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Meet the New Boss, Same as the Old Boss? - Health Care Reform to be Lead by a Director of Boston Scientific, Cerner, and Medco

Today we learned that President Obama has announced his new picks for Secretary of Health and Human Services and for Director of the White House Office for Health Reform. The choice of Nancy-Ann DeParle for the latter position raises some issues. The NY Times <a href="http://www.nytimes.com/2009/03/03/us/politics/03health.html">provides some background</a>: <blockquote> He also named Nancy-Ann DeParle to coordinate health policy for the administration. Her position, counselor to the president and director of the White House Office for Health Reform, is not subject to Senate confirmation. Ms. DeParle was commissioner of the Tennessee Department of Human Services from 1987 to 1989. Under President Bill Clinton, from 1997 to 2000, she was administrator of the Health Care Financing Administration, now known as the Centers for Medicare and Medicaid Services. Since then, she has gained extensive experience in the business world. That experience, though seen as an asset by many, prompted questions from some of the people vetting personnel for Mr. Obama, supporters of Ms. DeParle said. Ms. DeParle has been a director of large health care companies including Medco Health Solutions, a pharmacy benefit manager; Cerner, a supplier of health information technology, including electronic medical records; Boston Scientific, a medical device company; DaVita, which runs kidney dialysis centers; and Triad Hospitals. </blockquote> In addition, <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/03/02/AR2009030200371.html">according to the Washington Post</a>, <blockquote> DeParle, 52, was previously commissioner of the Department of Human Services in Tennessee. During the Clinton administration, she worked in the Office of Management and Budget and later oversaw Medicare and Medicaid as the administrator of the Health Care Financing Administration. DeParle currently is managing director of CCMP Capital, a private equity firm. She also serves on the boards of several firms related to health care. A White House spokesman said she is in the process of resigning all those positions. </blockquote> Administration spokespeople apparently brushed aside any questions about Ms DeParle's conflicts of interest. A <a href="http://www.nytimes.com/2009/03/03/us/politics/03czar.html">separate article in the NY Times </a>noted: <blockquote> In picking Nancy-Ann DeParle to champion an overhaul of the nation’s health system, President Obama selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy and respect on both sides of the political aisle — not to mention degrees from Harvard Law School and Oxford University. But in putting Ms. DeParle in charge of an issue that has bedeviled presidents for decades, Mr. Obama also chose to overlook Ms. DeParle’s business ties to companies that have a direct stake in the health care debate. In announcing her appointment Monday as the director of the White House Office of Health Reform, Mr. Obama expressed 'absolute confidence' in Ms. DeParle, who ran the agency that oversaw Medicare and Medicaid during the Clinton administration. But the White House instantly faced questions about whether her appointment was skirting the spirit, if not the letter, of the president’s tough conflict-of-interest policy. Since leaving the Clinton administration, Ms. DeParle has been managing director of a private equity firm, CCMP Capital, and a board member of companies like Boston Scientific, Cerner and Medco Health Solutions. White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was 'directly or substantially' related to former clients or employers. 'It is our view, and the view of counsel here, that the incidence of that will be very low,' an administration official said of the need for Ms. DeParle to recuse herself from decisions. The official, who was not authorized to speak publicly, said Ms. DeParle would be working mostly with federal agencies and lawmakers, and not directly with companies. </blockquote> MedInformaticsMD just <a href="http://hcrenewal.blogspot.com/2009/03/cerner-board-member-as-healthcare-czar.html">posted</a> about his concerns specifically vis a vis Ms DeParle's current position as a leader of Cerner. My main concern here is that Ms DeParle's ties to multiple health care corporations are so strong as to jeopardize her ability to be the new leader of health care reform for the whole country. To review, Ms DeParle is currently a member of the boards of three health care corporations, Boston Scientific, Cerner, and Medco. As we have <a href="http://hcrenewal.blogspot.com/2006/03/new-species-of-conflict-of-interest-in.html">discussed</a> many times previously, a corporate director has a legal obligation to advance the profits and financial fortunes of the corporation he or she serves. As Robert AG Monks put it, corporate directors are supposed to "demonstrate unyielding loyalty to the company's shareholders" [Per Monks RAG, Minow N. <a href="http://www.amazon.com/Corporate-Governance-Robert-G-Monks/dp/1405116986">Corporate Governance</a>, 3rd edition. Malden, MA: Blackwell Publishing, 2004. P.200.] As compensation for that loyalty, corporate directors are usually exceedingly well-paid for the nominal hours they spend in their meetings. In particular, per <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=5545615&format=PDF">the company's 2008 proxy statement</a>, in 2007, Ms DeParle received $160,338 in total compensation from Boston Scientific, and held 62,020 of its shares. Further, per <a href="http://library.corporate-ir.net/library/11/118/118401/items/287619/CERN_2008proxy.pdf">the Cerner 2008 proxy statement</a>, in 2007 she received $195,051 from that company, and held 27,000 of its shares. Ms DeParle was just elected to the Medco board in 2008, so her compensation and stock holdings were not listed in <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=5588519&format=PDF">that year's proxy statement</a>, but presumably her total compensation would mirror what other directors received in 2007: a retainer of $50,000, and an annual grant of shares and options worth $175,000 at the time it would be granted. Given her previous obligation of "unyielding loyalty"to and generous compensation from major health care corporations, it might be hard to suddenly be indifferent to their interests. Of course, a White House spokesperson pledged that Ms DeParle would "recuse herself from any matter that was 'directly or substantially' related to former clients or employers." The problem is that most of the issues that might come up in discussions of health care reform might be directly and substantially related to the interests of the companies Ms DeParle now leads. For example, one obvious way to control costs in a reformed health care system would be to reduce the current reimbursement system's bias in favor of procedures over cognition. Boston Scientific makes much of its money selling devices that are used during such procedures. Any general shifting of reimbursement more in favor of cognition rather than procedures could reduce Boston Scientific's profits, profits which Ms DeParle is currently sworn to protect. So would Ms DeParle recuse herself from all discussions of reimbursement? I submit that if Ms DeParle recused herself from discussion of all issues that might affect the interests of Boston Scientific, Cerner, and Medco, let alone the private corporations she directs whose interests might be less easy to define, and let alone the corporations which she used to direct, she would have very little to do in her new position. On the other hand, were Ms DeParle to be an active Director of the White House Office of Health Care Reform, would the reform be in the interests of all the US people, or in the interests from the large and powerful corporations whose interests she was so recently pledged to protect? Does this new appointment truly reflect President Obama's statement that he did not come to Washington "to work for the powerful and well-connected interests who have run this city for too long?"

