What the November, 2009, Breast Cancer Screening Argument Obscured

In November, 2009, a rancorous argument about screening mammography for women aged 40-49 was touched off by the publication of updated guidelines(1), supported by a systematic literature review(2) by the US Preventive Services Task Force (USPSTF).  The guidelines suggested that yearly mammographic screening for women in that age group should not be automatic, but a decision made for individual patients after discussion between the patients and their doctors.  This was based on a critical review of the best available data which suggested that the benefits of screening acrue to only a few patients.  1904 women would have to start screening and continue for multiple rounds to prevent one cancer death over 11-20 years of follow-up.  These benefits had to be balanced...

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The Interim Final Rule on Standards

Yesterday at 4:15pm, HHS/ONC released the Interim Final Rule (IFR) - Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology.Pages 79-81 contain the content and vocabulary standardsPage 85 contains the privacy standards.Let's examine the major recommendations.The standards selected leverage the hard work done by HITSP, Consolidated Health Informatics, Federal Health Architecture, NCVHS, and government agency efforts . The IFR notes that unless marked with the following superscripts, all of the adopted standards are from the ONC process that took place prior to the enactment of the HITECH Act or are required by other HHS regulations.A number sign �#� indicates that the HIT Standards Committee...

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My New Year's Resolutions

I've taken a few days off to travel to Southern California for a holiday family get together filled with seasonal celebration, great meals, a few hikes, and helping my parents around the house.Now that it's New Year's Eve, it's time to reflect on the experiences of the previous 12 months and evaluate changes I can make in my priorities to improve my work, home, and personal lives. 2009 has been a year that required incredible energy just to keep pace with the changes in healthcare IT. Despite my best efforts in 2009, there are areas that need even more energy and focus in 2010.1. Use all my skills to support EHR change management - it's very clear to me that many clinicians do not want an EHR. Meaningful use is an incentive, but many clinicians remain unconvinced that EHRs will save...

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Food Allergy Issues One of Top Restaurant Trends in 2010

The National Restaurant Association lists gluten-free and food allergy-conscious meals within their top ten list of trends for 2010.Wouldn't it be wonderful to walk into a restaurant and ask to see the dairy, egg and nut-free menu? Then wouldn't it be even more wonderful to know that whatever is ordered will be prepared by a specially trained staff to avoid cross-contamination and accidental allergens?This is a trend that I hope sticks and spreads.Here's the complete list of restaurant tren...

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Petersburg Health Clinic

The Petersburg Health Care Alliance Clinic provides a wide range of medical services. It accepts Medicare and Medicaid, along with most major private health insurance plans. It also provides services on a sliding scale (depending on your income). The clinic is located at 541 S. Sycamore St., and is open Monday -Friday. 8:15am to 5:00pm. Visit their website by clicking here, or call (804) 957-9...

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On Automobile, and Health Care Companies Run by Finance People

The New Republic published "Upper Mismanagement" about what happens when businesses are run by people who do not understand their companies' businesses.  Although the article was focused on the decline of manufacturing in the US, its applicability to health care is obvious:Harvard business professor Rakesh Khurana, with whom I discussed these questions at length, observes that most of GM�s top executives in recent decades hailed from a finance rather than an operations background. (Outgoing GM CEO Fritz Henderson and his failed predecessor, Rick Wagoner, both worked their way up from the company�s vaunted Treasurer�s office.) But these executives were frequently numb to the sorts of innovations that enable high-quality production at low cost. As Khurana quips, �That�s how you...

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The $20 Million Dollar Journal Editor

Last week, the Milwaukee Journal-Sentinel reported on a royally paid journal editor:In 2002, Thomas Zdeblick, a University of Wisconsin orthopedic surgeon who has pocketed millions of dollars in royalties from the spinal device maker Medtronic, took over as editor-in-chief of a medical journal about spinal disorders.It would be the beginning of a beautiful friendship.In the years to come, Zdeblick would receive more than $20 million in patent royalties from Medtronic for spinal implants sold by the company. And the medical journal he edited would become a conduit for positive research articles involving Medtronic spinal products, a Journal Sentinel analysis found.Zdeblick took over editorship of the Journal of Spinal Disorders & Techniques seven years ago. Since then, studies involving...

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Finnish EHR's Clumsy, Mission Hostile, Consume Doctors' Precious Time

It seems common wisdom in the U.S. that the "Europeans are way ahead of us" in computerized medicine.Perhaps the common wisdom is not so wise. This from Finland:HELSINGIN SANOMATINTERNATIONAL EDITION - HOMEClumsy computer systems consume doctors� timeWhen Arto Virtanen, a doctor at a public health clinic, wants to access the information of a young patient, 12 windows of different sizes open up on different parts of his computer screen. Virtanen has to deal with each of them every time a patient visits him for routine postnatal care.�It used to be that a municipal doctor would see six or seven patients in an hour, when documentation was not at its present level�, Virtanen says. �Then there came more paperwork, and four patients were seen in an hour. Now if a doctor wants to read all the...

