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Non-Profit Hospital Executive Salaries Continue to Defy Gravity and Logic

The old saying is that nothing is certain except death and taxes.  In health care, the other near certainty seems to be that compensation for health care leaders is big and always getting bigger.  Over the past few weeks several reports about the compensation of top executives of US non-profit hospitals and hospital systems have appeared.  So it is time to do our latest round-up of incessantly buoyant hospital executive compensation, and argumentative hot air that seems to fuel it.  I will first summarize the latest cases in alphabetical order by state, and then examine some common justifications for the seemingly anti gravitational nature of executive compensation in this part of health care. Arizona On AZCentral.com was an <a href="http://www.azcentral.com/news/politics/articles/20130208maricopa-county-health-care-chief-big-raise.html">article</a> about the CEO of a single relatively small public hospital system: <blockquote class="tr_bq">The leaders of Maricopa County’s public health-care system agreed to raise chief executive Betsey Bayless’ pay by 33 percent, bringing her salary to $500,000.</blockquote> That may not seem like a lot of money as executive compensation goes, but consider the context: <blockquote class="tr_bq">The Maricopa Integrated Health System is a public hospital system that provides care for the Valley’s poor and uninsured. It is funded by federal and state health-care dollars and a special county levy paid by all county property-tax payers. MIHS budgeted $3.5 million for market adjustments and merit raises for its employees in fiscal 2013. Bayless’ salary increase alone will consume one-quarter of the $500,000 the board had allocated this fiscal year to bring all employees’ pay in line with similar positions elsewhere. The health-care system’s rank-and-file employees have received annual merit-based salary increases of no more than 2.9 percent since fiscal 2008.</blockquote> Nonetheless, the CEO did not exactly feel rich: <blockquote class="tr_bq">Bayless said she did not request the raise and was not expecting it. She said she believes MIHS employees will understand that her salary has been comparatively low and that her replacement likely will be brought in at an even higher salary.</blockquote> She justified her pay by comparing it to what she thought the market would bear. <blockquote class="tr_bq">'Any salary information will show you that my salary is always the lowest of any (hospital) CEO currently in the entire state, even the little-bitty hospitals,' Bayless said. 'On any measure, 375 (thousand dollars) is below market. So, do I feel undercompensated? I don’t know. But on any measure, it always comes in below market.'</blockquote> Members of the hospital system's board also justified the pay on the grounds that it was at the market rate: <blockquote class="tr_bq">[Board Members Mary] Harden and [Terence] McMahon said they voted for the pay raise because a national search firm hired to find Bayless’ replacement set $500,000 as a minimum competitive salary for qualified candidates.</blockquote> Another board member also noted how hard CEO Bayless works: <blockquote class="tr_bq">'The lady works 70-plus hours a week. She’s on call 24/7. So, I think the job warrants it. She works very, very hard,'  Dewane said.</blockquote>I am sure health care professionals who also work long hours, and are frequently on call, but unlike managers, have to make decisions with real life and death consequences would understand, or not. California In California a report focused in contrast on the bigger hospitals and hospital systems.  California Healthcare News <a href="http://www.payersandproviders.com/news-article.php?news_id=138&region=3">reported</a> on the best compensated hospital executives in the state.  In general, <blockquote class="tr_bq">More than one in five non-profit hospital chief executive officers in California received compensation totaling $1 million or more in 2010, according to a new pay survey by Payers & Providers. Altogether, 32 CEOs of the 154 surveyed received pay packages that ventured into the seven figures. That compares to 19 CEOs who received seven-figure pay packages in the only prior survey Payers & Providers conducted. That survey was published in June 2010, and relied primarily on data from 2007 and 2008.  </blockquote> Some specifics about the best paid executives: <blockquote class="tr_bq">Kaiser Permanente's George Halvorson is the most highly-compensated hospital system executive in California, receiving $7.74 million in 2010. That included more than $6 million in additional compensation. Halvorson is retiring as Kaiser's CEO in June. Thomas Priselac, the chief executive officer of Cedars-Sinai Medical Center in Los Angeles, was the highest-paid standalone hospital CEO, earning $2.77 million in 2010. That included additional compensation of $1.6 million.</blockquote> The article provided the justification for Priselac's seven-figure compensation: <blockquote class="tr_bq">According to an email response from Cedars-Sinai spokesperson Duke Helfand, Priselac's compensation 'reflects the top-tier clinical, research and educational performance the medical center consistently has delivered in his 19 years of leadership.'</blockquote> He did not offer how this performance was measured, how it compared to that of any other hospital, or whether anyone other than the CEO might have been responsible for that performance. The survey results included the best compensated CEO of a health-district <blockquote class="tr_bq">Michael Covert,  the CEO of the two hospital Palomar-Pomerado Health system in San Diego County, was the highest-paid district hospital CEO, earning $1.09 million in 2010. He was among two district hospital CEOs to earn seven-figure compensation. </blockquote> The survey results also included the best compensated CEO for academic medical centers run by the (state supported) University of California: <blockquote class="tr_bq">David T. Feinberg, M.D., is by far the highest-paid CEO among those who oversee the five research hospitals operated by the University of California. Feinberg, who runs Ronald Reagan UCLA Medical Center, earned $1.33 million in 2010 – the only seven-figure pay package among that cohort of CEOs, and nearly $450,000 more than the second-highest earner in that group, Mark Laret of UC San Francisco Medical Center.</blockquote>Connecticut Becker's Hospital Review <a href="http://www.beckershospitalreview.com/compensation-issues/9-connecticut-hospital-ceos-pay-tops-1m-in-fy-2011.html">provided information</a> on the highest paid Connecticut hospital CEOs: <blockquote class="tr_bq">Here are the nine CEOs who earned at least $1 million in 2011. •    Clarence Silvia, The Hospital of Central Connecticut: $2.76 million •    Marna Borgstrom, Yale-New Haven Hospital: $2.59 million •    Brian Grissler, Stamford Hospital: $2.24 million •    Elliot Joseph, Hartford Hospital: $1.74 million (*CEO is now Jeff Flaks) •    Frank Corvino, Greenwich Hospital: $1.71 million •    Susan Davis, RN, Saint Vincent's Medical Center: $1.48 million •    Chris Dadlez, Saint Francis Hospital and Medical Center: $1.42 million •    John Murphy, MD, Danbury Hospital: $1.08 million •    Christopher O'Connor, Hospital of Saint Raphael: $1.04 million</blockquote>  The report did not provide any justification for the pay levels, and I could find no further news coverage that was relevant. Massachusetts The Fitchburg (MA) Sentinel and Enterprise seemed to be the only media outlet which  <a href="http://www.sentinelandenterprise.com/local/ci_22266835/questions-raised-pay-mass-hospital-execs">noted</a> the compensation of hospital executives reported to the state attorney general.  It listed compensation of some regional hospital leaders, <blockquote class="tr_bq">Patrick Muldoon, president and CEO of HealthAlliance Hospital, a member of the UMass Memorial Health Care system, received a compensation package of $653,868 in 2010, the most recent year for which compensation data is publicly available. The HealthAlliance system includes a 135-bed community hospital with services on two campuses in Leominster and Fitchburg. Over that same period, Daniel P. Moen, former president and CEO of the 153-bed Heywood Hospital in Gardner, received a compensation package of $386,126. Christine Schuster, CEO of Emerson Hospital in Concord, earned a total compensation package of $669,844. Emerson has 179 beds. Lahey Clinic chief executive Howard Grant, who oversees a facility with 317 beds, was paid a total compensation package of $768,568 in 2010. </blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> The article did not note the justification for the pay of any of these CEOs.  I was unable to find any other recent reporting that took advantage of the data supplied to the state Attorney General.</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">New York</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">SUNY - Downstate Medical Center The New York Daily News <a href="http://www.nydailynews.com/new-york/brooklyn/suny-downstate-bigs-earn-200k-lich-closing-moves-article-1.1257273">reported</a> on compensation given to executives at one state supported university medical center:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">15 SUNY Downstate Medical Center bigs are raking in $200,000-plus salaries even as plans move forward to shut down its Long Island College Hospital campus. Downstate president Dr. John Williams who’s leading the drive to close the Cobble Hill hospital gets the fattest pay of all. He’s paid $650,000 a year salary and gets an annual housing allowance of up to $80,000 and the use of a car.</div></blockquote>It listed the following compensation information for other executives: <blockquote class="tr_bq">Other big hospital administrators’ salaries, 2011 * $552,556.33 — Debra Carey, vice president * $357,379.26 - Grace Wong, vice president * $334,072.19 — Ivan Lisnitzer, vice president * $312,182.24 — Paul Davis, assistant vice president * $286,954.51 Renee Poncet, vice president</blockquote> This should be viewed in the context of the medical center's current dire straits: <blockquote class="tr_bq">SUNY Downstate — which has a hospital and medical school in East Flatbush — is in such bad financial shape it could go broke by March, SUNY chairman Carl McCall has said.</blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Of course, despite these financial threats, a "spokesman" defended these payments again as market-based:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"><blockquote class="tr_bq">[Robert] Bellafioire defended the brigade of big salaries — though the controller’s audit suggested Downstate should consider cutting the number of high-paid administrators. </blockquote><blockquote class="tr_bq">'We have to offer competitive compensation, particularly when we’re up against any number of the country’s best hospitals and medical schools just across the bridge and in the metropolitan area,' Bellafiore said.</blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Rural Hospitals in Upstate New York On the other hand, the Plattsburgh (NY) Press-Republican <a href="http://pressrepublican.com/0100_news/x1303545809/Salaries-of-hospital-CEOs-detailed">reported</a> on the compensation given to hospital executives in rural northern New York state.  These included Alice Hyde Medical Center:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">John Johnson, president and chief executive officer, was paid $339,539 in 2010. He retired in the fall of 2012. He was replaced by Douglas DiVello, who is paid $246,682 in salary and benefits.