Meet the New Boss, Same as the Old Boss? - Health Care Reform to be Lead by a Director of Boston Scientific, Cerner, and Medco

Today we learned that President Obama has announced his new picks for Secretary of Health and Human Services and for Director of the White H...

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Cerner board member as Healthcare Czar

President Obama has declared that National Electronic Health Records are essential to curing healthcare's ills. From <a href="http://www.msnbc.msn.com/id/29466833/" style="font-family: arial;">MSNBC</a>: <blockquote style="font-family:arial;">WASHINGTON - President Barack Obama will name former Clinton administration health official Nancy-Ann DeParle on Monday to lead the newly created White House Office on Health Reform, a U.S. official said.DeParle, a former administrator of what is now the Centers for Medicare and Medicaid Services, will lead the White House office charged with coordinating Obama's ambitious healthcare reform efforts with Congress. </blockquote>From the <a href="http://www.nytimes.com/2009/03/03/us/politics/03czar.html?ref=us" style="font-family: arial;">NY Times:</a> <blockquote style="font-family:arial;">WASHINGTON — In picking Nancy-Ann DeParle to champion an overhaul of the nation’s health system, <a href="http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per" title="More articles about Barack Obama.">President Obama</a> selected someone with deep roots in the Washington bureaucracy, an intimate familiarity with health policy and respect on both sides of the political aisle — not to mention degrees from <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/h/harvard_university/index.html?inline=nyt-org" title="More articles about Harvard University.">Harvard</a> Law School and <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/o/oxford_university/index.html?inline=nyt-org" title="More articles about Oxford University">Oxford University</a>. But in putting Ms. DeParle in charge of an issue that has bedeviled presidents for decades, Mr. Obama also chose to overlook Ms. DeParle’s business ties to companies that have a direct stake in the health care debate.</blockquote> From <a href="http://www.cerner.com/public/Cerner_2.asp?id=27436" style="font-family: arial;">Cerner Corp</a>, one of the largest vendors of Health IT: <blockquote style="font-family:arial;"> Nancy-Ann DeParle was appointed to Cerner Corporation's Board of Directors in May 2001.</blockquote> From the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=granger_speaks_out" style="font-family: arial;">former head of the UK's Connecting For Health</a> National HIT program: "Sometimes we put in stuff that I'm just ashamed of ... Some of the stuff that Cerner has put in recently is appalling ... Cerner and prime contractor Fujitsu had not listened to end users ... Failed marriages and co-dependency with subcontractors ... A string of problems ranging from missing appointment records, to inability to report on wait times ... Almost a dozen cancelled go-live dates ... Stupid or evil people ... Stockholm syndrome -identifying with suppliers' interests rather than your own ... A little coterie of people out there who are "alleged experts" who were dismissed for reasons of non-performance."<o:p></o:p> From <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm" style="font-family: arial;"> The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee, Jan 2009:</a> <blockquote style="font-family:arial;">... 5 The termination of Fujitsu's contract has caused uncertainty among Trusts in the South and new deployments have stopped. One option being considered for new deployments is for Trusts to have a choice of either Lorenzo provided through CSC or the [Cerner] Millennium system provided through BT. There are, however, considerable problems with existing deployments of [Cerner] Millennium and serious concerns about the prospects for future deployments of Lorenzo. Before the new arrangements for the South are finalised, the Department should assess whether it would be wise for Trusts in the South to adopt these systems. Should either of the Local Service Providers take on additional commitments relating to the South, the Department should take particular care to assess the implications of the extra workload for the quality of services to Trusts in the Local Service Providers' existing areas of responsibility. 6 The Programme is not providing value for money at present because there have been few successful deployments of the [Cerner] Millennium system and none of Lorenzo in any Acute Trust. Trusts cannot be expected to take on the burden of deploying care records systems that do not work effectively. Unless the position on care records system deployments improves appreciably in the very near future (i.e. within the next six months), the Department should assess the financial case for allowing Trusts to put forward applications for central funding for alternative systems compatible with the objectives of the Programme.</blockquote> This appointment appears to my untrained eye, on the surface, to be a problem, even with typical promises that these conflicts of interest will not affect decisions. From the NY Times article: <blockquote style="font-family: arial;">White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was “directly or substantially” related to former clients or employers.