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‘Escape Fire’ leaves out IT, ultimately disappoints

I finally got the opportunity to catch the documentary film “Escape Fire,” a good 15 months after it went into limited theatrical release and became available in digital formats. I thought it would be an eye-opening exposé of all that ills the American healthcare industry, particularly for those who somehow believe we have the greatest care in the world. I excitingly ran this graphic when I first mentioned the movie on this blog back in October 2012:

The well-paced, 99-minute film interviews some notable figures in the fight to improve American healthcare — safety guru and former CMS head Dr. Don Berwick, journalist Shannon Brownlee, integrative medicine advocates Dr. Andrew Weill and Dr. Dean Ornish — as well as some lesser-known people trying to make a difference. It goes through a laundry list of all the culprits in the overpriced, underperforming mess of a healthcare system we have now, and examines approaches that seem to be producing better care for lower cost.

I expected the movie to have a liberal slant, but it really stayed away from the political battles that have poisoned healthcare “reform” the last couple of years. About the only presence of specific politicians were clips of both President Obama and Senate Republican leader Mitch McConnell both praising a highly incentivized employee wellness program at grocery chain Safeway that reportedly kept the company’s health expenses flat from 2005 through 2009, a remarkable achievement in an era of escalating costs.

However, filmmakers Matthew Heineman and Susan Froemke did discuss all the lobbyists’ money presumably buying off enough votes in Washington and at the state level that has helped entrench the status quo. They even scored an interview with Wendell Potter, the former top media spokesman for Cigna, who became a public voice against abuses by health insurers because his conscience got the better of him. As Brownlee noted in the film’s opening, the industry “doesn’t want to stop making money.”

Other reasons given for why healthcare is so expensive, ineffective and, yes, dangerous include:

  • direct-to-consumer drug advertising leading to overmedication;
  • public companies needing to keep profits up;
  • fee-for-service reimbursement;
  • the uninsured using emergency departments as their safety net;
  • lack of preventive care and education about lifestyle changes;
  • a shortage of primary care physicians;
  • cheap junk food that encourages people to eat poorly; and
  • severe suffering among the wounded military ranks.

The filmmakers also kind of imply that there isn’t much in the way of disease management or continuity of care. Brownlee described a “disease care” system that doesn’t want people to die, nor does it want them to get well. It just wants people getting ongoing treatment for the same chronic conditions.

One physician depicted in the movie, Dr. Erin Martin, left a safety-net clinic in The Dalles, Ore., because the work had become “demoralizing.” The same people kept coming back over and over, but few got better because Martin had to rush them out the door without consulting on lifestyle choices, since she was so overscheduled. “I’m not interested in getting my productivity up,” an exasperated Martin said. “I’m interested in helping patients.”

Another patient in rural Ohio had received at least seven stents and had cardiac catheterization more than two dozen times, but never saw any improvement in her symptoms for heart disease or diabetes until she went to the Cleveland Clinic, where physicians are all on salary and the incentives are more aligned than they were in her home town. As Berwick importantly noted, “We create a public expectation that more is better.” In this patient’s case, she was over-catheterized and over-stented to address an acute condition, but not treated for the underlying chronic problems.

The film also examined how the U.S. military turned to acupuncture as an alternative to narcotics because so many wounded soldiers have become hooked on pain pills. One soldier, a self-described “hillbilly” from Louisiana, got off the dozens of meds he had become addicted to and took up yoga, meditation and acupuncture to recover from an explosion in Afghanistan that left him partially paralyzed and with a bad case of post-traumatic stress disorder. The only laugh I had in the movie was when he told the acupuncturist at Walter Reed Army Medical Center in Washington, “Let’s open up some chi.”

I kept waiting and waiting for some evidence of information technology making healthcare better, but I never got it. After leaving the Oregon clinic, Martin took a job at a small practice in Washington state where she was seen toting a laptop between exam rooms, but, for the most part, I saw paper charts, paper medication lists and verbal communication between clinicians.

What really bothered me, however, is the fact that there was no discussion of EHRs, health information exchange or clinical decision support, no mention of the problem of misdiagnosis, no explicit discussion of patient handoffs, continuity of care, medication reconciliation and so many other points where the system breaks down. You can’t truly fix healthcare until you address those areas.

 

January 21, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Breaking news: Private-sector health groups agree to work with Obama

There’s some fairly significant news coming out of Washington tonight: A CNN Money report via Yahoo! says that six key private-sector health industry groups have agreed to participate in the Obama administration’s effort to reform healthcare by pledging to take $2 trillion in costs out of the system over the next 10 years.

“Six trade associations representing unions, hospitals, insurers and the drug industry have signed on to the commitment,” the story says. An Associated Press story says doctors are participating as well. Based on these stories, we can safely assume that coalition includes the AMA, AHA, AHIP, PhRMA and probably the Blue Cross and Blue Shield Association and the Service Employees International Union.

We’ll know for sure Monday when representatives from the six participating groups join President Obama at a press conference.

CNN reports that Obama will make reference to the AHIP-backed ad campaign that torpedoed reform efforts during the Clinton administration. “It is a recognition that the fictional television couple, Harry and Louise, who became the iconic faces of those who opposed health care reform in the ’90s, desperately need health care reform in 2009. And so does America,” Obama reportedly will say Monday.

