/2010/01/grassley-asks-hospitals-about.html">here</a>).  Sen. Grassley also wrote directly on HIT problems to HHS Secretry Sebelius on Feb. 24, 2010; see the letter <a href="http://www.scribd.com/doc/27483558/Grassley-Feb-24-Letters">here</a>.<br /><br />-- SS

Congresswoman Renee Ellmers on Health IT Concerns

A letter on Health IT from Congresswoman Renee Ellmers , (R) NC, Chairwoman of the U.S. House of Representative's Committee on Small Bus...

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