</blockquote> That is a relief - somewhat. This HIT company is likely to make huge profits in coming years. Will Ms. DePerle give up all financial stakes in this company and industry she and/or her family may hold such as stock, options and other tangibles? In a more general sense, can we as a country really trust such statements from business and government leaders any more? Should we? The <a href="http://www.dcexaminer.com/opinion/Obamas-HIT-will-likely-be-a-miss-40512247.html" style="font-family: arial;">Washington and San Francisco Examiners</a> have it about right in this common sense-filled editorial in which I am cited (I played no part in its appearance): <div id="article_inner" style="font-family:arial;"> <blockquote><h1>America’s foray into HIT will likely be a miss</h1> Examiner editorial 3/2/09 There is a provision of the $878 billion stimulus package rushed through Congress for $20 billion to develop a centralized national health information technology system. Proponents claim HIT will save $77 billion during the next 15 years and greatly reduce medical errors. Who could possibly object to that? Well, for starters, ask health care providers in Britain’s National Health Service, who have been trying to get their HIT system to work properly for the past five years. The cost of NHS’ HIT has escalated to six times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the United States. In January, Public Accounts Chairman Edward Leigh reported to fellow members of Parliament that essential systems are late or, when deployed, do not meet expectations of clinical staff. HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next six months. But even if HIT is eventually junked, British taxpayers will still have to pay for it. The National Academies of Science noted that much of the electronic medical data collected in the U.S. is used mainly to comply with regulations or to defend against lawsuits, rather than to improve patient care. A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one. And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors. After spending billions of dollars during the past three decades, only 4 percent of U.S. physicians have a fully functional HIT system, according to Drexel University biomedical informatics professor Scot Silverstein — and its not because doctors don’t want to use technology. These expensive systems are just not designed for their extremely complex and highly specialized needs. In an open letter to President Barack Obama, Silverstein said HIT is an experiment that’s unproven on a large scale. Computers in hospitals have also been linked to the spread of MRSA, a deadly antibiotic-resistant staph infection. Yet, the same federal government that can’t keep its own military veterans’ medical records secure is bound and determined to spend $20 billion in a top-down, centralized effort that has a very good chance of messing up yours.</blockquote> </div> This raises several questions: <ul><li>Was Ms. DeParle as a board member at Cerner acting definitively when complaints such as those from the UK came in? And perhaps do a google search on terms such as <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&q=healthcare+IT+failure&btnG=Google+Search">healthcare IT failure</a>? </li></ul><ul><li>Will Ms. DeParle support or oppose <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/regulation_and_oversight_hoffman.pdf">needed federal regulation</a> of an industry in which she holds (held) a Board Membership? </li></ul><ul><li>With (former) board members of HIT companies whose products apparently caused the UK's CfH program to cry "uncle" now in positions of ultimate power over U.S. healthcare, and with an administration locked into irrational exuberance over HIT, should physicians in the U.S. also look forward to a forced cybernetic dystopia as at my series <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">starting here</a>?</li></ul> Finally, this is not a piece against our President. He is not, nor expected to be, an expert in information technology and healthcare informatics. I actually feel sorry for him. I feel sorry for him in letting reactionary and opportunistic corporate elements of the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=ecosystem">healthcare IT ecosystem</a> lead him to make calls for full national HIT, along with penalties for nonadoption of this experimental and often defective technology, on the hyperaggressive, absurd and in fact damaging timeframe of five years, by 2014. See "<a href="http://www.jamia.org/cgi/content/short/13/1/106" style="font-family: arial;">Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?</a>" by Ford et al. And parroting the industry line, declaring with full confidence that Health IT will improve quality and decrease healthcare costs. The evidence on both issues is, let's just say, far more contradictory and questionable than the evidence that VIOXX kills people. -- SS

Cerner board member as Healthcare Czar

President Obama has declared that National Electronic Health Records are essential to curing healthcare's ills. From MSNBC : WASHINGTON ...

