Employers Back CHIP Electronic Medical Records Program

Gary McWilliams writes in The Wall Street Journal this morning that six major corporations are backing the Children's Hospital Informatics Program (CHIP). CHIP is the latest effort from the Dossia Network -- a nonprofit consortium of large employers -- to deploy an online health records management tool.

The Dossia Network will adopt the "Indivo" electronic medical record (EMR) developed at Children's Hospital Boston. In a detailed article in today's Information Week, Marianne Kolbasuk McGee describes a falling out between Dossia and previous tech partner Omnimedix. The new partnership between Dossia and CHIP will hopefully get the EMR back on track. McGee interviews several key players in her piece.

Corporations signing on include Wal-Mart, Intel, AT&T, BP, Pitney Bowes, Applied Materials, Cardinal Health, and drug maker Sanofi of France.

In chapter 2 of his book, Health Care Reform Now!, George Halvorson says, "fewer than one in ten doctors makes use of electronic health records." Halvorson cites the lack of standardized EMRs as a major impediment to continuous quality improvement in medical care.

There are 2.5 million employees represented by the CHIP partners. The group hopes to have capacity to handle 1 million EMRs within a year. The Wall Street Journal article mentions that employers hope the electronic system will reduce costs. That's the carrot for adoption. The stick?:

They also intend to require hospitals, doctors and pharmacies to update employee records in order to remain preferred health-care providers.

SOURCE: "Employers Back Development Of Web-Based Health Records" 09/17/07
SOURCE: "Intel, Wal-Mart, And Others Refocus To Get Worker E-Health Record System Running" 09/17/07
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Report Card on the Legislative Session

Even though a special session looms in California, the lack of progress on the health care issue has spawned criticism, anxiety and unease across the state.

Steven Harmon at the San Jose Mercury News examines the situation:

"They had the stars and the moon properly aligned, with the governor re-elected, and there were no election worries for the Legislature," said Tony Quinn, a GOP political analyst. "This was the year to do something. I expected to see more substantive stuff. But the governor didn't use the large mandate he got. It just petered out."

Left on the cutting room floor were hot-button issues such as health care reform, sentencing and parole reform, assisted suicide, water storage and redistricting reform.

[Gov. Arnold] Schwarzenegger has called lawmakers into special session in hopes of accomplishing what couldn't be done in the regular session: health care reform, and water storage and flood protection legislation.

But not everyone is optimistic, especially given the partisan divide that dominated a session that produced mostly tweaks to state laws, not memorable change.

A common thread in many articles is the idea that the seven-week long budget standoff was a primary factor in health care issues remaining unresolved.

Ted Lempert, former California State Assembly member and President of Children Now, comments in the Capitol Weekly:

California's recent budget battle did more than just heighten political friction. The two-month-long stalemate monopolized precious time needed to fix California's desperately broken health-care system, which leaves millions of Californians uninsured--including over 760,000 children. Uninsured children often miss the preventive care that decreases health-care costs borne by the public over time.

Now, with just a few weeks left on the legislative calendar, Democrats and Republicans alike have a responsibility to address their unfinished business--namely health-care reform. This is not a problem that can wait until the next legislative year. California, which always has prided itself on leading the nation in social and economic issues, today ranks 43rd among states in the percent of insured children. As families, businesses and the rest of the public are demanding immediate action, it is not hyperbole to say that health care reform is a life or death issue.

SOURCE: "Hopes for Major Achievement Dashed as California Legislature Wraps Up- 2007 Session in Review" 09/13/07
SOURCE: "Children's Health Care: Unfinished Business" 09/13/07
photo courtesy of A. Belani on Flickr remixed and used under this Creative Commons license

Votes and Vetos: AB8 Passes

All eyes in California are focused on Sacramento.

From the San Francisco Chronicle:

The state Legislature approved an overhaul of California's health care system Monday, but even before the votes were tallied Gov. Arnold Schwarzenegger vowed to veto the bill and call lawmakers into a special session after the current session ends this week.

Schwarzenegger said he would reject AB8, by Speaker Fabian Núñez, D-Los Angeles, because it puts too great a financial burden on employers and does not address the needs of 2.8 million of California's estimated 6.8 million uninsured residents.

