healthy4u

State, City Settle Case Alleging Medicaid Fraud

We have posted on a variety of settlements of cases alleging health care fraud, but this one has a new twist, as <a href="http://www.nytimes.com/2009/07/22/nyregion/22whistle.html">reported </a>by the NY Times, <blockquote> New York State and New York City officials agreed this week to repay the federal government for more than half a billion dollars in improper Medicaid claims, averting a potential court battle but adding more red ink to the state’s and city’s finances. The settlement, which federal officials said was the largest recovery of Medicaid funds in history, ends a lengthy dispute with the federal government over whether school districts around the state improperly sought Medicaid payments for speech therapy and other services dating to the early 1990s. Under the agreement, which was announced Tuesday, the city will repay about $100 million. The state will pay about $332 million in 10 installments over the next five and a half years and will also give up $107.9 million worth of Medicaid claims now owed by the federal government. Though neither city nor state officials are required to admit wrongdoing under the agreement, it does require the state’s Department of Education to submit to independent monitoring of its Medicaid-financed programs. Since the 1980s, Medicaid has helped school districts pay for the cost of services like speech therapy and psychological counseling for schoolchildren, including the cost of transportation to therapists’ offices. School districts in New York have been among the most aggressive in the country in seeking such aid: one federal study found that New York accounted for 44 percent of all student health services. Those lawsuits, filed under the federal False Claims Act, spurred several audits by the Department of Health and Human Services of city and state programs that finance speech therapy and other programs for disabled children. Those audits found substantial potential for fraud, reporting that a vast majority of the claims submitted did not meet federal requirements, and that in many cases there was no evidence that the services had actually been provided. </blockquote> This may be the first settlement of health care fraud allegations we have discussed in which all the involved parties were government agencies. The current fervent debate in the US about health care reform has focused on ever rising health care costs. However, this debate has largely ignored the ethics of health care, and the sorts of leadership of health care organizations that has lead to rampant and costly mischief, of which this case is just the latest example. How can we control costs while so many health care leaders are seeking every angle to make more money, whatever the consequences?

State, City Settle Case Alleging Medicaid Fraud

We have posted on a variety of settlements of cases alleging health care fraud, but this one has a new twist, as reported by the NY Times, N...

Đọc thêm »

