healthy4u: layoffs

Monetary losses and layoffs from EHR expenses and EHR mismanagement

More on monetary losses and layoffs from EHR expenses and EHR mismanagement: 1.  Layoffs to balance the budget... <a href="http://www.news-record.com/news/local_news/article_da765340-d912-11e2-9eac-001a4bcf6878.html">http://www.news-record.com/news/local_news/article_da765340-d912-11e2-9eac-001a4bcf6878.html</a> <blockquote class="tr_bq">... <a href="http://www.wakehealth.edu/">Wake Forest University Baptist Medical Center</a> [Winston-Salem, NC] said in November 2012, that it would cut 950 jobs — 6 percent of its total staff. Electronic records programs continue to push costs higher. The Winston-Salem Journal reported that Wake Forest’s <a href="http://www.epic.com/">Epic</a> [EHR] program caused $8 million in work interruptions during the 2012-2013 year alone. Wake Forest is cutting costs at least through June 30 to make up for some of Epic’s expense. Its efforts include furloughs, wage reductions and other cuts.</blockquote> 2.  Cerner EHR Project Loses U.K. Hospital 18 Million Pounds <a href="http://www.informationweek.com/healthcare/electronic-medical-records/ehr-project-loses-uk-hospital-18-million/240157036">http://www.informationweek.com/healthcare/electronic-medical-records/ehr-project-loses-uk-hospital-18-million/240157036</a> <blockquote class="tr_bq">... Royal Berkshire Foundation Trust's implementation of Cerner Millennium electronic health record system is costly to maintain and hard to use, causing patient backlogs ... British hospital's attempt to implement an electronic health record (EHR) system has been so disastrous that it has had to write off £18 million ($28 million). ... "Unfortunately, implementing the [EHR] system has at times been a difficult process and we acknowledge that we did not fully appreciate the challenges and resources required in a number of areas," said the hospital's chief executive, Ed Donald.  </blockquote> In 2013, I find the statement "we did not fully appreciate the challenges and resources required in a number of areas" remarkable. Dear Mr. Donald, please allow me to introduce you to a novel concept: A Google search.  (Free, no less.) Try this, for example:  <a href="https://www.google.com/search?q=healthcare%20IT%20failure">https://www.google.com/search?q=healthcare%20IT%20failure</a> (I note that competent experts in my field, Medical Informatics, given appropriate executive presence - including hiring and firing authority, instead of the usual 'internal consultant' roles - could have prevented your organization's mistakes, and for a mere fraction of the £18 million.) <blockquote class="tr_bq"> A campaign against public sector waste in Britain, The Taxpayer's Alliance, has seized on the hobbled project as an especially <a href="http://www.taxpayersalliance.com/waste/2013/06/nhs-trust-loses-18-million-system.html#more-51005">egregious example of bad procurement</a>. "[NHS] trusts must work a lot harder to get a good deal for the taxpayers footing the bill," it warned.  [I guess money doesn't grow on trees in the UK as it seems to in the US -ed.] The row comes in the same week British Parliament members expressed frustration that the funding scheme that supported other British hospitals' investment in EHRs, the controversial £9.8 billion ($15.2 billion) National Program for IT cancelled in 2011, <a href="http://www.informationweek.co.uk/healthcare/electronic-medical-records/zombie-it-contract-refuses-to-die/240156793">continues to cost the country millions</a>, with contracts in some cases not set to expire for 12 more years. [NPfIT in the NHS - see query link <a href="http://hcrenewal.blogspot.com/search/label/NPfIT">http://hcrenewal.blogspot.com/search/label/NPfIT</a> - ed.] Berkshire, however, opted out of that program in 2008 and had instead linked with the University of Pittsburgh Medical Center to help it implement Millennium. </blockquote> I am merely the messenger here... -- SS

Monetary losses and layoffs from EHR expenses and EHR mismanagement

More on monetary losses and layoffs from EHR expenses and EHR mismanagement: 1. Layoffs to balance the budget... http://www.news-record.com...

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Spend Billions More on HIT When Public-Health Services Get Crunched by Budget Woes?

