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Pharmacy Benefit Managers as Pharmaceutical Marketers

We posted a number of times about questionable practices Eli Lilly used to market its atypical anti-psychotic drug Zyprexa (olanzapine). A post from 2007, with links backward, is <a href="http://hcrenewal.blogspot.com/2007/02/more-on-zyprexa-memos.html">here</a>, and our most recent post is <a href="http://hcrenewal.blogspot.com/2009/06/handbook-for-ghost-writing.html">here</a>. The company remains entangled in litigation over its marketing of this drug. That litigation has lead to the release of numerous internal documents that provide quite a view of Lilly's marketing practices. Bloomberg continued its reporting on these documents, with its latest effort <a href="http://www.boston.com/business/healthcare/articles/2009/06/14/zyprexa_suit_highlights_cvs_links_to_lilly/">here</a> via the Boston Globe, describing yet another surprising way this drug was sold: <blockquote> A unit of CVS Caremark Corp. used its access to doctors to market Eli Lilly & Co.'s Zyprexa antipsychotic while it was under contract to bargain with the drug maker on behalf of health insurers, internal Lilly files disclosed in a multibillion-dollar lawsuit by insurers show. The subsidiary of CVS, the largest US drugstore chain, touted Zyprexa starting in 2003, according to e-mails made public by lawyers suing Lilly for overpayment. CVS's AdvancePCS, a pharmacy benefit manager, or PBM, offered to send 120,000 letters to doctors promoting the drug, Lilly's top-seller with $4.7 billion in sales last year, according to a confidential 2004 proposal. The CVS unit said it would charge $5 per letter. AdvancePCS, acquired by Woonsocket, R.I.-based CVS in 2007, said in the documents that the direct-mail campaign was 'designed to influence key prescribers' as part of a 'tactical plan for Zyprexa.' </blockquote> Furthermore, <blockquote> In AdvancePCS's 2004 pitch to Lilly offering to send out letters promoting Zyprexa, Kevin Aholt, the company's assistant vice president in charge of strategic alliances, said he could target physicians based 'on the most recent AdvancePCS claims data,' according to the unsealed documents. Aholt also said that one of the 'key issues' in the market for antipsychotic drugs was finding ways to 'accelerate the growth of new patient starts,' according to the proposal. </blockquote> Also, <blockquote> Steven Fuchs, an official at the PBM, asked Lilly officials in an April 2004 e-mail whether he should include information about Zyprexa's ability to calm agitated patients in the next round of letters to doctors. 'Would a discussion of that be something you would want to include?' Fuchs asked, according to the document. Lilly marketing executive Scott Dell responded in an e-mail that officials at the drug maker had discussed asking AdvancePCS to include material highlighting 'the new bipolar maintenance indication for Zyprexa.' </blockquote> AdvancePCS was not the only pharmacy benefits manager (PBM) that offered to help sell Zyprexa. <blockquote> CVS rival Express Scripts Inc. also sent out Zyprexa marketing letters, according to the unsealed documents and also isn't named as a defendant in the suits. </blockquote> So here we have at least two pharmacy benefit managers (PBMs) offering to help market a particular drug, for money, of course. What is the problem here? <blockquote> CVS's contracts with insurers and pensions meanwhile place it in an adversarial posture with Lilly, requiring it to use its buying power as leverage in drug-price negotiations. 'The problem is that PBMs are negotiating these hidden deals while at the same time telling employers that they represent them at the negotiating table,' said Gerry Purcell, a former PBM executive who advises companies on their drug plans. 'These documents will add fuel to the perception that the companies and the PBMs are in cahoots with each other.' </blockquote> Also, <blockquote> While PBMs negotiate on behalf of insurers, most states don't designate them as agents of the benefit plans, said Robert Garis, a pharmacy professor at Creighton University in Omaha who studies the industry. As a result, they aren't legally required to act only in the best interest of their clients, he said. Maine is one of a few states that have specified PBMs as fiduciaries, or agents, he noted. 'The companies have gotten around that by adding language to their contracts that exclude them from having to meet those fiduciary duties,' Garis said. </blockquote> Apparently, in this case, one PBM said it disclosed its relationship to the drug company to physicians, but it is not clear whether it was disclosed to the health care insurers and managed care organizations which paid the PBM to reduce the costs of drugs: <blockquote> CVS, which isn't a defendant in the Lilly suit, said that it tells doctors when it has 'financial relationships' with drug makers and that they are free to opt out of mailings. 'To engage in a point/counterpoint in a media outlet rather than in court would not be productive,' said Lilly spokeswoman Marni Lemons. Lemons declined to answer specific queries about the CVS or Express Scripts letters, whether Lilly paid for the practice, or other questions raised by the unsealed documents.... CVS said in its e-mailed statement that it has 'no active educational programs' related to Zyprexa. 'CVS Caremark discloses to its PBM clients that it may have financial relationships with pharmaceutical manufacturers in connection with these educational programs,' said Christine Cramer, a spokeswoman for the chain. 'CVS Caremark's PBM clients are aware of these programs and have the opportunity to opt out.' Maria Palumbo, a spokeswoman for Express Scripts, didn't respond to eight telephone and e-mail requests seeking comment. CVS covers 82 million people, with a market share of 12 percent, and is the largest pharmacy benefit manager, according to Atlantic Information Services. Express Scripts, which covers 55 million people, is the fifth largest. PBMs process about 75 percent of the retail prescriptions written annually in the United States, according to the insurance plans. The insurance plans sued the drug maker in 2005, contending it used researchers, pharmacy benefit managers, advocacy groups, and public agencies to promote Zyprexa. </blockquote> Whether or not the PBMs disclosed their relationships to the pharmaceutical company to everyone who might be interested, it does seem that having PBMs who are supposed to help insurers and managed care organizations control drug costs be paid by pharmaceutical companies to market drugs is yet another new species of institutional conflict of interest. Like the many other conflicts of interest, individual and institutional, we have discussed, this one appears to be mutually advantageous to the parties involved. However, it could have adverse consequences for physicians, patients, and the health care system. If the organizations that are supposed to be controlling drug costs are also promoting expensive drugs, the likely result would be excess prescription of expensive drugs to patients who may not derive benefits from the drugs outweighing their harms. This is another reminder how much we need more sunshine shone on the multitudinous conflicts of interest affecting just about every type of actor within the current US health care system.