</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> Then there was CVPH Medical Center in Plattsburgh </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Hospital President Stephens Mundy has been at CVPH for 10 years and was paid $749,563 in salary, bonuses and other compensation in 2010. His base salary for 2013 is $478,421,...</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">In addition, there was Elizabethtown Community:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Rodney Boula, president and chief executive officer at ECH, was paid $229,902 in 2010.</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Note that later the article explained that this hospital has no more than 25 beds. However, the reporter was unable to find out the compensation of the CEO of the Adirondack Medical Center in Saranac Lake:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Chandler Ralph, president and chief executive officer for 16 years, is not employed by the hospital or its umbrella organization, Adirondack Health. She is paid through a contract with a management company, Health Tech Management Services, said Joe Riccio, AMC communications director. Her salary is a confidential employment contract, 'just like any other vendor that does business' with the hospital, he said. Because of that, her salary was not available through IRS records. The Press-Republican pressed Ralph to release her salary, noting that it was publishing the pay of all other area hospital CEOs, but she refused, citing confidentiality.</div></blockquote><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Parenthetically, this seems to be an unusual case of the actual outsourcing of top leadership. This compensation information again should be considered in the context.  These are all relatively small hospitals in a rural area with low costs of living.  In addition, these hospitals were facing substantial financial challenges:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><blockquote class="tr_bq"><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Numerous jobs were cut in 2012 at the area’s five hospitals, some the first substantial layoffs in decades. One hospital recorded an operating deficit, and at some, programs and services were reduced. Adirondack Health, parent company of Adirondack Medical Center in Saranac Lake, and CVPH Medical Center in Plattsburgh, each laid off 17 employees last fall and eliminated vacant positions. Alice Hyde Medical Center in Malone let 12 people go in September and had closed down more than a dozen vacancies.</div></blockquote> <div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Nonetheless, the justifications for these compensation levels included the usual suspects.In an introductory discussion not specific to any hospital, we find:</div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> <blockquote class="tr_bq">'The responsibilities of a CEO have exploded in the last four years,' said William Van Slyke of the Healthcare Association of New York State, an organization that represents hospitals and health-care systems across the state.</blockquote>Similarly, <blockquote class="tr_bq">'Being a hospital CEO, you are ‘all in,’ all the time, every hour. It’s a tremendous responsibility.'</blockquote>  This is the familiar argument about how hard seemingly all hospital CEOs work.  As noted above, it is particularly incongruous in a health care setting in which numerous health professionals are also "all in," and these professionals bear the responsibility of making decisions and taking actions that can directly affect patients' health, safety, and even survival.  Following this were the equally familiar arguments that the compensation of CEOs is determined by the market, and so to retain CEOs one must pay at this market rate: <blockquote class="tr_bq">'Being a hospital CEO, especially in the state of New York, is complex and demanding job. There is an extraordinarily limited pool of candidates, and that increases their value.' 'I can’t speak for the hospitals in your area,' he told the Press-Republican, 'but a qualified and successful CEO can go anywhere in the country and make equal or higher salaries.'</blockquote> The Press Republican also elicited very similar articles justifying pay for individual hospital CEOs, for example, regarding the CEO of the Alice Hyde Medical Center, here is the "compensation is determined by the market" argument from "Dean Johnston, president of the Board of Trustees, and member of the hospital's Compensation Committee" <blockquote class="tr_bq">'It’s important that the salary is competitive with other institutions because it’s difficult to attract professional leaders who will improve the quality of care.'</blockquote> And from the same person, here is the "CEOs work very hard" argument <blockquote class="tr_bq"> 'It’s difficult being CEO,' Johnston continued, 'because you’re the head of a complex and multi-faceted institution.'</blockquote> Very similar arguments were made to justify the compensation of the CEO of CVPH Medical Center.  The Usual Talking Points and Logical Fallacies So, to summarize, hospital executive compensation, at least such compensation that gets noted in the media, seemingly never has been better.  CEOs at even the smallest, most rural, non-profit community hospitals can make well into the six figures.  CEOs at public hospitals can make over half a million dollars.  CEOs at larger hospitals, even those that are state supported, can make even more, up to millions a year for CEOs of moderate to large non-profit hospital systems.  Even hospitals that are facing financial challenges, or that are laying off employees still pay substantial amounts. In previous posts, we noted that whenever anyone bothers to try to justify extravagant executive compensation at hospitals, and for that matter, other health care organizations throughout the US, they seem to repeat the same set of talking points.    We first listed the talking points <a href="http://hcrenewal.blogspot.com/2011/09/talking-points-sans-original-thought-to.html">here</a>, and then provided additional examples of their use <a href="http://hcrenewal.blogspot.com/2011/09/more-repeats-of-talking-points.html">here</a>, <a href="http://hcrenewal.blogspot.com/2012/03/example-of-how-complex-takes-control.html">here</a> and <a href="http://hcrenewal.blogspot.com/2012/12/health-care-hired-managers-not-playing.html">here</a>.   The talking points are: -  we pay what everyone else pays -  CEOs work hard and are brilliant, and so deserve high pay -  high pay is needed to attract and retain competent, if not brilliant people. None of the examples of these talking points we have seen so far explain why these apply to CEOs and other top hired managers, but not to other kinds of employees.  So it should be no surprise that the justifications for the largesse to hospital executives found in the cases above follow the talking points yet again. We Pay What Everyone Else Pays  Another way to put this is that some market determines CEO pay.  We saw versions of this to support the compensation of the CEOs of Maricopa Integrated Health System in Arizona, and SUNY - Downstate Medical Center and Alice Hyde Medical Center in New York. Note that almost never is this argument supported by data about whether comparisons were actually made to a representative peer group.  In any case, as we <a href="http://hcrenewal.blogspot.com/2012/12/health-care-hired-managers-not-playing.html">asserted before</a>, this justification may be a logical fallacy, an <a href="http://www.nizkor.org/features/fallacies/appeal-to-common-practice.html">appeal to common practice</a>. CEOs Work Hard and Are Brilliant  This is an especially frequently used talking point.  I have yet to see an instance in which any hospital official would omit a CEO was anything other than supremely diligent and totally brilliant.  We saw versions of this to support the compensation of the CEOs of Maricopa (AZ), Cedars-Sinai Medical Center in California, the Alice Hyde Medical Center and CVPH Medical Center in New York, and generically to support all New York State hospital CEOs. As we noted above, this justification is almost never accompanied by any evidence that CEOs work harder or are more brilliant than the numerous health care professionals who actually make it possible for the hospital to operate.  I would guess it would be very hard to show that CEOs work longer hours, are under more stress, make more consequential decisions, are smarter or better trained than typical doctors, nurses and other health care professionals.  This justification thus appears to be another kind of logical fallacy, an <a href="http://www.nizkor.org/features/fallacies/appeal-to-authority.html">appeal to authority</a>. High Pay is Needed for Retention  We saw versions of this to support the CEOs of Maricopa, SUNY - Downstate, Alice Hyde, CVPH, and generically again to support all NY hospital CEOs.  </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Note that this justification is also almost never supported by any evidence.  As we noted <a href="http://hcrenewal.blogspot.com/2012/10/more-reasons-to-doubt-how-ceos-are.html">here</a>, while this argument, probably like the others, comes from the generic business management literature, there is little data in the larger business world to show that CEOs are very mobile, or likely to succeed when transplanted to a new environment.  In fact, a recent report looking at the mobility of CEOs worldwide called this a "self-serving myth."  (See <a href="http://www.huffingtonpost.com/2013/02/11/ceo-pay_n_2661438.html">this summary</a> for a link to it.) </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"> </div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">It is too bad that no one ever seems to get the opportunity to challenge these talking points when they are offered as justifications for outlandish executive compensation.  <div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy</div><div style="color: black; font: 10pt sans-serif; height: 1px; overflow: hidden; text-align: left; text-transform: none; width: 1px;"> Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy</div> </div></div><div style="background-color: white; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;">Summary</div> As we have <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">shown again and again</a>, the pay of top health care leaders seems to endlessly increase, without clear justification, regardless of the vicissitudes affecting the organizations they lead, their employees, their patients and society.  This suggests that health care organizations, like many other organizations, seem to be run primarily for the benefit of their executives and their cronies, regardless of what happens to anyone else.   As we have frequently said, current policies about paying hired health care managers leave the managers unaccountable for the effects of their actions on patients' and the public's health, and worse, fail to deter and may even encourage ignorance of the health care mission, frankly mission-hostile behavior, self-interest, conflicts of interest, and outright corruption.  Meanwhile, paying nearly all top managers as if they were brilliant, while setting much harsher standards for the employees who actually take care of patients, including health professionals, demoralizes those on whom patients actually depend for care. As we have said endlessly,....   Health care organizations need leaders that uphold the core values of health care, and focus on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research. On the other hand, those who authorize, direct and implement bad behavior ought to suffer negative consequences sufficient to deter future bad behavior. If we do not fix the severe problems affecting the leadership and governance of health care, and do not increase accountability, integrity and transparency of health care leadership and governance, we will be as much to blame as the leaders when the system collapses.

