Category Archives: politics

Can Health IT Save Health Care?

Adding health IT to our current system and claiming that will solve our health care problem is like taking a 1971 Ford Pinto and giving it a new paint job and sound system. It looks cool. It sounds cool. But you’re missing the point.

Health IT can be and should be a piece of the health reform puzzle. And it’s one of the few- and perhaps the only puzzle piece that holds bipartisan support. Even accounting for the initial upfront costs, health IT is touted to save billions of dollars. (And recent new argument: It’ll create jobs.)

This CBO report lists how health IT can:
• Eliminate the use of medical transcription and allow a physician to enter notes about a patient’s condition and care directly into a computerized record;
• Eliminate or substantially reduce the need to physically pull medical charts from office files for patients’ visits;
• Prompt providers to prescribe generic medicines instead of more costly brand-name drugs; and
• Reduce the duplication of diagnostic tests.

In addition to the above mechanisms to cut wasteful care given, there is very little doubt that health IT can improve the quality of care given. From that same CBO report, health IT can:
• Remind physicians about appropriate preventive care;
• Identify harmful drug interactions or possible allergic reactions to prescribed medicines, and
• Help physicians manage patients with complex chronic conditions.
• All problems cost money to fix, so preventing these problems from occurring does save money.

In public circles, the common rhetoric is that this higher quality of care results in lower costs. And this is where I take issue.

Yes, healthy people cost less. If you don’t need a doctor, you don’t cost much (duh). But healthy people don’t undergo high quality care; they don’t undergo any care!

On the other hand, by definition, those with chronic conditions are in constant need of care. High quality care to this population means doing more tests and providing more care more often.

That’s because only 56% of those with chronic conditions receive the recommended level of care. So higher quality care means more care. And in our system built on a la carte financing, more care means more money. Now this a real problem!

Those with one or more chronic condition currently make up 75% of our health care costs. And that number will only rise. (Explaining why is a whole other post)

Health IT can help providers know what care needs to be provided in order to adhere to these standards. Many EMRs in place today force providers to go through check-lists while caring for a patient to ensure that everything that is ‘supposed to be done’ is in fact done. EMRs also allow providers to be proactive and give patients appointment reminders to increase quality (and quantity) of care.

Does this mean we should forgo implementation of health IT? Of course not! Health IT can help us reduce needless spending for needless care and increase needed spending for needed care. It’s just that in weighing these two, spending may prevail.

Health IT is a powerful tool. But we have to recognize its place among other tools on the tool belt.

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US Behind in HIT Spending – Stimulus Insufficient

Despite the fact that the US spends nearly twice as much on healthcare as any other country, the US is as much as 12 years behind other OECD countries in health information technology investment. See the Commonwealth Fund’s entry on Health Care Spending and Use of Information Technology in OECD Countries.

hit-efforts-in-six-countries

The American Recovery & Reinvestment Act of 2009–the Stimulus Package–apportions $19 billion for investment into the HIT infrastructure in the US. As much as $3 billion goes to the Office of the National Coordinator (which will now be codified) and other standards creating bodies. The remaining amount will be given to providers primarily through increased Medicare reimbursement. If divided evenly, each hospital would receive approximately $11 million. A substantial sum, but hardly close to the $200 million over 3 years required in a typical implementation at a 300+ bed hospital. Only 10% of hospitals currently have full electronic health records. Another 20-30% are in planning or implementation stages. The stimulus may encourage more providers to enter the planning stages and will help along those already in the process during difficult economic times. But $11 million for the remaining 60-70% is entirely insufficient.

Evidence shows that the only providers that stand to get a return on investment in HIT are large network providers with geographically distributed practices, such as Kaiser or the VA. This makes sense, as the administrative cost of sharing information is high. The early adopters (the 10%) consist of these large networks and a few providers with well-funded, forward-thinking CIOs. The 20-30% currently planning hope to break even at best and justify the investment by improved patient care (especially through CPOE). The rest are mostly too small to realize significant cost savings and will likely need much more than $11 million to break even.