Pharmacy Benefit Managers as Pharmaceutical Marketers

We posted a number of times about questionable practices Eli Lilly used to market its atypical anti-psychotic drug Zyprexa ( olanzapine ). ...

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Citizentube: Watching video change our world

As you might have noticed, there's a lot of fascinating stuff that happens on YouTube every day. For example, did you know that a nine-year-old recently used YouTube to successfully <a href="http://www.citizentube.com/2009/05/9-year-old-uses-youtube-to-save.html">campaign</a> to save his local kickball lot? Have you seen the video of a Guatemalan lawyer who predicted his own <a href="http://www.citizentube.com/2009/05/dead-lawyers-video-accusation-causes.html">assassination</a> on YouTube moments before it happened? Or did you know that YouTube and Google have launched a <a href="http://www.citizentube.com/2009/06/new-model-for-political-interviews-and.html">new technology platform</a> for political debates, which allows you to submit and vote on the most important issues you want to discuss with political candidates? These are the sorts of things you can stay on top of with <a href="http://www.citizentube.com/">Citizentube</a>, a special YouTube blog devoted to chronicling the way that people are using video to change the world. If you've followed news and politics on YouTube, you might have <a href="http://www.youtube.com/blog?entry=zADtM47GcO0">noticed</a> that we started Citizentube as a <a href="http://www.youtube.com/citizentube">video channel</a> on the site a few years back, but we soon realized that keeping track of all the phenomenal uses of YouTube by posting our own videos just wasn't fast enough — so now we're blogging, too. We generally focus on two types of posts: the compelling political and social uses of YouTube that we see the community bubble up every day, and our own programming initiatives and partnerships in the political, news, and nonprofit arenas. Our team creates opportunities for you to engage with content that goes beyond the humorous or even the educational — content that changes the way you interact with your communities, institutions, and leaders. The first initiative we launched in this space was the You Choose '08 platform and the <a href="http://www.youtube.com/republicandebate">CNN/YouTube Debates</a> in 2007. Since then we've expanded our programming to the fields of <a href="http://www.youtube.com/senatehub">government</a>, <a href="http://www.youtube.com/inmyname">activism</a>, and <a href="http://www.youtube.com/projectreport">news & information</a>. On the blog, we'll post an occasional series that gives a bigger picture perspective of what's happening in the worlds of news reporting, government, and social change on YouTube. So be sure to check out www.citizentube.com and subscribe to our <a href="http://feeds.feedburner.com/blogspot/PrYR">RSS feed</a> (we're on Twitter, too: @citizentube). With more than 20 hours of video uploaded to YouTube every minute, our blog helps provide you with a filter that you can use to see the way that video is changing our world. Posted by Steve Grove, YouTube News and Politics