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Chatting away on iGoogle...

I'm a creature of habit. My morning routine consists of going to my desk with coffee mug in hand and checking my email, reading the news and updating my to-do list. One place I can do all of that without having to go to multiple websites is <a href="http://www.google.com/ig">iGoogle</a>. Having the ability to work on email right on my iGoogle page has been awesome, but I simply couldn't get the same Gmail experience without the chat feature. So we got together with the iGoogle team several months back to talk about how to integrate a chat feature on iGoogle, and since then, we've been running experiments with a small number of iGoogle users and have also been using it internally. We're pleased to announce that starting today we are extending the feature to a larger set of iGoogle users. Similar to the chat feature on Gmail, people will be able to send instant messages to their colleagues, friends and family straight from their iGoogle page. We've made this easy. If you're already a Gmail chat user, all your current chat settings will apply to iGoogle, so things will work the way you like in both places. But even more exciting is that you'll even be able to chat with friends who don't yet have a Gmail address — any email address will do. All you have to do is invite them as a chat buddy, and if they accept your invitation and sign up for iGoogle with their personal email account, their name becomes just a click away right on your page. Don't want to be bothered while you're checking out the latest news or reading your emails? You have a couple of options to hid the chat feature. You can either click the chat “options” link and selecting “hide chat,” or sign off completely by selecting "sign out of chat." It's worth noting that this feature may have some kinks, so we ask for your patience as we work through them. Here at Google, it's common practice for us to involve our users as early possible so we can make sure we get it right. We'll also be rolling this feature out slowly, so if you don't see it on your iGoogle page and you simply can't wait to check it out, feel free to opt in by going to <a href="http://www.google.com/ig/v2invite">www.google.com/ig/v2invite</a>. Currently, iGoogle chat is rolling out in English for our U.S. users. But don't worry, the feature is coming soon for other iGoogle supported languages and countries. You can check out our <a href="http://www.google.com/support/websearch/bin/answer.py?hl=en&answer=126293">Help Center</a> for more information on how it works, and as always, we are interested in hearing any <a href="http://www.google.com/support/forum/p/Web+Search?hl=en">feedback</a> you have. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKjvyZBIxJtgIjoeD_9PGUSbUmj1qbllA3PKPr8NCKEwLx8paAjOmglD81-OD6E2UWefoIlUecTX3xU4l6p8kKCo8vRKWO5Szb0FQYDXRne1sDcoXkE8UtAaIAPE3BxnV6medSICBJt3rg/s1600-h/iGoogle+chat.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5307652875888870546" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKjvyZBIxJtgIjoeD_9PGUSbUmj1qbllA3PKPr8NCKEwLx8paAjOmglD81-OD6E2UWefoIlUecTX3xU4l6p8kKCo8vRKWO5Szb0FQYDXRne1sDcoXkE8UtAaIAPE3BxnV6medSICBJt3rg/s400/iGoogle+chat.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 294px;" /></a> Posted by Rhett Robinson, Google Talk Engineer

Chatting away on iGoogle...

I'm a creature of habit. My morning routine consists of going to my desk with coffee mug in hand and checking my email, reading the news...

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A $4.3 Million Dollar CEO for a Not-For-Profit Health Care Insurance Corporation

