Tuesday, September 30, 2008

PBS Tonight: Critical Condition

Just a quick heads up that Critical Condition airs tonight at 9 on PBS. Info here. (Two videos in one day! Aren't you lucky?) So set your DVR or get home in time or whatever, just try to watch this tonight. Should be quite the buzz tomorrow.

From the site: Roger Weisberg's Critical Condition is a powerful, eye-opening look at the health care crisis in America. In an election season when health care reform has become one of the nation's most hotly debated issues, Critical Condition lays out the human consequences of an increasingly expensive and inaccessible system. Using the same cinema verite style he employed with Waging a Living (P.O.V., 2006), Weisberg allows ordinary hard-working Americans to tell their harrowing stories of battling critical illnesses without health insurance.
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Veni, Video, Vici

Wow. Good enough for NASA astronauts, good enough for pilots, good enough for health care providers? An interesting video, about, um, video.

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Getting There...

An information exchange of a thousand patients begins with a single discharge.

The Nationwide Health Information Network, basically a separate Internet of health care organisations and systems, underwent it's first real test last week. Among other achievements, we saw the creation of a fabulous new acronym: DURSA. Stands for Data Usage and Reciprocal Support Agreement.

In the test, 19 organisations demonstrated the ability to access and retrieve patient level data, albeit fictitious patients, from NHIN partners, which include DoD, the VA, and SSA.

A live test with real data is scheduled for December, but ten years from now, we'll be looking back at this test as the first successful day we exchanged data, I think this is truly the the beginning of the end of the beginning. We're nearly there. I can smell it.

I've been attending the AHIC meetings remotely, but couldn't make it to this one due to my being Nyquil'ed up to the gills for a week, but you can read more about this truly momentous occasion at GovHealthIT, HIT News, and for bonus points here's an article on the national EHR in the UK, which has finally grown a pair and decided that patients who don't want to be included on the national system need to opt out of the program.
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Monday, September 29, 2008

Stop Touching My Buttons!

I've railed about this before, but I had to fill a prescription today and it still bugs the living bejesus out of me.

I went down to Rite Aid, filled my scrip for antibiotics, and was told to wait a few minutes.

During that time I watched five other customers pick up their medications, and each time the pharmacist or assistant would lean over the counter and quickly tap the buttons on the little digital readout that says "I decline to be counseled", negating the option for the customer to even see the message let alone ask what counseling they might need.

For one thing, whenever I talk to pharmacists there's the usual conversation that they are the last bastion of customer protection, that it is only they who can spot fatal errors, typos, wrong meds and the like. And yet every time I go near a pharmacy I see this occurring.

According to the Office of the Professions:

Pharmacists or pharmacy interns must provide counseling:

* before dispensing a medication for the first time to a new patient
* before dispensing a new medication to an existing patient
* if the dose, strength, route of administration, or directions for use have changed for an existing prescription previously dispensed to an existing patient


If you are having a prescription re-filled or you are having a prescription filled for a drug or medication you have been treated with previously, pharmacy staff must offer to provide counseling in keeping with the processes described above.

If you pharmacists are so important to the world, and I *do* think you are, let us click our own buttons. Evidently there's not a pharmacist - in New York City at least - who believes counseling is all that important.

Which is it?

I would dearly love some commentary on this. Have you seen the same thing happening? Does your pharmacist counsel you? Would you want said counseling?
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If I Had Seven Hundred Billion Dollars...

The alternate title for this piece is "USA To Ensure Universal Access To Credit"

Seven. Hundred. Billion. Dollars.




Apparently, a few banks not going bankrupt is more important to the US than everyone having universal access to affordable health care.

This $700 billion is on top of the billions already spent shoveling loans and bailouts to Detroit's Big Three, AIG, Fannie and Freddie and Bear Sterns. bringing the grand total to 1.2 TRILLION dollars.


According to this report by the AMSA puts the cost of single payor universal coverage at $34 to $69 billion. That used to sound like a lot of money. As of this morning, that's chump change. (As an aside, the big four investment banks, as was, paid out just over 30 billion in bonuses last year...)

Of course, that doesn't include the Federal studies by the Congressional Budget Office and the General Accounting office that show single payer universal health care would save $100 to $200 billion per year.

Hell, let's call the cost a round 100 billion. Hell, let's tack it on to this amazing piece of bailout legislation right now. All we do is print the money anyway, right?

What's more important? Consumers having universal access to credit? Or health care?

Apparently, a couple of finance wonks are going to make that decision for you.

The best part? Ploughing 50 billion into creating a single payor system is apparently too much government in your health care, we don't do nationalised here, no thank you sir, we like smaller government.

Pretty sure we just nationalised a large chunk of the financial sector though... Can I have my shares now please? Wouldn't it make more sense for the government to buy up the actual mortgages, instead of pouring money into hedge funds that risked their livelihood on vaporous mortgage-backed instruments?

Go read this article in Time if you haven't already, and see if there's anything in there you can find it in you to disagree with.

For more fun, read this article on AlterNet which has ten easy ways to pay for this mess without sucking it out of our wallets. My favourites? Tax the stock transactions like everyone else, and get capital gains taxes in line with income tax rates.
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TLA Heaven

One of the joys of starting a major new project is figuring out all the TLAs (Three Letter Acronyms). The current push for HIT and HIE in the USA is no different, and is awash in TLAs that are still struggling to define themselves. EHR, EMR, PHR, WTH? IDK.

