Sunday, January 30, 2011

HITECH and Funding Cuts: The Battle Begins

At "US House of Representatives Proposes to Defund Largest Non-Consented Medical Experiment in U.S. History: HITECH" I predicted this:

... I have no financial conflicts of interest regarding HITECH or health IT to weep about. Others do, and it's not hard to predict their financial interests will push them to oppose repeal "by any means necessary."

The next few months should be an interesting time in the politics of healthcare IT.

A replacement HITECH act that's "HI" on research and caution, but not so "HIGH" on stealth, coercion and euphoria (i.e., as on mind altering substances) would be welcomed.

The battle's already begun. At "Meaningful Use incentives jeopardized by GOP bill", Jan. 28, 2011 by at Dan Bowman at FierceHealthIT.com, views exactly as I expected have begun being proffered by the industry:

... All of that [possibility of HITECH funding termination] has HIMSS Vice President for government relations Dave Roberts just a little on edge, reports Healthcare IT News.

"We're trying to tell people that this process is going on. This is only one body [of Congress]. Don't let this be a concern," he said. But "if this is a new way of thinking, that could be concerning. So I think that while this particular bill may not pass, it's something that has to be watched closely."

Patti Dodgren, CEO of Hielix--which helps to facilitate electronic health information exchanges across the U.S., shares Roberts' view. [Any possible conflicts of interest towards full-speed-ahead-damn-the-torpedoes health IT diffusion in that role, I ask? - ed.]

"Just the suggestion of repealing HITECH stimulus funds for physicians...is short-sighted at best, and threatens the very progress that is already beginning to be realized within the industry to move our healthcare system into the 20th [yes, 20th] Century," Dodgren told FierceHealthIT. "All this bill serves to do is strengthen the cynics of health IT.

[Translation: "short sighted" and "cynic" = those more interested in taking the time to do health IT "right" and in patient rights and patient well being, than in personal gain - ed.]

We work with thousands of physicians and state government healthcare officials who have worked tirelessly over the past months to achieve the benefits that healthcare IT promises [no, Ms. Dodgren, they haven't, actually; you and they have merely encouraged a rushed, cavalier and reckless rollout (of a technology even HIMSS' former Chairman of the Board, a physician, admitted is not ready), damaging - not helping - health IT's prospects. See below - ed.], and this bill is a disservice to them and to the healthcare industry."


It may be a "disservice" to those who stand to profit from the health IT industry, but it's a great service to the healthcare industry and to the patients it serves.

I didn't really need to look, as experience at HC Renewal has proven time and again about the healthcare pundits, but the credentials of someone making such claims about health IT are not impressive IMO.

From an online bio, Ms. Dodgren holds the illustrious "CPHIMS" certification that I wrote about at my April 2008 post "Is the HIMSS Certified Professional in Healthcare Information and Management Systems stamp substantive, or just alphabet soup?". After 8 years as Director Budgeting & Financial Systems at (now-defunct) Digital Equipment Corp. (DEC) and 4 years as Senior Business Analyst at Dun & Bradstreet, she has been a "change management professional" for twenty years who "co-founded a management consulting practice which specializes in the application of change management principles to health information technology." I note no medical (or medical informatics) training or experience.

My reply to these people is as follows, as posted in a FierceHealthIT comment:

http://histalk2.com/2010/07/19/histalk-interviews-barry-chaiken/

... We’re still learning, in healthcare, about that user interface. We’re still learning about how to put the applications together in a clinical workflow that’s going to be valuable to the patients and to the people who are providing care. Let’s be patient. Let’s give them a chance to figure out the right way to do this. Let’s give the application providers an opportunity to make this better.

Let the industry learn the responsible way, not on patients' and physicians' blood, sweat and tears through way-too-early national initiatives that will only add to the $14 trillion national debt (http://www.usdebtclock.org/), and throw some of the money into industry pockets.


Franky, as a physician with no financial conflict-of-interest axes to grind, I am increasingly disgusted with the cavalier, money-grubbing attitudes of the health IT industry and its pundits. Their attitudes and behaviors represent a poster study of healthcare industry at its worst.

This latter fact is not lost on me as I speak with government representatives seeking to improve medical drug/device watchdog legislation, and to attorneys looking to protect patients from harm or gain recompense for those already injured as a result of faulty IT.

-- SS

8 comments:

Anonymous said...

The concept that the government is a never ending flow of money and holds some special secret knowledge is something we all will have to deal with in the coming months. While in church over the weekend a person was very upset our governor turned down $400M in high speed rail funds. The concept that our state, with a large budget deficit, would have to contribute and then continue to underwrite this project was never discussed.

In order to punish our state the money was not returned but sent to another state where they will start their project in a rural area with little or no ridership, thus not decreasing traffic, or being cost effective.

We all remember the spectacle in Detroit where a radio station was going to give away government money. People nearly rioted and when asked where the money was coming from had no answer.

Today we are seeing positions taken by people with made up credentials who are in effect marketing people selling snake oil. What they have learned over their professional lives is to sell the concept and let others pay the price, both financially, and in this case, with subpar health care.

There is a new battle cry sweeping the country:

“Facts are the enemy of truth” and the facts are HIT and EMR’s offer no benefit in their current form. The fear in this industry is people will see this concept is not ready for prime time and end funding, this ending their jobs.

Steve Lucas

Anonymous said...