Digital activism on YouTube

(This is the second of a series of posts from YouTube's news and politics blog, <a href="http://www.citizentube.com/">Citizentube</a>. -Ed.) Activism today isn't limited to picket lines and marches on the Mall — people have taken their movements to the web, and <a href="http://www.youtube.com/">YouTube</a> has become an important platform for exposure. Every day, people use YouTube to fight for causes, whether they're hunger-striking celebrities like <a href="http://www.citizentube.com/2009/05/mia-farrow-fasts-for-darfur-vlogs-on.html">Mia Farrow</a>, or <a href="http://www.citizentube.com/2009/05/9-year-old-uses-youtube-to-save.html">9-year-olds trying to save the neighborhood kickball lot</a> from destruction. On <a href="http://www.citizentube.com/">Citizentube</a>, our YouTube blog that chronicles the way people use video to change the world, we've seen digital activists use YouTube in three basic ways: to shine a light on issues that need more exposure, to drive action around causes they care about, and to create connections between people and organizations that share their desire to make a difference. Some of the most compelling videos we see are those that spotlight important issues that aren't being covered in the mainstream media. <a href="http://www.youtube.com/witness">Witness</a>, a nonprofit organization whose mission is to document human rights abuses around the world through video, offers an excellent example — <a href="http://www.youtube.com/watch?v=z2EEJkyntV4">this video</a> from their YouTube channel chronicles the clashes between the Burmese military and rural ethnic minorities. <a href="http://www.citizentube.com/2009/07/invisiblepeopletv-giving-voice-to.html">Invisiblepeople.tv</a>, a relative newcomer to YouTube, is taking a similar approach by tackling a more domestic issue: homelessness. This summer, the group is traveling across America to document the real, unedited stories of people living on the streets, in tent communes and in cars — and posting all of the footage to <a href="http://www.youtube.com/user/invisiblepeopletv">their YouTube channel</a>. And of course we've seen protesters in <a href="http://www.citizentube.com/2009/07/new-round-of-protests-in-iran.html">Iran</a>, <a href="http://www.citizentube.com/2009/07/violent-riots-in-urumqi-china.html">China</a> and elsewhere use YouTube to amplify their causes far beyond national borders. Other individuals and nonprofits are using YouTube as a direct advocacy tool, experimenting with ways to drive action from their videos to a particular cause. And we're building new products to make it even easier for them to do this effectively. For example, in March, we <a href="http://www.citizentube.com/2009/03/youtube-nonprofit-raises-10000-for.html">launched</a> a tool called "Call to Action," which allows nonprofit organizations to drive traffic from an <a href="http://www.google.com/support/youtube/bin/answer.py?hl=en&answer=150471">in-video overlay</a> to an off-site page where they can collect donations, signatures or email addresses. Shortly after launch, to commemorate World Water Day, we featured a video from charity:water on the YouTube homepage that used a call-to-action overlay to encourage YouTube users to donate money to build wells and provide clean, safe drinking water for those who don't have it. Through YouTube, <a href="http://www.youtube.com/charitywater">charity:water</a> was able to raise over $10,000 in one day — enough to build two brand-new wells in the Central African Republic and give over 150 people clean drinking water for 20 years. Yet some of the most innovative uses of YouTube for digital activism are those that leverage the communities that exist on YouTube around particular causes. YouTube is inherently a social experience and many of our users are hungry to partner and collaborate with others who share their passions. Last December, popular YouTube users the <a href="http://www.youtube.com/vlogbrothers">Vlogbrothers</a> launched the "<a href="http://www.youtube.com/watch?v=f4hqWfp3374">Project for Awesome</a>," a campaign which asked fellow budding change-makers to make videos about their favorite charities. Over 1,200 people joined the effort to promote their cause of choice. And just a few weeks ago, in partnership with President Obama's launch of serve.gov, we created "<a href="http://www.citizentube.com/2009/06/announcing-service-20-video-volunteers.html">Video Volunteers</a>", a new platform on YouTube which connects nonprofits that lack video resources with proven video-makers who want to use their skills to do good. There are already hundreds of posts from nonprofits seeking help on the <a href="http://www.youtube.com/videovolunteers">Video Volunteers YouTube channel</a>, so if you're interested in creating a video for an organization, head over to the channel now and find a cause you care about. Activism is constantly evolving on YouTube, so we'll keep posting fresh accounts of how citizens and nonprofits are changing the world, one video at a time, on Citizentube. Posted by Ramya Raghavan, YouTube Nonprofits & Activism

Digital activism on YouTube

(This is the second of a series of posts from YouTube's news and politics blog, Citizentube . -Ed.) Activism today isn't limited to ...

Đọc thêm »