I have the answer to these cutbacks of pubic health services. In the midst of economic chaos, let's spend tens of billions or even better, hundreds of billions of dollars more on experimental healthcare IT. (It <a href="http://hcrenewal.blogspot.com/2011/09/npfit-programme-going-pffft.html">worked out so well for the UK's NPfIT</a>, we should follow the NHS's example of how to wisely spend our crucial healthcare billions.) I will comment no further: <blockquote>Wall Street Journal Health Blog October 5, 2011, 10:00 AM ET <a style="font-weight: bold;" href="http://blogs.wsj.com/health/2011/10/05/public-health-services-get-crunched-by-budget-woes/">Public-Health Services Get Crunched by Budget Woes</a> By Betsy McKay Immunizations, emergency preparations for hurricanes, and restaurant inspections are among local public-health services being cut back or eliminated amid budget constraints. Some 55% of the nation’s county and city health departments reduced or eliminated at least one program between July 2010 and June 2011, and the public-health workforce continued to shrink, according to a new survey by the National Association of County and City Health Officials. The cuts hit maternal and child health services (at 21% of the departments reporting cuts), personal health services (20%), emergency preparedness (20%), chronic disease screenings (17%), and food safety (11%), among other programs. Health departments lost 5,400 jobs in the first half of this year, after losing 6,000 in all of 2010. There are currently about 120,600 local health department employees across the country after those cutbacks. While the workforce has been shrinking since 2008, the downsizing “is now eating into program capacity,” says Robert Pestronk, NACCHO’s executive director. Particularly worrying are the cutbacks in emergency-preparedness programs, he says. “It’s troublesome given what we’re seeing in terms of weather conditions and threats in communities,” he tells the Health Blog. Health-department employees help plan for emergencies such as hurricanes, make sure supplies are in place and work as responders. Meantime, cutbacks in immunization programs are making it harder for some children to get needed polio, tetanus and other preventive vaccinations, while reductions in food-safety programs mean fewer restaurant inspections or staff to interview people sickened in a food-borne illness outbreak, Pestronk says. These woes aren’t limited to local health departments. The Centers for Disease Control and Prevention has seen its budget for preparedness and response fall by more than $350 million since 2005, to about $832 million in fiscal 2011. That challenges the CDC’s ability to respond to a pandemic like the type featured in the recent bio-thriller “Contagion,” Rear Admiral Ali Khan, the CDC’s chief of public health preparedness and response, <a href="http://blogs.wsj.com/health/2011/09/09/contagion-screening-a-busmans-holiday-for-cdc-staffers/" target="_blank">told the Health Blog at a screening of the film</a>.</blockquote> Also see my March 2010 post "<a href="http://hcrenewal.blogspot.com/2010/03/hospitals-under-knife-sacrificing.html">Hospitals Under the Knife: Sacrificing Hospital Jobs for the Extravagance of Healthcare IT?</a>" where I observed: <blockquote>... In effect, NY hospital physicians, nurses and support staff will lose their job due to budget shortfalls, at the same time the NY hospitals have been spending hundreds of millions of dollars on the extravagance of experimental clinical IT systems whose benefit is still an unknown. Perhaps some of those millions could have been better spent on human beings, such as employees or better yet, patient care.</blockquote> -- SS

Spend Billions More on HIT When Public-Health Services Get Crunched by Budget Woes?

I have the answer to these cutbacks of pubic health services. In the midst of economic chaos, let's spend tens of billions or even bette...

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Hospitals Under the Knife: Sacrificing Hospital Jobs for the Extravagance of Healthcare IT?