The US stock markets are at lows unseen for more than 10 years, unemployment is rising, around the world national deficits are increasing, and times are tough for ostensibly not-for-profit Blue Cross and Blue Shield of Massachusetts, the state's largest health care insurer/ managed care organization. <a href="http://www.boston.com/business/healthcare/articles/2009/02/28/blue_cross_ceos_pay_rose_26/">Per the Boston Globe</a>: <blockquote> Blue Cross-Blue Shield's business was affected by the stock market decline, the recession, and the increasing cost of medical care. Membership at the state's largest health plan declined about 40,000 to just over 3 million. 'The decline in membership had an impact on results,' said chief financial officer Allen Maltz. 'In addition, many of our customers changed their benefits plans to products that have much lower margins.' Blue Cross-Blue Shield insures employees of national companies that have locations outside Massachusetts, Maltz said, and those customers accounted for some of the drop-off in membership. Maltz said Blue Cross-Blue Shield aims for a profit margin of between 1.5 and 2 percent. Last year's margin was almost zero. The firm had operating income from its medical claims business of just $1.6 million. A new state assessment on reserves lowered income by $21 million, Maltz said. Revenue was flat at $6.7 billion, and medical claims were also unchanged at $6 billion. Like most health insurers, Blue Cross-Blue Shield also relies on investment income, which fell 28 percent to $111 million. Maltz said the firm managed to avoid losses in the market by investing primarily in bonds and avoiding derivative securities that have declined precipitously in value. </blockquote> Well, things are tough all over. But they are apparently not so tough for Blue Cross Blue Shield's CEO: <blockquote> The salary and bonus paid to Cleve L. Killingsworth, chairman and chief executive of Blue Cross and Blue Shield of Massachusetts, increased 26 percent last year, to $3.5 million, even though the health insurer's membership declined and its net income fell 49 percent. Based on previous years' retirement benefits - which Blue Cross-Blue Shield did not report for 2008 - Killingsworth's total pay package was likely about $4.3 million, making him by far the highest paid healthcare executive in Massachusetts. </blockquote> And what was the justification for Killingworth's stellar pay? <blockquote> Salaries at Blue Cross-Blue Shield were inflated by a complex executive bonus plan in which senior officials get bonuses based on a rolling average of the previous three years. 'These executives and the company performed and exceeded our expectations,' said Jay McQuaide, a Blue Cross-Blue Shield spokesman. 'They earned these incentives.' The key metrics in the incentive plan are membership and net profit, he said. </blockquote> The company's board of directors did not do badly either. Unlike most boards of not-for-profit corporations, this one was paid: <blockquote> The insurer's board members also received a 33 percent increase in base pay, from $30,000 a year to $40,000. Most earn far more because of payments for attending meetings and serving on committees. </blockquote> Finally, <a href="http://www.bostonherald.com/business/general/view.bg?articleid=1155201&srvc=home&position=1">according to the Boston Herald</a>, other executives did quite nicely too: <blockquote> Bay State health insurance bosses continued to rake in multimillion-dollar compensation packages last year as the state and its taxpayers struggled to pay ever-increasing health-care costs. Data filed yesterday with the state’s Division of Insurance shows that Blue Cross Blue Shield of Massachusetts, the state’s largest HMO, doled out million-dollar pay packages to five executives, while Harvard Pilgrim Health Care paid its two highest-ranking executives a total of $2.7 million. Blue Cross’ top earner is Peter Meade, who retired last spring as executive vice president of corporate affairs. Meade took home $4 million, a sum that includes retirement benefits accrued during his 12 years at the HMO. </blockquote> It's just amazing that with all their talk about "pay for performance," top executives of health care organizations seem to make huge sums year in and year out, regardless of their organization's performance. (As an aside, how could someone say that the company's pay for performance "main metrics" were membership and net profit, when both fell, yet the CEO's pay rose?) There was a brilliant discussion of the culture that lead to this sad state of affairs <a href="http://www.timesonline.co.uk/tol/comment/columnists/minette_marrin/article5822151.ece">in the Times (UK) by Minette Marrin</a>. It was about British bankers, but it just as well could have been about American health care executives: <blockquote> The filthy rich, as Peter Mandelson affectionately calls them, are different. It is not just that they’re rich but that there’s something about being extremely rich that blurs ordinary perspective in all but the most exceptional people. Power may corrupt, but extreme wealth blinds and deafens. I first came across the filthy rich just after I was married and went to live in Hong Kong in the 1970s. Leaving poverty-stricken Britain, my husband and I joined a gold rush of bankers and brokers to what was then still a crown colony. What we saw was wealth and conspicuous consumption beyond the wildest dreams of avarice. Though we weren’t extremely highly paid, we spent a lot of time with people who were. Some were entrepreneurs and others were employees of banks and trading houses that, as today, offered them ways of making megabucks. Soon it became obvious that being very rich is like catching an insidious virus. Some people are able to resist it, but with most people the super-riches virus burrows into your nervous system for life. It blurs your perspective, weakens your grasp on reality and changes your identity into someone who is entitled to be very rich. </blockquote> Ms Marrin's description of "plutocratic blindness" seems to apply to a CEO of a so-called not-for-profit organization who could claim more than $4 million in a year in which the global economy collapsed, and his own organization did rather badly by any financial measure. This passage by Ms Marrin seems applicable to the Blue Cross Blue Shield Board who approved this disproportionate pay package: <blockquote> But I do know things are done quite differently on the parallel planet inhabited by the filthy rich. Remuneration boards unselfconsciously award each other astonishing packages, wrapped up in euphemism. </blockquote> The lack of selfconsciousness in this case may have been driven by the board's familiarity with how things used to be done in the American financial sector. A quarter of the board's members are leaders in that sector (see post <a href="http://hcrenewal.blogspot.com/2009/01/to-whom-did-scorpions-in-bottle-owe.html">here</a>). Let me close with Ms Marrin's suggested solution: <blockquote> The filthy rich culture that has developed in the past 20 years is sick. It needs strong medicine, fresh air, open windows. Above all, what’s needed is a cold dose of fear – fear of failing, of being sacked and of losing the lovely money. Here is an excellent antidote to greed. </blockquote>

A $4.3 Million Dollar CEO for a Not-For-Profit Health Care Insurance Corporation

The US stock markets are at lows unseen for more than 10 years, unemployment is rising, around the world national deficits are increasing, a...

