Art meets engineering with Google Chrome Artist Themes

A couple of weeks ago we <a href="http://googleblog.blogspot.com/2009/10/fast-simple-and-now-stylish-google.html">introduced</a> Artist Themes for Google Chrome. We asked leading designers, artists, illustrators and musicians to use the browser as their personal canvas for designing interesting themes.<br /><br />Since then, we've enjoyed hearing <a href="http://twitter.com/#search?q=google%20chrome%20themes">your thoughts</a> on these designs and how you've used them to personalize your browser. We've also been intrigued by the ways in which these themes have had <a href="http://chrome.blogspot.com/2009/10/from-anime-to-animation-google-chrome.html">interesting and unusual</a> cultural resonance with people around the world.<br /><br />To continue celebrating this collaboration of engineering and art, we've joined forces with our friends at YouTube to launch a new video (with a surprise ending) that we hope showcases the full beauty of these themes. Check it out at <a href="http://youtube.com/googlechromethemes">youtube.com/googlechromethemes</a> or by clicking on the image below.<br /><br /><a href="http://www.youtube.com/googlechromethemes" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5395441379586553090" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0A5KE5nhkG3IaGHk3UTXwpiqN8VlXI_g3Y0kycM3B9sddPEET-8HbJm6JMoMguFWvqjN4Nvo8wzKKonxQwVk_jPD48kyio7m7zkyDAiE6FOdX6jtQZOhl_idzN6Y3lug7ys0vSnZFVx-m/s400/GoogleChromeThemes-YouTube.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 206px;" /></a><br /><span class="byline-author">Posted by Jeff Gillette, Google Creative Lab</span>

Art meets engineering with Google Chrome Artist Themes

A couple of weeks ago we introduced Artist Themes for Google Chrome. We asked leading designers, artists, illustrators and musicians to use...

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NSW Nightmare and Overuse of Computers: Do We Really Need Full EHR's in ED's?