What Health Care Reformers Don't Discuss

Health care reform is now the big health care story in the US. Discussion of various health care reform proposals regularly lead in print and electronic media. Yet we have been very quiet here on Health Care Renewal about health care reform. I personally have written little, because it seems to me that hardly any of the discussion swirling around relates to the concerns we discuss on this blog. We write about the bad effects of continuing concentration and abuse of power in health care on physicians' and other health care professionals' core values. We note instances of ill-informed, incompetent, self-interested, conflicted, or even corrupt leaders of health care organizations. We discuss how problems with the governance of health care organizations allow such leadership. We comment on instances in which bad leaders use tactics such as deception, creation of perverse incentives, and intimidation. And we address how all this can lead to higher costs, decreasing access, poor patient outcomes, and demoralized professionals. For example, just in this month, July, 2009, we posted about: How Trusted Health Care Institutions are Lead by the Conflicted <ul><li>One of the largest and most respected medical societies gets three times as much income from the pharmaceutical, biotechnology and device industries as from membership dues, and its current generously salaried president just asks the public to "trust us, we're doctors" (link <a href="http://hcrenewal.blogspot.com/2009/07/again-logical-fallacies-in-defense-of.html">here</a>); </li><li>The White House health care reform czar just stepped off the board of directors of a health care corporation accused of "ruthless" behavior and making patients feel they are only equivalent to "dollars" (link <a href="http://hcrenewal.blogspot.com/2009/07/turning-patients-into-dialysis-dollars.html">here</a>); </li><li>An award-winning show on public television featured remarks favoring drug treatment of psychiatric illness by an academic "key opinion leader" without disclosing his multiple financial ties to the pharmaceutical industry (link <a href="http://hcrenewal.blogspot.com/2009/07/peabody-award-for-show-featuring.html">here</a>); </li><li>A state legislator pleaded guilty to selling his services to an academic medical center (link <a href="http://hcrenewal.blogspot.com/2009/07/ny-state-legislator-pleads-guilty-to.html">here</a>); </li></ul>Health Care Leaders Do Not Share Physicians' Traditional Values <ul><li>Leaders of the university that employs the academic "key opinion leader" mentioned above intimidated another of its professors because he wrote a blog critical of the pharmaceutical industry (link <a href="http://hcrenewal.blogspot.com/2009/07/blogger-that-dares-not-speak-his.html">here</a>); </li><li>A study showed that primary care doctors burn out not just because they think their pay is low, but because they work in "chaotic" environments, lead by people who do not inspire trust and whose values are not aligned with those of the physicians (link <a href="http://hcrenewal.blogspot.com/2009/07/window-on-unworkable-settings-in-which.html">here</a>); </li></ul>And our archives, going back now to the end of 2004, include much more.For the most part, however, these are not the issues discussed in the great health care reform debate. There does seem to be, at the margins, some discussion of a few productive approaches, which deserve credit. These include the Sunshine bill, which would improve disclosure of conflicts of interest generated by health care corporations' payments to health care professionals and academics; the push to support some comparative effectiveness research; and some attempts to address the perverse incentives built into the system used by Medicare to pay physicians. It is not clear, however, whether these efforts are going to get very far, and in any case, they remain peripheral to fervent discussions of health care financing, which seems to be the only topic of interest to most would-be health care reformers. I believe that the US health care reform will not produce good results if it fails to address the issues we discuss on Health Care Renewal. But discussion of them, of course, may threaten many with vested interests, and lots of people who have been made rich and powerful by the current system.So look forward to endless debates about whether the "public option" for health insurance is a good or bad idea, but nothing about how the insurance industry is lead, much less how pharmaceutical, biotechnology, device companies, hospitals and academic medical centers, medical not-for-profit organizations, health care information technology companies, and government agencies are lead, and how bad leadership facilitated by bad governance will continue to make things worse.

What Health Care Reformers Don't Discuss

Health care reform is now the big health care story in the US. Discussion of various health care reform proposals regularly lead in print an...

Đọc thêm »

JAMA letter: "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards"

