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To Whom Does a Leading "Off-Shore" Medical School Owe its Allegiance?

We have noted how existing US medical schools seem unwilling to invest or reward teaching (see post <a href="http://hcrenewal.blogspot.com/2007/04/medical-schools-to-faculty-show-me.html">here</a>.)   It is no secret in academic medicine that for years, US medical schools have been unable to train enough students to meet the country's current demand for doctors. Brain Drain Hence, a significant proportion of physicians practicing in the US were trained by medical schools in other countries.  One well-known adverse consequence of our disinclination to put sufficient resources into medical education is "brain drain," the migration of physicians from countries with severe physician shortages and major unmet health care needs to the US.  (For more discussion of this issue, see our 2005 post <a href="http://hcrenewal.blogspot.com/2005/10/physician-brain-drain.html">here</a>, and also Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353: 1810-1818. Link <a href="http://content.nejm.org/cgi/content/full/353/17/1810">here</a>.) At the end of 2009, the St Petersburg (Florida) Times published an <a href="http://www.tampabay.com/news/health/medicine/article1061189.ece">investigative report</a> which showed some further adverse effects of the US disinclination to support medical education sufficient to meet the country's needs.  Ross University and Its Problems The report profiled the problems at one important "off-shore" medical school. <blockquote>Ross University School of Medicine may be the biggest medical school you've never heard of. For decades, the school on the Caribbean island of Dominica has been accepting U.S. students whose poor test scores make it impossible for them to get into medical schools in the States. And though Ross is 1,500 miles from the mainland, U.S. residents who attend the school, and about two dozen other offshore medical schools, qualify for federal student loans. That has meant more than $150 million a year in government-guaranteed aid for Ross, which has about 3,500 students, double the biggest U.S. medical school. Ross and other foreign medical schools say they're responding to U.S. demand for new doctors as the population ages. And there's no question that these schools have produced thousands of practicing physicians. There are more than 80 Ross graduates in the Tampa Bay area alone. But federal regulators are taking a closer look at evidence suggesting taxpayers and students may be getting shortchanged by foreign medical schools. • At Ross, fewer than one-third of the students finish in four years, compared to nearly 100 percent at U.S. medical schools. [And as reported later in the article, the six-year graduation rate is only 66% - editor] • Since Ross, like other Caribbean medical schools, doesn't have a teaching hospital, it pays hospitals stateside for students' clinical training, with wide variations in quality. • Students of foreign medical schools like Ross graduate with higher average debt, $235,000 compared to the average $158,000 owed by graduates of U.S. medical schools, according to an August report to Congress by regulators. • About 20 percent of Ross graduates fail to land a residency, the key to a license to practice in the United States. If they cannot pay their student debts, taxpayers are left holding the bag. </blockquote> The article concludes with: <blockquote>In a report to Congress in August, the group that accredits offshore medical colleges recommended that the schools raise standards and improve reporting on everything from test scores to graduation rates to total cost. [Michael] Rendon, the former Ross registrar, said he agrees with the need to stiffen entrance requirements. 'We want doctors but we can't give that kind of money to everyone who's chasing a dream of being an M.D.,' he said. 'We need to be a little bit more discriminating about who those tax dollars go to.' </blockquote> Based on what I wrote above, these criticisms do seem very "US centric." It seems obvious that a school based in the tiny Commonwealth of Dominica, with a population of little more than 72,000, and an estimated gross domestic product of $726 million in 2008, (according to the <a href="https://www.cia.gov/library/publications/the-world-factbook/geos/do.html">CIA factbook</a>), might have trouble meeting US standards.  But instead of trying to do so, wouldn't it be better if the school could concentrate on training physicians to practice in the Caribbean region? But wait, it is not so simple...  Who  Really Owns Ross University? It is true that the missions of most of the medical schools outside of the US which make substantial contributions to the US physician workforce are mainly to train physicians to practice within their countries.  But that description hardly applies to Ross University.  Per the St Petersburg Times, <blockquote>Robert Ross, a commodities trader in New York, opened his medical school in 1978 in a motel in Dominica's capital at the suggestion of an employee whose son couldn't get into medical training in the States. By 2000, Ross had sold majority interest in both the medical school and an affiliated veterinary school in St. Kitts to a group of New York investors. Three years later, both schools were acquired by <a href="http://www.devryinc.com/index.jsp">DeVry, [Inc]</a> for $310 million. Ross is the only offshore medical school owned by a publicly traded corporation, which must disclose more financial data than privately owned schools. Last year, DeVry, better known for its tech training schools, reported $165.7 million in net income after taxes. But the company also reported an additional $140 million in tax-free income from the Ross operations. </blockquote> "<a href="http://www.rossu.edu/">Ross University</a>" <a href="http://www.rossu.edu/about/">describes itself</a> as: <blockquote>Ross University is one of the largest and most successful medical educators in the world – and remains one of the great secrets in medical education. Since opening in 1978, Ross has been committed to our students with a rigorous curricula that mirrors the education of its U.S. peers. </blockquote>I see nothing obvious on the "<a href="http://www.rossu.edu/">Ross University</a>" web-site that mentions DeVry Inc.  But "Ross University" and "<a href="http://www.rossu.edu/medical-school/">Ross University School of Medicine</a>" are really just operating subsidiaries of DeVry Inc, which does <a href="http://www.devryinc.com/index.jsp">describe itself</a> as: <blockquote>one of the largest publicly held, international, higher educational organizations in North America, is the parent organization for DeVry University, Ross University,.... </blockquote>This raises questions whether the US students who apply to the medical school know they will be taught by a for-profit US corporation? Who Leads Ross University?   Note that the CEO of DeVry Inc, and his lieutenants most responsible for medical education at Ross University do not seem to have the sort of qualifications you would expect from those in charge of a "unviversity" and a medical school.  Per the DeVry Inc., web-site: <a href="http://www.devryinc.com/corporate_information/about/srmgmt_daniel_hamburger.jsp">Daniel Hamburger</a>: <blockquote>Daniel Hamburger is President and Chief Executive Officer of DeVry Inc. Hamburger joined DeVry in 2002 as Executive Vice President, responsible for DeVry’s online operations and Becker Professional Review. He was named President and Chief Operating Officer in 2004, and Chief Executive Officer in 2006. Prior to DeVry, Hamburger served as Chairman and Chief Executive Officer of Indeliq (pronounced 'in-DELL-ik'), now owned by Accenture Learning. In addition, his previous experience includes serving as Division President of WW Grainger's Internet Commerce group, growing revenues from $10 million to over $100 million in one year. Previously, Hamburger started the Internet Services Group for RR Donnelley’s Metromail division, and was responsible for its venture capital investments. He also served as a consultant with Bain & Company in London, Warsaw and Boston. Hamburger graduated in 1986 from the University of Michigan with bachelor's and master's degrees in Industrial Engineering. In 1990, he earned an MBA from Harvard Business School. </blockquote><a href="http://www.devryinc.com/corporate_information/about/thomas_shepherd.jsp">Dr Thomas C Shepherd</a>: <blockquote>Dr. Thomas C. Shepherd has been the president of Ross University since 2004. In this position, Dr. Shepherd is responsible for the operations of the School of Medicine, located in Dominica,.... Prior to joining Ross University, Dr. Shepherd was the president of Bastyr University, a Washington-based university with multiple offerings in healthcare education. Prior to Bastyr he co-founded Royale Healthcare, Inc., a hospital management company in North Carolina, to provide hospitals and health systems throughout the United States with management and consulting services. He has served in senior management roles for a variety of [for-profit] hospitals and healthcare systems, including Hallmark Healthcare (now Community Health Systems), American Healthcorp, Inc., and HCA. Dr. Shepherd received a bachelor of science degree in business administration cum laude from Fairleigh Dickinson University in 1972, a master’s degree in hospital administration from George Washington University in 1975, and a doctor of health administration from the Medical University of South Carolina in 1999. </blockquote><a href="http://www.devryinc.com/corporate_information/about/wiliam_hughson.jsp">William Hughson</a>: <blockquote>William Hughson is President of the Medical and Healthcare group at DeVry Inc. Hughson joined DeVry from DaVita Inc., a leading provider of dialysis services in the United States. At DaVita, he managed a wide number of business units including co-founding DaVita at Home, and founding DaVita Rx. Prior to that, he headed Ultra Lucca from 1997-1999, which under his guidance, rebranded itself A.G. Ferrari Foods and more than doubled in size. Previously, Hughson was president and chief financial officer of Noah’s New York Bagels, which he helped to grow from one to 39 stores. Hughson began his career in the Capital Markets Division of Morgan Stanley in 1986 and subsequently worked at Bain & Company in 1990. He received his bachelor’s degree in English from Williams College and graduated from the Stanford Graduate School of Business with a master’s in business administration. </blockquote>For their pains, Mr Hamburger had amassed 548,666 shares of DeVry stock, worth $30,966,709, at today's price of $56.44/share, and received $3,454,711 in total compensation in fiscal 2009, while Mr Shepherd had amassed 74,950 shares, worth $4,230,179,  and received $714,688, according to the <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=6551795&format=PDF">2009 DeVry Inc proxy statement</a>. Yet none of the three top leaders of DeVry Inc with responsibilities for the Ross University medical school subsidiary are physicians, have any obvious direct clinical or biomedical scientific experience, or have any educational expertise or experience. Conclusions So here we have a new kind of example of what laissez faire unregulated capitalism has wrought for US health care.  The medical school in tiny, impoverished Dominica exists only to train physicians for the US not for Dominica, or the Caribbean area.  Nonetheless, the school does not do a great job: one-third of its students do not graduate even in six years, and one-fifth of those graduates never even start a residency.  Yet the students pay more than $30,000 a year in tuition, and graduate with an average debt much higher than US trained medical students.   In fact, the school is actually a subsidiary of a large, US for-profit corporation, although it is not clear if this is made obvious, or even revealed to prospective students.  The leaders to whom the school report to seem to have no expertise or background in clinical medicine, biomedical science.   Yet they are handsomely rewarded for their lack of relevant expertise and experience, and apparently for the poor performance of their graduates. There is something really <a href="http://hcrenewal.blogspot.com/2010/01/more-on-perversity-in-hit-world.html">perverse</a> about a nation that spends $2.3 trillion a year on health care, yet does not spend enough on medical education to educate the physicians it needs, while drawing physicians from unregulated, for-profit schools located in less developed countries, but owned by US corporations.