Non-Profit Hospital Executive Salaries Continue to Defy Gravity and Logic

The old saying is that nothing is certain except death and taxes. In health care, the other near certainty seems to be that compensation fo...

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Texas Medical Association slams ONC Healthcare IT safety plan

The Texas Medical Association offers views similar to the views I have been writing about for a decade and a half on healthcare IT quality and patient care risks: <blockquote class="tr_bq">FierceHealth IT today</blockquote><div style="border-collapse: collapse; color: #222222; font-family: arial, sans-serif; font-size: 13px;"><div class="gmail_quote"> <blockquote><a href="http://links.mkt1985.com/ctt?kn=167&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__S4c8UaRxIHMoxpErecFsKw" target="_blank">Texas Medical Association slams ONC safety plan</a></blockquote><blockquote><table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;" width="31"></td><td style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;" valign="bottom" width="150">By Dan Bowman</td><td style="color: #888888; font-family: Verdana, Arial; font-size: 9px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;" valign="bottom"> </td></tr></tbody></table></blockquote><blockquote><table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td style="font-family: arial, sans-serif; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div><div>The <a href="http://links.mkt1985.com/ctt?kn=57&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__kdmrdIyd6sIcVcFLYphXQ" target="_blank">health IT safety action plan proposed by the Office of the National Coordinator for Health IT</a> in December is not specific enough to succeed, according to recent comments made by the Texas Medical Association. In its <a href="http://links.mkt1985.com/ctt?kn=92&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_assets_fiercemarkets_com__roPjbL4h6p1at3aX94znog" target="_blank">letter</a> to National Coordinator for Health IT Farzad Mostashari, TMA said that responsibility for the plan "lacks focus," and should be overseen by a "highly visible HIT Safety Czar.</div><div> </div><div>TMA also called setting mandatory deadlines and developing a "robust" reporting and learning system imperative to the success of the plan, saying that the plan's current reliance on voluntary reporting and funding represents a "fundamental weakness."</div><div> </div><div>"TMA believes that significant patient safety risks exist now, and new ones will emerge in the next one to two years as many [electronic health record] and other HIT vendors merge or go out of business," the letter said.</div><div> </div><div>Additionally, the group expressed doubts about a code of conduct proposed to keep vendors in line as far as ensuring cooperation with safety organizations for adverse event reporting. "TMA is concerned that this will not materially affect industry accountability and generate the changes that are needed," the letter said. "For example, what if a developer does not comply with said code of conduct? There is no penalty or impetus for change."</div><div> </div><div>The American Medical Association was a bit less harsh in its <a href="http://links.mkt1985.com/ctt?kn=190&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_ama_assn_org_resources_do_kLlOCnendmgZnkafWC36A" target="_blank">assessment</a> of ONC's plan. It supports most of the ideas outlined in the plan, although it called for more research to be done on the impact of electronic health record use regarding patient safety in the ambulatory setting.</div><div> </div><div>"Physicians are concerned about potential liabilities from EHR system design and software flaws, as well as lack of interoperability among EHR systems that could result in incomplete or missing information, which may lead to errors in patient diagnosis and treatment," the AMA letter said. "In addition, the impact that EHRs have on physician practice workflows can lead to unintended consequences. Those impacts are the result of how the software is developed."</div><div> </div><div><a href="http://links.mkt1985.com/ctt?kn=5&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__fdelaLMvtjHW1QKrOUvegg" target="_blank">HIMSS said in its letter to Mostashari</a> that it wants to see more provider-vendor cooperation when it comes to investigation of patient safety events, as well as usability, while the AHA said in its letter that its stakeholders would like to see more of a focus on a single, national approach to matching patients with their records with a goal of patient safety.</div><div> </div><div>The <a href="http://links.mkt1985.com/ctt?kn=146&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__Uy2fglIMzJM3HSXPTivQVg" target="_blank">College of Healthcare Information Management Executives, meanwhile, said that the plan needs to be facilitated</a> by stakeholders not directly under government control.</div><div> </div><div>To learn more: - here's the TMA <a href="http://links.mkt1985.com/ctt?kn=92&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_assets_fiercemarkets_com__roPjbL4h6p1at3aX94znog" target="_blank">letter</a> (.pdf) - read the AMA <a href="http://links.mkt1985.com/ctt?kn=190&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_ama_assn_org_resources_do_kLlOCnendmgZnkafWC36A" target="_blank">letter</a> (.pdf)</div><div> </div><div>Related Articles:<a href="http://links.mkt1985.com/ctt?kn=5&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__fdelaLMvtjHW1QKrOUvegg" target="_blank">HIMSS, AHA support ONC's patient safety plan</a> <a href="http://links.mkt1985.com/ctt?kn=146&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__Uy2fglIMzJM3HSXPTivQVg" target="_blank">CHIME: ONC's role in health IT safety plan 'overstated'</a> <a href="http://links.mkt1985.com/ctt?kn=57&ms=NDcyNDQxMAS2&r=MTg5MDYxNTI0MDQS1&b=0&j=MTQyMjg5MTEzS0&mt=1&rt=0" name="13cd3c696d1da2b0_13cd3c13f19db484_13cd3bf97a5f8ea4_13cd0586c68a10a9_fiercehealthit_com_story__kdmrdIyd6sIcVcFLYphXQ" target="_blank">HHS issues health IT safety action plan</a></div></div></td></tr></tbody></table></blockquote></div></div><div style="border-collapse: collapse; color: #222222; font-family: arial, sans-serif; font-size: 13px;"><div class="gmail_quote"> The TMA and AMA letters linked above are worth reading in their entirety. I note, with little surprise, the "softer" stances (e.g., self-policing vs. government oversight) taken by industry-dominated bodies such as HIMSS and CHIME. On the other hand, I find the AMA's "less harsh" views somewhat disappointing.  Their letter is welcome, and more research needs to be done as to risks in ambulatory settings (and inpatient settings as well).  However, the delays in action during the research are of concern. Where patient safety is concerned, fast action is a top priority.  Patients, needless to say, have more rights than computers and their sellers. -- SS </div></div>