May 10, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Allscripts to sell drug-packaging division, but who’s the buyer?

Allscripts-Misys Healthcare Solutions today announced an agreement in principle to sell one of its oldest assets, the Medication Services division. But the press release left out one minor detail: the name of the proposed buyer.

I’ve got a request in to the company, but if anyone else has any information, I’d love to hear it.

Allscripts has been prepackaging prescription drugs from its Libertyville, Ill., pharmacy facility (and former corporate headquarters building) for longer than it’s been selling electronic medical records, but medication services no longer is the central focus of the company.

“The proposed sale of our Medication Services business increases our focus on our core healthcare information technology businesses at a time when we expect electronic health records and electronic prescribing, along with our interoperability and connectivity efforts, to receive a substantial boost from the federal economic stimulus package,” CEO Glen Tullman said in the press release.

Allscripts says it will continue offering medication services through a co-marketing agreement. But, again, we don’t know who the company will be co-marketing with.

February 11, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Bad data mining

Recently I received a flier in the mail from Bausch & Lomb, offering me a free sample of an over-the-counter allergy drug called Alaway (ketotifen fumarate ophthalmic solution). “Don’t suffer through another allergy season. Stop itchy eyes,” the mailer said.

How did Bausch & Lomb know I have hay fever? It could only be from my history of purchasing OTC decongestants like Claritin-D and Alavert-D (both are loratadine/pseudoephedrine combos). And the reason why drug companies know I was taking this medication is because federal law now requires a photo ID and a signature to purchase any products containing pseudoephedrine. (Thanks, meth heads, for inconveniencing millions of innocent people.)

Clearly, pharmacies are selling their pseudoephedrine purchase logs to pharma marketers. Some might call this legitimate use of my personal information for disease management purposes under the treatment/payment/operations exception to HIPAA. It feels more like a violation of my privacy.

Anyone else have similar thoughts?

June 20, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

CDS=Cat decision support?

I’m sure the national media are jumping all over a “Perspective” essay in the July 26 New England Journal of Medicine about a cat named Oscar (at right) at Steere House Nursing and Rehabilitation Center in Providence, R.I., who has “an uncanny ability to predict when residents are about to die,” the report says.

“His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families,” writes David M. Dosa, M.D, a geriatrician at Rhode Island Hospital.

According to an Associated Press/Yahoo story, Oscar recently received a wall plaque publicly commending his “compassionate hospice care.”

I guess if you don’t have advanced information systems with full clinical decision support, you rely on the innate talents of the animal kingdom. Hey, if a method works, don’t knock it!

When doctors actually do turn to computers, it’s often for educational purposes. For what it’s worth, Manhattan Research now has a ranking of the top 10 pharmaceutical product Web sites that primary care physicians are visiting in 2007:

  1. Januvia
  2. Singulair
  3. Advair
  4. Chantix
  5. Adderall XR
  6. Byetta
  7. Gardasil
  8. Vytorin
  9. Avandia
  10. Concerta

In other news, URAC has a new competition to reward best practices in consumer empowerment and protection, with a related conference. The organization is taking applications through Aug. 15 at www.urac.org/bestpractices/. The awards will be presented at the first conference, set for next March in Orlando, Fla.

And finally, we come to the self-flagellation section of this post. My latest feature story on personal health records is out.

July 26, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Clout

In the days and weeks leading up to last month’s HIMSS conference, several people, probably hoping to get on my crowded dance card, noted that I was one of the more “important” journalists who covers health IT and healthcare policy. Flattering perhaps, but not exactly true. To me, importance in media is measured by audience size and influence. Based on a couple of recent stories, I really don’t have that much.

The Wall Street Journal reported last week how the price of generic drugs can vary so greatly from pharmacy to pharmacy. The story caught the attention of people all over America, including that of David E. Williams and his Health Business Blog, so much so that it’s generated extra traffic to my own blog the last couple of days. Why? Because I had essentially the same story nearly two years ago, first with this blog post from June 23, 2005, then in a story that ran in the Chicago Sun-Times on Sept. 19, 2005.

Now, the Sun-Times is a major daily newspaper in the nation’s third-largest media market, but it just doesn’t have the readership numbers or the cachet among national policy-makers as does the Journal. Still, I take pride in knowing that I had the story way early—in the same manner Detroit’s WXYZ-TV must have taken pride in having the same story a couple of years before I did.

The same thing happened on a smaller scale two weeks ago, when Government Health IT reported on the demise of the Santa Barbara County Care Data Exchange. That grabbed the attention of most of the healthcare trades nationwide, which is fine, except that Inside Healthcare Computing reported the news on Sept. 16, 2006. The archives are locked for subscribers only, but take my word, it’s there.

I didn’t write the story, though I am a frequent contributor to that publication. No matter, the target audience is more the CIO than the CEO or policy wonk. And guess which group has more clout on a national level?

Then there’s the matter of lifting the ban on cell phones in hospitals, something that’s also suddenly become a hot topic not only in the U.S., but in Britain as well. For the record, the Mobile Healthcare Alliance—a group that actually no longer exists—first put out a report at the 2004 TEPR conference, saying that the risk of hospital-systems interference from cell phones is manageable. Read my coverage here.

March 19, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.