My letter "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards" was published in JAMA yesterday. A preview of the letter can be seen <a href="http://jama.ama-assn.org/cgi/content/extract/302/4/382">here</a>, or a full version <a href="http://jama.ama-assn.org/cgi/content/full/302/4/382">here</a> if you subscribe to JAMA. <div> </div><div>The letter was in response to Koppel and Kreda's groundbreaking March 2009 JAMA article "<a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">Health Care Information Technology Vendors' Hold Harmless Clause: Implications for Patients and Clinicians</a>." </div><div><div> </div><div>The JAMA letter covered some of the same points I addressed extensively at my Drexel HIT website essay "<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=koppel_kreda">Hold Harmless and Keep Defects Secret Clauses</a>", including the major point that hospital executives signing such contracts are in violation of Joint Commission standards for conduct related to safety, and in violation of their fiduciary responsibilities towards patient and employee safety and freedom from undue liability. In the Drexel website essay I also noted that:</div><div> </div><div><blockquote>... these stipulations [hold harmless and gag clauses in contracts] further instantiate my observation that health IT lacks the rigor of medical science itself, its major Achilles heel.</blockquote></div><div> </div><div>Koppel and Kreda note <a href="http://jama.ama-assn.org/cgi/content/extract/302/4/382-a">in their JAMA reply</a> to my JAMA letter that:</div> <blockquote>Dr Silverstein's letter adds context to our Commentary on HIT vendors' self-protective "hold harmless" clauses while introducing an important discussion about hospitals' and vendors' possible violations of Joint Commission standards. We agree with Silverstein about the misapplication of the standard business software contracting model.</blockquote><div> <div>Of interest, the American Medical Informatics Association (AMIA) had authored a reply to Koppel and Kreda quite different than mine, which for a time appeared on their national website (www.jamia.org) but was later withdrawn apparently due to concerns that such a letter might be viewed as an official organizational position. It was entitled "Response to Commentary in JAMA -- Ross Koppel, David Kreda" and can be read in its entirety <a href="http://evernote.com/pub/poikonen/PublicPharmacoinformatics#Note/582cbf46-d342-46bc-a39e-3d57e3a31388">here</a>. </div> The AMIA response piece concluded:</div><div> </div><div><blockquote>"While we support increased transparency around error disclosure, the belief that the best approach to increase the safety and effectiveness of EHR systems is by legal regulation of system vendors is misplaced. Such an approach would stifle innovation and not achieve the desired goals. At a minimum equal attention needs to be given to the role that provider organizations bring to configuration, management and oversight of the software and related processes."</blockquote><blockquote> </blockquote></div></div><div>In fact, Koppel and Kreda addressed the provider side issues extensively in their article.</div><div> </div>Of interest, JAMA did not publish the AMIA response but instead published mine. Perhaps it's because JAMA felt I had something important to say, as opposed to simply making excuses for HIT vendors and valuing prevention of "stifling of innovation" over hospital leadership's safety and fiduciary obligations to patients and staff.<div> </div><div>"The belief that the best approach to improving HIT safety is via regulation is misplaced?" (Misplaced how, exactly?) Tell that to the airline or public transit or pharma or the medical device industries. Or to the public whose care is increasingly dependent upon these HIT systems.</div><div> </div><div>It is my firm opinion that "innovation" done recklessly, in secrecy, without accountability, and via exploitation is not innovation at all. <div> </div><div>-- SS July 23 addendum: Dr. Koppel has forwarded to me a letter he and Mr. Kreda submitted to AMIA in response to AMIA's aforementioned critique of his March 2009 JAMA "Hold Harmless Clause" article. Koppel and Kreda's letter, "On the AMIA Response to Commentary in JAMA by Ross Koppel and David Kreda" can be read <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/koppel_holdharmless_amia_reply.doc">here</a> (MS Word .doc format). Highlights: <blockquote> ... Where the AMIA authors disagree with us is the emphasis placed on errors produced in the coupling. [The coupling of healthcare organization and software, i.e., alterations and customizations beyond the control of the software vendor - ed.] We say a vast number or errors are generated in the marriage. But they say we have essentially ignored how many errors are created by doctors and hospitals seeking to consummate their relationship with HIT systems in situ ... ... A brief recap of our JAMA commentary seems in order. We wrote about: (1) the HIT vendor “non-disclosure” clauses that prevent clinicians from sharing information about errors generated from faulty software; (2) the clauses that remove all vendor responsibility for errors in their systems – and place all responsibility on clinicians and hospitals (the “hold harmless/learned intermediary” clauses); (3) the need to protect vendors from responsibilities for errors introduced when hospitals implement HIT or when untrained or incompetent clinicians use the HIT; and (4) the need for more balanced contracts that are fair to clinicians and hospitals ... ... Given that we addressed the non-software issues we are said to have ignored, we are not sure why our JAMA commentary earned the response it received on official AMIA letterhead. We hope, therefore that this letter can further a longer conversation about the many ways to make clinical IT software and its implementation better. Nonetheless, we stand by our statement that the imbalance in incentives we described in our JAMA Commentary is a structural obstacle that on balance hurts improving the clinical part of clinical IT. </blockquote>Read the whole thing at the link above. (I placed Koppel and Kreda's response to AMIA on my faculty server. The response, to the best of my knowledge, was not published by AMIA itself.) -- SS </div></div>

JAMA letter: "Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards"

My letter " Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards " was published in JAMA ...

