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CMIOs wanted in the UK

I’m getting ready to head west for, among other things, the annual AMDIS Physician-Computer Connection in Ojai, Calif., a high-level gathering of chief medical information officers. After years of fighting for a seat at the table, CMIOs now are being held up as a model, at least overseas.

Specifically, my friends at E-Health Insider in the UK have embarked on a mission to have every NHS hospital hire a chief clinical information officer, the British equivalent of the CMIO. Read more about the British perspective on the American CMIO here.

July 10, 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.

Founder of British interactive patient sites dies

The driving force behind popular British interactive patient sites HealthTalkOnline and YouthHealthTalk has died.

Dr. Ann McPherson, 65, died May 28 after a four-year struggle with pancreatic cancer. Dr. McPherson, a general practitioner at Oxford University, came up with the idea for a patient-experience site 15 years ago while fighting her own battle with breast cancer, E-Health Insider reports.

Dr. McPherson and Dr. Andrew Herxheimer, a former editor of the Drug and Therapeutics Bulletin, founded predecessor site DIPEx in 2001, long before the phrase “health 2.0″ gained acceptance. Their organization, the DIPEx Charity, divided the site into HealthTalkOnline for adults and YouthHealthTalk for teens, children and their families in 2008. Numerous British celebrities, including actor Hugh Grant and Radiohead singer Thom Yorke, have become public supporters of the charity.

She co-authored the 1987 book, Diary of a Teenage Health Freak, which has sold more than 1 million copies worldwide, according to an obituary in The Guardian. The book spawned a TV show in the U.K. in the early 1990s, and later, the still-active Teenage Health Freak Web site.

Dr. McPherson won the BMJ’s 2011 Healthcare Communicator of the Year award in April.

 

June 5, 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.

Slams on Berwick are getting pathetic

The slams on Dr. Donald Berwick, frankly, are getting pathetic.

Today, Fox News medical contributor Dr. Marc Siegel dismissed Berwick as a “basically a policy wonk” who “hasn’t really practiced since 1989.” Siegel tried to score points with sound bites. “This guy has more quotes than Yogi Berra, and let me tell you something, these quotes are an indictment on people that want clinicians to make decisions,” Siegel said on Fox this afternoon.

According to Siegel, comparative effectiveness “doesn’t work in the real world.” Well, sure, that’s the point of clinical decision support. Best practices are for common conditions, and clinical decision support is to help physicians either follow best practices in the case of common conditions or, just as importantly, diagnose and treat ailments that they don’t often see. (Read Dr. Atul Gawande’s best seller,  “Complications,” for a description of the chaos that ensues when physicians see rare cases.)

Fox News anchor Megyn Kelly tried to feign fairness by saying of President Obama’s recess appointment that installed Berwick as CMS administrator last year, “lots of presidents do it.” But she later said that that Berwick “loves” the British National Health System, trying to paint Berwick as a socialist. Once again, this isn’t about socialism or capitalism or any other ism that has unfortunately been the focus of “health reform” in this country. It’s about trying to improve the quality of care. (It’s not about insurance, no matter how many politicians or pundits say so.)

Defending Berwick was Dr. Cathleen London, a family practitioner at the Weill Cornell Iris Cantor Women’s Health Center in New York City. London took issue with Berwick’s opponents relying on sound bites to make their thin arguments. (Siegel smugly laughed this off.)

When Kelly again tried to tie Berwick to the NHS, London said, “He likes that we do evidence-based medicine, that the British have NICE that actually oversees what the NHS should cover and shouldn’t.” Yes, the British National Institute for Health and Clinical Excellence (NICE) is an independent advisory board that helps the NHS make coverage decisions. You know, the same way any insurance system, public or private, has to decide what and what not to cover.

To his credit, Siegel praised Berwick’s work at the Institute for Healthcare Improvement for helping to reduce deaths in hospitals. “He’s apparently very well liked among patient safety advocates,” Kelly added.