Texas Medical Association slams ONC Healthcare IT safety plan

The Texas Medical Association offers views similar to the views I have been writing about for a decade and a half on healthcare IT quality a...

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Guest post by Dr. Jon Patrick, U. of Sydney: On the ECRI Institute's recommendations following a "deep-dive" study of HIT-related events

At my Feb. 9, 2013 post "<a href="http://hcrenewal.blogspot.com/2013/02/ecri-institute-pso-uncovers-health.html" target="_blank">ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis</a>", I wrote about an ECRI Institute study of well-defined client data submitted over a 9-week period (a "deep dive" study) on EHR problems.  Risk-creating events at a level that should be a significant concern to patients and clinicians fell into the following categories:  <ul><li>inadequate data transfer from one HIT system to another </li><li>data entry in the wrong patient record</li><li>incorrect data entry in the patient record</li><li>failure of the HIT system to function as intended </li><li>configuration of the system in a way that can lead to mistakes </li></ul> Dr. Jon Patrick at U. Sydney, a scientist and medical informatician who sees the issues from a number of unique perspectives (<a href="http://rp-www.cs.usyd.edu.au/~jonpat/CV/CV_brief.html" target="_blank">link to bio</a>), has offered the following critique of the key recommendations made by the ECRI Institute as a result of this study of health IT events (see aforementioned post for the text of those recommendations).  One caveat is that neither he nor I have the full report as of this writing in part due to expense: <blockquote class="tr_bq">The ECRI has produced a report on HIT errors. I was concerned about the manner in which the Key Recommendations minimised, generalised or failed to concretise important issues that I offer these comments. On ECRI Key Recommendations: 1. Enlist leaders’ commitment and support for the organization’s health IT projects. JP: This is clearly a comment from one level of  management to those levels above it. It doesn't seem to be a comment about the nature of the HIT itself but more about the internal processes to getting it established. There is really not much to say here because if upper management don't want to do anything about the introduction of HIT then engaging in the task is probably futile, hence it was difficult to understand why it was included. 2. Involve health IT users in system planning, design, and selection. JP: yes, this is crucial to successful solutions. 3. Conduct a review of workflow and processes to determine how they must be modified. JP: the missing clause at the end of this sentence is "to fit the introduced HIT system". This is putting the cart before the horse. The notion that a piece of software designed by engineers should have priority over the team of clinicians who are experts in their business is highly naive. Also this statement is in contradiction to point 2 above. The privileging of the functioning of  the IT system as the expert over that of the clinical team, AND making a recommendation in contradiction to an earlier recommendation is absurd enough by itself  to undermine the credibility of  the report. 4. Evaluate the ability of existing IT systems within the organization to reliably exchange data with any health IT system under consideration. JP: And after the evaluation what should be done. This is hardly an informative recommendation. It is of the form "Do Something, it doesn't matter what you do, just do something."  A more compelling statement that would have enhanced the credibility of the authors and demonstrate their knowledge of the industry would have been: " Establish unambiguously and conclusively that any health IT system under consideration has the ability to reliably exchange data with existing IT systems within the organization". Note the focus needs to be on the incoming system being the object of conformity not the incumbent systems. 5. Conduct extensive tests before full implementation to ensure that the health IT system operates as expected. JP: this is a clearly a desirable goal and applies to point 4 above as well as all other aspects of the system functions. 6. Provide user training and ongoing support; educate users about the capabilities and limitations of the system. JP: This is a motherhood statement that does nothing to contribute to the nub of training issues in the use of HIT. Training is an ongoing issue for two reasons: staff change and new staff come on to the roster and need to be trained, and, these systems are complex and expert advice and skill needs to be available to staff as an ongoing service so that work is not delayed due to confusion on how to use the IT. An alternative proposal to reduce training costs and investment would be to design the system so that it matches current best practice of the clinical team so that learning the system is minimised because it fits seamlessly into their work processes. Surely the issue of educating users about the capabilities and limitations of the system is independent of the training topic. The users will discover on their own bat the limitations of the system as they try to use it. 7. Closely monitor the system’s ease of use and promptly address problems encountered by users. JP:This is a quite inadequate description of the action that needs to be taken. The real consideration is for them to have an effective avenue for expressing the limitations in a manner that is acceptable and they are NOT chastised as malcontents [or Luddites or technophobes - ed.] AND that the unnecessary or dangerous limitations are addressed promptly. 8. Introduce alterations to a health IT system in a controlled manner. JP: It is hard to understand what is meant by this statement. Firstly I would have said "introduce alterations to the clinical processes  in a controlled manner". Secondly, alterations to the HIT system need to be done promptly  when it is defective. Once again, as in point 3 above the technology is being preferenced over the clinical processes which I argue is back-to-front. 9. Monitor the system’s effectiveness with metrics established by the organization. JP: This is definitely something that should be done but it also needs a more directed purpose. It is easy to say to assess patient safety but most systems don't readily capture relevant data or supply analytical devises to easily draw a picture of patient  safety. However there is an equally important factor in care that is often overlooked and that is staff productivity and by implication morale. There is a need to understand better ways of assessing staff productivity in positive ways and the effect a CIS has on staff morale.  Typical comments about CISs is that they cost staff  up to 20% more time to maintain the patient record. Staff wouldn't mind giving up that time if it was returned in some other form, but it isn't, so they feel the time is stolen from them or from their patients. 10. Require reporting of health IT- related events and near misses. JP: This is poorly stated and is probably meant to read "health IT - related adverse events". This is a positive recommendation but does not go far enough. A more comprehensive statement would be "Install a process and technology for reporting adverse events and establish methods for evaluating the reports and recommending changes to clinical practice, or technology functionality and implementing them. 11. Conduct thorough event analysis and investigation to identify corrective measures. JP: This  goes some way to dealing with my point in item 10 above. Its weakness is in not identifying the types of problems and taking a firm stance on completing the correct action. SOME of the Items that have been OVERLOOKED 1. The system needs to be alterable at any time by the clinical leadership so as to immediately emplace revised work practices when they are approved. 2. The system needs to have native analytics so that the clinical leadership can monitor the activities of their teams and provide evidenced based feedback to support continuous process improvement. 3. The system needs highly accurate natural language processing so that the search for required content though the clinical record can be fast, efficient and reliable. Professor Jon Patrick Chair of Language Technology School of Information Technologies Faculty of Engineering University of Sydney Health Information Technologies Research Laboratory <a href="http://www.it.usyd.edu.au/~hitru">http://www.it.usyd.edu.au/~hitru</a></blockquote> This is excellent advice coming from perhaps the only computing expert in the world who's conducted a forensic analysis of a major commercial EHR product, one intended for high-risk ED's.  His analysis of that product, intended for government-mandated rollout in public hospitals in Dr. Patrick's Australian state of New South Wales, is at this link. This work has largely been ignored by the health IT industry and the academic Medical Informatics community.  However, I can assure the industry and the academic community that the report will not be ignored by those in the legal community if (perhaps I should say when) patients are injured or killed by the system's deficiencies. -- SS