To Whom Does a Leading "Off-Shore" Medical School Owe its Allegiance?

We have noted how existing US medical schools seem unwilling to invest or reward teaching (see post here .) It is no secret in academic me...

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Spectranetics Settles

I could not let this story, which came out just before the new year, completely slip by.  As reported <a href="http://www.gazette.com/articles/based-91487-spectranetics-springs.html">by the Colorado Springs Gazette</a>: <blockquote>Spectranetics, the Colorado Springs-based medical-laser manufacturer, will pay $5 million to resolve federal government allegations that the company illegally imported and marketed unapproved medical devices, the U.S. Department of Justice said Tuesday. Spectranetics will not face criminal prosecution, although it 'has accepted responsibility for its conduct' and agreed that 'officers and employees who acted on behalf of the company engaged in multiple areas of wrongdoing,' according to a Justice Department news release. The investigation had been under way since at least Sept. 4, 2008, when agents from the U.S. Food and Drug Administration and Immigration and Customs Enforcement raided the company’s Springs headquarters, seeking information and correspondence. Spectranetics manufactures sophisticated medical lasers used to clear blockages in coronary and leg arteries. At issue in the federal probe were allegations that Spectranetics imported medical devices and provided them to physicians for use in patients without federal regulatory approval, the Justice Department said. Also, Spectranetics allegedly conducted a clinical study that didn’t comply with federal regulations, while it also promoted products for which it hadn’t received FDA approval or clearance, according to the Justice Department. Spectranetics’ actions caused false claims to be submitted to Medicare from 2003 to 2008, the agency also alleged. Spectranetics will pay $4.9 million in civil damages to resolve the claims, the Justice Department said. In addition, the company said it has agreed to a future forfeiture of $100,000 in cash or property. Spectranetics has also instituted measures to prevent similar conduct and will cooperate in 'an ongoing criminal investigation,' the agency said. </blockquote> Also ongoing are a class-action lawsuit initiated by shareholders, and possibly a US Securities and Exchange Commission investigation. The Gazette also noted, <blockquote>The company also went through a management shake-up; then-President and CEO John Schulte resigned a few weeks after the September 2008 raid. </blockquote> Another day, another settlement of charges of wrong-doing by a health care organization.  So my stock response is xataloging legal settlements seems to be a useful way to assess the sorts of bad behavior manifested by large health care organizations (see some posts <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">here</a>). However, as we have said frequently, such settlements, including the "corporate integrity agreements" now frequently attached to them, seem to have done little to deter bad behavior. Usually, the companies involved only need to pay fines, and no individual who performed, directed or approved unethical or illegal acts will suffer any negative consequences. I submit once again that such fines are viewed merely as costs of doing business by the affected companies, and do not deter future bad behavior. As seems standard operating procedure for such settlements, the fine in this case was barely more than a financial speed bump, given that the company had revenues of about $104 million in 2008 (per its <a href="http://phx.corporate-ir.net/External.File?item=UGFyZW50SUQ9Mzk4MnxDaGlsZElEPS0xfFR5cGU9Mw==&t=1">2008 annual report</a>).  At least the CEO who was in charge at the time of the admitted wrongdoing actually lost his job.  However, presumably he was able to leave with at least the 792,354 shares of stock, currently worth $5,340,466, based on today's price of $6.74, 2.5% of outstanding shares which he beneficially owned prior to his departure, according to the company's <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=6289166&format=PDF">2008 proxy statement</a>. I once again submit that would-be health care reformers who want to improve care, reduce costs and improve access should advocate for real negative consequences for people who implement, direct or approve the various versions of fraud, kickbacks, and miscellaneous wrongdoing, corruption and malfeasance we have discussed on Health Care Renewal.