London noted that former CMS Administrator Tom Scully, a George W. Bush appointee, is a fan of Berwick. Still, Siegel continued on his argument that comparative effectiveness is restributive in that it takes healthcare away from some people. “You’re not going to be able to pay for very expensive care,” Siegel said.

Why exactly would we want very expensive care in cases where less expensive but equally effective treatments are available? Is it because of the public perception that more expensive care automatically means better care? It sounds like Siegel is either trying to perpetuate that myth or protect the profits of pharmaceutical and device manufacturers. But then he made the salient point that “insurance is overused” and that healthcare reform, which he derides as “ObamaCare,” did little to address that problem.

All that says is that both sides of the political debate are wrong, and the Senate Democrats are cowards for not standing up for better care.

March 23, 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.

Berwick political saga is a tragic attack on better healthcare

President Barack Obama has made plenty of mistakes in his first two-plus years in office, but none may be more serious for the future of America than his decision to install Donald M. Berwick, M.D., as a recess appointment to head the Centers for Medicare and Medicaid Services in July 2010.

Berwick really is a great choice to head CMS, but the underhanded nature of the recess appointment has provided fodder for all kinds of uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts. Just as CMS is gearing up to release widely anticipated proposed regulations for Accountable Care Organizations, we get the sad news that that Berwick’s days are numbered.

After refusing to allow Berwick to testify before the Senate last year, Obama renominated Berwick on Jan. 26. Newly empowered Republicans went on the attack. “The White House’s handling of this nomination—failing to respond to repeated requests for information and circumventing the Senate through a recess appointment—has made Dr. Berwick’s confirmation next to impossible,” the widely respected Sen. Orrin Hatch (R-Utah) said, according to American Medical News.

On March 4, Politico reported that Senate Democrats had given up on the nomination, despite the fact that Berwick had the support of the Medical Group Management Association, the American Hospital Association, the American Public Health Association and, notably, the Republican-leaning American Medical Association and America’s Health Insurance Plans.

How did this happen?

As I wrote last November when Republicans proposed de-funding of the Center for Medicare and Medicaid Innovation, a key element of real reform in the widely misunderstood “healthcare reform” legislation (the main misunderstanding is that insurance is not the same thing as care):

The Patient Protection and Affordable Care Act, widely referred to as “healthcare reform” and mocked by some as a government takeover of healthcare, aka “ObamaCare,” is not popular in Republican circles. That’s no secret.

It’s also well known that, in their drive to repudiate everything Obama, many Republicans, giddy over their victory in last week’s midterm election, have said they want to repeal the PPACA in its entirety, throwing out the baby with the bathwater. (You know, our healthcare system is wonderful the way it is, so we didn’t need any changes in the first place.)

What really got me was the news that some of the more conservative and libertarian elements of the GOP are specifically threatening to pull the $10 billion in funding already authorized for the Center for Medicare and Medicaid Innovation, a CMS program created by the PPACA. This is a center that CMS Administrator Dr. Donald Berwick has called “the jewel in the crown” of the reform bill, and Berwick has unfairly been labeled a socialist, granny-killing pariah by some right-wing zealots who have no idea of his life-saving work at the Institute for Healthcare Improvement.

The new Republican-majority House of Representatives could not make a bigger mistake than defunding the Center for Health Innovation. For years, conservatives have complained of Medicare’s plodding bureaucracy impeding innovation—you know, the very thing the program is intended to foster.

What the PPACA does is allow CMS, via this new innovation center, to try new ideas without having to make sure their experiments are budget-neutral from the start. (The requirement for budget neutrality is why Medicare pay-for-performance and pay-for-prevention initiatives have never really gotten off the ground.) And CMS no longer has to be content with small demonstrations. Instead, the Center for Medicare Innovation is authorized to run wider-scale pilots and then seek congressional appropriations to ramp up any program that proves successful in producing better care for less money.

That’s how you bend the cost curve, a favorite term in policy circles. Killing the Center for Medicare and Medicaid Innovation would just perpetuate the ugly status quo.