Đọc thêm »

Explore the moon in Google Earth

Posted by Anousheh Ansari, Trustee, X PRIZE Foundation, and first female private space explorer [From time to time we invite guests to blog about initiatives of interest, and are very pleased to have Anousheh Ansari join us here. – Ed.] Ever since I was a young girl, it has been a dream of mine to travel into space. In September of 2006, I was fortunate enough to make that dream a reality — I took off from the launch pad in <a href="http://www.russianspaceweb.com/baikonur.html">Baikonur</a> bound for the International Space Station and became the world's first private female space tourist. Since then, it's been my mission to help as many people as possible think ambitiously about ways to push the boundaries of exploration, both here on Earth and beyond. As a trustee of the <a href="http://www.xprize.org/">X PRIZE Foundation</a>, and the sponsor of the Ansari X PRIZE, I support Google's goal of opening up space through projects like the Google Lunar X PRIZE, which serve to educate the public about the global benefits of space exploration. That's why I'm so excited about the release of <a href="http://earth.google.com/moon">Moon in Google Earth,</a> which is launching today at the <a href="http://www.newseum.org/">Newseum</a> in Washington D.C. This tool will make it easier for millions of people to learn about space, our moon and some of the most significant and dazzling discoveries humanity has accomplished together. Moon in Google Earth enables you to explore lunar imagery as well as informational content about the <a href="http://en.wikipedia.org/wiki/Apollo_program">Apollo landing</a> sites, panoramic images shot by the Apollo astronauts, narrated tours and much more. I believe that this educational tool is a critical step into the future, a way to both develop the dreams of young people globally, and inspire new audacious goals. With Google Earth, young explorers around the world can bounce around the galaxy in <a href="http://earth.google.com/sky">Sky</a>, fly to <a href="http://earth.google.com/mars">Mars</a> and now visit the <a href="http://earth.google.com/moon">moon</a> from wherever they may be. To learn more watch the video below or visit the <a href="http://google-latlong.blogspot.com/2009/07/fly-yourself-to-moon.html">Lat Long Blog</a>. Finally, outer space doesn't seem so far away anymore. <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/zHJ77RsnFXI&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/zHJ77RsnFXI&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object>

Explore the moon in Google Earth

Posted by Anousheh Ansari, Trustee, X PRIZE Foundation, and first female private space explorer [From time to time we invite guests to blog ...

Đọc thêm »

Philadelphia VA Hospital Brachytherapy Debacle: For The Want of One Competent and Industrious IT Person