Guest post by Dr. Jon Patrick, U. of Sydney: On the ECRI Institute's recommendations following a "deep-dive" study of HIT-related events

At my Feb. 9, 2013 post " ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis ", I wrot...

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A New ECRI Institute Study On Health Information Technology-Related Events

As I wrote <a href="http://hcrenewal.blogspot.com/2012/12/pennsylvania-patient-safety-authority.html" target="_blank">here</a>, I was a reviewer of the report in the PA-based, ECRI Institute-conducted study "The Role of the Electronic Health Record in Patient Safety Events."  ECRI studied the Pennsylvania Patient Safety Reporting System database for HIT-related errors.    <blockquote class="tr_bq">The <a href="http://www.ecri.org/" target="_blank">ECRI Institute</a> is an independent organization renowned for its safety testing of medical technologies and reporting on same, and that "researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care."  I've mentioned it and its bylaws in this blog in the past as a model for independent, unbiased testing and reporting of healthcare technologies. </blockquote> The full report in PDF is <a href="http://www.patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Dec;9%284%29/documents/113.pdf" target="_blank">at this link</a>.  In the report, the Pennsylvania Patient Safety Authority analyzed reports of EHR-related events from a state database (the Pennsylvania Patient Safety Reporting System or PA-PSRS, pronounced "PAY-sirs") of reported medical errors and identified several major themes. My review input led to a discrete "limitations" section.  Also, my invited July 2012 presentation to the PA Patient Safety Authority "Asking the Right Questions: Using Known HIT Safety Issues to Improve Risk Reporting and Analysis" with ECRI in attendance (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/PA_patient_safety_Jul2012.ppt" target="_blank">link to PPT here</a>) on the danger of limited datasets due to systematic impediments to information diffusion was apparently taken seriously.  ECRI decided to do something about the knowledge gap, and they asked the right questions. They've just released this summary of a new study they conducted.  I have a few comments which follow:    <blockquote class="tr_bq"><a href="http://www.prnewswire.com/news-releases/ecri-institute-pso-uncovers-health-information-technology-related-events-in-deep-dive-analysis-190064661.html" target="_blank">ECRI Institute PSO Uncovers Health Information Technology-Related Events in Deep Dive Analysis</a> Data transfer, data entry, system configurations, and more identified as serious problem areas   PLYMOUTH MEETING, Pa., Feb. 6, 2013 /PRNewswire-USNewswire/ -- The federal government is spending about $19 billion to encourage hospitals, physician practices, and other healthcare organizations to invest in their health information technology (HIT) infrastructure with the goal of improving patient safety and quality through the Health Information Technology for Economic and Clinical Health (HITECH) Act. Concerned about the unintended consequences of HIT and the potential for errors to cause patient harm, <a href="https://www.ecri.org/PatientSafetyOrganization/Pages/default.aspx" target="_blank">ECRI Institute Patient Safety Organization</a> (PSO) recently conducted a PSO Deep Dive™ analysis on HIT-related safety events. Their just-released 48-page report identified five potential problem areas, which can be assessed with the accompanying toolkit. The <a href="https://eshop.ecri.org/p-140-pso-deep-dive-health-information-technology.aspx" target="_blank">report and toolkit are available for purchase</a> [appx. $350 U.S. - ed.] without membership in ECRI Institute PSO. "Minimizing the unintended consequences of HIT systems and maximizing the potential of HIT to improve patient safety should be an ongoing focus of every healthcare organization," says Karen P. Zimmer , MD, MPH, FAAP, medical director, ECRI Institute PSO. Based on [voluntary - ed.] reports submitted to the PSO from participating organizations, ECRI Institute PSO experts identified the following key HIT-related problems: <ul type="disc"><li>inadequate data transfer from one HIT system to another </li><li>data entry in the wrong patient record </li><li>incorrect data entry in the patient record </li><li>failure of the HIT system to function as intended </li><li>configuration of the system in a way that can lead to mistakes </li></ul> To collect enough reports for meaningful evaluation, ECRI Institute PSO asked participating organizations to submit standardized data about HIT events during a nine-week period. This enabled ECRI Institute PSO to identify patterns and trends from the aggregated data and share the findings, as well as its recommendations. The data in the PSO Deep Dive represents only that collected using the Agency for Healthcare Research and Quality (AHRQ) HIT Common Formats.  [Not the improved formats developed by AHRQ in their <a href="http://healthit.ahrq.gov/HealthITHazardManagerFinalReport" target="_blank">IT Hazards Manager project</a>, still in development - ed.]  ECRI Institute PSO data encompasses over 800 HIT-related events. According to the report, HIT must be considered in the context of the environment in which it operates during the three phases of any HIT project: planning for new or replacement systems, system implementation, and ongoing use and evaluation of the system. "Shortsighted approaches to HIT can lead to adverse consequences," caution the authors. "Healthcare organizations should consider the findings and recommendations in the PSO Deep Dive as part of their effort to achieve those goals," adds Zimmer. The HIT PSO Deep Dive findings were published in a 48-page report and toolkit with self-assessment questionnaire and action plan form available to all ECRI Institute PSO Members and its partner PSO members. The table of contents of the report is available for <a href="https://www.ecri.org/EmailResources/PSRQ/ECRI_Institute_PSO_Deep%20Dive_HIT_TOC.pdf" target="_blank">free viewing/download</a>. Additional information will be presented in ECRI Institute PSO's Monthly Brief free e-newsletter March edition; go to <a href="https://www.ecri.org/psobrief" target="_blank">www.ecri.org/psobrief</a> to sign up. The full report and toolkit are also <a href="https://eshop.ecri.org/p-140-pso-deep-dive-health-information-technology.aspx" target="_blank">available for purchase</a>. For questions about this topic, or for information about purchasing the report, please contact ECRI Institute PSO by telephone at (610) 825-6000, ext. 5558; by e-mail at <a href="mailto:pso@ecri.org" target="_blank">pso@ecri.org</a>; by fax at <a href="tel:%28610%29%20834-1275" target="_blank" value="+16108341275">(610) 834-1275</a>, or by mail at 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA.</blockquote> From the free linked TOC document: Key Recommendations <ul><li>Enlist leaders’ commitment and support for the organization’s health IT projects.</li></ul><ul><li>Involve health IT users in system planning, design, and selection.</li></ul><ul><li>Conduct a review of workflow and processes to determine how they must be modified.</li></ul><ul><li>Evaluate the ability of existing IT systems within the organization to reliably exchange data with any health IT system under consideration.</li></ul><ul><li>Conduct extensive tests before full implementation to ensure that the health IT system operates as expected.</li></ul><ul><li>Provide user training and ongoing support; educate users about the capabilities and limitations of the system.</li></ul><ul><li>Closely monitor the system’s ease of use and promptly address problems encountered by users.</li></ul><ul><li>Introduce alterations to a health IT system in a controlled manner.</li></ul><ul><li>Monitor the system’s effectiveness with metrics established by the organization.</li></ul><ul><li>Require reporting of health IT-related events and near misses.</li></ul><ul><li>Conduct thorough event analysis and investigation to identify corrective measures.</li></ul> My comments are these: <ul><li>The ECRI study, report and recommendations are quite welcome. </li></ul><ul><li>The case reports received were apparently voluntary and probably "conservative" and understated as hospitals are not happy to release data on problems and harms that can lead to, or support, litigation.   </li></ul><ul><li>The study was just 9 weeks long, and with a limited set of healthcare organizations participating.  800 HIT-related events were identified. </li></ul><ul><li> The relevant issues discovered in the events, as summarized in the bullet points above, are capable of causing clinician distraction, incorrect decisions, "use error" (as opposed to "user error", see <a href="http://hcrenewal.blogspot.com/2011/10/nist-on-ehr-mission-hostile-user.html" target="_blank">here</a>), patient harm, and death.  (I am aware of such issues in the press including harms and deaths, as readers here have read at links such as <a href="http://hcrenewal.blogspot.com/search/label/glitch" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/09/sweet-death-that-wasnt-very-sweet-how_24.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/06/babys-death-spotlights-safety-risks.html" target="_blank">these</a>, and others about which I am providing expert-witness consultation and cannot share.) </li></ul><ul><li>I believe ECRI has now begun to peer below the water level, through the muck of industry control of the narrative, of what FDA CDRH leader Jeffrey Shuren MD JD referred to as "<a href="http://hcrenewal.blogspot.com/2010/02/fda-on-health-it-adverse-consequences.html" target="_blank">the tip of the iceberg</a>" - i.e., the current level of knowledge of health IT difficulties, defects and harms. </li></ul><ul><li>The report is yet another red flag for a far more robust (and mandatory, in my view) post-marketing surveillance of health IT.   </li></ul><ul><li>Those who claim these findings are "anecdotes" (as <a href="http://hcrenewal.blogspot.com/2013/02/ama-news-ehr-sloppy-and-paste-and-why.html" target="_blank">here</a>) are looking increasingly foolish and cavalier. </li></ul> Finally, readers of this blog have been reading about these issues for years.  You heard it here first. -- SS

