Tuesday, April 16, 2013

Fred Schulte: "GOP senators call for overhaul of electronic health records program"

Fred Schulte, investigative reporter at the Center for Public Integrity (link to bio), has authored a new article worth reading in its entirety:

GOP senators call for overhaul of electronic health records program
Lawmakers say Obama's $35 billion initiative pushing health information technology isn't working.

Six U.S. Senators are calling for an overhaul of the federal government’s $35 billion plan for doctors and hospitals to switch from paper to electronic medical records, citing concerns from patient privacy to possible Medicare billing fraud.

The report issued Tuesday by the half-dozen Republicans concedes that many lawmakers and medical experts believe the digital systems can reduce health care costs and improve the quality of care by reducing duplicative testing and cutting down on medical errors.  [Eventually, and with great effort the details of which many in the field lacking appropriate education and expertise are painfully unaware - ed.]

But the report asserts that the Obama administration’s push to use billions of dollars in stimulus money helping doctors and hospitals buy digital systems needs to be “recalibrated.”

“Now, nearly four years after the enactment…and after hundreds of pages of regulations implementing the program,” the document says, “we see evidence that the program is at risk of not achieving its goals and that $35 billion in taxpayer money is being spent ineffectively in the process.”

I've been calling for a "recalibration" (i.e., a cessation of putting the cart before the horse) and slowing down, for years.  See for instance my July 2010 post "Meaningful Use Final Rule: Have the Administration and ONC Put the Cart Before the Horse on Health IT?" and its hyperlinks at http://hcrenewal.blogspot.com/2010/07/meaningful-use-final-rule-have.html.

Among the report’s conclusions:
  • Despite expectations of cost savings, the digital systems may be increasing unnecessary medical tests and billings to Medicare.
  • The government has not demanded that the various digital systems be able to share medical information, a critical element to their success.
  • Few controls exist to prevent fraud and abuse. Many doctors and hospitals are receiving money by simply attesting that they are meeting required standards.
  • Procedures to protect the privacy of patient records are lax and may jeopardize sensitive patient data.”
  • It remains unclear whether doctors and hospitals that have accepted stimulus funding will be able to maintain the systems without government money.

I have as an even larger concern the quality and fitness (and hence safety) of today's health IT systems.  In what may be the first robust study, the findings as I have pointed out on this blog are of great concern:

Health Leaders Media
April 5, 2013
HIT Errors 'Tip of the Iceberg,' Says ECRI 

Healthcare systems' transitions from paper records to electronic ones are causing harm and in so many serious ways, providers are only now beginning to understand the scope.  [I understood the scope years ago as reflected in my writings - ed.]

Computer programs truncated dosage fields, leading to morphine-caused respiratory arrest; lab test and transplant surgery records didn't talk to each other, leading to organ rejection and patient death; and an electronic systems' misinterpretation of the time "midnight" meant an infant received antibiotics one dangerous day too late.

These are among the 171 health information technology malfunctions and disconnects that caused or could have caused patient harm in a report to the ECRI Institute's Patient Safety Organization. Thirty-six participating hospitals reported the data under a special voluntary program conducted last year.

Karen Zimmer, MD, medical director of the institute, says the reports of so many types of errors and harm got the staff's attention in part because the program captured so many serious errors within just a nine-week project last spring.  [Including 8 injures and 3 possible deaths in just 9 weeks as I wrote at "Peering Underneath the Iceberg's Water Level: AMNews on the New ECRI Deep Dive Study of Health IT Events" here - ed.]

The volume of errors in the voluntary reports was she says, "an awareness raiser."

"If we're seeing this much under a voluntary reporting program, we know this is just the tip of the iceberg; we know these events are very much underreported."

... ECRI is currently evaluating a similar, and much larger list of reports from many of the 800 hospitals that contract with ECRI's PSO services.

The fact that only GOP Senators so far have made this call is perhaps somewhat surprising, considering the abuse that side of the aisle often takes for being pro-business and anti-citizen rights.

On the other hand, hospital accidents are a truly non-partisan issue.  A Democrat or Republican (or member of any other poitical party), and their loved ones, are all in the same boat.

As this point in time, I recommend any patient have a strong advocate following everything done, not done, supposed to be done, not supposed to be done, med and allergy lists and fulfillment, action on lab and imaging reports, etc. -- importantly, not depending on IT-dependent clinicians to do so.

-- SS

6 comments:

Anonymous said...

"As this point in time, I recommend any patient have a strong advocate following everything done, not done, supposed to be done, not supposed to be done, med and allergy lists and fulfillment, action on lab and imaging reports, etc. -- importantly, not depending on IT-dependent clinicians to do so"

Ironic.?!? Currently considering quitting my job, IN HEALTHCARE, to do just as you say above.

Anonymous said...

I often look at Ontario, Canada as a test bed for American ideas. This editorial shows what happens when government officials who are looking out for themselves and their friends gain access to the public coffers.

http://www.torontosun.com/2013/04/12/chemo-scandal-is-third-strike

We should also remember that with a lower population these numbers reflect just a fraction of the cost that we as Americans would see given the same situations.

Steve Lucas

InformaticsMD said...

Anonymous at April 17, 2013 at 5:54:00 AM EDT said...

Ironic.?!? Currently considering quitting my job, IN HEALTHCARE, to do just as you say above.

Just as it was the job of the airline pilots of Air France 447, where temporary inconsistencies between the airspeed measurements contributed to the plane plunging into the ocean, to keep the passengers safe...

Or of the Three Mile Island nuclear plant operators, where mechanical failures were compounded by the initial failure of plant operators to recognize the situation as a loss-of-coolant accident due to inadequate training and human factors, such as human-computer interaction design oversights relating to ambiguous control room indicators in the power plant's user interface, to keep civilians and the surrounding land safe.

(source: Wikipedia entries)

-- SS

InformaticsMD said...

Steve Lucas wrote:

I often look at Ontario, Canada as a test bed for American ideas. This editorial shows what happens when government officials who are looking out for themselves and their friends gain access to the public coffers.

http://www.torontosun.com/2013/04/12/chemo-scandal-is-third-strike


I could only read a few sentences into that article before I became nauseated.

Honi soit qui mal y pense.

-- SS



Anonymous said...

Interesting....
From modern healthcare. Re: reboot.

Finally, the senators have prepared a separate letter addressed to health IT stakeholders and members of the public, asking for feedback on issues raised in their white paper and “any areas of concern, and potential solutions” to improve implementation of the health IT provisions of the American Recovery and Reinvestment Act of 2009. The letter to stakeholders was either mailed or e-mailed to “stakeholders we regularly work with or have heard from in the past,” a spokesperson for Thune said in an e-mail.

Link: http://www.thune.senate.gov/public/index.cfm/files/serve?File_id=92d23a53-4de8-42e1-8cfd-ff861779cf44

I had better get started............,!

InformaticsMD said...

Anonymous April 17, 2013 at 9:45:00 PM EDT wrote:

I had better get started............

Feel free to use my material on health IT risks, with attribution.

-- SS