This post should perhaps be subtitled "The Theatre of the Absurd." At Healthcare Renewal and other sites I've often commented on the remarkable accommodation given to IT personnel in hospitals, even when these personnel make capricious decisions that are contrary to the support of the mission of healthcare organizations, or contrary to the mission itself. I <a href="http://hcrenewal.blogspot.com/2009/03/health-it-project-success-and-failure.html">wrote that</a> many HIT problems observationally appeared due to ill-informed, capricious edicts of overempowered (relative to clinical leadership) MIS leaders, sanctioned by equally ill-informed executive leadership, for which the IT personnel were rarely held accountable. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=clinical%20computing%20problems%20in%20ICU">Endangerment of ICU patients</a> via PC's entirely inappropriate for a biohazards environment, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">chaos in a critical procedure area</a> from IT complacency and incompetence, payment of millions of dollars for <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/DUCOM_EMR_Complaint.pdf">HIT with gross defects rendering it unusable</a> by clinicians without consultation of in-house medical informatics expertise, and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=pharma">denial of access for hundreds of drug discovery scientists</a> to the informatics tools their own leaders said were essential to new drug discovery are just a few of the situations I've personally observed due to IT department whimsy. Remarkably, none of these situations nor others reported from numerous sources resulted in repercussions against the teflon-coated IT deities (other than, in some cases, generous promotions), thereby obstructing remediation of the attitudinal and competency problems that created the scenarios. If physicians had it this good, they'd be chopping off wrong limbs, removing the wrong organs, and failing to diagnose and treat with impunity. At my June 2009 posting regarding an unfolding clinical debacle of national import at the Philadelphia VA hospital entitled "<a href="http://hcrenewal.blogspot.com/2009/06/computer-and-other-mysteries-at.html">Bungled Brachytherapy, Computer Interfaces and Other Mysteries At The Philadelphia Veterans Administration Hospital</a>" I wrote: <blockquote>... I am uncertain how "computer interface problems" (in the <a href="http://www.philly.com/philly/news/homepage/20090621_Feds_see_wider_woes_in_VA_s_cancer_errors.html">Philadelphia Inquirer</a>, they were referred to as "glitches") prevented medical personnel from determining treatment success over several years. I would be most interested in hearing more about these "interface problems."</blockquote> That question has now been answered, and I am disappointed (but not surprised) at the results. Having rewritten a poor interface between a gamma scintillation camera and a PDP-11 computer in medical school during a nuclear medicine rotation at Boston City Hospital, allowing endusers to identify ROI's (regions of interest) with a light pen for automated calculation of intensities, I thought perhaps some arcane coding or driver configuration was the culprit at the VAMC Philadelphia. That was not the case: <a href="http://www.philly.com/inquirer/front_page/20090719_VA_radiation_errors_laid_to_offline_computer.html?viewAll=y">VA radiation errors laid to offline computer</a>By Marie McCullough and Josh Goldstein Philadelphia Inquirer July 19, 2009... It is not surprising, then, that NRC and VA investigators spent considerable time delving into why the calculations weren't done for more than a year at the Philadelphia VA. Their investigative reports blamed a "computer interface problem" - the same terminology Kao used during his testimony last month at a congressional hearing. The implication was that some intractable technology breakdown was behind the lapse in care [i.e., some cryptic problem requiring magical incantations and byzantine scripts that mere mortals could not understand nor remedy - ed.] In fact, technology had little to do with the breakdown, as James Bagian discovered when he led an inquiry at the Philadelphia VA and the veterans' health system's 12 other brachytherapy programs. Bagian, a Philadelphia-born physician and former astronaut who is now the national VA's patient-safety director, discovered that the "interface problem" was nothing more than the disconnected computer. Here's what else his inquiry found: The computer was initially unplugged so that another medical device could use the network port. Then, various departments dithered and ducked a request for an additional network port, which was finally installed - after a year. ["Various departments dithered and ducked?" Which departments, exactly? See below - ed.] Some doctors, physicists, and other professionals at the VA acknowledged it was "clinically inappropriate" to omit the post-implant calculations. Some said they had informed their "chain of command." When asked why they didn't tell the hospital's patient-safety officer, they said "it had not occurred to them to do so." ["Had not occurred to them to do so?" I've seen situations where physicians and scientists were afraid of IT leaders, due to the latter's often overinflated political influence and proficiency in playing games of political intrigue. Did this occur here, I wonder? - ed.] So, it appears that for the want of one network connection, installed by one competent, industrious, non-complacent IT person, a national scandal has erupted that has injured many patients. First, I ask the following questions regarding the "various departments" that "dithered and ducked" the responsibility to install an additional network connection in the brachytherapy suite: <ul><li>Was the job the responsibility of the Department of Medicine? The doctors and nurses? Could they have done so? </li><li>Perhaps it was the responsibility of the Public Relations Department (who now have to pick up the pieces?)