A New ECRI Institute Study On Health Information Technology-Related Events

As I wrote here , I was a reviewer of the report in the PA-based, ECRI Institute-conducted study " The Role of the Electronic Health Re...

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New York Mayor Bloomberg: Gun Control - Yes, Bad Health IT Control - No?

The Mayor of New York, Bloomberg, calls for anti-gun legislation because accidents and unexpected events such as theft or use by a child can happen, even with legally owned guns (I don't think he believes law-abiding citizens who own them for defense or for sport would break the law with them). Yet the selfsame Mayor uncritically calls for spread of another technology that in its present state is prone to accidents and unintended consequences, and unlike guns, at a level that even the Institute of Medicine has admitted in unknown due to systematic impediments to transparency (see the middle of <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html" target="_blank">this post</a> for source). From a release at <a href="http://mikebloomberg.com/">MikeBloomberg.com</a>: <blockquote class="tr_bq"><a href="http://www.mikebloomberg.com/index.cfm?objectid=B530DDFC-C29C-7CA2-FF25BD11B52E6F7E" target="_blank">Mayor Bloomberg Announces Expansion of Electronic Health Records Result in Major Health Care Improvements</a> Feb 07, 2013 | NYC.gov Mayor Bloomberg, Deputy for Health and Human Services Linda I. Gibbs, Health Commissioner Thomas A. Farley today announced that the use of electronic health records has led to better health outcomes for tens of thousands New Yorkers in the critical areas of high blood pressure management, diabetes and tobacco control. New York City's introduction of electronic health records, which has become a national model, was a result of the Primary Care Information Project, a program that began in 2005 to help medical providers, particularly those with underserved patients, use technology to improve the quality and efficiency of health care. The prompts that electronic health records give doctors, such as signaling a daily dose of aspirin to prevent heart disease or follow up questions for someone who smokes, make a dramatic difference in how aggressively they treat the chronic health conditions of their patients. Through 3,200 primary care providers serving more than three million New Yorkers with electronic health records, over 96,000 additional patients reduced their high blood pressure, 81,000 patients improved their diabetes management and an additional 58,000 smokers were given assistance and successfully quit. The Mayor made the announcement at the “NYC Celebrates Improved Health Through Technology” event at the New York Institute of Technology where he was joined by Centers for Disease Control and Prevention Director Dr. Thomas Frieden, National Coordinator for Health Information Technology Dr. Farzad Mostashari and Director of Health Services Andrea Cohen.</blockquote> There is no doubt the technology can accomplish such goals.  The IT I authored or spearheaded at major hospitals improved quality of care in areas such as diabetes and asthma care, invasive cardiology, and others. The release, however, is missing the most important points. The issue is not whether benefits can accrue from health IT. The issues are ... at what level of harms in its present state, since the technology is unregulated and unvetted for potential risks, and also - are there simpler and cheaper ways to accomplish these ends, e.g., so that the underserved can get more access to care. There is no mention of unintended harms, or even concern about harms, in the release - the very same harms mentioned by Joint Commission, FDA, Institute of Medicine (for example see <a href="http://hcrenewal.blogspot.com/2008/12/joint-commission-sentinel-events-alert.html" target="_blank">JC</a>, <a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html" target="_blank">FDA</a>, <a href="http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html" target="_blank">IOM</a>) and many others. That qualifies the press release as propaganda.  It is not balanced, almost like an ad for, say, VIOXX. Apparently, for the Mayor it's OK to have increased risk and innocent victims due to bad health IT (like <a href="http://hcrenewal.blogspot.com/search/label/glitch" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/09/sweet-death-that-wasnt-very-sweet-how_24.html" target="_blank">these</a> and <a href="http://hcrenewal.blogspot.com/2011/06/babys-death-spotlights-safety-risks.html" target="_blank">these</a>, and others I cannot talk about due to case settlements), but not innocent victims of legally owned but stolen guns. Medicine's tradition for centuries has been "first, do no harm", not "when you have benefits to the many, it's OK to overlook the risks and the roadkill." We don't tolerate that any more from the likes of Merck, Pfizer, or Medtronic (to name a few examples). Why does health IT always get special accommodation, as I have frequently asked? <blockquote class="tr_bq">With new federal funding for 2013, NYC REACH is now working to help behavioral health professionals and specialists with high numbers of Medicaid patients adopt and implement electronic health records to continue to improve care across the City. </blockquote> Let's hope they don't have an Avatar rerun (<a href="http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html" target="_blank">link</a>) or Contra Costa meltdown (<a href="http://hcrenewal.blogspot.com/2012/08/contra-costas-45-million-computer.html" target="_blank">link</a>, <a href="http://hcrenewal.blogspot.com/2012/09/in-addition-to-nurses-doctors-now-air.html" target="_blank">link</a>). Note: this post is not about gun control, a complex issue unto itself, but about medical ethics and hypocrisy.  -- SS Feb. 8, 2013 Addendum:  Prof. Jon Patrick of U. Sydney opines: I can only say the story is a well crated ANECDOTE. The pertinent text is this: <blockquote class="tr_bq">Between 2008 and 2011, the number of preventive care services participating doctors provided grew, on average, by about 290%, from 39 services per 100 patients to 113 services per 100 patients – nearly a threefold increase.</blockquote> Which tells us the only tangible piece of information in that services are increased - where are the figures from the EDs or hospital intakes that show the number of visits for these diseases have gone down? The other interesting point is the valid claim of better analytics - but they don't say how they were used, if at all: <blockquote class="tr_bq">"Patients served by doctors participating in the program were, for example, reminded to take daily aspirin doses to prevent heart disease or counseled to quit smoking. Electronic Health Records also permit doctors to view data on their entire population of patients, which helps them modify their routine office practices to help all of their patients and then evaluate how well those changes work."</blockquote> -- SS

New York Mayor Bloomberg: Gun Control - Yes, Bad Health IT Control - No?