Spectranetics Settles

I could not let this story, which came out just before the new year, completely slip by. As reported by the Colorado Springs Gazette : Spec...

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IT Religion and Windows 7 "God Mode"

I've written in the past that IT has become something of a religion, with computers as an altar or shrine, programmers and technicians as clergy, programming a sacrament, and an irrational exuberance and "faith" prevailing about the computer's miraculous capabilities despite growing literature to the contrary. Of course, my focus has been on <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">computers in medicine</a>. I am generally very happy with Windows 7. Microsoft has done well, but this caught my attention: <a href="http://news.cnet.com/8301-13860_3-10423985-56.html"> </a><blockquote><a href="http://news.cnet.com/8301-13860_3-10423985-56.html">Understanding Windows 7's 'GodMode'</a> CNET News January 4, 2010 12:41 PM PST Although its name suggests perhaps even grander capabilities, Windows enthusiasts are excited over the discovery of a hidden "GodMode" feature that lets users access all of the operating system's control panels from within a single folder. By creating a new folder in Windows 7 and renaming it with a certain text string at the end, users are able to have a single place to do everything from changing the look of the mouse pointer to making a new hard-drive partition. ... To enter "GodMode," one need only create a new folder and then rename the folder to the following: <blockquote style="font-weight: bold;">GodMode.{ED7BA470-8E54-465E-825C-99712043E01C}</blockquote> Once that is done, the folder's icon will change to resemble a control panel and will contain dozens of control options. </blockquote> I've tried it, and it works. Upon renaming a new desktop folder as above, the folder actually transforms into the following icon and label: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLmMcZo1bRqQoFNOrXlT223w-XGJPBOO_jbgDoepPkiZz3LDeZyWHRsGM6Bj6YExyjAdDXFY4QB27ebV_4303X76dnY9V68uwdNVTYk8kwjFHa0QbIBAJwOopiMDUApHC7Pz0rjWHA-oQN/s1600-h/godmode.bmp" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5423490590552765362" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLmMcZo1bRqQoFNOrXlT223w-XGJPBOO_jbgDoepPkiZz3LDeZyWHRsGM6Bj6YExyjAdDXFY4QB27ebV_4303X76dnY9V68uwdNVTYk8kwjFHa0QbIBAJwOopiMDUApHC7Pz0rjWHA-oQN/s320/godmode.bmp" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 123px; height: 99px;" /></a> Then, on opening the "God Mode" icon a comprehensive list of control options appears. Very convenient and useful. While the name was clearly intended to be humorous, I think that the originators of this name could and should have come up with a less theistic name. Not on religious grounds, but on psychological ones - i.e., the impact such nomenclature might have on IT personnel. I'm already seeing comments such as "<a href="http://www.webtlk.com/2010/01/02/become-a-windows-god-how-to-enable-godmode-on-windows-7/">Did you know that you can become a God? Well, at least on Windows 7!</a>" on IT enthusiast sites... The culture of IT is already patronizing enough towards end users, thank you very much. I felt the same way ca. 1976 when visiting professors from MIT implemented the programming language "<a href="http://en.wikipedia.org/wiki/Logo_%28programming_language%29">Logo</a>" on Boston University's <a href="http://en.wikipedia.org/wiki/IBM_System/370">IBM 370</a>-based <a href="http://courseweb.stthomas.edu/resmith/s/fs/index.html#RAX">RAX</a> timesharing system. The RAX/370 monitor command for restarting after a Logo interpreter fault was "RESAT GOD" (resume at symbolic address 'God', a symbol defined by the professors to represent an address in the 370's user program address space). Since the Logo interpreter was in beta, I had to type that <a href="http://www.imdb.com/title/tt0049833/">Charlton Heston</a>-esque command often... Note: having spent some time in Saudi Arabia, I'm not sure how well this Windows 7 holiness will go over in that part of the world... -- SS Addendum: I've discovered that renaming a folder to, say, "Bob.{ED7BA470-8E54-465E-825C-99712043E01C}" creates an icon with identical capabilities, but with a ... <a href="http://en.wikipedia.org/wiki/Microsoft_Bob">somewhat less presumptuous name</a>. :) <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlpF887X5JHYEDz-udFf2nmdqSsL5IztqSn1XNba2mMLRgPhOKjQPFkC_HwgzTxIV7fpZ0gIAS3N_zOsJwdkHArARZmP6l_Xi_5Re7EhkRVaBHkRtISBdmiyM905IXHv7mUU9pw2ZOGafp/s1600-h/ms_bob.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5423678780837424322" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlpF887X5JHYEDz-udFf2nmdqSsL5IztqSn1XNba2mMLRgPhOKjQPFkC_HwgzTxIV7fpZ0gIAS3N_zOsJwdkHArARZmP6l_Xi_5Re7EhkRVaBHkRtISBdmiyM905IXHv7mUU9pw2ZOGafp/s320/ms_bob.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 131px; height: 73px;" /></a>

IT Religion and Windows 7 "God Mode"

I've written in the past that IT has become something of a religion, with computers as an altar or shrine, programmers and technicians a...

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More on Perversity in the Healthcare IT World: Is Meditech Employing Sockpuppets?