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Are Dissmissive Industry and Government Reactions to Physician Concerns about EHR's and other Clinical IT Simply Perverse?

Yes, they are.At the Nov. 10, 2009 essay "Academic Freedom and ED EHR's Down Under: Another Update and a Welcome Development" and preceding essays linked to it, I wrote about an Australian informatics professor's travails in writing about ED EHR's.He wrote a mixed-method essay about the mission hostile user experiences ED physicians in NSW reported about the EHR's they were being compelled to use, in addition to similar negative commentary from ED physician experts in other lands. The latest version of the paper "A Critical Essay on the Deployment of an ED Clinical Information System - Systemic Failure or Bad Luck" is here (PDF) or accessible from his department's webpage here.The government attempted to censor the paper and likely censure the author, and I speculate the HIT industry was...

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Food Allergy Reactions

Do you carry more than one dose of epinephrine in the event of an allergic reaction? A recent study shows certain risk factors associated with the need for more than one dose. One surprise...a history of asthma does not appear to be one of those risk factors. People requiring more than one dose tend to be younger and tend to present with wheezing, cyanosis (bluish/purplish tinge to the skin), arrhythmias (abnormal heart rhythms), nausea, vomiting and shock. Those who present with hives are less likely to require a second dose.Check out the full abstract and think about whether more than one dose of epinephrine is right for you or your chi...

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Food Allergy Assistant Wishes Everyone a Merry Christmas!

Photo Cre...

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Measuring Happiness

It's Christmas Eve and I've put the Blackberry to bed, stopped the strategic planning, and set aside the work of worry.My daughter does not want to discuss upcoming college tours or the cube root of 127. Instead, we're discussing our personal definitions of happiness.For my daughter, it's the little things that make her happy. The smiles from her friends, the smell of soy hot chocolate, and the idea of sleeping for 12 hours without homework to do.For me, I measure happiness by looking at my reflection in the people around me. Have my parents had a good year because of something I've done? Has my wife been empowered to pursue her dreams?...

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Merry Christmas, ER & cocci reactivation scares

Merry Christmas! As you can see from this year's Christmas picture, Denise looks healthy and Jacob wins the prize for best expression. We're grateful for another year that Denise has been able to continue on the long road to recovery and I can't help but reflect on this picture from 2005 when she wasn't doing so well.We had a couple points of anxiety since the last post.During a summer vacation trip we had a scare that resulted in a trip to ER, but all turned out well. Denise was swimming and doing somersaults in the pool with the kids. After getting out, she suddenly complained of severe chest/ab pain, numbness in hands, shortness of breath,...

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Boston Scientific (Again) Settles - This Time, Charges of Kickbacks Disguised as Clinical Studies

One would think that the stories about bad behavior by health care organizations would quiet down just before Christmas, but no...As reported by the AP:U.S. attorneys in Boston said Wednesday heart device maker Boston Scientific will pay $22 million to resolve allegations its Guidant division paid kickbacks to doctors to get them to use its heart devices.The U.S. Department of Justice said Guidant paid physicians $1,000 to $1,500 each in 2003 and 2004 to participate in four studies, called RaCE, RaCE II, RaCE III, and MERITS. It said the studies were designed to increase sales of pacemakers and defibrillators.Federal officials said the company targeted doctors who favored products made by other companies, hoping the payments would induce them to use Guidant devices more often. They said Guidant...

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ONC Defines a Taxonomy of Robust Healthcare IT Leadership

As in my post "More On Healthcare Management By Domain Neutral Generalists", Roy Poses' post "Health Care Leaders: Don't Know Much About Health Care" and many others on the topic of ill informed healthcare management (query link) at Healthcare Renewal, a common theme is lack of appropriate education and background in many of today's healthcare leaders.ONC, the Office of the National Coordinator of health IT at HHS, has apparently now defined a taxonomy of health IT leadership in their funding opportunity announcements (FOA's).Note the formal educational recommendations I've highlighted. Seems they�ve heard the message about the importance of cross-disciplinary -- and formal -- education for health IT leaders and even lower level workers: From the Founding Opportunity Announcement "Program...

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How to Give a Course on Corruption in the Health Sector

Just out from the U4 Anti-Corruption Resource Center is a brief paper on "Approaches to teaching and learning about corruption in the health sector."  (Note that U4 has a very useful web-page on corruption health care, also now appearing in the links in our side-bar.)The paper begins by describing the overall goals of such a course:The overall goals for training in anti-corruption in health are to help people develop the knowledge, skills, and attitudes they will need to identify and understand problems of corruption in health, design anti-corruption strategies, strengthen health systems for good governance,transparency, and accountability, and advocate for integrity in governance. An additional goal is to prepare people to respond to individual experiences they may have with corruption,...

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