The Mayor of New York, Bloomberg, calls for anti-gun legislation because accidents and unexpected events such as theft or use by a child can...

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From Parallel Universes? Dueling Accounts of VA/DoD EHR Integration

At a March 2010 post "<a href="http://hcrenewal.blogspot.com/2010/03/will-it-take-luminosity-of-dozen.html" target="_blank">VA / DoD EHR Interface Debacle: Will It Take the Luminosity Of A Dozen Supernovas To Shed Light On The Obvious About Healthcare IT?</a>" I wrote about problems with ongoing efforts to integrate the Veteran Administration's EHR and the Dept. of Defense (active military) EHR. Now there appears to be two dueling accounts of the task's progress: Account One: <blockquote class="tr_bq"> <a href="http://www.defense.gov/news/newsarticle.aspx?id=119206" target="_blank">DOD, VA to Speed Integration of Health Records</a> By Jim Garamone American Forces Press Service WASHINGTON, Feb. 5, 2013 – The secretaries of Defense and Veterans Affairs announced their departments will speed implementation of the Integrated Electronic Health Record program, allowing service members and veterans better access and more importantly, better medical care. This approach is affordable, achievable, and if we refocus our efforts we believe we can achieve the key goal of a seamless system for health records between VA and DOD on a greatly accelerated schedule,” said Defense Secretary Leon E. Panetta following a meeting with Secretary of Veterans Affairs Eric Shinseki at VA headquarters here. The departments are able to step up the records program because of advances in information technology while working with existing platforms. The original goal was to have the system deployed by 2018. Now the expectation is by the end of next year. The goal is to provide one set of electronic records from entry into the military through veteran status. The program is designed to allow service members or veterans to download information and present it to doctors or other health care providers without delays. Previously, service members had to hand carry paper files from DOD facilities to Veterans Affairs. Once complete, the record program will provide DOD and VA clinicians with the complete medical records of more than 18 million service members, veterans and their beneficiaries. “We’ve agreed to improve interoperability before the end of this year by standardizing health care data,” Shinseki said. The two departments will also accelerate the exchange of real-time data by September. The departments are upgrading the graphical user interface to display the new standardized VA and DOD healthcare data by the end of this year, Shinseki said. ... “By this summer, DOD and VA will field and begin conducting a pilot program on the common interface for doctors at seven joint rehab centers across the country and we’ll also expand its use at two other sites,” Panetta said. “All of these facilities will be interoperable by the end of July 2013, so fast time track, but we think we can get it done.”</blockquote><blockquote>“Rather than building a single, integrated system from scratch, we will focus our immediate efforts on integrating VA and DOD health data as quickly as possible by upgrading our existing systems,” Panetta said.</blockquote>  Account Two: <blockquote class="tr_bq">IMMEDIATE RELEASE: February 6, 2013 CONTACT: Curt Cashour (202) 225-3527 <a href="http://www.sanders.senate.gov/newsroom/news/?id=39d4cb1d-1653-4c0e-9ce5-8e389dbe1e64" target="_blank">Senate and House Veterans’ Committee Leaders Fault VA and DoD on Integrated Health Record System</a> WASHINGTON, D.C. – The chairmen and ranking members of the Senate and House Committees on Veterans’ Affairs today faulted the Pentagon and Department of Veterans Affairs for backing off plans to create a single computer system to integrate electronic medical records for troops and veterans. Senate Committee on Veterans’ Affairs Chairman Bernie Sanders (I-Vt.) said: “I am deeply disappointed by the VA and Defense Department decision to back away from a commitment to develop and implement a truly integrated, single, electronic health record. President Obama charged the departments with creating a seamless system of integration so that service members transitioning from active duty to civilian life don’t have to worry about whether their health records will be lost or their claims delayed. An integrated record would allow for a streamlined and timely claims process, faster decisions on benefits, less duplication in medical testing and more efficient, cost-effective treatment for both physical and mental health needs. Now more than ever we need greater cooperation between the departments to solve the serious challenges that continue to confront our service members and veterans. I will continue to work to achieve better coordination by the departments and to ensure that the needs of veterans are met.” House Committee on Veterans’ Affairs Chairman Jeff Miller (R-Fla.) said: “The decision by DOD and VA to turn their backs on a truly integrated electronic health record system is deeply troubling. The need for a record system integrated across all DOD and VA components has been universally accepted for years, and until yesterday, both agencies have given us nothing but assurances they were working toward that goal. Previous attempts by DOD and VA to use disparate computer systems to produce universal electronic health records have failed, and unfortunately it appears they are repeating past mistakes.  [This seems the "focal point" of the apparent discrepancy, one system vs. two that are interfaced - ed.]  When DOD and VA take shortcuts, the veterans and service members under their care will be shortchanged.” Sen. Richard Burr (R-N.C), the ranking member of the Senate committee, said: “The fact that VA and DoD would reverse course on a plan they have been working towards for years that would create a coordinated electronic health record system between the two agencies is concerning and disappointing. I am concerned about what this means for our nation’s service members and veterans, particularly those who will be transitioning from active duty service to civilian life in the near future. We owe it to our nation’s defenders to do all we can to care for them and provide the most effective, efficient service we can, and coordination and communication between these two agencies is absolutely vital.” Rep. Mike Michaud (D-Maine), ranking member of the House committee, said: “This is a huge setback and completely unacceptable. For years we have been told by both agencies that progress was made and that things were on track. I’m disappointed that our nation’s two largest government agencies – one of which is the world’s foremost developer of high-tech machines and cyber-systems – could not come together on something that would have been so beneficial to those that served. We have just witnessed hundreds of millions of dollars go down the drain.” Additional Contacts: Michael Briggs (Sanders) 202 224-5141 David Ward (Burr) 202 228-2971 Ed Gilman (Michaud) 202 225-6306 </blockquote> So, some are touting a marvelous effort ready for prime time in 2014, and others are speaking of hundreds of millions of dollars down the drain with nothing to show for it. As Captain Kirk said to Mr. Spock in the award-winning Star Trek episode "<a href="http://en.wikipedia.org/wiki/The_City_on_the_Edge_of_Forever" target="_blank">The City on the Edge of Forever</a>" about conflicting accounts of the early 1930's death of <a href="http://penciledin.com/wp/wp-content/uploads/2006/12/edith_keeler_and_jim_kirk.jpg" target="_blank">Edith Keeler</a>, played by a pre-Dynasty Joan Collins, vs. Keeler's mid-to-late-1930's rise to national fame and her becoming the cause of World War Two being lost ... "They both can't be true."  <blockquote class="tr_bq">(Using the clock-mender's tools, Spock gets an image on his tricorder screen of a newspaper report. Edith Keeler, social worker from 21st Street Mission was killed today, it says. Kirk enters.) KIRK: How are the stone knives and bearskins? SPOCK: I may have found our focal point in time. KIRK: You may also find you have a connection burning someplace. SPOCK: Yes. I'm overloading those lines. I believe we'll have our answer on this screen. KIRK: Good. SPOCK: And, Captain, you may find this a bit distressing. KIRK: Let's see what you have. SPOCK: I've slowed down the recording we made from the time vortex. KIRK: February 23rd, 1936. Six years from now. (reading below the headline FDR confers with slum area 'angel') The President and Edith Keeler conferred for some time today (Then the whole thing goes up in flames.) KIRK: How bad? SPOCK: Bad enough. KIRK: The President and Edith Keeler. SPOCK: It would seem unlikely, Jim. A few moments ago, I read a 1930 newspaper article. KIRK: We know her future. Within six years from now, she'll become very important. Nationally famous. SPOCK: Or Captain, Edith Keeler will die - this year. I saw her obituary. Some sort of traffic accident. KIRK: You must be mistaken. They both can't be true.  </blockquote> Based on the points I raised in the aforementioned March 2010 post about current IT leadership and organizational structures (not to mention <a href="http://en.wikipedia.org/wiki/Beltway_bandits" target="_blank">Beltway Bandit</a> IT consultants), I am skeptical that either plan - monolithic vs. interfaced - has a snowball's chance of success. Edith Keeler dies in either scenario.  Let's just hope a war is not lost because of this cybernetic "how to do health IT poorly" feud. -- SS Feb. 7, 2013  Addendum: I've received a comment that this post is a bit "geeky" but droll. My response is a word often used by another highly popular SF character:  <a href="http://www.youtube.com/watch?v=xYnzZ2rczSo" target="_blank">Indeed</a>. -- SS