If the HIT devices were any good, Congress would not have a bill to defund their forced implementation. Congress reads stories like this: 2000 medical records vanish is several hospitals:http://seattletimes.nwsource.com/html/localnews/2014036271_swedish26m.html

Do ya think the taxpayers should pay for defective devices that increase the risk of death?

HIMSS needs to be investigfated for tax fraud and deception of the Congress of the United States.

As for the POTUS, well he has got the Allscripts CEO as a personal HIT advisor.

Scot M Silverstein MD said...

Steve Lucas at January 31, 2011 7:40:00 AM EST writes:

Today we are seeing positions taken by people with made up credentials

Indeed that occurs whereby people simple lie about their credentials. I am not making such a claim here.

My claim is that the manner of achieving credentials such as CPHIMS are uncompelling to me - e.g., not even as rigorous as the process I underwent to obtain an amateur radio Extra class FCC license (a hobby).

Healthcare is not a hobby-grade endeavor.

-- SS

Scot M Silverstein MD said...

Anonymous January 31, 2011 9:34:00 AM EST writes:

Congress reads stories like this: 2000 medical records vanish is several hospitals: http://seattletimes.nwsource.com/html/localnews/2014036271_swedish26m.html

The problem is, they also read writings of people too inept to understand, or too amoral to care about, the risk of that type of event, or that risk is a very bad thing.

I was stunned when I first encountered that type of imprudence as a CMIO, in an ICU no less.

-- SS

EMR and HIPAA said...

Certainly the pundits are completely predictable. I think you'll find this analysis of the Meaningful Use repeal interesting: http://www.emrandhipaa.com/emr-and-hipaa/2011/01/28/the-meaningful-use-sky-is-falling/ Make sure to read the comments on the post as well.

Anonymous said...

HITECH and MU are meaningfully wasteful deployments of hard earned taxpayers' funds. This country could learn from the financial debacle in the UK. The few loud mouthed e-patients want to look at their cholesterol levels ought to sit down.

I wish these HIT proponents could access the EHRs of their train wrecked relatives laying in bed critically ill, waiting for the doctor to sign on to order life saving therapy. I am sure these learned e-patients will have 20 hours/day to scrutinize the EHR and help me help the care team.

Live it or live with IT said...

Even your supporters are falling prey to the influence of those desirous of the HIT falacy:

http://www.healthbeatblog.com/2011/01/electronic-health-records-should-congress-defund-the-stampede-to-convert-to-ehrs-no-but-.html

Within it says "I am hardly an IT expert" and then goes on to pontificant on the benefits of Health IT, yet now with a political partisan twist.

Absurd. What was once about patients, then became about money, and now is about political face saving.

Scot M Silverstein MD said...

Live it or live with IT said...

Even your supporters are falling prey to the influence of those desirous of the HIT fallacy

In fact, HIT can work. It can be designed and implemented to productively assist clinicians in real world settings.

This will not happen, unfortunately, in the current healthcare and healthcare IT environments...As I wrote here:

Health IT reminds me of dentistry in its early days. B.T. Longbothom, author of the second dentistry book published in the U.S. ("A Treatise on Dentistry", 1802), gave an excellent description in his preface of problems at the time. His observations apply to Medical Informatics in our present age:

The word "dentist" has been so infamously abused by ignorant pretenders, and is in general so indifferently understood, that I cannot forbear giving what I conceive to be its original meaning: viz, the profession of one who undertakes and is capable not only of cleaning, extracting, replacing by transplantation and making artificial teeth, but can also from his knowledge of dentistry, preserve those that remain in good condition, prevent in a very great degree, those that are loose, or those that are in a decayed state, from being further injured, and can guard against the several diseases, to which the teeth, gums and mouth are liable, a knowledge none but those regularly instructed, and who have had a long, and extensive practice, can possibly attain, but which is absolutely necessary, to complete the character of a Surgeon Dentist.

Hardly anyone spoke out.

More than thirty years later, untrained practitioners were as prevalent as ever. One of the leading dentists of the time, Shearjashub Spooner, in his "Guide to Sound Teeth, or, A Popular Treatise on the Teeth" (1836) warned the public of a phenomenon I believe now applies to Medical Informatics and healthcare IT:

One thing is certain, this profession must either rise or sink. If means are not taken to suppress and discountenance the malpractices of the multitude of incompetent persons, who are pressing into it, merely for the sake of its emoluments, it must sink, - for the few competent and well educated men, who are now upholding it, will abandon a disreputable profession, in a country of enterprise like ours, and turn their attention to some other calling more congenial to the feelings of honorable and enlightened men.

I understand that point of view.

As I also wrote here, I can add that as a medical informaticist who actually studied biomedical information science, user interface design for clinicians and other topics, I am beginning to feel like William Clowes, the famous surgeon of the Tudor period, who inveighed against the skills of many of the practitioners of his own time, characterizing them as:

".. no better than than runagates or vagabonds ... shameless in countenance, lewd in disposition, brutish in judgment and understanding ... tinkers, tooth-drawers, peddlers, ostlers, carters, porters, horse-gelders, horse-leeches, idiots, applesquires, broom-men, bawds, witches, conjurers, soothsayers, sow-gelders, rogues, and rat-catchers!"

That seems to capture the essence of many of the HIT ecosystem players of today.

Finally, I do not seek supporters; my motto is simple and comes from long ago:

"The object of life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane."

-- Marcus Aurelius