Congress approves $19 billion for health IT

Excerpt by Andrew Noyes, Congress Daily from NextGov.com

Deal Leaves Money, Language On Health IT Mostly Intact

The compromise stimulus deal leaves much of each chamber’s proposed funding for health information technology intact, according to an overview circulated by House Speaker Pelosi Wednesday and a preliminary summary of the compromise that was subject to change. The final package provides $19 billion to encourage nationwide adoption of electronic medical records, with $17 billion for Medicare and Medicaid incentives for federally qualified health centers, rural health clinics, children’s hospitals, and others. The Senate version, which won approval Tuesday after members stripped out $100 billion, included $16 billion for Medicare and Medicaid incentives, about $2 billion less than the House plan that passed last month. The Senate also imposed a $1.5 billion cap on incentive payments to “critical access hospitals,” while the House included no such language. Conferees reportedly accounted for those facilities, but it is unclear whether the cap remained.

The negotiated stimulus would provide temporary bonuses of as much as $64,000 for physicians and up to $11 million for hospitals that adopt e-health records, the summary document stated. Medicare penalties for noncompliance would also be phased in starting in 2014. The package would also codify the HHS Office of the National Coordinator for Health IT and establish a transparent process for developing standards for e-health records by 2010. An immediate $2 billion would be available to HHS for health IT infrastructure, training, telemedicine, and other grants. The Senate had previously asked for $3 billion, while the House wanted just over $2 billion.

The package would also expand federal privacy and security protections for health IT, such as requiring that an individual be notified if there is an unauthorized disclosure or use of their health information and requiring a patient’s permission to use their personal records for marketing purposes. Details had not emerged by presstime about whether complaints by the privacy community had been addressed. Some watchdogs pressed conferees to take specific steps to close what they argued were marketing loopholes left open in the House and Senate versions as well as make changes to breach notification language. Several sources said they believed a House provision mandating healthcare operations rules from HHS had been dropped entirely. Providers complained the regulations could have required either prior patient consent or the use of de-identified data before information could be exchanged.

President Bush Delivers Farewell Speech – Jan 15

President Bush delivered his farewell address Jan 15, 2009. Regardless of one’s party affiliation and political likes and dislikes, a Presidential farewell provides an interesting perspective into the legacy by which a President hopes to be remembered. And this is why I found President Bush’s address so shocking. He begins by acknowledging the truly astonishing nature of the transition:

Five days from now, the world will witness the vitality of American democracy. In a tradition dating back to our founding, the presidency will pass to a successor chosen by you, the American people. Standing on the steps of the Capitol will be a man whose history reflects the enduring promise of our land. This is a moment of hope and pride for our whole nation. And I join all Americans in offering best wishes to President-elect Obama, his wife Michelle, and their two beautiful girls.

Then, he narrows in to the single event that shaped both his speech and his entire presidency:

This evening, my thoughts return to the first night I addressed you from this house — September the 11th, 2001.

Some insight into the administration’s view of US intervention in Afghanistan and Iraq:

Afghanistan has gone from a nation where the Taliban harbored al-Qaida and stoned women in the streets to a young democracy that is fighting terror and encouraging girls to go to school. Iraq has gone from a brutal dictatorship and a sworn enemy of America to an Arab democracy at the heart of the Middle East and a friend of the United States.

Bush contributes 7 years with no terrorist attacks to the creation of the Department of Homeland Security, transformation of the military and intelligence community, and taking “the fight to terrorists and those who support them”:

There is legitimate debate about many of these decisions. But there can be little debate about the results. America has gone more than seven years without another terrorist attack on our soil.

Now, a return to the ideological struggle between good and evil:

The battles waged by our troops are part of a broader struggle between two dramatically different systems. Under one, a small band of fanatics demands total obedience to an oppressive ideology, condemns women to subservience and marks unbelievers for murder. The other system is based on the conviction that freedom is the universal gift of Almighty God, and that liberty and justice light the path to peace.

I’ve often spoken to you about good and evil, and this has made some uncomfortable. But good and evil are present in this world, and between the two of them there can be no compromise. Murdering the innocent to advance an ideology is wrong every time, everywhere. Freeing people from oppression and despair is eternally right. This nation must continue to speak out for justice and truth. We must always be willing to act in their defense — and to advance the cause of peace.

9/11 laid such a heavy burden on this administration that Bush only gives a single paragraph to the other major events of his administration: expansion of Medicare prescription drug benefits, No Child Left Behind (which he doesn’t mention by name), lower taxes, promotion of faith-based programs, and providing assistance to persons living with HIV/AIDS.