<div style="text-align: center;">(Note to readers: also see my Jan. 7, 2010 followup post "<a href="http://hcrenewal.blogspot.com/2010/01/socky-meditech-sockpuppet-on-vacation.html" style="font-family: arial;">Socky the Meditech Sockpuppet on Vacation?</a>")</div> At "<a href="http://hcrenewal.blogspot.com/2009/12/are-dissmissive-industry-and-government.html">Are Dissmissive Industry and Government Reactions to Physician Concerns about EHR's and other Clinical IT Simply Perverse?</a>" I observed that cavalier dismissals of physician reports on HIT unusability and difficulties fit quite well the definition of "perverse:" <blockquote> Merriam-Webster dictionary: <a href="http://www.merriam-webster.com/dictionary/Perverse">Perverse</a> (adj). Etymology: Middle English, from Anglo-French purvers, pervers, from Latin perversus, from past participle of pervertere Date: 14th century 1 a : turned away from what is right or good : corrupt b : improper, incorrect c : contrary to the evidence or the direction of the judge on a point of law <perverse> 2 a : obstinate in opposing what is right, reasonable, or accepted : wrongheaded b : arising from or indicative of stubbornness or obstinacy 3 : marked by peevishness or petulance : cranky 4 : marked by perversion : perverted</perverse></blockquote> In a later post, "<a href="http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html">An Honest Physician Survey on EHR's</a>" I reported on the comments submitted by hundreds of physician members of the <a href="http://www.aapsonline.org/">American Association of Physicians and Surgeons</a> (an organization mainly of physicians in private practice who strongly support physician independence and other conservative views, founded in 1943) in a 2008 survey about HIT: <a href="http://aapsonline.org/surveys/hitsurveyresults.pdf" style="font-weight: bold;"></a> <blockquote><a href="http://aapsonline.org/surveys/hitsurveyresults.pdf" style="font-weight: bold;">AAPS - PHYSICIAN ATTITUDES & ADOPTION OF HEALTH INFORMATION TECHNOLOGY</a> (PDF)</blockquote> The common theme in their feedback was how HIT in its present form disrupted private practice physicians, distracted them from the physician-patient relationship and impaired their ability to properly care for patients. See the above-linked post and AAPS survey report. An anonymous, usually lively and even combative reader "IT Guy," who claims to be an IT professional at an HIT vendor, on occasion leaves comments to my HIT posts. These are typically in the form of unsubstantiated refutations of the material in the posts, and ad hominem attacks in the unmitigated defense of HIT, e.g., referring to this writer as "a teaching professor at a major university who has virtually no understanding of statistical analysis" or as a "grandstanding self-promoter" (See, for example, <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true">here</a> at January 5, 2010 8:53:00 AM EST. Read the entire thread.) In the latest case, "IT Guy" commented on my report of the AAPS HIT survey responses <a href="http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html#c2210228343379076434">as follows</a>: <a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow"></a> <blockquote><a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow">IT Guy</a> said... It's the March of the Ludites. Thanks for a very funny post. <div class="comment-timestamp">January 4, 2010 12:28:00 PM EST</div></blockquote><div class="comment-timestamp"></div> I failed to see the humor in dozens of adverse comments about HIT from private practice physicians, and replied with a link to my <a href="http://hcrenewal.blogspot.com/2009/12/are-dissmissive-industry-and-government.html">initial post about HIT industry perversity</a> mentioned above, which elicited the even more perverse response: <a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow"></a> <blockquote><a href="http://www.blogger.com/profile/15695921178556625665" onclick="window.open(this.href);return false;" rel="nofollow">IT Guy</a> said... No one is dissmissive of legitimate concerns. Luddites are a different story. Most of the "concerns" in that diatribe are of the Luddite variety. <div class="comment-timestamp">January 4, 2010 1:33:00 PM EST</div></blockquote><div class="comment-timestamp"></div> In other words, a survey of physician concerns is a "diatribe" and it is up to the "IT guys" to determine which physician concerns are "legitimate" and which are of the "Luddite" variety. "IT Guy" remains anonymous and has been so since he first started posting comments here, despite prodding to reveal his identity to better facilitate an understanding of where his/her viewpoints arose. He/she has neglected to do so. Even the blogger profile is blank, click to enlarge: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2qfCG46u1rT-15jqP0fBkOLk9fOonO49xQ-1oDlRjVHVJ_bby2k5g90jDLYtt7kqp1FTLjT7CRAo8kbB1IrsN_sRkIZJn8Cdabsq3ioc-9ajRvdmFUDXqMcpGZsTDodu77bB4ENpu3bcP/s1600-h/itguy.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5423280702099210722" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2qfCG46u1rT-15jqP0fBkOLk9fOonO49xQ-1oDlRjVHVJ_bby2k5g90jDLYtt7kqp1FTLjT7CRAo8kbB1IrsN_sRkIZJn8Cdabsq3ioc-9ajRvdmFUDXqMcpGZsTDodu77bB4ENpu3bcP/s320/itguy.jpg" style="cursor: pointer; display: block; height: 233px; margin: 0px auto 10px; text-align: center; width: 209px;" /></a> Now, I welcome anonymous comments and have a thick skin - to a point. When the comments go ad hominem or perverse, I do consider deleting them. However, when such comments are potentially revelatory of major issues, I promote and amplify them - as now. Read on. This person also apparently uses the anonymous moniker "Programmer" at the <a href="http://www.histalk.com/">HIStalk</a> blog where he similarly attacks my comments made under my actual name S Silverstein or under MedInformaticsMD. The HIStalk site owner actually edited out defamatory comments made about me in Oct. 2009 at HIStalk comment #28 <a href="http://histalk2.com/2009/10/17/monday-morning-update-101909/comment-page-1/#comment-6240">at this HIStalk comment thread</a> and apologized for this entry on his blog: <blockquote>#28 Programmer [at HIStalk blog - ed.]October 20th, 2009 at 11:57 am <div class="commenttxt"> Yes, it’s that simple. If you select for pre-IT and post-IT data and use a large enough sample size the other factors with equal out. If the sample size is large enough you should have a relatively small margin of error. [i.e., "Programmer" -- who I soon show is also "IT Guy" -- opines that in comparing clinical adverse event rates pre- and post healthcare IT installation, all you need is a large enough sample size, which then nullifies or cancels out, for example, changes occurring over time that are not related to the intervention, and other potential confounders in a pre-post comparison. If only evaluation studies in healthcare informatics were that simple ... it is concerning that IT vendor personnel might have such beliefs - ed.]And the fact that a teaching professor at a major university has virtually no understanding of statistical analysis makes me say “at least I don’t have to worry about losing my job to one of his students." [Latter sentence was removed by HIStalk owner - ed.] </div></blockquote>Now, back at HC Renewal see <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=5650114337316261515&isPopup=true">this combative comment thread</a> where "IT Guy" a.k.a. "Programmer" refers to that removal, and repeats the above statistical faux pas and ad hominem ("just to make sure I read the whole thing"), and adds another ad hominem for good measure. I let them remain. (Comment dated October 20, 2009 1:35:00 PM EDT.) HIStalk's "Programmer" and HC Renewal's "IT guy" are apparently one and the same. Getting to the core of this posting, I repeat, when such comments are potentially revelatory of major issues in HIT, I promote them - as here. The raison d'être for this posting is an interesting pattern: Before "IT Guy" posts comments at HC Renewal, "hits" appear from a major health IT vendor's IP in our publicly-accessible <a href="http://www.sitemeter.com/stats.asp?site=s20hcrenewal">Sitemeter log</a>, with outclicks to the comment sections of posts where "IT Guy's" comments then appear. For example: <blockquote>Domain Name (Unknown) IP Address 12.11.157.