At "<a href="http://hcrenewal.blogspot.com/2009/10/from-down-under-story-of-deployment-of.html">From Down Under: The Story of the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck</a>" I posted excerpts from a paper of the same name by an Australian medical informatics specialist, Professor Jon Patrick from the <span>Health Information Technologies Research Laboratory (HITRL)</span>, <span>University of Sydney</span>, about what appears to be an Emergency Department (ED) nightmare. The paper is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/ed3.pdf">here</a>. <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[10/24 note: not available at present at this link or from its author in Australia; I pulled it from the Drexel U. server in the U.S. at the author's request while his right to post it on his department's server in Australia is being discussed Down Under - ed.]</span><br /><br /><span style="font-size:100%;"><blockquote>[2010 update: the paper is now at the following link (PDF):<span style="font-weight: bold;"><a href="http://www.it.usyd.edu.au/%7Ehitru/essays/The%20Story%20of%20the%20Deployment%20of%20an%20ED%20Clinical%20Information%20System6.0.pdf"> A Critical Essay on the Deployment of an ED Clinical Information System - Systemic Failure or Bad Luck</a>, version 6</span>. Prof. Jon Patrick, Health Information Technologies Research Laboratory, University of Sydney, Australia, Dec. 2009.]</blockquote></span><br />Those excerpts should be frightening to anyone who ever gets ill and might need to visit an ED (meaning, all of us).<br /><br />An ED electronic health record system (EHR) is being installed in an entire Australian state, New South Wales (NSW), with 200+ hospitals that apparently presents a <a href="http://tinyurl.com/hostileuserexper">mission hostile user experience</a> and is causing great opposition by critical care physicians in a setting where death can occur - suddenly and irreversibly - in the flash of an eye.<br /><br />His essay about the problems with complex EHR's (of American design and manufacture, no less) being installed in Australian ED's -- without doubt a highly expensive undertaking -- raises several questions about both the EHR industry and hospitals themselves.<br /><br />When I was a CMIO at a 1400+ bed hospital system a decade ago, a regional center in a state with very few hospitals at all (Medical Center of Delaware, now Christiana Care Health System), I counseled that the best solution in my opinion for the very, very busy ED was document imaging of paper, supplemented by a nurse/intake triage system to rapidly record and/or confirm basics (e.g., meds/major problems/allergies/vitals) that was interfaced to the main EHR system.<br /><br />I based this on the assessment that in the ED, a localized and "closed" environment, the incidence of charts getting lost or writing being illegible <span style="font-weight: bold; font-style: italic;">resulting in adverse outcomes</span> was minimal. ED charts also did not get lost when patients moved to the floors and the information passed along on paper was adequate for quick transfer and acceptance. Therefore we felt images of past ED charts (of paper) would be satisfactory for assisting care in the ED, where time constraints and hectic pace made the type of EHR system and primary data entry described in the Australian paper disadvantageous (and for exactly the reasons described in the above linked essay from Down Under).<br /><br />Document imaging is a proven technology that works well even in high volume settings. For example I managed a pharma departmental budget of $13 million, as did an entire pharma company, using an enterprise document imaging system.<br /><br />I've also been startled by the ED EHR installed at the hospital where I take my mother, who unfortunately has needed far too many admissions in recent years than I care to see. Some of the ED staff were my former medical colleagues and even high school classmates. They've told me, in no uncertain terms, that they felt the system was terrible, again for many of the reasons cited in the Australian essay. My own views of it (albeit brief) showed what appeared to be a <a href="http://tinyurl.com/hostileuserexper">mission hostile user environment</a>, including multiple very tiny pulldowns, cornucopia-like picklists, and screens.<br /><br />Most recently that system did not prevent busy ED docs from almost giving my mother Levaquin after her telling the triage nurse it had caused tendon rupture in the past - and the data being entered. They actually brought in a bag of it to hang, and if I'd not been there as medical advocate for my mother they might have given it. Then when she got to the floor, the next day they almost gave it to her again, except by this time mom was her own medical advocate. I trained in that hospital, and as Admitting Officer for the ED held the record for the most number of admissions, ever, in one night (New Year's Eve 1986), when it was beyond crazy, starting out with one of our own physicians being brought in, shot in the chest, and dying after open heart massage just to set the mood.<br /><br />The surgeons did the cutting. The heart massage was relegated to the physician present who <span style="font-style: italic;">didn't</span> cut - the internal medicine representative - me.<br /><br />We managed to treat hundreds and admit several dozens of sick patients using paper, and despite our gloomy emotional state not a single error occurred, to my knowledge.<br /><br />With all this in mind, I raise these questions:<br /><br /><ul><li>Can the EHR industry actually produce a competent ED EHR that can be used by ED physicians to enter detailed data in real time?</li></ul><ul><li>Do we really need full EHR's in the ED?</li></ul><ul><li>A related question: is the extent of ED adverse events related to lost or illegible ED charts (that could not be remediated with non-technology-based solutions far less expensive and troublesome than EHR's) known to a significant degree of confidence?</li></ul><ul><li>Is there <span style="font-weight: bold; font-style: italic;">trustworthy</span> literature that shows that the time, expense, and resources for a full ED EHR are worth it in terms of clinical outcomes, ROI etc.? (By trustworthy, I mean scientific peer reviewed literature without author conflict of interest - common in biomedicine as readers of this and other healthcare blogs know, e.g., see <a href="http://hcrenewal.blogspot.com/search?q=ghostwriting">this link</a> - not glossy pseudo-P.R. health IT throwaway journals.)</li></ul><ul><li>Considering that the literature on benefits of EHR's in general is equivocal, I should also ask, is there literature that refutes the value of full ED EHR's, or shows it as possibly having a negative return?<br /></li></ul>Or:<br /><br /><ul><li>Are we over-computerizing healthcare, even specialties and subspecialties where doing so might actually be deleterious due to the nature of their specific medical environments, just because "we can" (and because there is money to be made by some)?</li></ul><ul><li>Are we doing so based on irrational exuberance, leap of faith, hope, and/or an uncritical belief that if health IT provides benefits to medical domain "A0", it therefore must benefit medical domains and subdomains B1 to B99 through Z1 to Z99 as well?<br /></li></ul><br />I am concerned about the probability that the latter is the case.<br /><br />I think it not unreasonable to ask these questions before we in the United States spend billions of dollars on our own ED's.<br /><br />-- SS

NSW Nightmare and Overuse of Computers: Do We Really Need Full EHR's in ED's?

At " From Down Under: The Story of the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck " I posted e...