Citizentube: Watching video change our world

As you might have noticed, there's a lot of fascinating stuff that happens on YouTube every day. For example, did you know that a nine-y...

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A Handbook for Ghost-Writing

We posted a number of times about questionable practices Eli Lilly used to market its atypical anti-psychotic drug Zyprexa (olanzapine). A post from 2007, with links backward, is <a href="http://hcrenewal.blogspot.com/2007/02/more-on-zyprexa-memos.html">here</a>, and our most recent post is <a href="http://hcrenewal.blogspot.com/2009/01/what-me-worry-lilly-fined-over-zyprexa.html">here</a>. The company remains entangled in litigation over its marketing of this drug. That litigation has lead to the release of numerous internal documents that provide quite a view of Lilly's marketing practices. In particular, a Bloomberg <a href="http://www.bloomberg.com/apps/news?pid=20601109&sid=aVvfe.v1k_VY">news article </a>discussed how the company used ghost-writers: <blockquote> Ensuring that medical journal articles presented Zyprexa study results in a positive light was one way for Lilly to reach its sales goal, company officials said in its plan, according to the documents. To do that, Lilly officials hired ghostwriters to prepare submissions to journals such as Progress in Neurology and Psychiatry, according to the unsealed documents. </blockquote> The article then described how Lilly marketers set up a ghost-written article. <blockquote> 'The paper for the Progress in Neurology and Psychiatry supplement has been completed and sent to the journal for peer review,' Kerrie Mitchell, an employee of the public relations agency Cohn & Wolfe, wrote in a Feb. 23, 2001, e-mail to Michael Sale, a Lilly marketing official. The message was among the unsealed files. 'We ‘ghost’ wrote this article and then worked with author Dr. Haddad to work up the final copy,' Mitchell said in the e- mail. Eric Litchfield, a spokesman for Cohn & Wolfe, didn’t immediately return a call seeking comment. Peter Haddad, a researcher at Greater Manchester West Mental Health NHS Foundation Trust in the U.K., was listed as the article’s lead author. Haddad didn’t respond to requests for comment. The global Lilly team approved a draft of Haddad’s ghost- written paper in 2000, according to the unsealed documents. </blockquote> Lilly marketers, rather than articles' putative authors, sometimes exerted pressure to get ghost-written articles published. For example, <blockquote> Lilly officials e-mailed journal editors to complain about delays in publishing favorable Zyprexa articles, according to the unsealed documents. In one instance, Lilly employees contacted the Journal of Clinical Epidemiology about delays of an article criticizing a previously published piece linking Zyprexa, as well as the class of atypical antipsychotics, to diabetes. After Suraja Roychowdhury, Lilly’s senior scientific communications coordinator, wrote to the journal in November 2002, its editor, Andre Knottnerus, replied in an e-mail that it was 'a bit strange to be contacted via the Lilly product team. Dr. Buse and coauthors can contact us directly next time.' Knottnerus was referring to the manuscript’s lead author, John Buse, a former president of the American Diabetes Association. A copy of the Nov. 22, 2002, e-mail was included in the unsealed documents. Patrizia Cavazzoni, a Lilly staffer who co-wrote the article, e-mailed Buse on Jan. 9, 2003, seeking permission to send a separate e-mail asking to expedite publication. She also asked Buse if he would prefer 'to send it in your name?' It isn’t clear from the e-mail chain whether the e-mail was sent by Buse or Cavazzoni. </blockquote> Finally, Lilly developed a handbook for ghost-writers: <blockquote> To ensure that ghostwritten Zyprexa articles met Lilly’s standards, company officials issued a guide to preparing them, according to the unsealed files. The guide, 'Medical Press: Pre-Launch Feature Outline,' was undated. It’s unclear from the documents which teams in