Let’s spend a minute on that last one. The President’s Emergency Plan for AIDS Relief (PEPFAR) is largely considered to be the most successful international aid program the US has enacted and recieves strong bipartisan support. PEPFAR provided $50 billion over 5 years to fund anti-retrovirals and contraceptive distribution networks, as well as educational programs (usually abstinence based, although this is changing). PEPFAR has had a slew of problems, but is still one of the largest sources of funding for AIDS relief. Yet, President Bush hardly even mentions it.

But more than anything, I am struck by the divisiveness of his language. President Bush entered office vowing to be a “uniter not a divider”, yet he left with extremely low approval ratings and negative perceptions of the US worldwide. Drawing sharp lines between black and white, good and evil, may be useful to him in his personal life, but divisions such as these can have harmful and polarizing effects in politics. Unity is not achieved by publicly labeling outsiders. If a group identifies themselves by their opposition to you, calling them evil strengthens their identity and opens you up to scrutiny (consider Bush and the torture at Guantanamo).

While discussing this issue with a friend of mine, he said something quite insightful: “Great men in history have created divisiveness and offense without exception.  They simply know that their ultimate goals are more important than public acceptance…Great men may create terrible controversy, but at least they have the appropriate methodology and results to back it up.” Therefore, division isn’t the problem, it creating division without support, without evidence, without proper methodology.

Politics is labeled the art of compromise for a reason. Political philosopher Jean Bethke Elshtain states: “But compromise is not a mediocre way to do politics; it is an adventure, the only way to do democratic politics.” Certainly, this argument is a simplification, but I look forward to the departure of divisive ideology from the White House.

(Read the full text of President Bush’s farewell address here: http://www.baltimoresun.com/news/nation/bal-bushtext0115,0,3697667.story)

(Read more of my friend’s blog at http://nateahern.blogspot.com/)

More Quotes About Obama from Around the World

More amazing quotes (some hopeful, others frightening) about President-Elect Barrack Obama from around the world, including some from the United Nations, Cuba, Nicaragua, Liberia, Iraq, and Afghanistan:

“This is, I believe, an historic opportunity…I am confident that we can look forward to an era of renewed partnership and a new multilateralism. If ever there were a time for the world to join together, it is now: the global financial crisis; the crisis of climate change; the challenge of fulfilling our promises on the Millennium Development Goals, made more difficult by the twin crises of food and energy prices.” -Ban Ki-Moon, United Nations Secretary-Genreal, Nov 5 2008, Daily Briefing

“I wish Godspeed to the man who was my former opponent and will be my president. And I call on all Americans, as I have often in this campaign, to not despair of our present difficulties, but to believe, always, in the promise and greatness of America, because nothing is inevitable here. Americans never quit. We never surrender. We never hide from history. We make history.” -Senator John McCain, conceding presidency to Obama night of Nov 5 (full text)

“We believe this is the decision of American voters. We respect their will. But there are many upcoming challenges. We don’t think there will be change in policy overnight. There won’t be quick disengagement here. A great deal is at stake here.” -Hoshyar Zebari, Iraqi Foreign Minister

“As any successful CEO will tell you, leadership, vision and motivation has far more impact on results than any tax cut or increase.” -Mark Cuban, American billionaire entreprenuer, from Blog Maverick

“If Obama takes some action to ease the embargo, it would be welcomed and of course it would be of help, but we’re prepared for conditions to remain the same.” -Cuba’s Foreign Investment Minister Marta Lomas

“Really it’s a miracle that the United States for the first time in its history has a black president who has shown he is willing to dialogue with Latin American countries and is open to reviewing free trade agreements.” -Nicaraugan President Daniel Ortega

“This is a momentous day not only in the history of the United States of America, but also for us in Kenya. The victory of Senator Obama is our own victory because of his roots here in Kenya. As a country, we are full of pride for his success.” -Kenyan President Mwai Kibaki

“All Africans now know that if you persevere, all things are possible.” -Liberian President Ellen Johnson-Sirleaf, the first woman elected to head an African country

“The election of Senator Barack Obama to the presidency of the United States has taken the American people and the rest of the world with them into a new era – an era where race, colour and ethnicity, I hope, will also disappear… in politics in the rest of the world.” -Hamid Karzai, Afghan President

For more quotes, including some from Obama’s speech, check out my previous blog entry: Obama’s Victory Speech & Notable Quotes.