Politics Over Productivity

Children's health care is a subject we cannot get away from, especially recently. The SCHIP legislation and President Bush's veto are impossible to escape when one surveys the morning news. Vitriol pours from both sides of the issue as thick and bitter as service station coffee.

As one digs through the multitude of vituperative articles, blog posts, and paid propaganda, it becomes more and more apparent that most of the discussion is politics rather than objective analysis. The Democrats are now experiencing the backlash from their recent radio campaign. In that campaign, Graeme Frost, age 12, made a radio address asking President Bush to sign off on the SCHIP legislation on the grounds that he and his siblings would not have received hospital care after their auto accident without it.

From the Baltimore Sun

But while the Frosts were helping a bipartisan majority in Congress sell a plan to expand the program, they were not prepared for comments such as this one, posted over the weekend on the conservative Web site Redstate:

"If federal funds were required [they] could die for all I care. Let the parents get second jobs, let their state foot the bill or let them seek help from private charities. ... I would hire a team of PIs and find out exactly how much there parents made and where they spent every nickel. Then I'd do everything possible to destroy their lives with that info."

The arguments continue, as chronicled in the Baltimore Sun, over the state of the Frost family's finances and their reliance on SCHIP. Rush Limbaugh discussed the family's assets and financial status on his show last Monday, while conservative blogger Michelle Malkin posted about visiting the family's business and driving by their home.

Quotes such as this one (again from Redstate) seem par for the course:

"Hang 'em. Publicly," the contributor wrote. "Let 'em twist in the wind and be eaten by ravens. Then maybe the bunch of socialist patsies will think twice."

You do not have to be an advocate of public hangings or destroying lives to make your point. The Atlanta Journal-Constitution is a fine example:

Are the Democrats grandstanding? Are they playing politics with a critical issue? Of course, they are. When don't politicians play politics? But at least they're blanketing the airwaves and blitzing the phone lines with an issue that matters — health care for children of working families.

It's a little vexing to listen to ultraconservative Republicans berate Democrats for trying to score political points. For the past several years, the GOP has made a fine art of scoring points over issues both petty and private: for example, the overblown travel office "scandal" during the Clinton years; for another, the intrusion into the difficult decisions faced by the family of Terri Schiavo. They've exploited flag-burning, same-sex marriage and religious faith, all to gain political advantage. It seems a bit churlish for them to complain when the tables are turned.

And so the debate rages on.

SOURCE: "Frost Family Draws Ire of Conservatives" 10/10/07
SOURCE: "Democrats Politicking for Good Reason: Peach Care" 10/10/07
photo courtesy of Graniers on Flickr, used under this Creative Commons license

HealthVault: Holy Grail or Pandora's Box?

How many aspects of your life do you handle online? Do you buy books from Amazon? Do you bid or sell on eBay? Do you check your bank balance in a browser? How about your investments? Do you communicate by email more often than you write physical letters? Most modern Americans do at least one or two of these things on a regular basis. Now consider this, when was the last times you looked at your prescriptions, X-Rays, or health records online?

The advantages and cost savings of EMRs are consistently touted, both on this blog and in many other places. The recent unveiling of Microsoft's HealthVault makes it seem a viable EMR option is looming on the horizon. While at first glance this is a good thing there are many who seem uneasy about it. Robert Langreth, Senior Editor for Forbes, is one of them:

Microsoft, the company whose personal computer software is regularly attacked by hackers, the company reprimanded by governments for its aggressive monopolistic behavior?

While the aknowledged leader in the field of computing, Microsoft's history does lend itself to some unsease when considering privacy concerns (Win XP, Service Pack 2 anyone?). Langreth's interview with Peter Neupert, Microsoft VP in charge of development for their health group, is an interesting one as Langreth tries to counter that perception.

Microsoft argues that HealthVault can avoid the countless security problems that have afflicted its operating systems. "It's an apples and oranges comparison," he [Langreth] asserts. "It's a lot easier for us to manage a service for reliability, security and privacy than it is to manage hundreds of millions of distributed personal computers." Microsoft is working with two hacker organizations to test the security of its system.