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RT @google: Tweets and updates and search, oh my!

At Google, our goal is to create the most comprehensive, relevant and fast search in the world. In the past few years, an entirely new type of data has emerged — real-time updates like those on Twitter have appeared not only as a way for people to communicate their thoughts and feelings, but also as an interesting source of data about what is happening right now in regard to a particular topic.<br /><br />Given this new type of information and its value to search, we are very excited to announce that we have reached an agreement with Twitter to include their updates in our search results. We believe that our search results and user experience will greatly benefit from the inclusion of this up-to-the-minute data, and we look forward to having a product that showcases how tweets can make search better in the coming months. That way, the next time you search for something that can be aided by a real-time observation, say, snow conditions at your favorite ski resort, you'll find tweets from other users who are there and sharing the latest and greatest information.<br /><br /><span class="byline-author">Posted by Marissa Mayer, Vice President of Search Products and User Experience</span>

RT @google: Tweets and updates and search, oh my!

At Google, our goal is to create the most comprehensive, relevant and fast search in the world. In the past few years, an entirely new type ...

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Private medical records offered for sale

Private medical records have been offered for sale in the U.K.<br /><br />And quite cheaply, too...<br /><div><br /></div> <p></p><blockquote><p>e-Health Insider (Europe)<br /><a href="http://www.e-health-insider.com/news/5311/private_medical_records_offered_for_sale">Private Medical Records Offered for Sale</a><br />Oct. 20, 2009</p><p>Medical records of patients treated at a private British hospital, The London Clinic, have been illegally sold to undercover investigators.</p> <p>The revelations were made in ITV’s Tonight Programme report, Health Records For Sale, broadcast last night.</p> <p>The programme reported that hundreds of files containing details of patients’ conditions, home addresses and dates of birth were offered to undercover reporters for just £4 each by sales executives from India, contacted online. </p></blockquote><p><br /></p><p>That's about $6.56 U.S. each. A genuine bargain for those intrepid medical identity thieves, and pesky government death panels ...<br /></p><p><br /></p><p></p><blockquote><p>The records offered for sale appear to have been medical records that consultants working at the London Clinic, the hospital processes its own records internally, who contracted with a firm called DGL (DGL) Information Technologies UK to digitise their records.</p> <p>DGL is then claimed to have sub-contracted to another firm, Scanning and Data Solutions (SDS), which scanned them into computers in the UK. SDS in turn is said to have sub-contracted further work on the files to a company in Pune, India, which had signed tight confidentiality agreements.</p></blockquote><p></p> <p><br /></p><p>With all this contracting and subcontracting - four layers? - adding potential security breach possibilities, and if this is not an uncommon practice, perhaps paper is safer than electronic health records?</p><p><br /></p> <p></p><blockquote><p>... The reporters bought more than 100 records belonging to UK patients but were told they could obtain up to 30,000 more on demand. Confidential records were offered by condition such as particular cancers.</p> <p>Of 116 files bought by ITV, 100 of which were confirmed as genuine, were for patients who had been treated in private hospitals. Although not NHS records they did contain some NHS data, including referral letters from GPs.</p></blockquote><p></p> <p><br /></p><p>The potential abuses resulting from such sales are of great concern. If it happened in the UK, it can happen in the U.S.<br /></p><p><br /></p> <p></p><blockquote>One patient whose record was affected by the security breach said in the documentary that the data breach was ‘one step up from grave-robbing’.</blockquote><p></p><br />I agree with that assessment.<br /><br />These practices call for the most severe penalties, and if the authorities lack the will, confidence in EMR privacy, confidentiality and security will suffer, along with the physician-patient relationship.<br /><br />The old ST:TOS line "Sometimes a man will tell his bartender things he'll never tell his doctor" could become too applicable for comfort.<br /><br /><br /><div><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJp41WBDQ76VdB-mxikHGGecfpdKHyB-zpaa3i2Lp_ZkzMjCDey9Qr3xTH5pku0zE99lZ3xjDU7Llu6lt9svT3eweuxseDlGh_9EE9gcqXXiFPeWzn118de6q0xAidCuN5U-Ngev95-U7r/s1600-h/Cage_05.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5394858019287916098" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJp41WBDQ76VdB-mxikHGGecfpdKHyB-zpaa3i2Lp_ZkzMjCDey9Qr3xTH5pku0zE99lZ3xjDU7Llu6lt9svT3eweuxseDlGh_9EE9gcqXXiFPeWzn118de6q0xAidCuN5U-Ngev95-U7r/s320/Cage_05.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 262px; height: 196px;" /></a><span style="font-size:85%;">Sometimes a man will tell his bartender things he'll never tell his doctor ... especially if they suspect their data is for sale to the <a href="http://en.wikipedia.org/wiki/Talosians">Talosians</a>, Captain ...<br /></span></div><br /></div><div>-- SS</div>