A WSJ article on the financial condition of NY hospitals, and specifically a line by NY Mayor Bloomberg, caught my eye: <blockquote>Wall Street Journal Mar. 26, 2010 <a href="http://online.wsj.com/article/SB10001424052748703409804575144184025495398.html">Hospitals Under the Knife</a> New York City System Aims to Cut 2,600 More Jobs as State Funding Drops By MICHAEL HOWARD SAUL and SUZANNE SATALINE NEW YORK—The nation's largest public hospital system plans to slash its work force—including doctors and nurses—by about 10% over two years as government aid drops and the number of uninsured patients jumps. With its budget deficit set to top $1 billion, New York City's Health and Hospitals Corp. plans to eliminate 2,600 jobs in the fiscal year that begins July 1. That comes on top of 1,300 positions to be eliminated this year."No hospital system in the country is exempt from the crushing economics facing the health-care industry," said New York Mayor Michael Bloomberg. He noted that New York had been early to adopt electronic medical records but said that state budget cuts were hitting the system hard. ... Previous job cuts focused on trimming support staff, but the new measures will include physicians and nurses, Alan Aviles, the corporation's president, said in an interview.</blockquote> "Early to adopt EMR's BUT the budget cuts were hitting the system hard?" To the knowledgeable, this seems a non sequitur. Its message is clearly that yes, we spent hundreds of millions of dollars on EMR's, but the adoption of EMR's should have saved us jillions of dollars, helping insulate us from economic downturns. Yet some very serious researchers say this is not the case. For starters, there's, Ashish Jha’s research at the Harvard School of Public Health that compared 3,000 hospitals at various stages in the adoption of computerized health records and found little difference in the cost and quality of care. A New York Times story "Little Benefit Seen, So Far, in Electronic Patient Records" on those findings is <a href="http://www.nytimes.com/2009/11/16/business/16records.html?_r=1">here</a>. Was anyone in the Governor's office or hospital governance reading their own newspaper? Then, there's the Nov. 2009 “<a style="font-weight: bold;" href="http://www.ischool.drexel.edu/faculty/ssilverstein/AJM-Himmelstein-Hospital-Computing.pdf">Hospital Computing and the Costs and Quality of Care: A National Study</a>” (Amer J Med 123:1; 40-46) by Himmelstein and Wololhandler at Harvard Medical School, that also concluded “as currently implemented, hospital computing might [very] modestly improve process measures of quality but not administrative or overall costs." There's the June 2009 <a href="http://www.wharton.upenn.edu/">Wharton School of Business</a> article "Information Technology: Not a Cure for the High Cost of Health Care" that I wrote about <a href="http://hcrenewal.blogspot.com/2009/06/wharton-on-healthcare-it-can-i-go-home.html">at this HC Renewal post</a>. Senior Wharton professors wrote: <blockquote>Technology could increase health care costs without markedly improving quality, according to experts at Wharton. ... "No one has done the careful research to indicate that if one health care system has information technology and the other doesn't, then the care is different. There are no controlled trials," says <a style="font-family: arial;" href="http://www.wharton.upenn.edu/faculty/pauly.html">Mark Pauly</a>, a health care management professor at Wharton. All that technology is no panacea, he warns. In fact, he believes IT could actually raise costs because of culture clashes, training, the implementation of the systems [I would say "the mayhem that often goes on during the implementation" - ed.] and the labor required to maintain the new technology. "The best-case scenario is that information technology will improve quality but not lower costs. The worst case is that there's no difference at all." ... That opinion is echoed by other experts at Wharton and the University of Pennsylvania. "The focus on IT in health care is a good thing, but there's way too much hype about it and misunderstanding about what the benefits will be and how quickly they will come," says <a style="font-family: arial;" href="http://www.med.upenn.edu/apps/faculty/index.php/g346/p6433357">Peter Gabriel</a>, medical director of clinical information systems at the University of Pennsylvania Health System. [<a style="font-family: arial;" href="http://www.wharton.upenn.edu/faculty/volpp.html">Kevin Volpp</a>, professor of medicine and health care management] agrees that tracking real cost savings from health care IT is a difficult task, but he expects there to be some benefits from spotting and eliminating redundant care. But those benefits aren't likely to add up to big savings, says <a style="font-family: arial;" href="http://www.wharton.upenn.edu/faculty/burnsl.html">Lawton R. Burns</a>, director of the <a style="font-family: arial;" href="http://hcmg.wharton.upenn.edu/chme/">Wharton Center for Health Management and Economics</a>. "I agree that information technology is important, but it's not the slam dunk it's portrayed to be," he says. The chase to reduce costs, improve quality and expand coverage is deemed the "iron triangle of health care. A lot of us wince [at that goal]," Burns notes. "It's arguable that we can't do any of those things well." <a style="font-family: arial;" href="http://www.wharton.upenn.edu/faculty/asch.html">David A. Asch</a>, a Wharton health care management and economics professor, agrees that technology is a big part of reform. "No one is arguing against it, but that doesn't mean that it's not oversold," he says. Gabriel likens the fascination over IT in health care to a shiny new object that's easier to focus on relative to more daunting issues. ... In addition, it's unclear what cultural issues [a big theme in my writings - ed.] will emerge as information