Although HealthVault will be free for consumers, this is no philanthropic effort. Microsoft hopes HealthVault will translate into more search revenues through targeted health-related ads. The site includes an improved online search that uses a machine-learning algorithm to help consumers search through articles on health issues by breaking broad topics into concrete subcategories.

"By providing a great health search experience, we will actually improve the search loyalty of Microsoft overall," says Sean Nolan, the Microsoft programmer who designed the site. He admits though that moving into the medical record arena "is a huge crazy challenge." Among other issues, Microsoft will have to tiptoe the line between assuring people their information is private -- and serving up advertisements relevant to the health problems they have.

Walking that line might be easier than suspected. The success of numerous social networking sites, as well as online products such as the Google suite of applications show that while this is a concern it seems a rapidly diminishing one. People everywhere are getting used to seeing keyed text ads in the margins of their Gmail / Hotmail / Yahoo mail, getting reccommendations from eBay and Amazon when shopping, and generally having their data not only stored on the net but also implemented for promotional means.

Is this good? Is this bad? Will the public embrace or revile it? Only time will tell.

It is, after all, "a huge crazy challenge."

SOURCE: "Who Are You Going To Trust?" 10/08/07
Photo courtesy of: Library of Congress via pingnews.

Digital Medicine

While the pros and cons of SCHIP dominate the news and the blogosphere, a quiet little press release snuck onto the web this morning offering news of advances in the field of electronic medical records (EMRs).

CNNMoney reprints the original Siemens press release:

Siemens Medical Solutions is fulfilling the demand for a workflow-oriented, patient-centric approach to healthcare with its Enterprise Document Management (EDM) and Soarian(R) Healthcare Information Management (HIM) solutions, which are helping healthcare institutions enhance patient care, improve patient safety initiatives, and reduce healthcare costs.

Why would this drive the costs of health care down?

Accessible from any location, EDM and Soarian HIM coordinate processes within and between departments, as well as tasks between users. With their Web-based intuitive user interfaces, the solutions host concurrent and multi- user access, helping to eliminate multiple trips by clinicians and patient financial services staff to the HIM department to access patient data. When patient charts are virtual, costs and time associated with chart storage and retrieval are reduced. Many EDM and Soarian HIM customers are seeing positive outcomes as a result of use at their facilities.

So....

Transparent and portable medical information, eh? Good idea, sounds familiar. According to the release the implementation of these digital sstems has driven down costs while improving efficiency and accessibility. Photocopying costs are a good example. The cost of making copies of medical records was reduced by $100,000 annually for CaroMont Health of North Carolina. and $45,000 for the Mountain States Health Alliance after the implementation of HIM solutions.

The release presents some specific examples on a case by case basis:

CaroMont Health has reduced the number of record requests by 30 percent, its record analysis by 50 percent, its medical records delinquency rate by 84 percent, unbilled accounts receivables by 50 percent and photocopying costs by $100,000 annually.

You can rest assured that we will be returning to this story when there is more to report.


SOURCE: "
Siemens Soarian Health Information Management is Widely Adopted by Leading Healthcare Institutions in 2007: Leading Healthcare Institutions Embrace Technology That Enables Free Flow of Patient Documentation Throughout the Enterprise
" 10/08/07
Image by George Williams

Microsoft Trumps Google with Online Health Service

Microsoft has beaten Google to the punch on offering an online health records solution.

Both companies have been developing online systems for Electronic Medical Records (EMRs) for quite some time now. A prototype of Google Health was shown to health professionals and advisors in August of this year, but has yet to launch and may be experiencing difficulties after having recently lost its leader Adam Bosworth.

While Google Health remains in limbo, Microsoft's HealthVault, announced in Washington yesterday, is now online and includes an impressive array of partners, as pointed out by the New York Times:

The organizations that have signed up for HealthVault projects with Microsoft include the American Heart Association, Johnson & Johnson LifeScan, New York-Presbyterian Hospital, the Mayo Clinic and MedStar Health, a network of seven hospitals in the Baltimore-Washington region. The partner strategy is a page from Microsoft's old playbook. Convincing other companies to build upon its technology, and then helping them do it, was a major reason Windows became the dominant personal computer operating system.

The service is free to consumers and revenue will be generated by search driven advertising, something ubiquitous in Google's online applications such as Gmail.