Software Advice has, IMO, a nice piece up discussing the difference between an Electronic Medical Record and Electronic Health Record, complete with some cool numbers and graphs from Google. Click through to read EHR vs EMR - What’s the Difference?

Bonus points for knowing all the acronyms above :) If you need help you can always consult the Urban Dictionary.
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Thursday, September 18, 2008

Too Many Chefs

Colour me cynical, but after reading this article from Gov Health IT by Nancy Ferris, covering eHI's annual survey of Health Information Exchanges, I can't help but hang my head in despair.

I quote:

Although the number of HIEs reporting this year held steady at 130, the number that are actually exchanging data grew by 31 percent, from 32 to 42. Eighteen of the 130 HIEs are new to this year’s survey, indicating that interest in using health IT continues to increase, said Janet Marchibroda, chief executive officer of the eHealth Initiative.

On the surface, seems like good news, right?

But wait a minute.

One hundred and thirty HIEs?


Nearly a gross.

Do we *really* need 130 HIEs to cover 50 states?

Unless I'm mistaken, we have four major credit cards, and three credit bureaus. Covering roughly the same amount of transactions for the same amount of people. In real time.


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Wednesday, September 17, 2008

Blame Canada

This will be a very short post, but I think it's worth mentioning...

Whenever the conversation turns to a national health care system in the USA, the detractors invariably point at Canada and say "Canada's system sucks" and use that as the be all and end all of why national health care can never work.

The thing is, Canada's health system *does* suck.

Shock! Horror! Did he really just say that?

Yes, yes he did.

But listen carefully. Canada is not the only system to compare against.

In fact, in the Euro-Canada Health Consumer Index report published this very year, comparing Canada to 29 European health systems, Canada came in 23rd.

Canada is not the system to aspire to. They are working on their system, and their problems do not have to be the USA's problems.

This week we saw the release of the first annual Canada Health Consumer Index, spring-boarding off the afore-mentioned report. From that self-examining report:
· Access to healthcare varies widely from province to province, whether in terms of availability of family doctors and midwives, the affordability and timely approval of new drugs or the waiting time to see a specialist.
· Even the best-performing provinces do not provide the standard of care that is commonplace in Western Europe.
· Canada lacks a culture of accountability and transparency in healthcare, and it still puts providers and bureaucrats ahead of consumers.

So, my point is, stop pointing at Canada and declaring universal health care to be universally bad. Saying no to universal health care because Canada's is not great is like saying no to democratic elections because Iraq doesn't do them very well.

Pick the best performers and compare to *them*.

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Up and Over Down Under

The Australian Capital Territory, Australia's answer to Washington D.C., publishes a very detailed quarterly report on it's health care services.

Australia, like all, sorry, most, sorry, everyone except the USA, provides health insurance for all as part of the government's duty to it's citizens. The reports, which have been published starting in 2005, are easy to read, easy to understand, and provide a wealth of useful information while delivering a highly honest and transparent report on the taxpayer service. Some nice examples are wait times for surgery, often thrown out as the number one reason to avoid universal health care. For patients who needed surgery with 30 days, the median time to surgery was 14 days (down from 16 the year before).

Also of interest is the measure "unplanned return to operating theatre within an episode of care". This is a measure we can never follow in the US, as we have no episodic record, the patient bounces between a half dozen, unconnected providers. Under universal health, the system knows the patient all the way through an episode of care.

Hospital acquire bloodstream infection rates are freely posted, and even dental services are reported on.

All in all, a concise, readable report that shows us the way things should, and could be done.
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Obama, McCain Health Plans Redux

Kaiser Family Foundation has great coverage of the three reports examining the various ins and outs of the two major health reform proposals.

Long story short, Obama covers 34 million people, McCain covers five.Full story...

Thursday, September 4, 2008

More Chartered Value Exchanges

Eleven more communities will join the fourteen already designated by Leavitt as Chartered Value Exchanges - collaborations focused on improving care and transparency.

The new Chartered Value Exchanges are:

* Aligning Forces for Quality, based in York, Pa.;
* the California Chartered Value Exchange, in San Francisco;
* the Colorado Chartered Value Exchange in Denver;
* eHealth Connecticut, Inc., of Middletown, Conn.;
* the Greater Louisville Value Exchange Partnership in Louisville, Ky. ;
* the Health Improvement Collaborative of Greater Cincinnati and HealthBridge, in Cincinnati, Ohio;
* the Kansas City Quality Improvement Consortium, in Kansas City, Mo. ;
* Michigan Health Information Alliance, in Mt. Pleasant, Mich.;
* the Nevada Partnership for Value-driven Health Care, in Las Vegas,;
* the Quality Health First program, managed by the Indiana Health Information Exchange of Indianapolis, Ind.;
* and the Virginia Health Care Alliance of Glen Allen, Va.
Full story...

Disclosures and Disclaimers


My employer is compensated through funding to provide analytical research, technology solutions, and Web-based public and private health care performance reports by the State of New York, the State of Illinois, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Commonwealth Fund and Bridges to Excellence. I am not being compensated by any of these organisations to create articles for or make edits to this Web site or any other medium; and all posts authored by me are as an individual and do not represent my employer or the agencies I work for.