Private medical records offered for sale

Private medical records have been offered for sale in the U.K. And quite cheaply, too... e-Health Insider (Europe) Private Medi...

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From Down Under: The Story of the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck?

I'd opine that bad luck had little to do with it.<div><br /></div><div>A paper by an Australian professor of informatics about travails with a new ED EHR, manufactured by a large American HIT vendor, appeared recently (it is currently unavailable.) I remind that the issues affect a most critical area, the ED's in over <span style="font-weight: bold;">200 hospitals </span><span>in Australia's</span><span style="font-weight: bold;"> </span><em></em>most populous state, New South Wales (NSW). The paper is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/ed3.pdf">here</a>.<br /><br /><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[10/24 note: not available at present at this link or from its author in Australia; I pulled it from the Drexel U. server in the U.S. at the author's request while his right to post it on his department's server in Australia is being discussed Down Under - ed.]</span><br /><br /><span style="font-style: italic; font-weight: bold;">[Jan. 2010 followup: an attempted censorship situation was resolved. See </span><a href="http://hcrenewal.blogspot.com/2009/11/academic-freedom-and-ed-ehrs-down-under_10.html" style="font-style: italic; font-weight: bold;">this update</a><span style="font-style: italic; font-weight: bold;">. Current paper in ver. 6 is </span><a href="http://www.it.usyd.edu.au/%7Ehitru/essays/The%20Story%20of%20the%20Deployment%20of%20an%20ED%20Clinical%20Information%20System6.0.pdf" style="font-style: italic; font-weight: bold;">here</a> <span style="font-style: italic;"><span style="font-weight: bold;">- </span></span><span style="font-style: italic; font-weight: bold;">PDF.]</span><br /><br />Highlights:</div><div><br /></div><div><div></div><blockquote><div>... One criticism of [new ED EHR] is that the clinical documentation is built on the American model which doesn't fit the Australian workflow. In the same vein another commentator said it was a "system designed by administrators for administrators with no understanding whatsoever of clinical workflow and need".</div><div><br /></div><div>... At the operational level in EDs staff dislike the software for various reasons such as: too many keystrokes to load data, hence, too complicated search pathways to find data, plus they are unable to get extraction of reports.</div><div><br /></div><div>Their dislike has reached very intense levels with many staff dismissive of its usefulness. In more than one hospital the system was credited with causing a 50% decrease in the number of patients seen by a doctor in the first 20 minutes of arrival at the ED. In at least one hospital the direct data entry of clinical notes as done with [old ED EHR] <b><i><span class="Apple-style-span" style="color: rgb(255, 0, 0);">[an earlier system - ed.]</span></i></b> has been abandoned and transferred to paper as the [new ED EHR] process was seen as too cumbersome and time costly.</div><div><br /></div><div>... Other comments about [new ED EHR] were: "I prefer looking at a paper result than the counter-intuitive waste of my time trolling through the system.</div><div><br /></div><div>... I keep forgetting how the damn thing is supposed to work and find it more a time waster than a help."</div><div><br /></div><div>... Similarly, "every single user *hates* it with a passion ... ENTERING the data is a pure nightmare"</div><div><br /></div><div>And another: </div><div><br /></div><div>... "it is exclusively used by the nurses and entirely ignored by the doctors"</div><div><br /></div><div>And another:</div><div><br /></div><div>... "Clumsy, complicated (not complex), user hostile, and above all slow at any task I tried".</div><div><br /></div><div>... “We stated the system was dangerous (multiple reasons) and that we would not use it in its current state. We also got agreement that the nurse practitioner not use it for clinical details."</div><div><br />... “We in X and Y had a major confrontation with the NSW ‘gurus’ and refused to use it in ED in its current state. A clinician produced a well researched document to support our claims of its cumbersome stupidity. “People present (at the meeting) were local vmos, nurse practitioner who works in ED and the local ceo etc, plus reps from [new ED EHR vendor] , NSW health etc. One clinician was present by videoconference. Nurses presented a long document detailing multiple concerns. </div><div><br /></div><div>“The meeting was quite emotional and heated as they tried over and over again to pull the wool over our eyes. For example, they started out offering “more support”. One clinician replied that this was like giving us a defective car then sending out someone to show us how to drive it. </div><div><br /></div><div>I asked was the support available at 3 A.M.? Blank faces.</div><div><br />They dissimulated info that “other doctors” in small country hospitals were trialing the system and had “no problems”. When asked which hospitals and which doctors again blank faces. They finally came up with a name who one of our partners rang that night and found him to be furious his name was used and that they were about to dump the system too...</div></blockquote><div><br /><br />The conclusion probably sounds familiar to HC Renewal readers:<br /><br /><blockquote>... I wish to make a salient point about the nature of the delivered software with respect to the whole process of change management in the introduction of new IT infrastructure. In these situations there is always a great deal of noise and attention given to the processes of systems review, workflow redesign, and staff training.<br /><br />In many ways this is paying attention to the smoke rather than the fire. The actual design and operation of the software is fundamental to the successful introduction of information technology. It is a necessary condition that the software works in a fashion that optimally fits the activities and workflow of the recipient organisation, and this fit is the single largest determinant of a successful system wide implementation. Like any foundation if it is not properly designed and constructed the edifice above it will collapse no matter what amount of attention and details you put into it. The delivered software is the foundation of any clinical information system. It would seem that in this case this understanding has not been grasped by authorities in NSW.<br /><br />... Without optimal design and implementation there will be <span style="font-weight: bold;">no cost efficiencies and productivity gains delivered by IT, but rather, it will contribute to the spiralling expense</span>. We can only hope that Government will understand that a modest investment in R&D for clinical information systems is needed to create the desired improvements in productivity, cost reduction and patient safety.</blockquote><br />I believe our own government here could learn from this.<br /></div><div><br /></div><div style="font-weight: bold;">Read the whole thing, <span style="font-weight: normal;">including the series of ethical issues the author raises.</span> <span style="font-weight: normal;">I believe the lessons apply not just to the one vendor mentioned, but to most HIT vendors, especially the large ones.</span><br /><br /><span style="font-weight: normal;">Also note the observations from another Australian, Dr David G More MB, PhD, FACHI in an essay entitled "The Blight on the Landscape Health IT Awards" <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=australia">at this link</a>.</span><i style=""><span style="font-family:Arial;"></span></i> </div><div><br /></div><div>-- SS</div></div>