Lilly’s top 10 markets for the drug received it. The primer provided a how-to for writing articles, such as instructing the author to use Zyprexa’s generic name, olanzapine, instead of its brand moniker, according to the documents. Scientists in medical research traditionally refer to a drug’s chemical name. The guide also offered tips on how to find authors by identifying a 'key opinion leader' and providing them either an outline of the article or a finished copy. Authors could include a study investigator, an advisory board member or “Lilly-friendly” doctor, according to the documents. A sample article laid out how a Lilly employee may find a doctor to ghostwrite a submission that would 'prepare the market' for the launch of an intramuscular injectable version of the drug. It also offered an outline for the contents of the article, beginning with background on another drug, droperidol, which had been withdrawn from several countries. The article, with the suggested title 'Filling the Droperidol Gap,' noted that an anti-anxiety drug could be used, before going on to say, 'more advanced IM treatments may soon be available to provide a superior alternative.' The article explained that injectable Zyprexa had just received approval from the FDA, and recounted its clinical trial history. 'The anticipated forthcoming availability of atypical antipsychotics in an IM formulation could be a major step forward in the treatment of acute agitation associated with schizophrenia,' the sample article concluded. </blockquote> We addressed ghost-writing frequently when we started Health Care Renewal, and have returned to the topic periodically (see these more recent links, from 2008, <a href="http://hcrenewal.blogspot.com/2008/04/ghosts-come-home-to-roost.html">here</a> and <a href="http://hcrenewal.blogspot.com/2008/12/haunting-of-hormone-replacement-therapy.html">here</a>). The most striking feature of this newest case is the use of a "ghost-writers' handbook" denoting how systematized the practice has become. With each new case, it becomes clearer how common the practice may be. Since the parties involved seem ashamed enough of the practice to try to keep it well hidden, it may be that ghost-writing is even more common than we now realize. Nonetheless, while the practice may be common, and mutually advantageous for ghost-writers, the academics who front for them, and the marketers who hire them all, as we and others have <a href="http://hcrenewal.blogspot.com/2007/04/haunted-medical-literature-moffatt-and.html">said before</a>, ghost-writing is dangerous to health. It deludes physicians and patients into thinking health care products are more beneficial and less risky than they really are. Ghost-writing also undermines science by shifting the agenda away from interesting and important questions to questions whose answers may mainly benefit vested interests. Finally, on a personal note, ghost-writing demoralizes honest academics who must run their own studies, write their own papers, and manage the logistics of paper submission in competition with fake authors backed by corporate money and corporate staff. Scientists and academics who allow and front for ghost-writers ought to be ashamed of themselves. See also <a href="http://clinpsyc.blogspot.com/2009/06/greedy-and-ghostly-scientists.html">comments</a> in the Clinical Psychology and Psychiatry blog, and <a href="http://brodyhooked.blogspot.com/2009/06/lillys-off-label-marketing-of-zyprexa.html">discussion</a> of some of the other recent revelations about Zyprexa marketing in the Hooked: Ethics, Medicine and Pharma blog. ADDENDUM (14 June, 2009) - Also see <a href="http://www.margaretsoltan.com/?p=13876">comments</a> by Prof Margaret Soltan on the University Diary blog on the "Stockholm Syndrome" as manifested by "key opinion leaders" in the pay of health care corporations. ADDENDUM (15 June, 2009) - Furthermore, see <a href="http://brodyhooked.blogspot.com/2009/06/more-zyprexa-documents-released.html">comments</a> by Dr Howard Brody in the Hooked: Ethics, Medicine and Pharma Blog.