From Parallel Universes? Dueling Accounts of VA/DoD EHR Integration

At a March 2010 post " VA / DoD EHR Interface Debacle: Will It Take the Luminosity Of A Dozen Supernovas To Shed Light On The Obvious ...

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More on the lengths a hospital will go through to protect their EHR from discovery

At "<a href="http://hcrenewal.blogspot.com/2013/02/the-lengths-hospital-will-go-to-in.html" target="_blank">The lengths a hospital will go to in order to protect their EHR - Motion for Reconsideration of Denial of Motion for Reconsideration of Denial of Objections</a>" I wrote about obstruction of litigation by the defense regarding a case where an EHR contributed to patient injury and death.  The major basis for the new "Motion for Reconsideration" (a request for the court to reconsider its prior denial of an earlier Motion for Reconsideration of an initial court decision to dismiss defense objections to the Complaint) is this.  From the actual filing (emphases mine): <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnpG-m0KgmFf1SDTC66r0r7UnCNShPd4C2wjS-vC4ICCVN-LvfjydhYYnVLTyVgnjCIliJ3x7QJQDN-YEAN55-zXD6kow4DToFtvO1M26f8UzqGBMrjZgP9OVmiji0pjqswEMereUeo-rC/s1600/request.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnpG-m0KgmFf1SDTC66r0r7UnCNShPd4C2wjS-vC4ICCVN-LvfjydhYYnVLTyVgnjCIliJ3x7QJQDN-YEAN55-zXD6kow4DToFtvO1M26f8UzqGBMrjZgP9OVmiji0pjqswEMereUeo-rC/s400/request.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">(click to enlarge)</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS22oiR8aMkHGUg3PGnMd1dp12SNGeDrYDdZky60rEmnbLepkXDK7JsneauL06oBAf0qNt8XyluCWNhwCRqahW3xVIadJiDvXv265Rg6JzZ90rb3H3nIFiXmUC2G7UvCQbe3okTtQlAOpS/s1600/request.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a> Here is likely why the court "never addressed the issue":  they don't have time to address frivolous claims.  Neither does the Superior court that also declined to hear this argument.  (It's actually the defense who never addressed the following in all their filings): From the official publication of the Civil Procedure Rules Committee in the state, effective a decade ago: <div class="MsoNormal"> </div> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0U6lMWpjedAb5GxPK8VKdmEN5cCoppS1TRPf228O7KvGm60pqw9uTO7kDyM7PFH3T-3hntaHlXp4PBRHB2SVcrtj3I_KWJNd1pnWyqorZ1PymkMNcwjVXxCy3bofu1Gstkqu0aPlRju5H/s1600/COM_rule.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="310" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0U6lMWpjedAb5GxPK8VKdmEN5cCoppS1TRPf228O7KvGm60pqw9uTO7kDyM7PFH3T-3hntaHlXp4PBRHB2SVcrtj3I_KWJNd1pnWyqorZ1PymkMNcwjVXxCy3bofu1Gstkqu0aPlRju5H/s1600/COM_rule.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">That's pretty clear.  One certificate for non-defendants for whom the defendant is vicariously liable.  Further, a decade ago recommendation 200 also was approved and added to the note; the medical professional providing the justifying statement doesn't even need to name the 'other professionals who deviated.'</td></tr></tbody></table><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg22mcCEeRXP6J0T8uCwMR_WMYh_KlE4b53G1RbYOYlD415zo2hEdXBlSmsJps5YPBTZ9OgZ8gCvTFht0DJgzk6S6BQumdLpe52okhBxBfjHAURrHMqILHQLpKBw9GjfCLDlSO59dsFgIUB/s1600/COM_rule.jpg" style="margin-left: 1em; margin-right: 1em;"> </a></div> <div class="MsoNormal">The mandated Certificate was timely filed, as was a separate Certificate of Merit for direct corporate liability in the malpractice suit. Further -  from the actual mandated Certificate of Merit document, direct from the State code:</div><div class="MsoNormal"> </div><div class="MsoNormal"> </div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixAa3B99m6MO7XethT5ZgWA_TAhXznYeumzRo3sLnqZYl6P989MybhhtxMvtT3ts-7x_SuobMm20p2LRwuNhxOUC5-yrsc86xUxBa-ESfvJL1laqlM65z8ZmzSyJf5caaYUaY7bHN95sDw/s1600/COM.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixAa3B99m6MO7XethT5ZgWA_TAhXznYeumzRo3sLnqZYl6P989MybhhtxMvtT3ts-7x_SuobMm20p2LRwuNhxOUC5-yrsc86xUxBa-ESfvJL1laqlM65z8ZmzSyJf5caaYUaY7bHN95sDw/s1600/COM.jpg" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">I don't think the Courts expect parties to edit their documents to accommodate their own whims.</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"></div><div class="MsoNormal"></div><div class="MsoNormal"> </div><div class="MsoNormal"> The only option for identifying those sued is “Name of Defendant.”  No fields are present specifying “Name(s) of Defendant’s agent, employee (etc.) for whom Defendant is being held vicariously liable”, or similar, nor is some other multi-labeled Certificate of Merit for such purposes in existence.</div><div class="MsoNormal"> </div><div class="MsoNormal">This is some rather inventive lawyering and misuse of court process, either to needlessly prolong the case, or to harass the plaintiff.  The judges will likely not be amused. On the other hand, the delays have allowed me to be able to see and review metadata (e.g., audit trails and other "data about data") produced from the very same EHR system that was in use at this hospital, via my legal support work in another case in the state.  It took time for that production to occur.  This will make it much harder for the hospital to pull the wool over my eyes regarding metadata discovery. That's one reason why I'd been patient with all this. My patience is now long expired. My mother, the original plaintiff, is unavailable for comment.</div><div class="MsoNormal"> </div><div class="MsoNormal">-- SS</div>

More on the lengths a hospital will go through to protect their EHR from discovery

At " The lengths a hospital will go to in order to protect their EHR - Motion for Reconsideration of Denial of Motion for Reconsiderati...

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