</li><li>Was it the reponsibility of the Facilities Department? </li><li>Was it the responsibility of the Housekeeping Department?</li><li>Or, was it the responsibility of the IT Department and CIO? </li></ul> (If you need help answering these questions, stop reading now.) I also ask: <ul><li>Why was the IT department's failing to perform this task kept low profile through use of cryptic "interface problem" language that implied complex IT problems, as opposed to simple people problems? </li><li>Who originated this language?</li><li>Did they believe the truth could remain hidden? </li><li>Why do we use the term "medical malpractice" to describe negligence in medical care, not "provider glitch?" Why the different standards? </li></ul> I can visualize what went on behind the scenes in the IT department, refrains I have heard before - "we don't have the resources ... we need to hold more meetings to consider the issues ... it's the vendor's responsibility ... it's the network group's job, not the hardware group ... putting a new network outlet in there will cause packet storms and interfere with system XYZ ... we need to get consensus .... you [doctors] can't understand the complexities of the problem, but don't worry, we'll make it better ... hey, the docs don't need it anyway ..." What would happen to, say, the Facilities Department if a plumbing problem led to failure of a piece of vital equipment in the OR's, and they failed to repair it for a year? This is not to excuse the multiple layers of complacency among clinicians, safety staff, and others for toleration of this network denial situation and the lack of QC on the procedures themselves, but at the heart of this debacle is this attitude, which seems common in hospital IT departments: <blockquote style="font-style: italic;">"Doctors and nurses toil in hospitals so IT personnel can have comfy jobs and nifty computers."</blockquote> Perhaps on this occasion, IT leaders and personnel may end up on the witness stand and be held accountable, and perhaps lose their jobs instead of being promoted. However, even this is doubtful, and it has taken a congressional investigation led by Sen. Arlen Specter to get even this far, to simply find out that the mysterious "interface glitches" were a lack of a network jack due to laziness and complacency. Finally, I point out that it is hospital IT personnel upon whom clinicians will depend for acquisition and implementation of the HIT tools the President of the United States said are essential to changing the culture of healthcare. As I have written, before the IT profession can change the culture of healthcare (in a positive manner, that is), its own culture must change. IT personnel in hospitals must become part of the clinical team and support the mission of clinicians, not the other way around. July 22 addendum:<div> </div><div>I note again that multiple people failed here, including executives, physicians, safety officers, etc. I believe responsibility needs to be fairly assigned. However, IT needs to be included. I've witnessed or heard about too many HIT incidents where IT personnel and leadership remained scot-free when their behavior and attitudes were contributors or root causes.<div>As per my letter to the editor published in JAMA on July 22, "<a href="http://jama.ama-assn.org/cgi/content/extract/302/4/382">Health Care Information Technology, Hospital Responsibilities, and Joint Commission Standards</a>", IT privilege and accommodation must stop. HIT is not business IT used for widget inventory or payroll. As the VA incident shows, patient lives and well being are at stake.July 24 addendum:More on this from a blog on medical physics, "The Sharp End of the Photon", <a href="http://www.drflounder.com/archives/406">here</a>:<blockquote>... the errors in the placement of the radioactive seeds went undiscovered for so long because post-implant dosimetry was not performed. This involves CT scanning the patient, finding the positions of the seeds and calculating the ultimate dose the patient received. In the NRC report, the explanation was that a problem with the interface between the CT scanner and the treatment planning computer prevented transferring the CT images.</blockquote>A "problem with the interface", indeed.Also provided is a link to testimonies from witnesses at the house.gov website, which are <a href="http://veterans.house.gov/hearings/hearing.aspx?newsid=438">here</a>.Notable is the absence of any testimony from IT leadership. The only allusion to IT is in testimony by the doctor who performed the procedures who stated:<blockquote>"There should be a method of categorizing systematic problems by level of urgency so that serious problems, such as those involving failures of medical equipment or transfer of patient-related data, will receive immediate attention from the proper personnel and be quickly resolved."</blockquote>Perhaps, but not in this case. A simple phone call to IT should have been adequate to resolve this particular simple problem. -- SS </div></div>