A Handbook for Ghost-Writing

We posted a number of times about questionable practices Eli Lilly used to market its atypical anti-psychotic drug Zyprexa (olanzapine). A p...

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Voting for iGoogle photo themes now open

A few weeks ago we launched the <a href="http://www.google.com/intl/en/landing/photographyprize/">Google Photography Prize</a>, a global student competition for students to create themes for iGoogle. Our goal was to find talented student photographers and give them unprecedented online and offline exposure. It may seem a little brave to unleash student art on our homepage, but we've been hugely impressed the number and quality of entries we received. From among the thousands of entries from around the world, we've just announced the shortlist of 36 finalists. Now they're up for your vote - the most popular six you choose will make it to the finals. The 6 finalists will be exhibited at the <a href="http://www.saatchi-gallery.co.uk/gallery/intro.htm">Saatchi Gallery</a> in London and have the chance to win the first prize of £5,000 ($7,500), plus an invitation to spend the day with the internationally renowned photographer <a href="http://images.google.com/images?hl=en&q=martin+parr&btnG=Search+Images&gbv=2&aq=f&oq=">Martin Parr</a>. On the voting page you can also add your favourite as a theme to your iGoogle homepage. Millions of people have already chosen to adorn their iGoogle page with images, with everything from seascapes to original art. Now you can have some fantastic photography from some of the best up-and-coming photographic talent out there right on your homepage. So take a look, enjoy the photographs, and <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html">please vote</a> — the deadline is June 17th. And if you are in London this month, come see the exhibit of the winners at the Saatchi Gallery, starting the 24th and running for a week. Posted by Posted by Louise Rigby, Consumer Marketing Team

Voting for iGoogle photo themes now open

A few weeks ago we launched the Google Photography Prize , a global student competition for students to create themes for iGoogle. Our goal ...

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Snack time with the new iGoogle for Android and iPhone

<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEholG9oSlNgGhVUAXdDbuy_JBEUjQvSpreqOLX0AKm0qUyB3dNqNy0XDCU0pW3xxDP9H-lubOMwsfblg3Zm-c3G0cQem9xisp1ThlFWWCCsiAc0hbVKJ-VMvuQovC6KKAFvnbKBmJbpmxen/s1600-h/igoogle.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5346285525123312402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEholG9oSlNgGhVUAXdDbuy_JBEUjQvSpreqOLX0AKm0qUyB3dNqNy0XDCU0pW3xxDP9H-lubOMwsfblg3Zm-c3G0cQem9xisp1ThlFWWCCsiAc0hbVKJ-VMvuQovC6KKAFvnbKBmJbpmxen/s400/igoogle.jpg" style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 272px; height: 331px;" /></a>(cross-posted with the <a href="http://googlemobile.blogspot.com/2009/06/snack-time-with-new-igoogle-for-android.html">Google Mobile Blog</a>) We like iGoogle because it lets us "snack" on interesting information all day long. We can read a little bit of news here and there, glance at finance portfolios, take a look at the weather forecast, and then do a Google search. It doesn't require a big commitment of time and energy — it's simply there for us whenever we need it. This kind of availability is even more important on a phone, where it can take a long time to surf. That's why iGoogle is so convenient on mobile devices. When you're waiting in line, you can check iGoogle on your phone for a quick "info snack" — even in areas with mediocre network coverage. But speed isn't everything. Many of you have told us that you wanted to use more of your iGoogle gadgets on your phone. You wanted to see your tabs, too. We read your blog comments and forum posts and put your requests at the top of our to-do list. Today, we're excited to roll out an improved beta version of iGoogle for the iPhone and Android-powered devices. This new version is faster and easier to use. It supports tabs as well as more of your favorite gadgets, including those built by third-party developers. Note that not all gadgets — like those with Flash — will work in mobile browsers. One of our favorite new features is the in-line display of articles for feed-based gadgets. That means you can read article summaries without leaving the page. You can also rearrange gadget order or keep your favorite gadgets open for your next visit. None of these changes will mess up the layout of gadgets on your desktop computer, so feel free to play around and tune your mobile experience.  <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/B_ICorRs6J8&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/B_ICorRs6J8&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> The new version of iGoogle for mobile is available in 38 languages. To try it out, go to igoogle.com in your mobile browser and tap "Try the new Mobile iGoogle". Bookmark the page or make it your home page so you can return to it quickly. Finally, please fill out our survey by clicking on the "Tell us what you think" link at the top of the new home page. We'll continue to use your feedback to make iGoogle even better.<div> </div><div>Update on 6/12 @ 8:50 AM: Video added. Check it out!</div><div> <div>Posted by Dan Zivkovic and Zhen Wang, Software Engineers, Google mobile team</div></div>