# (Medical Information Technology) [Meditech - ed.] ISP AT&T WorldNet Services Location Continent : North America Country : United States (Facts) State : Massachusetts City : Milford Lat/Long : 42.1544, -71.521 (Map) Language English (U.S.) en-us Operating System Microsoft WinXP Browser Internet Explorer 6.0 Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1; .NET CLR 1.1.4322; .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648) Javascript version 1.3 Monitor Resolution : 1024 x 768 Color Depth : 32 bits Time of Visit Jan 4 2010 11:49:49 am Last Page View Jan 4 2010 12:55:12 pm Visit Length 1 hour 5 minutes 23 seconds Page Views 12 Referring URL Visit Entry Page <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=5aed7d70d55e446ca5afa8ea987230d0&URL=http%3a%2f%2fhcrenewal.blogspot.com%2f" target="_blank">http://hcrenewal.blogspot.com/</a> Visit Exit Page <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=5aed7d70d55e446ca5afa8ea987230d0&URL=http%3a%2f%2fhcrenewal.blogspot.com%2f" target="_blank">http://hcrenewal.blogspot.com/</a> Out Click 0 comments <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true">https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true</a> Time Zone UTC-5:00 Visitor's Time Jan 4 2010 11:49:49 am Visit Number 643,748</blockquote> At the time of the outclick, there were "0 comments" to that post, as shown in the log above. Shortly after, IT Guy's aforementioned "Funny March of the Luddites" comment appeared ... as comment #1. Likewise today, several "hits" appeared from IP 12.11.157.# with outlinks to the comment thread, for instance as seen below when only 23 comments were present, mostly from "IT Guy", Dr. Poses and myself: <blockquote>Domain Name (Unknown) IP Address 12.11.157.# (Medical Information Technology) ISP AT&T WorldNet Services Location Continent : North America Country : United States (Facts) State : Massachusetts City : Milford Lat/Long : 42.1544, -71.521 (Map) Language English (U.S.) en-us Operating System Microsoft WinXP Browser Internet Explorer 6.0 Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1; .NET CLR 1.1.4322; .NET CLR 2.0.50727; .NET CLR 3.0.04506.30; .NET CLR 3.0.04506.648) Javascript version 1.3 Monitor Resolution : 1024 x 768 Color Depth : 32 bits Time of Visit Jan 5 2010 9:38:07 am Last Page View Jan 5 2010 9:57:40 am Visit Length 19 minutes 33 seconds Page Views 3 Referring URL Visit Entry Page http://hcrenewal.blogspot.com/ Visit Exit Page http://hcrenewal.blogspot.com/ Out Click 23 comments <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true" style="font-weight: bold;">https://www.blogger.com/comment.g?blogID=9551150&postID=4799128165855153590&isPopup=true</a> Time Zone UTC-5:00 Visitor's Time Jan 5 2010 9:38:07 am Visit Number 644,308</blockquote> After that, more comments from "IT Guy" appeared starting with ... #24. The pattern has remained consistent. Now, the evidence is circumstantial but it does not take a Sherlock Holmes to realize it is quite likely this commenter is an employee of a healthcare IT vendor named in the above links, <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&source=hp&q=Medical+Information+Technology%2C+Inc&btnG=Google+Search">Medical Information Technology, Inc</a>., a.k.a. <a href="http://www.meditech.com/">Meditech</a>. I am concerned that a possible employee of an HIT company - any HIT company -- might find physician concerns about HIT as serious as those expressed in the AAPS survey "funny" and "of the Luddite variety." I also am concerned that an employee might think that in situ pre-post evaluations of the technology need not take into account possible confounders. If this person is an HIT vendor employee and IT professional at this HIT company or any other -- I think it likely he/she holds such a position at some HIT company and such attitudes -- then a number of questions are raised: <ul><li>How common is this attitude among HIT vendor employees? Is this a systemic problem?</li></ul><ul><li>How do such attitudes translate into satisfying customer requests for remediation of HIT defects and problems?</li></ul><ul><li>Should HIT vendors be doing better due diligence in their hiring practices to assure they hire IT personnel with a service mentality and who understand that clinicians are the enablers of medicine, they the facilitators? (A point my graduate healthcare informatics students are taught and grasp readily.)</li></ul> At the very least, perhaps employees of HIT companies (such as the one in the logs above at Meditech, whoever they may be) should pay more attention to improving HIT, rather than spending 1 hour 5 minutes 23 seconds reading 12 posts here during business hours. "IT Guy" is welcome to continue submitting anonymous comments, but if they contain ad hominem they will be deleted. -- SS Addendum 1/5/10: A HC Renewal reader with an MBA non-anonymously relates the following (emphases mine): <blockquote>In reading this thread of comments I have to believe IT Guy is a salesperson. My only question is: Were you assigned this blog or did you choose it? We had this problem a number of years ago where a salesperson was assigned a number of blogs with the intent of using up valuable time in trying to discredit the postings. In my very first sales class we learned to focus on irrelevant points, constantly shift the discussion, and generally try to distract criticism. I would say that HCR is creating heat for IT Guy’s employer and the industry in general. I find it sad that a company would allow an employee to attack anyone in an open forum. IT Guy needs to check with his superiors to find out if they approve of this use of his time, and I hope he is not using a company computer, unless once again this attack is company sanctioned. Steve Lucas</blockquote> I think that is an interesting possibility - someone paid to disrupt. It fits, and again invoking Sherlock Holmes, there is the means, the motive and the opportunity. Time for another definition: <blockquote>Sock puppeting: "the act of creating a fake online identity to praise, defend or create the illusion of support for one’s self, allies or company." (<a href="http://www.nytimes.com/2007/07/16/technology/16blog.html?ex=1342238400&en=9a3424961f9d2163&ei=5088&partner=rssnyt&emc=rss">NY Times</a>)</blockquote> If true (unfortunately for the salesperson), I make this observation: To most of the readers of Healthcare Renewal, who find a focus on irrelevancy and irrationality to be signs of foolishness and hysteria (we clinicians have seen it all, by the way), this salesperson has nothing to sell. Another perversity also comes to mind. If what Mr. Lucas suggests is indeed occurring, a company behind such actions would be exhibiting self destructive behavior in trying to disrupt and discredit those who could actually help them to make better products and be more competitive. I remind that patients are the true "customer." It also follows that, if this analysis is true, the defamatory attacks left at HIStalk and here at HC Renewal would have been made with foreknowledge of their falsity and with malice.  I have informed the company's General Counsel of this information and hope that will be sufficient to cause the harassment from their company to cease. Defamation, I also add, is certainly not a particularly wise HIT vendor strategy with the HIT industry under investigation by US Senator Grassley (see Oct. 2009 PDF letter to a number of vendors and management consultant firms <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/grassley_erecords102409.pdf">here</a>). Having worked in pharma, however, another self-destructive industry due to its internal pathologies, I've seen worse done to critics. Incidentally, another probable blog troll/sockpuppet comment from that industry is in the <a href="http://hcrenewal.blogspot.com/2008/01/merck-and-vytorin-who-exactly-is.html#c8072942025901224211">comments</a> section at <a href="http://hcrenewal.blogspot.com/2008/01/merck-and-vytorin-who-exactly-is.html">this Jan. 2008 post</a>. -- SS