Philadelphia VA Hospital Brachytherapy Debacle: For The Want of One Competent and Industrious IT Person

This post should perhaps be subtitled "The Theatre of the Absurd." At Healthcare Renewal and other sites I've often commented ...

Đọc thêm »

STOSSEL and ACRE: WHERE'S the BEEF?

STOSSEL and ACRE – WHERE’S the BEEF? Thomas Stossel from Harvard is at it again. As Daniel Carlat has humorously <a href="http://carlatpsychiatry.blogspot.com/2009/07/acre-academics-craving-reimbursement.html">described</a>, Stossel is planning the inaugural meeting next week of a group to counter those he calls pharmascolds. The group is named ACRE – Association of Clinical Researchers and Educators. Here is its website: <a href="http://www.acreonline.org/">http://www.acreonline.org/</a> For months, Stossel has been warning of the dire negative consequences that will result from tightened conflict of interest policies, but he has not presented any persuasive examples of damage to “productive relationships between industry and physicians involved in clinical research and educational outreach.” At the same time, Dr. Stossel has conveniently overlooked the shenanigans of the bad actors whom Senator Grassley exposed. Dr. Stossel is a blowhard, as I have described here <a href="http://hcrenewal.blogspot.com/2008/02/dr-stossel-sounds-off.html">before</a>. But wait! ACRE has found something! A News item in the July 2009 issue of Nature Medicine (“Conflict of interest rules seen by some as too stringent”) quoted one of the participants in the upcoming ACRE conference. Avi Markowitz, chief of oncology at UT Medical Branch, Galveston, came up with this example: Patients taking a Sanofi Aventis chemotherapy product may experience peripheral neuropathy, which can cause unpleasant sensations in the hands and feet. ‘Sanofi Aventis had been providing Markowitz and his UTMB colleagues with free blankets and gloves for those patients. Last fall, however, the university adopted stricter rules banning industry freebies. Now, Markowitz can’t even accept the unbranded blankets and gloves that Sanofi Aventis has offered to provide.’ Reading between the lines, it is a good bet that these items originally were branded. Whatever. And never mind that the patients receiving chemotherapy at UTMB are doubtless billed a hefty facility fee that must include comfort items like blankets and gloves. Since when does a chief of oncology need to beg for these basic patient care provisions from drug companies? Is this all that ACRE can come up with? The ACRE homepage warned sternly of “restrictive conflict of interest policies that often sever productive relationships between industry and physicians involved in clinical research and educational outreach.” Does Thomas Stossel’s whining and catastrophizing through ACRE come down to piffling items like blankets and gloves for chemotherapy patients? That’s it? Where’s the beef? At least ACRE has the good sense not to include on its program the smooth operators whom Senator Grassley outed – like Nemeroff at Emory, Schatzberg at Stanford, Kuklo at Walter Reed, Keller at Brown, Biederman at Harvard. Not even Stossel has been brazen enough to try to defend them. The Nature Medicine News item does close on a helpful note: 'Stossel would like to see abuses involving financial conflicts of interest treated more like cases of scientific misconduct. Rather than forcing everyone to abide by prohibitive rules, he says administrators should focus on weeding out those who misbehave.' I say Amen to that, even if it is a day late and a dollar short. We have arrived at our present state of discomfiture because the leaders of academic institutions and professional societies looked the other way for too long. They failed to do their job of reining in the ethical outliers. Grassley had to do it for them. As a result, the rest of us will be burdened with new regulations for years to come. Those who did speak up years ago were ignored or demonized. As the saying goes, every group gets the leadership it deserves. Those in academic medicine had better not count on Stossel and ACRE to lead them out of the wilderness. Bernard Carroll.

STOSSEL and ACRE: WHERE'S the BEEF?

STOSSEL and ACRE – WHERE’S the BEEF? Thomas Stossel from Harvard is at it again. As Daniel Carlat has humorously described , Stossel is plan...

Đọc thêm »