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YouTube Symphony Orchestra winners are announced

(Cross-posted from the <a href="http://www.youtube.com/blog?entry=Hc0bh6GiXlw">YouTube Blog</a>) Today we are proud to announce the winners of the world's first online collaborative orchestra. The global YouTube community and a judging panel containing members of the world's most renowned orchestras have selected over 90 talented musicians to be part of the YouTube Symphony Orchestra. Together, these professional and amateur musicians play 26 different instruments and come from 30+ countries and territories on six continents. To grasp the level of talent we’re talking about, just take a look at the stellar string section: <object height="385" width="480"><param name="movie" value="http://www.youtube.com/p/AE38CDDE6DAA23CC&hl=en"> <embed src="http://www.youtube.com/p/AE38CDDE6DAA23CC&hl=en" type="application/x-shockwave-flash" height="385" width="480"></embed></object> The selected musicians will travel from around the world to New York City to participate in a collaborative summit for classical music on April 12-15, 2009, concluding with a concert at Carnegie Hall under the direction of <a href="http://www.youtube.com/michaeltilsonthomas">Michael Tilson Thomas</a>, San Francisco Symphony Music Director, New World Symphony Founder and Artistic Director, and London Symphony Orchestra Principal Guest Conductor. All the winning audition videos are on the <a href="http://www.youtube.com/symphony">YouTube Symphony Orchestra Channel</a>; please share your congratulations with these musicians in the comments section, and don’t forget to stay tuned as we follow them on the road to Carnegie Hall. (If you’d like to cheer them on in person, tickets are on sale now at <a href="http://www.carnegiehall.org/article/box_office/events/evt_13015.html?selecteddate=04152009"> www.carnegiehall.org</a>.) Cue the congratulatory strings! Posted by Michele Flannery, YouTube Music

YouTube Symphony Orchestra winners are announced

(Cross-posted from the YouTube Blog ) Today we are proud to announce the winners of the world's first online collaborative orchestra. Th...

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Where Is Our Medical Leadership on the Death Traps Known as Misdesigned Healthcare IT?

