Friday, February 08, 2013

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 this post for source).

From a release at

Mayor Bloomberg Announces Expansion of Electronic Health Records Result in Major Health Care Improvements
Feb 07, 2013 |

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.

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 JC, FDA, IOM) 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 these and these and these and these, 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?

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.

Let's hope they don't have an Avatar rerun (link) or Contra Costa meltdown (link, link).

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:

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.

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:

"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."

-- SS


Anonymous said...

"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"

Maybe the successes would have been even greater if the docs hadn't wasted so much time on unfriendly interfaces, work-arounds, and ridiculous prompts, as opposed to talking with their patients?

Anonymous said...

Those numbers seem too good to be true. I await reading of the details in the medical journals, especially about the UIs and true costs.

Steve Lucas said...

Mayor Bloomberg may be better served by mandating short skirts on women. Yes, there may be unintended consequences, but this is a small price to pay for a rising stock market, or that is the way the myth about cause and effect goes.

Steve Lucas

Anonymous said...

patients could be reminded without an expensive EMR; and what, exactly did the doctors do to modify their practice based on massaging the output of their EMR, exactly? That has the tone of the ONC chief chearleader, Farzad himself.