Snack time with the new iGoogle for Android and iPhone

(cross-posted with the Google Mobile Blog ) We like iGoogle because it lets us "snack" on interesting information all day long. We...

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Wharton on Healthcare IT: Can I Go Home Now?

Professors at the <a href="http://www.wharton.upenn.edu/">Wharton School</a> of the University of Pennsylvania (one of the most prestigious business colleges in the world) had some very interesting observations about healthcare IT yesterday in an article entitled: <blockquote>"<a href="http://knowledge.wharton.upenn.edu/article.cfm?articleID=2260">Information Technology: Not a Cure for the High Cost of Health Care</a>."</blockquote> I have been writing on these same themes - <a href="http://hcrenewal.blogspot.com/search/label/irrational%20exuberance">irrational exuberance</a>, HIT not being a panacea or cybernetic miracle, HIT as a facilitating tool in medicine, not a revolutionary one (but only if "done right"), inadequate research to back up the often grandiose claims, and so forth for over a decade ("Contemporary Issues in Medical Informatics: Common Examples of Healthcare IT Failure", <a href="http://www.tinyurl.com/hit-misadventure">link</a>). I penned such sacrilege, often at risk to my career due the unpopularity of these ideas, itself due to the irrational exuberance of the HIT community (these attitudes were perhaps in part <a href="http://hcrenewal.blogspot.com/2009/05/machinery-behind-healthcare-reform-how.html">manufactured by a healthcare IT lobby</a>). Here are excerpts of what Wharton professors observed. Do read the entire article at the link above: <blockquote> President Obama made information technology a linchpin in his plan to reform health care when he included $19 billion in computerized medical record funding in the $787 billion American Recovery and Reinvestment Act of 2009. The goal: Use technology to reduce costs and improve the quality of care. The reality: Technology could increase health care costs without markedly improving quality, according to experts at Wharton [except perhaps in very highly specialized projects, not easily portable, such as <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">here</a> - and not without its own set of problems - ed.] ... "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 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." [I believe if HIT is "done well", we can achieve best case, and lower costs as well to an extent, but there is enormous complexity behind the two simple words "done well" that I'm not sure we've fully mastered as a society yet - ed.] ... 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 [an understatement - ed.] and misunderstanding about what the benefits will be and how quickly they will come," says <a 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 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. [Agree - ed.] But those benefits aren't likely to add up to big savings, says <a href="http://www.wharton.upenn.edu/faculty/burnsl.html">Lawton R. Burns</a>, director of the <a 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 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> All themes obvious to me after an informatics fellowship and term as CMIO at a major hospital, and to a number of my like minded colleagues as well. However, these themes were as hard to get published and recognized (i.e., turned into "memes") as a book against Global Warming ... The Wharton article concludes with this pithy wisdom: <blockquote>Experts say these projects are worth the effort, but the industry should keep its expectations in check [i.e., ditch the irrational exuberance - ed.] and closely scrutinize investments. "To the extent [that] these technologies improve the quality of care and get the patient more involved, I'm all for them," says [<a href="http://pennhealth.com/WagForm/MainPage.aspx?config=provider&P=PP&ID=268">Richard Neill</a>, residency director and vice chair at the University of Pennsylvania's <a href="http://www.uphs.upenn.edu/fampract/">Department of Family Medicine and Community Health</a>]. "But the technology is not a sea change -- just a chance to change."</blockquote> Anyone in Washington listening? Finally, after a decade of writing on these same observations to a public apparently inclined to believe the myths and promised cybernetic miracles nourished by the IT industry, and getting nowhere until some very serious organizations caught on this year and joined in (the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=JointCommissionAlert">Joint Commission</a>, the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=NRC">National Research Council</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=UK">UK House of Commons</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=koppel_kreda">JAMA</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=workshop">AMIA</a>, Wharton, etc.) I ask: can I go home now? -- SS

Wharton on Healthcare IT: Can I Go Home Now?