More on Perversity in the Healthcare IT World: Is Meditech Employing Sockpuppets?

(Note to readers: also see my Jan. 7, 2010 followup post " Socky the Meditech Sockpuppet on Vacation? ") At " Are Dissmissi...

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One Small Step Towards Reducing Conflicts of Interest Affecting Academic Medical Leaders

Two articles, one<a href="http://www.nytimes.com/2010/01/03/health/research/03hospital.html"> in the New York Times</a> by Duff Wilson, the other <a href="http://www.boston.com/news/local/massachusetts/articles/2010/01/03/partners_healthcare_curbs_fees_staff_can_accept_from_drug_makers/">in the Boston Globe</a> by Liz Kowalczyk, brought the issue of the conflicts of interest generated by leaders in academic medicine sitting on the boards of health care corporations to wide attention.  The news was that Partners Healthcare, the large hospital network that includes two of Harvard University's main teaching hospitals, for the first time is limiting the role its leaders can take on such boards of directors.  As written by Duff Wilson, <blockquote>The owner of two research hospitals affiliated with the Harvard Medical School has imposed restrictions on outside pay for two dozen senior officials who also sit on the boards of pharmaceutical or biotechnology companies. The limits come in the wake of growing criticism of the ties between industry and academia. Medical experts say they believe the conflict-of-interest rules at the institution, Partners HealthCare, go further than those of any other academic medical center in restricting outside pay from drug companies. The rules, which became effective on Friday, impose limits specifically on outside directors who guide some of the nation’s biggest companies. Senior officials at the two hospitals, Massachusetts General and Brigham and Women’s Hospitals in Boston, must limit their pay for serving as outside directors to what the policy calls 'a level befitting an academic role' — no more than $5,000 a day for actual work for the board. Some had been receiving more than $200,000 a year. Also, they may no longer accept stock. The proper pay for time spent on board meetings under the new policy was calculated at $500 an hour for a 10-hour day, said Christopher Clark, a senior lawyer at Partners and director of a new office for interactions with industry. Stock and options were banned because they tie the director’s fortunes to company profits. </blockquote> As far as I know, this policy is the first instance of a US not-for-profit academic medical institution limiting the role its leaders and/or faculty may take as directors of for-profit health care corporations. So it is an important step. Furthermore, also as far as I know, the coverage this news item received on Sunday is the first time this issue has been discussed openly in the mainstream media. A New Species of Conflicts of Interest On the other hand, we first discussed the conflicts posed by leaders of academic medicine sitting on the boards of for-profit health care corporations in 2006 on <a href="http://hcrenewal.blogspot.com/">Health Care Renewal</a>, calling it a "<a href="http://hcrenewal.blogspot.com/2006/03/new-species-of-conflict-of-interest-in.html">new species of conflict of interest</a>" at that time.  Since then, we have found many other examples of such conflicts.  We <a href="http://hcrenewal.blogspot.com/2009/03/putting-new-schein-to-fda.html">noted</a> that sitting on a corporate board is a particular problem for an academic medical leader because a corporate director has a legal obligation to advance the profits and financial fortunes of the corporation he or she serves. As Robert AG Monks put it, corporate directors are supposed to "demonstrate unyielding loyalty to the company's shareholders" [Per Monks RAG, Minow N. <a href="http://www.amazon.com/Corporate-Governance-Robert-G-Monks/dp/1405116986">Corporate Governance</a>, 3rd edition. Malden, MA: Blackwell Publishing, 2004. P.200.]  This legal requirement ties a corporate board member far more tightly to the interests of the corporation than do the obligations of, for example, a consultant to the corporation.  Moreover, some have charged that many for-profit corporate board members are just cronies of the top corporate leaders.For example, <blockquote>Tthe cronyism of major corporate boards, especially those in the finance area, has become legendary. Rubber-stamp directors who rarely buck the chairman or challenge the CEO are unfortunately all too common. These boards did not serve either their companies or shareholders well. </blockquote>[per Ritholtz B. <a href="http://bailoutnation.net/">Bailout Nation</a>.  Hoboken, NJ: John Wiley & Sons, 2009. pp. 198-199.] In that case, this would only makes things worse, tying board members to the personal interests of top managers of health care corporations, rather than to the interests of the entire stockholder population. A (Baby) Step in the Right Direction Given the potential severity of board of directors level conflicts of interest for academic medical leaders, any step that reduces them deserves applause.  That being said, Partners Healthcare's restrictions on these conflicts are at best baby steps in the right direction. Note that the new policy only affects a small number of people.  Liz Kowalczyk wrote, "the policy affects roughly 25 vice presidents, clinical department heads, and other top executives...."  So it neither affects lower ranking clinical leaders, or Partners' own board. The policy's limit on directors' compensation ($500/ hour, or $5000/ day, assuming a 10-hour day, which would annualize to $1,040,000 per year assuming an 8-hour day, and $1,300,000 assuming a 10-hour day), might be comparable to the current exaggerated earnings of top Partners' executives, but substantially exceeds the compensation of most practicing physicians or medical academics, and hence does not seem to be a very significant limitation.  Requiring payments be made in cash rather than stock options might be regarded as an improvement rather than a restriction.  The policy does not restrict the number of boards a Partners leader may sit on. Finally, the policy does not do anything substantial to manage to conflicts generated by board members' legal obligations to their companies and stockholders, nor their tendency to become cronies of top corporate management.  Are Conflicts of Interest Even a Problem? While acknowledging the new, slightly restrictive policy, top Partners leaders did not seem to want to acknowledge that there is any downside to academic medical leaders sitting on health care corporations' boards.  For example, <blockquote>'We thought it was a very good idea to have institutional officials serve on boards, but we did not want to have personal enrichment,' [former Partners Chief Academic Officer and current Professor] Dr. [Eugene] Braunwald said. [NY Times] </blockquote> Note that for most people, $500/hour appear to be personally enriching.   Also, <blockquote>'These relationships also have significant benefits,' ... [Christopher Clark, director of Partners Office for Interactions with Industry] said. 'They give us some insight into how the companies work and how they are doing, and making sure the companies are aware of the academic perspective.' [Boston Globe] </blockquote> Mr Clark did not note the many other ways to see how companies work and to communicate the academic perspective to them which do not involve academic leaders being paid by these companies. Dr Dennis Ausiello, chief of medicine at Massachusetts General Hospital, said <blockquote>Pfizer and other companies were crucial to translate academic research into drugs that benefit patients. At Partners, he has oversight of a research, ventures and licensing office that seeks to commercialize the hospitals’ intellectual property. 'I’m very proud of my board work,' he said. 'I’m not there to make money. I certainly think I should be compensated fairly and symmetrically with my fellow board members, but if my institutions rule otherwise, as they have, I will continue to serve on the board.' </blockquote> While drug companies do make products that are good for society, could they not continue to do so without academic leaders on their boards? If Dr Ausiello did not care about his compensation, why did he continue to accept it? So it is hardly clear that Partners Healthcare's leadership even now would credit Harvard Professor Emeritus and Editor Emeritus of the New England Journal of Medicine Dr Arnold Relman's point of view, <blockquote>I think that’s a gross conflict for an official of an academic medical center to be on the board of a pharmaceutical company. It’s happening more and more around the country. If it isn’t stopped, I think the academic institutions are going to lose the confidence of the country and the government and they will no longer deserve the tax exemption or anything else. They will be part of industry itself. </blockquote> Indeed. But at least now, the issue may be apparent to more people than just the dedicated readers of <a href="http://hcrenewal.blogspot.com/">Health Care Renewal.</a>  The more it is discussed, the more academic medical leaders may realize how much credibility they would gain if they were seen as impartial experts and dedicated physicians, rather than the protectors of corporate stockholders, or worse, the cronies of corporate bosses. ADDENDUM (4 January, 2010) - see also comments by Professor Margaret Soltan <a href="http://www.margaretsoltan.com/?p=20510">on University Diaries</a>, Merrill Goozner <a href="http://www.gooznews.com/node/3221">on the GoozNews blog</a>, and Dr Howard Brody <a href="http://brodyhooked.blogspot.com/2010/01/times-they-are-achangin-so-says-harvard.html">on the Hooked: Ethics, Medicine and Pharma blog</a>. ADDENDUM (6 January, 2010) - see also comments by Dr Daniel Carlat <a href="http://carlatpsychiatry.blogspot.com/2010/01/should-doctors-serve-on-drug-company.html">on the Carlat Psychiatry Blog</a>.