Despite the vote's outcome, there is still a long road ahead for reformers. Schwarzenegger's veto will bring a return to the ongoing debate, while the special session will keep it in the public eye.

Jordan Rau at the Los Angeles Times speculates on the content of possible resolutions:

An agreement would be likely to include a requirement that employers provide health coverage for workers or pay a fee to the state, which would then arrange for insurance for those workers. That proposal forms the heart of the Democratic bill.

The deal probably would also incorporate a tax on hospitals that would help California capture an extra $2 billion in federal aid. The California Hospital Assn. endorsed such a tax last week after Schwarzenegger lobbied hospital executives.

SOURCE: "Health Care Bill Passes Legislature, But Governor Says He'll Veto It" 09/11/07
SOURCE: "Governor Plans Health Care Veto, Talks" 09/11/07
photo courtesy of Fronco Folini on Flickr remixed and used under this Creative Commons license

Universal Concerns About Universal Health Care

In California, the legislative calendar is coming to an end, and still the debate on health care reform seems far from resolution. As competing plans are dissected and debated on the floor, citizens and business groups are stepping up to make their feelings known. Health providers and small businesses are putting out press releases to make their stance on the issue a matter of public record, and the one constant throughout is the sense of urgency that is felt on the subject.

Among others making their position known, the California Association of Physicians Groups stresses the lack of attention to preventative services in any of the current legislation:

California's network of 150 medical groups applauds the leadership in producing their pending health care reform proposals, but a critical factor necessary for these to succeed is glaringly missing -- namely, an express requirement for an affordable, coordinated benefit plan that emphasizes prevention, disease management, and increased access to healthcare.

Small businesses overwhelmingly support universal coverage according to the San Diego Business Journal:

Eighty percent of those surveyed also believe that businesses should provide their employees with health care, according to the survey released Aug. 24 by Small Business for Affordable Healthcare, a coalition of the Small Business Majority, a progressive nonprofit organization based in Sausalito.

The California Primary Care Association joins the bandwagon, invoking the "year of health care reform," which draws to and end soon:

The California Primary Care Association (CPCA), which represents over 650 community clinics and health centers throughout the state, today delivered a letter to Governor Schwarzenegger and legislative leaders calling on them to move now to enact meaningful, comprehensive health care reform that fixes California's malfunctioning system of health care. With just days remaining in the legislative session, the window of opportunity is closing fast on what was proclaimed to be the year of health care reform in California.

SOURCE: "Media Statement From Don Crane, President, California Association of Physician Groups" 09/10/07
SOURCE: "Despite High Cost, Small Business Says It Supports Universal Health Care" 09/10/07
SOURCE: "Act Now to Fix Our Broken Health Care System" 09/07/07

photo courtesy of HeyPaul on Flickr remixed and used under this Creative Commons license

A Populist Prescription from Barack Obama

Health care is the subject on everybody's lips, especially those running for office. Members of both major political parties have laid out their platforms on this issue as they either campaign for office or prepare to do so, but there is dissent within each party as well. Barack Obama created quite a stir yesterday with his reaction to comments on Hillary Clinton's failed attempt at reform back in 1993. The Associated Press provides a relevant quote from his Sac City, Iowa, appearance:

"It was a closed process and not everybody understood what was taking place, so when the insurance companies and the drug companies started running those 'Harry and Louise' ads, nobody really knew what was what. That's why the American people have to be involved."

After Clinton's plan was proposed, special interest groups ran the commercials, featuring a fictional couple worrying about losing their ability to pick their own doctors and warning that the government would take control of the health care system. Support for the health care expansion evaporated and the effort was eventually dropped.

Obama said the lesson to be learned was to involve the American people in the effort. Without political support, no health care expansion can be approved, he said.

Obama then followed the announcement of his more populist approach with the statement that he would announce outlines of a health care reform package in his first 100 days as President. The details of this package would then be drafted by a bi-partisan commission. Alec McGillis at The Washington Post takes note of the tactical change this represents within the overall debate:

The remarks were a new twist on the health care debate that has played a dominant role so far in the Democratic race -- until now, most of the candidates have focused on the differences between their plans, not how they would go about actually getting reform enacted. The comments also represented a variation on a theme that Obama first introduced in an interview with The Washington Post last month -- that he would be in a better position to unite the country than would Clinton, given her polarizing reputation among many voters. And it is a rebuttal of sorts to the argument Clinton has been making on the trail in recent days -- that she, unlike Obama, has the experience to know how to work within the system to get things done. In Clinton's highest-profile bid for reform, Obama is reminding voters, the system won.