technology is adopted. These cultural issues are in the forefront of primary care physician relationships. Experts at Wharton and Penn say physicians are generally skeptical of the technology movement. How much will a technology overhaul add to operating costs? How much will it cost to retrain workers? What's the electronic record learning curve? And what happens when a doctor has a laptop between him and the patient? "Individual physicians just don't know where the money is going to come from," says Pauly. "If IT is tied to reimbursements it could work, but [many] are skeptical." Burns adds that the physician-patient relationship can also be altered. "Technology adoption changes the way you practice. What happens when your primary care physician is looking at his screen instead of you?" </blockquote> There are the concerns of Abraham Verghese, Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford, who wrote in the Wall Street Journal in a June 2009 article "<a style="font-weight: bold;" href="http://online.wsj.com/article/SB10001424052970204005504574235751720822322.html">The Myth of Prevention</a>" that: <blockquote>... I have similar problems with the way President Obama hopes to pay for the huge and costly health reform package he has in mind that will cover all Americans; he is counting on the “savings” that will come as a result of investing in preventive care and investing in the electronic medical record among other things. It’s a dangerous and probably an incorrect projection. </blockquote> Finally, this is an experimental technology whose benefits and risks are not well known. In the article "<a style="font-weight: bold;" href="http://archinte.ama-assn.org/cgi/content/short/167/13/1400">Electronic Health Record Use and the Quality of Ambulatory Care in the United States</a>" (Arch Intern Med. 2007;167:1400-1405), the authors examined electronic medical records use throughout the U.S. and the association of EMR use with 17 basic quality indicators. They concluded that “as implemented, EMRs were not associated with better quality ambulatory care.” Further, the FDA recently testified that this technology can actually harm and kill patients, but the extent is unknown. Existing FDA data is likely the "tip of the iceberg", testified FDA official Jeffrey Shuren MD, JD at the HIT Policy Committee, Adoption/Certification Workgroup, special meeting on health IT safety on February 25, 2010. I described Shuren's testimony in my HC Renewal post "<a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2010/02/fda-on-health-it-adverse-consequences.html">FDA on Health IT Adverse Consequences: 44 Reported Injuries And 6 Deaths, Probably Just 'Tip of Iceberg'</a>." Considering FDA is nearly unknown as the go-to for such reports, and the low reporting of medical errors related to computing noted by Koppel at the same meeting, the actual rates of injury and death could be much, much larger. In effect, NY hospital physicians, nurses and support staff will lose their job due to budget shortfalls, at the same time the NY hospitals have been spending hundreds of millions of dollars on the extravagance of experimental clinical IT systems whose benefit is still an unknown. Perhaps some of those millions could have been better spent on human beings, such as employees or better yet, patient care. As I've written before, the health IT industry seems to be staging an invasion of healthcare to its own benefit. Now, clinical personnel are losing their jobs as a result, and patient care is likely to suffer. While I'm supportive of EMR experimentation when finances are stable (when performed with patient safety considerations as paramount, of course), this is not the time for such extravagance in NY, especially when jobs - both support and clinical - are threatened. Irrational exuberance in technology is bad enough - it's far worse when you can't afford the objects of your affection. One suggestion is that the healthcare IT experiments be put on hold as unaffordable under current conditions, and resumed when finances are more stable. The money could be diverted to keeping physicians, nurses and support staff employed. The risks could also be studied further. However, this might cause some executives somewhere to have to forgo their pet contracts with their friendly HIT vendors and management consultant companies. Computers are more important than people, after all. At a time of massive international economic difficulty, "Blood for Computers!" can be the new rallying cry. Since many of the layoffs will involve union members of <a href="http://www.dc37.net/">District Council 37</a>, the city's largest municipal employee union, perhaps the rallying cry "Computers for Union Busting!" could also apply. (Some people would have no problems with that, but these are real, live hospital staff being put out of work, and the patients they care for being affected.) -- SS 3/26/10 Addendum: The advice above may apply to an entire country, the UK, that seems to have spent about £13 billion (about $19 billion U.S.) on health IT that <a href="http://www.computerweekly.com/blogs/tony_collins/2009/06/16-key-points-in-gateway-revie.html">doesn't work</a>. Per the Telegraph article today "<a style="font-weight: bold;" href="http://www.telegraph.co.uk/health/healthnews/7529454/Hospital-wards-to-shut-in-secret-NHS-cuts.html">Hospital wards to shut in secret NHS cuts</a>": <blockquote> Tens of thousands of NHS workers would be sacked, hospital units closed and patients denied treatments under secret plans for £20 billion of health cuts. ... The proposals could lead to: <ul class="storylist"><li>10 per cent of NHS staff being sacked in some areas.</li><li>The loss of thousands of hospital beds.</li><li>A reduction in the number of ambulance call-outs.</li><li>Medical professionals being replaced by less qualified assistants.</li></ul></blockquote> At least the IT industry is alive and well. -- SS