Professors at the Wharton School of the University of Pennsylvania (one of the most prestigious business colleges in the world) had some ve...

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Public CCHIT response to NJ "CCHIT or else" Health IT Bill

In my June 7 post <a href="http://hcrenewal.blogspot.com/2009/06/open-letter-to-mark-leavitt-chairman.html">Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use of Non-"Certified" HIT</a> I asked CCHIT's chair pointed questions about a remarkable NJ Bill to make non-CCHIT-certified health IT forbidden for sale or use, with civil penalties, in the state of NJ. His response is posted in the link. I've just become aware of a June 8 public response to the Bill at CCHIT's site "EHR Decisions" entitled <a href="http://ehrdecisions.com/2009/06/08/legislating-health-it-beware-of-land-mines/">Legislating Health IT: Beware of Land Mines:</a><blockquote style="font-family:arial;"> <a href="http://ehrdecisions.com/2009/06/08/legislating-health-it-beware-of-land-mines/"></a>... A number of people contacted me this weekend about a <a title="More on the New Jersey bill" href="http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM">bill on the floor of the New Jersey legislature</a> which proposes to make the purchase of non-CCHIT Certified products illegal. I want to make a few facts clear, then share some news about our plans going forward in the new environment created by ARRA. First, I do not believe this is an appropriate use of health IT certification. Our goal, stated in almost every presentation I’ve given, and to which I’ve adhered in my leadership of the Commission, has always been to unlock positive incentives for health IT adoption. <a title="Bridges to Excellence" href="http://www.bridgestoexcellence.org/">Bridges to Excellence</a> provides a role model for integrating health IT into outcome-based, pay for performance incentives. Successfully executed, <a title="Recovery.gov" href="http://www.recovery.gov/">ARRA</a> might too. But the New Jersey bill is nowhere near that. Making software purchases illegal, like dangerous substances? Let’s “just say no” to that idea. Second, neither I personally, nor <a title="CCHIT" href="http://cchit.org/">CCHIT</a> as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings ... </blockquote> A fine answer. Read the whole thing. I was probably one of the first to call this NJ Bill to his attention, under the assumption the leader of CCHIT would know about a bill calling for CCHIT exclusivity and "or else" civil penalties in a major state. (CCHIT's founder HIMSS <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/20/AR2009052003600.html?nav=emailpage">certainly has been cheerleading</a> for all health IT that receives ARRA support to be CCHIT certified. Is it reasonable to assume CCHIT's leader had knowledge of that?)Instead of thanks for my calling the NJ Bill to Mark Leavitt's attention, potentially saving him from far worse troubles over it than my questions (I am, after all, a political nobody!), I got ... well, embellishments ... decide for yourself at the "Open Letter" link above. You're welcome, Mark. Hope you're equally as charitable to the NJ Assembly members who actually made this trouble for you. p.s. the exact wording of a question I asked him on Jun. 7: <blockquote style="font-family:arial;">"Did you, or anyone in a governance or leadership position at CCHIT, play a role in sponsorhip of this bill, through financial contributions, lobbying, advocacy for its proposals, and/or other means to prohibit sale of non-CCHIT certified HIT?"</blockquote> His June 8 post says:<blockquote>Second, neither I personally, nor <a title="CCHIT" href="http://cchit.org/">CCHIT</a> as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill</blockquote>It even looks like I gave him the language for the public response. Again, Mark, you're welcome.And your apology for the embellished section of your response to my simple questions is accepted.Oh wait...Haven't gotten that yet.<div>-- SS</div><div> </div>

Public CCHIT response to NJ "CCHIT or else" Health IT Bill

In my June 7 post Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use...

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