In my series on health IT (<a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">starting here</a>) whose human engineering is ill conceived, philistine and presents clinicians with a mission hostile user experience, I have kept a neutral stance regarding the role of our so-called professional society representatives. If we were pilots or police officers or even bus drivers asked to use such seriously impaired devices, we and our unions would have declared war long ago. (I worked some years ago as Medical Programs Manager for the regional transit authority in Philadelphia, and say this quite confidently. <a href="http://www.twu.com/about/officers/lombardo.html">Mr. Lombardo</a> would likely agree.) Right next to my Feb. 18 <a href="http://online.wsj.com/article/SB123492035330205101.html">Wall Street Journal letter to the editor</a> on HIT was a letter from the President-elect of the American Medical Association, J. James Rohack, M.D. Dr. Rohack wrote to the WSJ (emphases mine): <blockquote style="font-family: arial;">You admit in your editorial "<a class="" href="http://online.wsj.com/article/SB123431432273870909.html">A Health-Tech Monopoly</a>" (Feb. 11) that electronic medical records "might do some actual good." We agree, and that is why we support the health information technology provisions of the economic stimulus bill. The economic stimulus bill being considered will create important national HIT interoperability standards. These standards are essential to achieve the promise HIT holds to help increase patient safety, improve care coordination and reduce unnecessary paperwork. As is true in other industries, basic standards will provide the essential foundation on which the private sector can build innovative commercial products. Competition and innovation are bedrocks of America's economic system, as they should be in health care. The HIT provisions in the bill maintain this vision, while building on existing federal efforts to encourage HIT adoption. This bill does not authorize the government to dictate clinical guidelines or national coverage decisions. Medical treatment decisions remain in the hands of physicians. The bill also provides physicians with significant financial assistance for HIT purchases. This critical support is needed so that physicians can make HIT purchases [why would they want to buy defective and hard to use cybernetic monstrosities at any price? - ed.], and patients can then begin to reap the benefit.</blockquote> Where's the innovation in vendor HIT products, whose user interaction even after decades of information science, computer science, biomedical informatics, HCI and other research looks like it was designed by high schoolers? Interoperability standards and financial incentives are, I'm going to venture to say, nearly irrelevant to the poor acceptance of HIT by the average physician in 2009. Our medical leaders seem to be becoming parrots, repeating the irrelevant (in the near term, to 'Joe the Doctor' and 'Rosie the RN') mantras about standards and interoperability, seeing the galaxy while missing the Black Hole whose event horizon they are nearing. Again, I speak from experience. When I was CMIO, we were getting quite good results from our HIT efforts at Christiana Care a decade ago, long before standards were as well formulated as today, for example as seen at the <a href="http://www.hhs.gov/healthit/chiinitiative.html">Consolidated Informatics Initiative</a> site at HHS. Completely lacking in this relatively milquetoast letter to the WSJ is the issue of the mission hostile user experience presented to clinicians by most current HIT applications, designed as inventory systems by MIS-inclined mindsets rather than as clinical tools (if you don't believe me, then believe the U.S. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=NRC">National Academies</a> and National Research Council, and its informatics pioneers Stead and Barnett): <blockquote> Current efforts aimed at the nationwide deployment of health care information technology (IT) will not be sufficient to achieve medical leaders' vision of health care in the 21st century and may even set back the cause, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving. ... Most importantly, current health care IT systems offer little cognitive support; clinicians spend a great deal of time sifting through large amounts of raw data (such as lab and other test results) and integrating it with their medical knowledge to form a whole picture of the patient. Many care providers told the committee that data entered into their IT systems was used mainly to comply with regulations or to defend against lawsuits, rather than to improve care. As a result, valuable time and energy is spent managing data as opposed to understanding the patient</blockquote><o:p></o:p> I encourage clinicians injured and offended by the hostile products they are being coerced to use, organizationally and now nationally, to write to our medical leadership. I wrote the following to <a href="mailto:James.Rohack@ama-assn.org">Dr. Rohack</a>: <blockquote>Dear Dr. Rohack, I wish to call your attention to my series on the site of the Foundation for Integrity and Responsibility in Medicine, the multi author blog Healthcare Renewal. The series outlines the major problems with today's healthcare information technology: poor design and vendor freedom from accountability and information sharing on defects. The series starts <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html" target="blank">here </a>. </blockquote> Thus the AMA leadership is informed of these issues. They can ignore them (after all, I'm just a nobody <a href="http://hcrenewal.blogspot.com/2008/09/mhra-report-on-influence-of-healthcare.html">writing on a godforsaken corner of the digital gutter known as the blogosphere</a>), or they can represent their profession. I encourage others to write their medical leadership as well. -- SS

Where Is Our Medical Leadership on the Death Traps Known as Misdesigned Healthcare IT?

In my series on health IT ( starting here ) whose human engineering is ill conceived, philistine and presents clinicians with a mission ho...

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Information Technology Makes Healthcare Easier? Is This Industry Trying to Harm Patients? Part 7 of a Series