One Small Step Towards Reducing Conflicts of Interest Affecting Academic Medical Leaders

Two articles, one in the New York Times by Duff Wilson, the other in the Boston Globe by Liz Kowalczyk, brought the issue of the conflict...

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Several Vignettes from a Healthcare IT Consultant/Informaticist

Reproduced with permission. These vignettes and the candid 2008 physician survey results recently posted <a href="http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html">here</a> make one wonder whether health IT in its present form is not "meaningfully useful," but rather "meaninglessly useless": <ul><li>A Michigan hospital system uses Cerner for their EHR. This hospital system 'supports' 2 ambulatory systems, eClinical Works and NextGen. Despite huge investments of time and money on all sides (physicians, hospitals, others), there's very little interoperability between these systems. People are 'pulling their hair out,' discouragement is growing, costs are skyrocketing, and some people are backing away from HIT vendors in general. Even doctors are realizing that it makes no sense to spend $100k (or more) to recoup $44k in 'incentives' for systems that don't work.</li></ul> <ul><li>In a major NextGen deployment in a primary care setting we're finding that physicians who thought that they wanted structured data are now backing away from and actively avoiding the structured data. Instead they are opting for the 'free text' sections of the system (this is true for both the people entering the data, and the people who are reading and making sense of the data). The structured data have proven to often not be clinically meaningful.</li></ul> <ul><li>On the medical-legal front, professional liability issues associated with structured data are increasing. [In a] recent newsletter from a Michigan-based medical malpractice company ... note in the newsletter under "Additional Features Creating Risk" the patient safety and risk issues associated with structured data in a SureScripts approved eRx system. Surprisingly very little is said about the medical-legal dimension of HIT.</li></ul> <ul><li>Most important are patient safety issues. Recently I surveyed 2 pharmacists and 12 physician leaders and asked them to interpret an Rx generated by a structured data eRx system (which is used by a number of Michigan-based CMHs). Both pharmacists and 9 of the 12 physicians INCORRECTLY interpreted the Rx. Currently colleagues [and I] are working on a much larger study of the flawed structured data associated with a SureScripts approved eRx system.</li></ul> How long, do I ask, will it take for the U.S. to reach the heights of glory and accomplishment in clinical IT as the <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">UK has achieved</a> for its £12.7 bn , under present assumptions and attitudes of irrational (or purchased) exuberance? -- SS

Several Vignettes from a Healthcare IT Consultant/Informaticist

Reproduced with permission. These vignettes and the candid 2008 physician survey results recently posted here make one wonder whether heal...

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An Honest Physician Survey on EHR's