From Down Under: The Story of the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck?

I'd opine that bad luck had little to do with it. A paper by an Australian professor of informatics about travails with a new ED EHR, m...

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More accessibility features in Android 1.6

<span style="font-style: italic;">From time to time, our own T.V. Raman shares his tips on how to use Google from his perspective as a technologist who cannot see — tips that sighted people, among others, may also find useful.</span><br /><br />The most recent release of Android 1.6, a.k.a. Donut, introduces accessibility features designed to make Android apps more widely usable by blind and low-vision users. In brief, Android 1.6 includes a built-in screenreader and <a href="http://android-developers.blogspot.com/search/label/Text-to-Speech">text-to-speech</a> (TTS) engine which make it possible to use most Android applications, as well as all of Android's default UI, when not looking at the screen.<br /><br />Android-powered devices with Android 1.6 and future software versions will include the following accessibility enhancements:<br /><ul><li>Text-to-Speech (TTS) is now bundled with the Android platform. The platform comes with voices for English (U.S. and U.K.), French, Italian, Spanish and German.</li><li>A standardized Text To Speech API is part of the Android SDK, and this enables developers to create high-quality talking applications.</li><li>Starting with Android 1.6, the Android platform includes a set of easy to use accessibility APIs that make it possible to create accessibility aids such as screenreaders for the blind.</li><li>Application authors can easily ensure that their applications remain usable by blind and visually impaired users by ensuring that all parts of the user interface are reachable via the trackball; and all image controls have associated textual metadata.</li><li>Starting with Android 1.6, the Android platform comes with applications that provide spoken, auditory (non-speech sounds) and haptic (vibration) feedback. Named TalkBack, SoundBack and KickBack, these applications are available via the Settings > Accessibility menu.</li><li>In addition, <a href="http://eyes-free.googlecode.com/">project Eyes-Free</a> (which includes accessibility tools such as TalkBack) provides several UI enhancements for using touch-screen input. Many of these <a href="http://www.nytimes.com/2009/01/04/business/04blind.html">innovations</a> are available via Android Market and are already being heavily used. We believe these eyes-free tools will serve our users with special needs as well.</li></ul>You can turn on the accessibility features by going to Settings --> Accessibility and checking the box "Accessibility". While the web browser and browser-based applications do not yet "talk" using these enhancements, we're working on them for upcoming releases. Check out this <a href="http://google-opensource.blogspot.com/2009/10/talkback-open-source-screenreader-for.html">Google Open Source Blog post</a> for more details, and stay tuned to the <a href="http://www.youtube.com/user/eyesfreeandroid">eyes-free channel on YouTube</a> for step-by-step demonstrations on configuring and using accessibility support on Android.<span class="byline-author"><br /></span>

