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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: Mostashari to leave ONC

National health IT coordinator Dr. Farzad Mostashari will leave the Office of the National Coordinator for Health Information Technology at an unspecified time this fall.

From Twitter:


Government Health IT reports this morning that HHS Secretary Kathleen Sebelius broke the news in a letter to agency staff.

“During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the Department. His expertise, enthusiasm and commitment to innovation and health IT will surely be missed,” Sebelius wrote, according to Government Health IT. “In the short term, he will continue to serve in this role while a search is underway for a replacement.”

The fourth national coordinator since the position was created in 2004, Mostashari has been in his current job since April 2011. Prior to joining ONC in 2009, he led the Primary Care Information Project for the New York City Department of Health and Mental Hygiene.

UPDATE, 10:46 am CDT: I have the full memo from Sebelius.

Hello Colleagues,

I am writing to share the news that Dr. Farzad Mostashari has advised me he will be stepping down as National Coordinator for Health Information Technology this fall.

Farzad has been a leader in the Office of the National Coordinator for Health Information Technology (ONC) for the last four years.  Farzad joined the office in 2009 as Principal Deputy National Coordinator and took over as the National Coordinator in 2011.  During his tenure, ONC has been at the forefront of designing and implementing a number of initiatives to promote the adoption of health IT among health care providers.  Farzad has seen through the successful design and implementation of ONC’s HITECH programs, which provide health IT training and guidance to communities and providers; linked the meaningful use of electronic health records to population health goals; and laid a strong foundation for increasing the interoperability of health records—all while ensuring the ultimate focus remains on patients and their families.  This critical work has not only brought about important improvements in the business of health care, but also has helped providers better coordinate care, which can improve patients’ health while saving money at the same time.

During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the Department.  His expertise, enthusiasm and commitment to innovation and health IT will surely be  missed.  In the short term, he will continue to serve in this role while a search is underway for a replacement. Please join me in wishing Farzad all the best in his future endeavors.

Kathleen Sebelius

 

 

August 6, 2013 I Written By

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

Guest podcast: Suzanne Leveille from OpenNotes

I now present the latest health IT-related podcast from Sivad Business Solutions, an interview with Suzanne Leveille, research director of OpenNotes, a project to give patients online access to the entirety of their own medical records, including the visit notes from clinicians. Leveille describes a trial at Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle. She reported that not one of the 105 participating physicians asked for the access to be shut off after a year. In some cases, patients even discovered errors and prevented adverse events.


Here is the description from Sivad:

A pleasure to welcome Suzanne Leveille to the program today. Suzanne is a professor of nursing at The University of Massachusetts-Boston, and the research director for OpenNotes.

OpenNotes is an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians.

As a patient, you have the right to read the notes your doctor or clinician writes about you during or after your appointment. Having the chance to read and discuss them with your doctor or family member can help you take better control of your health and health care.

As a healthcare professional, you may build better relationships with your patients and take better care of them when you share your visit notes. Our evidence suggests that opening up visit notes to patients may make care more efficient, improve communication, and most importantly may help patients become more actively involved with their health and health care.

Some highlights from the conversation include: the dramatic improvement between patient and doctor communications; how they overcome potential push back and resistance from physicians; patients became more engaged in their personal health care; OpenNotes has been pleasantly surprised at the patient engagement; how advanced technologies and mobile technology are going to impact the future of this idea; and how they are planning to spread the word and get more patients and doctors improving communications and care with OpenNotes!

 

May 16, 2013 I Written By

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

Podcast: This time, I’m the interviewee

In a rare turn of events, I’m the one being asked the questions on a podcast by Sivad Business Solutions, which hosts regular audio discussions on a variety of business topics. I give kind of a high-level view of health IT and offer my very strong opinions on patient safety and healthcare reform. There’s an interesting discussion about EHRs being designed to maximize reimbursements rather than assure safety.

Interestingly, we recorded this via Skype. I like the audio quality, if not the nasal quality of my own voice, more than usual that day.

Hopefully the embedded audio works. If not, click here.

September 18, 2012 I Written By

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

Why healthcare is so troubled, and what consumers are doing about it

Consumerism hasn’t completely caught on in healthcare, but it has gained a bit of a toehold. Consider these two slides shown Monday at the Healthcare Unbound conference in San Diego:

Look at the bottom of each slide, starting with the second one. According to GreatCall, maker of the Jitterbug phone for seniors, 35 percent of consumers plan to buy “wellness electronics” in the next year. That’s great news and a great opportunity for people in health IT to make sure such devices connect to larger networks to data collected will be usable.

In the upper slide, Kaiser Permanente cites numbers showing one reason why healthcare is in such a crisis. Again, look at the bottom. Just 2 percent of current residents in internal medicine will end up in primary care. That’s not exactly reassuring in the face of a projected shortage of 40,000 family practice physicians by 2020. Thus, connected devices will gain in importance as an adjunct to primary care for the purpose of disease management.

Really, it could be our only hope.

July 12, 2011 I Written By

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

A health IT reality check

I canceled my last vendor meeting at HIMSS09 yesterday so I could make a last-minute doctor’s appointment at 1:15 p.m. (ah, the joys of not having to travel for a major conference). As it turned out, I slogged through most of HIMSS with bronchitis. I hope I didn’t get anyone else sick.

My regular internist is not in this particular office on Wednesdays, so I was seen by another partner in the five-physician primary care practice—the most tech-savvy one. The entire patient-physician encounter lasted the usual 10 minutes, but I got a wonderful demonstration in that short time of the issues facing so many practices.

The doctor pulled up my record on the Sage Intergy EMR that the practice has had for the last three years (a replacement for an earlier system), but couldn’t find much of a history on me. I had given my regular physician a printed list of my medications and allergies the last time I was in there for a checkup last year, but that never got into my electronic chart. No matter, this doctor took my information verbally, and typed everything in as I was talking to him. (I checked, and it was accurate.)

He examined me, entered the diagnosis into the EMR and gave me some simple, verbal instructions, since he didn’t write any prescriptions for this encounter. (Even I know that antibiotics are ineffective against viral bronchitis, so I picked up some OTC medicine for sore throat and cough at a local Walgreens.)

I was surprised my history hadn’t gotten into the record, but this doctor was not. He is what you could call an early adopter, having been convinced to go electronic a decade ago. He said he’s been fighting his partners for years to get them to use the EMR for more than just entering orders and diagnoses. He said he loves the Intergy system, which should make the folks in Tampa smile, but wishes he could persuade the other doctors to do more and make a larger investment.

This practice has spent $120,000 over the past three years on the EMR, but needs another $50,000 to integrate or upgrade the practice management system so the two sides could share demographic and insurance data, making the whole operation more efficient. Unfortunately, the other doctors don’t want to spend the extra money while primary care is under so much financial pressure. Until there is the link between practice management and EMR, the practice isn’t even able to report its activity to capture the new 2% Medicare bonus for e-prescribing, the doctor said.

All the stimulus money sounds exciting for those of us who view health IT from on high, but January 2011 might as well be an eternity from now for those on the front lines of medicine.

April 9, 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.