SOURCE: "Obama Vows Open Health Reform Process " 09/05/07
SOURCE: "Obama Draws Clinton Contrast" 09/05/07
photo courtesy of SEIU International on Flickr remixed and used under this Creative Commons license

Six Figures Is Not Enough

The ongoing debate about health care centers mainly on the 47 million Americans who are unable to afford the costs of insurance and medical treatment. In an observation that throws things into stark relief, as well as shatters preconceptions, the Daily News opens a recent editorial with this:

When White House spokesman Tony Snow announced his resignation Friday, he cited financial reasons. In his high-profile job as the president's mouthpiece, he was paid $168,000. But even that wasn't enough for him to afford to support his family of five and pay the bills for his cancer treatment.

Certainly Snow's situation is far removed from most of America's blue-, white- and pink-collar workers. But if one of the well-paid close aides to the president can't afford health care costs, how does that bode for the rest of us?

After that attention getting example, the editorial goes on to compare the bills currently up for the vote in California, pointing out that the primary differences are partisan in nature. The column ends by exhorting the state government to resolve the ideological differences on this issue for the good of everyone:

California's leaders owe it to the state's hard workers to spend this Labor Day holiday working together on a compromise bill that both Republicans and Democrats, workers and businesses, can support.

SOURCE: "A Labor Day Gift: Where Did the Year of Health care Reform Go?" 09/02/07
photo courtesy of davidsilver on Flickr remixed and used under this Creative Commons license

Healthy Voices Across The Nation

From the halls and meeting rooms of Capitol Hill to the offices and press conferences of governors around the country, proposals and ideas for reforming our health care system are being announced and argued. A vast array of approaches and plans are being put forth as people on both sides of the partisan fence attempt to find an equitable and implementable solution to the current state of affairs.

Across the nation, citizens are being consulted on the subject as the politicians evaluate possible support for their various plans.

East Coast: In Vermont, the state Legislature's Health Care Reform Commission is consulting its constituency for input. According to the announcement in the Rutland Herald, some questions the Commission put forth in their open hearing were:

What do you believe the next steps should be in health care reform?

What specific suggestions do you have for expanding the state's new Catamount health insurance program for people without coverage?

In addition to expanding affordable coverage, which of the options being considered by the commission are most important to successful health care reform?

Midwest: In Iowa, the consultation with the voting public continues, as reported by The Journal. Their article focuses on Kay Ciha, a resident who has had constant issues with the Medicare system since her husband suffered an accident:

Ciha was one of about 20 county residents from all walks of life - seniors, businesspeople, physicians - that took part in a forum for the Legislative Commission on Affordable Health Care Plans for Small Businesses and Families, a bipartisan group of legislators working to provide a cost-effective health care to Iowans. Sen. Becky Schmitz and a representative for U.S. Congressman Dave Loebsack attended the meeting to hear the wish lists of people who were present.

West Coast: eMax Health reports, the findings of CaliforniaSpeaks, a 3,500 person statewide conversation that took place simultaneously across Sacramento, San Diego, Humboldt County, Fresno, Los Angeles, San Luis Obispo, Oakland and Riverside on August 11:

The eight sites were linked by satellite, so that participants could see and hear what other attendees said across the state. Skilled facilitators led face-to-face discussions at each location while ideas were recorded, considered and voted upon throughout the day with personal voting keypads. To ensure that attendees spanned all different ages, ethnicities, and socio-economic backgrounds, CaliforniaSpeaks used a random selection process to invite most of the participants to take part in the conversation.

While there is a diversity of opinions on the subject, concern over the issue seems nearly universal.

SOURCE: "Public Input Sought on Health Care Reform" 08/29/07
SOURCE: "Citizens Voice Concerns on Health Care" 08/30/07
SOURCE: "How Californians View Current Health Care Reform Proposals" 08/30/07
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