Information Week compares this to other efforts :

Microsoft's consumer-centric model for PHRs differs from the approach others are taking, especially employer-sponsored PHRs, like Dossia, a consortium of employers including Intel and Wal-Mart, which is building a PHR system for its workers.

Although Dossia says its employer members will not have access to workers health data, in the larger picture, trust and privacy questions are issues that hinder consumer confidence in electronic medical records systems overall, including PHRs offered by health plans and insurers.

However, with the consumer being the controller of data in HealthVault, users may be more accepting, said Deborah Peel, founder of privacy advocacy group, the Patient Privacy Right Foundation, who was a speaker at the HealthVault event.

CRN reminds us of prior Microsoft attempts using this consumer driven model:

Whether consumers will trust Microsoft to manage sensitive health information is an open question. Microsoft takes pains in HealthVault's terms of service to specify that it will not use any information stored at the site for commercial purposes or release it to any outside parties without explicit permission. However, customer concerns about giving Microsoft access to a treasure trove of personal data killed off Microsoft's Hailstorm project five years ago, which aimed to aggregate users' financial and other personal details in one Microsoft-owned repository.

SOURCE: "Microsoft Rolls Out Personal Health Records" 10/04/07
SOURCE: "Microsoft Unveils Free Web Health Tools for Consumers" 10/04/07
SOURCE: "Microsoft Beats Google To Consumer Health Market" 10/04/07
photo courtesy of Orangeacid using this Creative Commons license

The Veto Heard Round The World

President George W. Bush on Wednesday issued his expected veto of $35 Billion in children's health care funding. In short order the commentary and criticism of this move have rippled through not only our own national news, but across the the global media as well. Here is a quick World Tour of reactions to this fourth veto of President Bush's career:

The first stop on our world tour is Korea, where we pick up a copy of The Korea Times and read about the SCHIP legislation:

The bill has problems. It is expensive, $35 billion over five years; the use of a cigarette tax to finance it is questionable; and it may indeed cover some families who could afford private insurance.

But it is not, as some overheated opponents charge, socialized medicine or anything like it. Some Republicans charge that SCHIP is the first step toward "HillaryCare," but even if that were in the back of the Democratic candidate's mind, it would be beside the point.

Then we head over to nearby China to see what The Xinhua News Agency has to say:

The veto of Bush was seen by analysts as a high-risk gamble that might impair his party's efforts to compete with democrats for the next presidency and the dominance in Congress.

Lets shift perspective to Western Europe, how are they viewing this? A quick glance at The Economist (UK Edition) unearths the following:

Up with children, down with smokers: it was, in other words, an easy sell. But Mr Bush balked for several reasons. He said that expansion would mean shifting the programme's focus away from poor children. Better off parents might be tempted to drop their private coverage in lieu of the government option, nudging the country down the dangerous road to nationalised care. Mr Bush objected to the tax increase. And although this White House is not known for fiscal restraint, it thought the expansion would cost too much. Mr Bush had previously said that a $5 billion spending increase would be about right.

Getting a bit closer to home we find the Dominican Republic rejoicing at the veto. Why? As Dominican Today reports, it has saved their industry:

Tobacco farmers of the country's north region (Cibao) yesterday heard with joy the news that U.S. president George Bush's vetoed a bill passed by Congress, which threatened to decimate the Dominican and Central American tobacco industries.

The president of the Cibao Tobacco Harvesters Federation, Jorge Mercado, said the U.S. president's decision would reactivate the north zone's tobacco industry, mainly in Santiago province. "The veto of the law represents hope and relief for more than 300 harvesters in this region who have lived off the production of tobacco for centuries."

Agriculture minister Salvador Jiménez, quoted by the newspaper Diario Libre, said if the bill had been signed into law the country would've lost some 54,000 jobs.

Stay tuned.

SOURCE: "Veto of Child Health Bill" 10/04/07
SOURCE: "Bipartisan Tension Tightens as Bush Vetoes Program" 10/04/07
SOURCE: "Why Did George Bush Veto a Popular Health Care Bill?" 10/04/07
SOURCE: "Bush Veto Saves The Dominican Tobacco Industry" 10/04/07
photo courtesy of Bluedharma used under this Creative Commons license

Lilly CEO Calls for Reform and EMRs

While the health care reform community is focused on President George W. Bush’s imminent veto of the children's health insurance bill, a major announcement about Electronic Medical Records (EMRs) has evaded the spotlight.