More accessibility features in Android 1.6

From time to time, our own T.V. Raman shares his tips on how to use Google from his perspective as a technologist who cannot see — tips that...

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News Flash: 1945 Law Allows Concentration of Power in US Health Insurance

Last week, some media reports noted that US Congressional Democrats countered an insurance industry study suggesting health care reform would cost much more than estimated by threatening a repeal of the McCarran-Ferguson Act's anti-trust exemption for health insurance. For example, <a href="http://prescriptions.blogs.nytimes.com/2009/10/14/for-insurers-a-question-of-trust-and-antitrust/">in the New York Times Prescriptions Blog</a>:<br /><br /><blockquote>In a rare appearance as a witness at a Senate hearing, the majority leader, Harry Reid of Nevada, told the Judiciary Committee on Wednesday that <em>it should repeal a 1945 law that granted the insurance industry limited exemption to national antitrust laws by allowing states to regulate insurers.<br /></em><br />The law, <em>the McCarran-Ferguson Act</em>, is often cited by Mr. Reid and other critics of the health insurance industry as a <em>reason why coverage can be so expensive for many people. <strong>They say the law allows insurers to monopolize markets and fix prices in ways that are usually illegal</strong>.<br /></em><br />'Since 1945, the insurance industry has enjoyed exemption from federal antitrust laws because of the McCarran-Ferguson Act,' Mr. Reid said.<br /><br /><em>'Providing an exemption for insurance companies to antitrust laws has been anticompetitive</em> and damaging to the American economy,' Mr. Reid continued. <em>'Health insurance premiums have continued to rise at a rapid rate</em>, forcing businesses to cut back on health insurance coverage and forcing many families to choose between health insurance and basic necessities.'<br /><br />He added: <em>'Insurance companies have become so large they dominate entire regions of the country. They have become so powerful they block start-up businesses from entering the market, and they put smaller companies out of business. They have become so dominant that they dictate business practices. They are so influential that they exert tremendous influence over public policy</em>.'<br /></blockquote><p>Also, the chief anti-trust enforcement officer in Obama administration weighed in with similar sentiments, as reported by Bloomberg News <a href="http://www.philly.com/inquirer/world_us/20091015_Insurers__exemption_is_said_to_boost_costs.html">via the Philadelphia Inquirer</a>:<br /></p><blockquote><br />Christine Varney, the Obama administration's chief antitrust enforcer, told lawmakers yesterday that <em>repealing the insurance industry's antitrust exemption would spur competition and further the drive to control the cost of health insurance</em>.<br /><br />Varney, head of the Justice Department's antitrust division, told the Senate Judiciary Committee that ending the exemption would 'allow competition to have a greater role in reforming health and medical malpractice insurance markets.' </blockquote><br />So why would this discussion be relevant to Health Care Renewal? First of all, the exemption of insurance companies from anti-trust laws (US laws designed to prevent monopolies and other anti-competitive business practices) may have allowed these companies to grow into business behemoths, and for individual companies to dominate local insurance markets. In some locales, businesses and individuals have very few health insurance policies available because only a few companies dominate the market. In fact, every recent year, the US American Medical Association (AMA) has put out a report on insurance market consolidation decrying concentration among power in local markets among few companies.<br /><br />For example, the <a href="http://www.ama-assn.org/ama/pub/news/news/health-insurers-consolidate.shtml">AMA news release </a>for the 2009 report said:<br /><br /><blockquote><br />The vast majority of health insurance markets in the U.S. are dominated by one or two health insurers, according to a new study by the American Medical Association (AMA) that examined insurer competition in markets across the country. Most alarmingly, in nearly all 314 metropolitan areas studied, there is evidence that patients and physicians have fewer options and are left vulnerable to the demands of the health insurer.