This post is part 7 of a series on the stunningly poor human engineering of production healthcare IT from major vendors, in use today at major medical centers. These devices provide a decidedly mission hostile user experience, yet with an almost religious fervor are being touted as cybernetic miracles to cure healthcare's ills. (Note: Part 1 of this series is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">here</a>, part 2 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and.html">here</a>, part 3 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_24.html">here</a>, part 4 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_26.html">here</a>, part 5 is <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_27.html">here</a>, part 6 is <a href="http://hcrenewal.blogspot.com/2009/02/it-makes-healthcare-easier-is-this.html">here</a>, part 7 is <a href="http://hcrenewal.blogspot.com/2009/03/information-technology-makes-healthcare.html">here</a>, and part 8 is <a href="http://hcrenewal.blogspot.com/2009/03/malpractices-of-multitudes-mission.html">here</a>. 2011 addendums: a post that can be considered part 9 is <a href="http://hcrenewal.blogspot.com/2011/04/special-k-red-berries-mission-hostile.html">here</a>, part 10 is <a href="http://hcrenewal.blogspot.com/2011/12/ehr-mission-hostile-user-experience.html">here</a>.) Want to make a doctor or nurse miserable? Want to up the odds for error? Simply force them to review lab results on a screen as sloppily designed and cluttered as this one: <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDLFQ-PAS3aBLCVpAFdakpdwVOpeaoSkPuHFl7j_-U6pBkcU-KNdT7tNiDDHvIVFp21KL_4A72ciatUwGdBpqB0B1Ao8Ho2RgSiUDkj8ogNzauKXTipo3TdAheaQqA5M7v_SWTVQrJ5VxO/s1600-h/labclutter.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5308468215143121762" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDLFQ-PAS3aBLCVpAFdakpdwVOpeaoSkPuHFl7j_-U6pBkcU-KNdT7tNiDDHvIVFp21KL_4A72ciatUwGdBpqB0B1Ao8Ho2RgSiUDkj8ogNzauKXTipo3TdAheaQqA5M7v_SWTVQrJ5VxO/s320/labclutter.jpg" style="cursor: pointer; display: block; height: 216px; margin: 0px auto 10px; text-align: center; width: 392px;" /></a>(click to enlarge)</div> What technical genius programmed this monstrosity? The clutter is enough to impair the best clinicians who have to use such screens day in and day out on their often substantial patient loads. How is such a screen better than paper? Does the clinician really need to see subcomponents of panels such as General Chemistry split up all over the place, into sections of columns? Perhaps monolithic columns and horizontal scrolling would be less cognitively taxing? More columns, of course, could be placed in the available screen width if space were not wasted by ... units and Abn's! Does the clinician really need to see "Abn" as opposed to, say, "A" for abnormals? (At least the abnormals are actually marked in this application, unlike <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and.html">here</a> in "Warning! No warnings!) Does the clinician need to see units such as mg/dL (milligrams pre deciliter) and mEq/L (milliequivalents per liter) on each and every lab value? Correction - on ANY lab value? Could not that information be placed - once - in the column or row headers? (Oh, wait ... as shown <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-testers-and_26.html">here</a>, those headers in some products have a tendency to scroll away, forcing the "track the value with your finger" method of medical error prevention!) <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTPpUz3d7SAmGmxAKZzZozBebb5LKK7E-XY4wSyAV7v42lxdq871V9RZfDEh7izPrg2ShhoTlDf116cfpPVNIqvoV-7k_zXYopKDRryp3YYpNXhIDmyo6Q14tigqUDeJrZ81YI2nPYain2/s1600-h/scroll2.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5308453800556330290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTPpUz3d7SAmGmxAKZzZozBebb5LKK7E-XY4wSyAV7v42lxdq871V9RZfDEh7izPrg2ShhoTlDf116cfpPVNIqvoV-7k_zXYopKDRryp3YYpNXhIDmyo6Q14tigqUDeJrZ81YI2nPYain2/s320/scroll2.jpg" style="cursor: pointer; display: block; height: 276px; margin: 0px auto 10px; text-align: center; width: 372px;" /></a>(click to enlarge)</div> Then there's this, just in from Down Under on clinical decision support, touted as one of the most important benefits of HIT: <div class="Ti"></div><blockquote><div class="Ti"><a href="http://www.mja.com.au/public/issues/190_05_020309/swe11286_fm.html">Quality of drug interaction alerts in prescribing and dispensing software</a></div><div class="By"><a href="http://www.blogger.com/blogger.g?blogID=9551150" name="0_elementId-1095765"></a><a href="http://www.blogger.com/blogger.g?blogID=9551150" name="0_pgfId-1101519"></a>Sweidan et al., Medical Journal of Australia 2009; 190 (5): 251-254</div> <div class="Abs"><a href="http://www.blogger.com/blogger.g?blogID=9551150" name="0_elementId-1095776"></a>Objective: To investigate the quality of drug interaction decision support in selected prescribing and dispensing software systems, and to compare this information with that found in a range of reference sources. </div><div class="Abs"><a href="http://www.blogger.com/blogger.g?blogID=9551150" name="0_pgfId-1091820"></a> Design and setting: A comparative study, conducted between June 2006 and February 2007, of the support provided for making decisions about 20 major and 20 minor drug interactions in six prescribing and three dispensing software systems used in primary care in Australia. Five electronic reference sources were evaluated for comparison </div><div class="Abs"><a href="http://www.blogger.com/blogger.g?blogID=9551150" name="0_pgfId-1091821"></a></div><div class="Abs"><a href="http://www.blogger.com/blogger.g?blogID=9551150" name="0_pgfId-1091822"></a> Results: Six of the nine software systems had a sensitivity rate ≥ 90%, detecting most of the major interactions. Only 3/9 systems had a specificity rate of ≥ 80%, with other systems providing inappropriate or unhelpful alerts for many minor interactions. Only 2/9 systems provided adequate information about clinical effects for more than half the major drug interactions, and 1/9 provided useful management advice for more than half of these. The reference sources had high sensitivity and in general provided more comprehensive clinical information than the software systems. </div><div class="Abs"><a href="http://www.blogger.com/blogger.g?blogID=9551150" name="0_pgfId-1091823"></a> Conclusions: Drug interaction decision support in commonly used prescribing and dispensing software has significant shortcomings.</div></blockquote><div class="Abs"></div> More in part 8. -- SS

Information Technology Makes Healthcare Easier? Is This Industry Trying to Harm Patients? Part 7 of a Series

This post is part 7 of a series on the stunningly poor human engineering of production healthcare IT from major vendors, in use today at m...

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