Hospitals Under the Knife: Sacrificing Hospital Jobs for the Extravagance of Healthcare IT?

A WSJ article on the financial condition of NY hospitals, and specifically a line by NY Mayor Bloomberg, caught my eye: Wall Street Journal ...

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Abbott's TriCor Fails To Beat A Sugar Pill in Diabetics - And In Pharma's Current Death Spiral, Forget About a Drug That Will

In numerous national publications today, we are once again reminded that lowering the risk of diabetics for vascular events (MI/heart attack, CVA/stroke etc.) and death is far more complex than lowering measures such as cholesterol and blood pressure. Note these articles: <a href="http://blogs.forbes.com/sciencebiz/2010/03/abbotts-tricor-fails-to-beat-a-sugar-pill/"></a><blockquote><a href="http://blogs.forbes.com/sciencebiz/2010/03/abbotts-tricor-fails-to-beat-a-sugar-pill/">Abbott's TriCor Fails To Beat A Sugar Pill</a> March 14, 2010 - 9:58 am Matthew Herper Forbes.com ATLANTA -- A popular triglyceride-lowering drug that has been taken by millions of Americans failed to prevent heart disease in a big federal study being presented today. The drug, TriCor from Abbott Laboratories, has been used for over a quarter of a century to lower levels of fatty particles in the blood called triglycerides. The presumption has been that doing so would prevent heart attacks or heart-related deaths. TriCor has annual sales of more than $1 billion. But the new study being presented at the American College of Cardiology meeting casts doubt on this. In the study, funded by the National Heart, Lung and Blood Institute, 5,500 patients with diabetes got either TriCor or a placebo. After five years, there was no difference in the rate of heart attacks, strokes and deaths in the patients who got Tricor versus those who took a sugar pill. </blockquote>and <a href="http://online.wsj.com/article/SB10001424052748703457104575121951874047506.html"></a><blockquote><a href="http://online.wsj.com/article/SB10001424052748703457104575121951874047506.html">Search for Better Diabetes Therapy Falls Short</a> Mar. 14, 2010, 9:39 P.M. ET Ron Winslow Wall Street Journal Current Treatments, While Effective, Failed to Also Help Prevent Heart Attacks and Stroke ATLANTA—New strategies to prevent and treat diabetes and heart disease failed to improve care in two major studies, frustrating researchers' efforts to find more-effective approaches to the world's burgeoning diabetes epidemic. The studies are among the first large trials to test whether treatments recommended for diabetes patients also reduce the risk of heart attacks and strokes. Diabetics are between two and four times as likely to die of cardiovascular causes as nondiabetics. The lack of data on whether strategies to treat diabetes actually lower heart risk is of growing concern to physicians, researchers and regulators. One new study, called Accord, found that treating blood pressure to lower levels than recommended in current practice doesn't further reduce risk of death, heart attack and stroke among people with diabetes. The same study also found that the drug Tricor, marketed by <a href="http://online.wsj.com/public/quotes/main.html?type=djn&symbol=ABT" class="companyRollover link11unvisited">Abbott Laboratories</a>, failed to prevent such events even though it lowered levels of blood fats called triglycerides that are associated with high diabetes risk. In the other report, dubbed Navigator, a diabetes drug called Starlix failed to prevent people at high risk of diabetes from progressing to the disease. The blood-pressure medicine Diovan did modestly reduce risk of developing diabetes in the same study, but neither drug significantly cut the risk of heart-related deaths, heart attacks and strokes. Both pills in this study are sold by <a href="http://online.wsj.com/public/quotes/main.html?type=djn&symbol=NVS" class="companyRollover link11unvisited">Novartis</a> SA of Switzerland.</blockquote> There is a meta-issue I wish to bring up: It's clear there are many phenomena going on in diabetes and other metabolic disorders that we simply do not understand. It's also very likely that there are new drugs, yet undiscovered, that could be developed and that would improve mortality and morbidity. It's too bad the pharmaceutical industry is now largely run by <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=pharma">dyscompetents, incompetents</a>, and other <a href="http://hcrenewal.blogspot.com/2009/01/pfizerwyeth-merger-and-sacrificing.html">management charlatans</a>, not to mention those responsible for questionable or outright criminal behaviors (such as <a href="http://hcrenewal.blogspot.com/search/label/fraud">here</a>, <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">here</a>). This privileged class has apparently so demoralized pharma rank and file including the very soul of drug discovery (chemists) - based for example on "layoff thread" comments on a very popular blog for medicinal, synthetic and other chemists such as <a href="http://pipeline.corante.com/archives/2010/02/17/merck_announces_cuts.php">here</a> - that these new drugs are increasingly unlikely to be developed at all. The industry in its current anti-intellectual, "lay them off and watch the stock price rise", short-term narrow-minded idiocy-driven death spiral is basically good for nothing except money games. Pity. -- SS

Abbott's TriCor Fails To Beat A Sugar Pill in Diabetics - And In Pharma's Current Death Spiral, Forget About a Drug That Will

In numerous national publications today, we are once again reminded that lowering the risk of diabetics for vascular events (MI/heart attack...

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