I often believe surveys of physicians about EHR's do not present the results candidly, but rather are selective in what is reported - and what is omitted - and generally sugar-coated. Examples of very candid reports are rare, probably due to pushback, such as <a href="http://hcrenewal.blogspot.com/2009/11/academic-freedom-and-ed-ehrs-down-under_10.html">this recent report on ED EHR's</a> in New South Wales from Australia. Often the pushback takes the form of the report "lacking peer review", which in a non-free market, vendor-dominated situation (as in pharma, with money flowing everywhere but up) is as likely to produce censorship or, at best, groupthink, as objective science. Here is one that is candid, by the American Association of Physicians and Surgeons. The <a href="http://www.aapsonline.org/">Association of American Physicians and Surgeons</a> , founded in 1943, regularly testifies before the U.S. Department of Health and Human Services regarding development and implementation of health information technology. It consists largely of physicians in private practice. I've been a member of the organization, but was not at the time this survey was performed and written up: <a href="http://aapsonline.org/surveys/hitsurveyresults.pdf" style="font-weight: bold;">PHYSICIAN ATTITUDES & ADOPTION OF HEALTH INFORMATION TECHNOLOGY</a> (PDF) Results Compiled on 6/9/2008 Specialties Responding: Family Practice 73 Psychology 38 Internal Medicine 33 OBG 27 Orthopedic Surgery 27 Ophthalmology 26 General Surgery 22 Dermatology 21 ENT/OTO 15 AN 14 Neurology 13 Pain Management 13 Urology 12 Pulmonary Diseases 11 Neurosurgery 8 Vascular Surgery 6 Cardiology 5 Radiology 5 Gastro 5 Emergency Med 4 I am simply reproducing some of the comments received below without additional comment: <blockquote>A patient's medical history is nobody's business but the doctor's and the patient's. All EHRs examined are cumbersome and ineffiecient As a 'computer programmer,' can see pushing buttons to make statements about a patient's health, really makes patient care more distant, takes the personal, hand-touched art out of practicing medicine, AND lends itself to inaccuracies and errors As a primary care physician, I rarely see patients for one problem, yet most EHRs Ive tested are based on the 'problem/visit' models.Expanding the visit to include the 'oh, by the way, doc's' is cumbersome and even more time consuming. Better--paper record (for patient, also, to keep) Big Brother is watching you--1984 Can't view my study printouts and look for change--pages 'turn' too slow Comment: I do write notes on my computer but it is not part of any 'system.' I do not send bills via computer. Comment: as anesthesiologists, we use the hospital's EMR, but we haven't implemented our own. Possibility that it won't lead to improvements in quality of care Comment: However, I work with a physician's group to promote EHRs and run into many obstacles Comment: we have spent upwards of $200,000 on Nextgen software plus hardware for our clinic and have never been able to make it function over the past 5 years Compatibility Concern about presumed access to record by multiple non-insurance third parties. continued cost of support, maintenance, and updates of hardware and software cost benefit ratio too high Cost of upgrades degradation of personal dr/pt relationship. Instead of a conversation between two people there is the intrusion of a mechanical 'other.' Distraction from personal patient care diverts attention from patient to data processing Doesn't work. Studies show no better. Push for EHR due to 'Big Brother's' appetite for info and control. Don't need it or want it. Concern about accuracy. Many of the automated consult letters I receive contain glaring errors and omissions. EHR generates false pre-programmed info that does not truly reflect the time actually spent with the patient allowing the MD to 'upcode' for the visit and bill higher. It is more honest for me t spend 20' with my patient and write wo words of actually pertinent info. Ehr in use for nurses only at my second site and it slows down the care they give. EHR is most impersonal. It does not give a fell for what is going on with patient. EHR notes are poor, very poor. Full of useless verbiage and usually no place for physicians to add specific notes (or they are lost in the mass of irrelevant detail automatically supplied by the program. Also encourages physicians, who are often pressed for time, to make any specific notes.) EMR are very time consuming, result in production of lengthy repetitive notes of questionable clinical value and reliability. Comment: companies go out of business and new systems need to be installed. Comment: Federal and state govt. will continually add requirements EMR printouts contain extensive boiler plate data. The real data is hard to glean from the chaff. Fills the chart with negative (non-used) information Getting the computer 'right' will become more important than taking care of the patient. Have started process Have used EHR and find written records more reliable and practical I am a fulltime ER doctor. I have no say but if they go electronic, I go. I am blind I am concerned with control that's being exercised here. There's no room for creativity, judgement and financial shortfalls. If the government or insurance companies would take the overhead including this financial then it might be palatable I am not a good 'typer'--on a keyboard--I do not type at all. Don't want to type, never will. I am not trained as a secretary or clerk. I do not want to have to turn on a computer everytime I speak to a patient or need a chart with consulting with another physician or a pharmacist. I feel like I would be a secretary to enter data on my patients so that government can easily slide into socialized medicine. I hate typing and anything that distracts me from writing and examining I have not found a system that will speed up my patient encounter. All make it slower--with keyboard--not patient--time. I see no benefits; would certainly disrupt my thinking process. If mandated--no standard for format. Took 15 years to finally get standard for electronic billing. If purchased would be faced with frequent expensive changes to format. They still can't get the new NPI number to work! Everyone I know who spent $50,000 to buy a system either junked it or are planning to! In 2000, I lost my billing staff. Led to a computer-based billing system due to that. The transition was horrible! I could not use the system myself and training for staff was expensive; the IT guy was expensive; billing personnel who had experience with my system were few. In the end, 4 years later, I had an AR $136,000 and as aconsequence, I closed that practice Inappropriate EMR causes defocus from reason for visit, etc. Problem with sketches. Still would need 2 charts--one paper, photos, etc. and 1 EMR Inefficient. They do not provide the clinical data that I need. It is impossible to skim through an electronic record to find data. It is impossible to sketch the affected anatomy in electronic records. If the computer breaks down or the technology becomes obsolete, the patient record disappears. It takes too long to enter data into a computer. You still need a paper chart to share reports and other patient paper records. It will be of no value in my single practitioner spine surgery practice lack of any standard format/compatibility of various systems Lack of personal patient interplay Less time with patient, more time with computer. There are better ways to give ER docs access to patient's med records. Survey ER docs to learn what info they would need when pt. is unconscious. Put that into pt. ID card using 2D Barcodes or magnetic strips. Card readers in ERs can then access that info. If AAPS helped develop and sponsor this for its members, it could be a source of $$ for AAPS loss of dr-patient relationship Loss of patient control over privacy of records Loss of quality of patient's personal records. Physical deterioration of data over many years Inadequate accuracy of voice recognition technology Lack of evidence that EHRs are any better or equal to paper records except in narrow applications I purchased an EHR system and was unimpressed. Main reason: prefer personal notes. I believe dictated notes are more specific and detailed and are customized for each patient visit May not be able to get to computer records in case of computer crash or power failure (eg. Katrina). most software have major problems in functionality and changes how physicians practice in a potentially negative way Must have voice recognition for input at 100% accuracy and reliability. my patients are given copies of all reports (lab, x-ray, consults) as they are collected and told to keep in their medical file No adequate voice recognition systems No clinical evidence that this improves outcome. No clinical evidence that there is a return of investment. No evidence that EHR will improve care or reduce costs to the patient/doctor/healthcare system. No improvement in quality of care provided. Once they force us into the more expensive, time-consuming system that does not work, they own us! It is too easy for the courts, government, hackers and insurance companies to take 'all,' once it is in the system! One of worst business decision we made. open source software is available (but VA Vista split into Open Vista and World Vista groups and is written in a language that is not known to many programmers) but I haven't taken the time to find something that could work--I don't know if any of them can keep up with the government requirement oppose all government interference Paper charts are much more accurate and efficient for me. Patient safety perpetuation of errors Preoccupation with the computer takes time from patient. Increased errors from EMR especially CPOE. We already have well established safety checks and reviews in our system for tracking tests and medicines. No system especially CPOE have been tested for safety and efficacy nor approved by any regulatory agency and thus the alteration of care from these (?) is nothing but an experiment and patients have not signed consent. Preoccupation with the computer takes time from patient. Increased errors from EMR. We already have well-established safety checks in our system for tracking tests and medicines. No systems have been tested for safety and efficicacy nor approved by any regulatory agency Reduced time with patients. My patients complain about other doctors playing with EHR computer instead of looking at them during visit. reliance on psychological pen and paper tests Slower system than handwritten notes slows review of chart at each office visit some parties are paying $10,000 per month for technical support Sorry, I cannot fill this out--I have visual problems Still building the software Studies are not showing conclusive evidence that EMRs improve patient care or safety, but do increase practice costs. systems are difficult to implement; I've been trying for 2 years The EHR in the hospital slows me down. A paper record is more efficient for me. The systems seem to impede quality clinical care and passing along of relevant clinical information There is not one advantage to me, at all! There is one product I would use, PRAXIS. [www.informed.com] I would need $30,000 infrastructure and $30,000 adoption overhead grant in order to do so They don't improve patient care--just adds to overload time taken up up for data; focus on computer rather than on patient in the exam room Too rigid. I like to draw pictures of what I see on ophthalmological exam. Typed, dictated note can be read much more quickly. I use a print about 1/2 the size of your print on this page and there are perhaps 4 or 5 pages of regular print per page which I read without glasses. Computer and power problems do not hide my records. Unfunded mandate with huge cost in a severely declining reimbursement arena. without a personalized note, it is worthless.</blockquote> Read the entire report as linked above. No additional comments are needed. -- SS

An Honest Physician Survey on EHR's

I often believe surveys of physicians about EHR's do not present the results candidly, but rather are selective in what is reported - an...

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