Sidney Taurel, CEO of pharmaceutical giant Eli Lilly put forth a call for development of a health information technology system. His proposed system would be a collaborative effort of both public and private sectors and would involve the U.S. government, the health care industry and the medical community as active participants.

The aim is tracking both actual effectiveness and side effects of drugs that have been released into the market. This "real world" data will enhance the safety profile of drugs first established through standard drug trials.

CNNMoney reports on Taurel's address at the Cleveland Clinic:

Although traditional drug trials will continue to test new hypotheses about medicines after they have reached the market, Taurel outlined how a well-functioning health IT system could serve not only to frame hypotheses for so-called "Phase IV" clinical research, but also become the practical equivalent of massive, real-world trials. Such a system would collect detailed data from day-to-day medical practices and feed insights quickly, seamlessly and at a lower cost to doctors, regulators, and drug manufacturers. The result would be a more accurate picture of a drug's safety and efficacy than exists today.

Once again we see the importance of developing portable, transparent records as Kaiser-Permanente CEO George Halvorson outlines in his book, Health Care Reform Now!

The CNNMoney article goes on to describe the current collaboration along these lines:

Taurel explained that as EMR systems build out, they provide what amounts to a 'commons' in which organizations can collaborate to share health information.

For example, Lilly, Pfizer, and Johnson & Johnson are collaborating with 'e-Health Initiative' - a not-for-profit health information technology group - as well as with the Indiana Health Information Exchange and the Partners Healthcare System in Boston. The goal is to test how safety signals can be located and understood using existing data, potentially leading to a better understanding of the risk and benefits of medicines.

SOURCE: "Lilly’s CEO Calls For Reform of Nation’s Drug Safety System" 10/02/07
photo courtesy of Uh…Bob

Eight States to Sue Administration Over Child Health Care

As the time approaches for President Bush to veto the current SCHIP legislation, as he has repeatedly promised, the adversarial nature of the debate is turning litigious. Tom Hester at Newsday reports:

New Jersey on Monday joined seven states in filing separate lawsuits against the Bush administration's challenge of proposed federal rules the states say will force poor children to lose health coverage.

The lawsuit for New Jersey was filed Monday morning in federal court in Trenton, state Attorney General Anne Milgram said. New Jersey joins Maryland, Arizona, California, Illinois, New Hampshire, New York and Washington in filing similar litigation.

"The Bush administration has gone beyond its regulatory rights," New Jersey Gov. Jon S. Corzine said as he announced the lawsuit at an East Orange health center.

At the core of the conflict are rules issued by the Center for Medicare and Medicaid Services which the suits claim exceed the statutory authority set forth in Title XXI of the Social Security Act. The SCHIP legislation currently facing veto would remove these new strictures. What new strictures, you ask? Ralph Thomas at the Seattle Times brings us the following clarification:

Under the restrictions, before states can start enrolling kids above 250 percent of the poverty level, they must make sure they are covering at least 95 percent of kids at or below 200 percent of the poverty level.

[Washington State Governor] Gregoire said no state has been able to reach that mark. She said Washington has one of the nation's highest coverage rates, at about 91 percent.

"We just do not believe that is achievable and in fact was put in place to guarantee that we couldn't go above 250 percent of poverty," she said.

The restrictions also require new enrollees above 250 percent of the poverty level to go a year without insurance before they could enroll in SCHIP.

These strictures are being cast as beyond the legal limitations on federal power, and more states continue to bring suit agaisnt them.

"The federal government lacks the authority to do what it is trying to do," [NJ Attorney General] Milgram said, adding that New Jersey's plan has been approved eight times, including five times by the Bush administration.

[New Jersey Gov. Jon S.] Corzine has said the rules could risk health insurance coverage for 10,000 New Jersey poor children.

SOURCE: "8 States Sue Bush Over Children's Health Insurance" 10/01/07
SOURCE: "State to Sue Feds Over Childrens Health Insurance" 10/02/07
photo courtesy of Scott Ableman