That commentary drew five responses on the site, four of which were negative. And every last one of the negative comments were written anonymously. The only commenter to list a name also happened to be the lone supportive response.

I am in no way surprised. Politically motivated lies abound about Berwick, and few of the critics want to be held accountable for misleading the public.

The week before last, I was somewhat critical of the Lucidicus Project and Jared M. Rhoads, who hosted the most recent Health Wonk Review. He did a fine job hosting HWR, but in scanning some earlier posts on the Lucidicus site—hewing closely to confused, angry, misguided ideology of the tea party—I noticed something that got my blood boiling.

On Jan. 27, Rhoads wrote that Berwick was “on a one-way path,” a path that leads to socialism and a government takeover of healthcare. “Without free-market solutions on the table, the one-way march to an NHS-like system will continue. Berwick has just one solution in mind for the problems created by government: more government.”

He also wrote, “Berwick is openly enamored of the U.K.’s National Health Service (NHS) model, in which the government essentially makes decisions for people about the care that they receive, and in which patients can be penalized for attempting to pay for additional care out of their own pockets. The system is characterized by bureaucracy, rationing, and redistribution of wealth and resources.”

At least give Rhoads credit for not cowardly hiding behind a cloak of anonymity.

Yes, it is true that Berwick has publicly spoken of his admiration for the NHS, but it was more about the British decision to make quality improvement a key element of healthcare than it was about a desire to bring an entirely government-run system to the United States. In my post about that edition of HWR, I asked if Berwick hadn’t done more to prevent needless deaths and adverse events than pretty much anyone else alive today.

That’s the same question I asked in an e-mail to the anti-reform (read “crackpot”) group called Docs4PatientCare. Why do I say crackpot? The Atlanta-based organization contacted me last fall with links to a series of videos, including one from group representative Scott Barbour, M.D. According to the original pitch to me, “Utilizing quotes from Dr. Berwick, Dr. Barbour exposed that, ‘He is not interested in better health care. He is only concerned about implementing his socialist agenda.’”

In another video, Docs4PatientCare Vice President Fred Shessel, M.D., said of Berwick, “This is a man who has made a career out of socializing medicine and rationing care for the very young, the very old and the very sick. It is a backdoor power grab. It is dragging our country down the road to socialism and we should resist it.”

I responded to this pitch with a short question: “Berwick isn’t interested in better care? Do you know anything about his work at IHI?” I never got a response. Docs4PatientCare seemingly was trying to hoodwink media that don’t know any better and/or care more about politics than facts.

Here are the facts, from another piece I wrote last year:

A longtime champion of patient safety, Berwick co-founded the Institute of Healthcare Improvement in 1989 and led it until he became CMS administrator by virtue of a controversial “recess appointment” in July 2010, preventing the Senate from questioning him about his views. At IHI, Berwick created and championed the 100,000 Lives Campaign, an effort to prevent that many deaths in an 18-month period by getting thousands of U.S. hospitals to follow simple, preventive safety measures voluntarily. The program later turned its focus to nonlethal adverse events and became the 5 Million Lives Campaign. Berwick is a pediatrician who also holds a master’s degree in public policy.

In kicking off the 100,000 Lives Campaign in December 2004, Berwick made the following audacious challenge to American hospitals: “I think we should save 100,000 lives. I think we should do that by June 14, 2006. 9 a.m.” At that appointed hour 18 months later, he announced that the campaign had prevented 122,300 unnecessary deaths. Berwick was careful not to make IT a prerequisite for participating in either campaign, but he’s come to see the benefits of EMRs and clinical decision support. Now, as head of CMS, he effectively leads the “meaningful use” incentive program. Though the Stage 1 rules were mostly done by the time he took the reins, you can be sure Berwick will be pushing for true quality improvement in subsequent stages of meaningful use.

The key word in the above passage is “voluntary.” There were no mandates when the private-sector IHI encouraged hospitals to do what is right for patients.

Months later, Berwick has indeed been pushing for true quality improvement in meaningful use. I’ll have more on that later in the week.

March 14, 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.