<br /></blockquote><br />So this does seem to be a case of concentration, if not necessarily abuse of power in health care.<br /><br />Why this is real news however, is that the 1945 McCarran-Ferguson Act, its baleful influence, and calls for its repeal are not old news. In fact, up to now, they have not been news, or part of health care policy discussions at all.<br /><br />My first response to the news articles above was "the McCarran what act?" I had never heard of this 64 year old law, and never heard it cited as an enabler of concentration of power in health insurance, and never heard a call for its repeal.<br /><br />Maybe that means I am no expert in this field. But, the first 10 pages of a Google Scholar search for the terms "McCarran Ferguson health insurance exemption" revealed precisely one article in the health care / services/ policy research literature that discussed this act (from 1998, in Health Affairs,(1) and without clearly relating the act to concentration of power in health insurance.) Similarly, a PubMed search, using the term "McCarran-Ferguson Act" produced nine articles, none in mainstream health care/ services/ policy research journals, much less general medical journals (three were in the Am J Law Med, 2 in AIDS Policy Law, one in Benefits Q, one in J Am Osteopath Assoc, one in J Pediatr Health Care, one in Am J Hosp Pharm, the most recent published in 2004, all the others in 1999 or earlier. There was nothing except the article above in Health Affars, nothing in Medical Care, nothing in Health Services Research, and nothing in any of the big general medical journals.)<br /><br />Therefore, maybe the 1945 McCarran-Ferguson Act was a major cause of consolidation in the health insurance market, and this consolidation may be an important contributor to high health care costs and poor health care access. But this notion apparently has not appeared in any major medical or health care/ services/ policy research journal in the last 20 years.<br /><br />If the McCarran-Ferguson Act has been around for 64 years, and is a major cause of rising health care costs and declining health care access, why has no one bothered to discuss it where any physician or health care/ policy researcher might see it?<br /><br />It seems that the failure to bring the McCarran-Ferguson Act into polite conversation is another example of the <a href="http://hcrenewal.blogspot.com/2007/08/bling-bling-poltical-correctness-and.html">anechoic effect</a>. We have noted again and again that for physicians or health care professionals to discuss certain aspects of our dysfunctional health care system, often aspects that relate high costs, declining access, and poor costs to concentration and abuse of power, is "just not done." So it seems like discussing how a federal law from another era barred government action to prevent concentration of power in the health care industry, concentration of power that made some people very rich, was "just not done."<br /><br />Of course, if there was any discussion of this law and its effects, maybe someone would have called for its repeal before 2009.<br /><br />Dr Aubrey Blumsohn provided <a href="http://scientific-misconduct.blogspot.com/2007/05/on-decorum-in-medicine.html">a reminder </a>from the UK to us in the US: ""the desire to maintain decorum and status in medicine seems also to overwhelm all standards of decency. Our profession is inclined to fixate on the irrelevant while ignoring some very bad things."<br /><br />If we really want to improve health care here in the US, and around the world, a modest beginning would be to begin open discussion of the various skeletons rattling around in the health care closet.<br /><br />Reference<br /><br />1. Nichols LM, Blumberg LJ. A different kind of ‘New Federalism’? the Health Insurance Portability And Accountability Act of 1996. Health Aff 1998; 17 (3): 25. [Link <a href="http://healthaff.highwire.org/cgi/reprint/17/3/25">here</a>.]

News Flash: 1945 Law Allows Concentration of Power in US Health Insurance

Last week, some media reports noted that US Congressional Democrats countered an insurance industry study suggesting health care reform woul...

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