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A business opportunity and a milestone

I just had a thought. After reading that Walgreen Co. has announced plans to open walk-in medical clinics in a handful of stores in St. Louis and Kansas City, I realized there is a business opportunity here for some enterprising health IT vendor to offer personal health records to patients who use such clinics. Some other form of the Continuity of Care Record would work, too.

Full-disclosure time: I actually have to give mad props to Bruce Japsen, who mentioned in his story in Wednesday’s Chicago Tribune that the AMA and others have raised concerns about continuity of care for patients of retail clinics. I’ve met Bruce maybe once or twice, but my former boss and his (at a different times), Clark Bell, says he’s good people. That’s good enough for me, so you can make the royalty checks out to both of us.

OK, just kidding. I have ethics. I’ve taken a $5 Starbucks card from a vendor, but not much more than that. Regardless, I still think it’s a good idea to produce some sort of electronic report for walk-in patients to take back to their regular physicians.

And now for the milestone part of this post, as advertised in the headline. Today, this blog had its 10,000th visitor since I began tracking traffic in September 2004. No. 10,000 came from the network at Youngstown State University, on a link from Misys Healthcare Systems.
Thanks for all your clicking!

April 26, 2006 I Written By

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

More on Brailer

I’m working on a story about Dr. David Brailer’s resignation that will appear in Health-IT World tomorrow, but since so many people are coming to this page in search of details, here is a brief synopsis from this morning’s media conference call:

  • Brailer’s resignation is effective May 19. He has agreed to head up the search for a successor, although a replacement might not be on the job until late summer, just because any political appointee must pass a background check and clear any financial conflicts of interest. In the meantime, the Office of the National Coordinator for Health Information Technology is nearing the end of its search for a permanent deputy coordinator.

  • A successor likely will come from outside the federal government.

  • He does not have a new job lined up yet.

  • Brailer says that he originally agreed to take the job for two years because he doesn’t consider himself an inside-the-Beltway type. Indeed, the primary reason cited for his departure is the fact that his wife and young son are in San Francisco, and Brailer has been commuting coast-to-coast on a weekly basis, at his own expense. He joined the conference call from his San Francisco home—at 6:30 a.m. PDT.

  • Although he considers the job to be rewarding, Brailer talked of the hectic schedule and the many hours of “very tedious work.”

  • He says that his agenda is “ahead of schedule,” although it took about a year longer than planned to get the office fully up and running, mostly due to the fact that his office was locked out of federal appropriations for fiscal year 2005. That said, he says that the administration’s $150 million budget request for ONCHIT for fiscal 2007 “is about right.”

  • He has two chief concerns: that the health IT adoption gap between large health systems and small providers will persist; and that, once people get connected, they will not necessarily share information.

  • Brailer still struggles to get other federal departments to understand how the healthcare system works, though he says that many members of Congress are showing great interest.

I have an audio recording of the conference call and perhaps will post some snippets later this week. It was a government-sponsored event, so it’s in the public domain.

On a side note, Thursday marks the second anniversary of the executive order that created the position of national health IT coordinator.

April 24, 2006 I Written By

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

I wish I knew more

I’ve been getting a lot of traffic on this blog today, and at least a few of the searches that brought people here had to do with Dr. David Brailer’s resignation and speculation about who might replace him.

As far as I know, the Office of the National Coordinator for Health Information Technology has not said anything publicly, though Brailer will hold a media conference call on Monday. HHS Secretary Mike Leavitt did put out a short statement yesterday:

It is with regret that I have accepted Dr. Brailer’s resignation as the National Coordinator for Health Information Technology. Over the past two years, David has made significant progress in advancing the President’s health IT agenda and laying the building blocks for future progress.

While I will miss him here at HHS, I am pleased that David has agreed to serve as Vice-Chair of the American Health Information Community (The Community), which is charged with making recommendations to the Secretary of HHS to facilitate the development and adoption of standards-based health IT. David has helped the Community identify promising breakthroughs for near-term progress while continuing to move us closer to longer-term health IT goals. David will also continue to serve as a consultant to HHS to help lead the President’s health care transparency initiative.

Until a replacement for David’s position is announced, the work of the Office of the National Coordinator will continue under the leadership of the four permanent directors of the office.

There was nothing from the White House, either.

According to the story in the Financial Times today, Brailer is leaving because of family concerns. It’s well known that he has been flying back and forth to Washington from his home in San Francisco pretty much every weekend on his own dime, and that does not include all the travel that his job has required.

Brailer did say at the World Health Care Congress on Tuesday that he wouldn’t be around when President Bush’s 10-year deadline for bringing electronic health records to “most Americans” comes in 2014, but I’d hardly call that a hint that he would announce his resignation two days later. Rumors of him leaving because of the overwhelming workload have been around for at least a year, and nobody’s really taken them seriously.

I don’t have any insight just yet as to who his replacement might be, but suffice it to say that it will be someone with a firm grasp on IT, patient safety and healthcare finance, and who hews to the Bush administration’s preference for private-sector leadership and funding over a government-financed effort. The latter part rules out a lot of people.

I was remarking at the WHCC this week that despite the fact that the conference organizers trotted out a whole bunch of administration officials even as Bush’s popularity numbers plummet, the healthcare team the White House has put together has some pretty good credentials. You don’t see the army of political hacks that has pervaded other parts of the executive branch. Let’s hope it stays that way.

If anyone has any clues or suggestions about who might replace Brailer, I’d love to hear them.

And now back to the two other stories I am supposed to finish by the end of today….

April 21, 2006 I Written By

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

Low-tech e-prescribing?

I just got an e-mail from the Florida Health Care Coalition about its new campaign to reduce prescribing errors. No, it’s not a statewide e-prescribing initiative, but a sticker that says “I won’t accept a prescription if I can’t read the writing.” It’s a phrase that supposedly originated from former Treasury Secretary Paul O’Neill, now a patient-safety advocate in Pittsburgh.

The group asks people to wear the stickers when they visit their physicians or to attach smaller ones to their insurance cards. It’s less than subtle and not exactly high-tech, but it’s an idea.

Either way, it won’t prevent transcription errors on the pharmacy end of things.

April 20, 2006 I Written By

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

More from Europe

I can’t talk about my recent trip to Holland and Belgium without mentioning that I met in Brussels with an official from the European Commission e-health office.

While most everyone who cares about IT in healthcare knows about Connecting for Health (formerly the National Programme for IT) in England, there is plenty going on across Europe in the areas of patient-centered care and regional interoperability. I will be reporting on this in the coming weeks.

April 12, 2006 I Written By

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

Mea culpa

I must confess, I fell into the same trap so many millions of other Americans do when it comes to selecting a doctor. I took the recommendation of my internist for an orthopedic practice without consulting quality ratings or inquiring about prices.

And, because I am an individual with pre-existing conditions, I actually have a health savings account with a high-deductible health plan that excludes pretty much everything I usually get cared for, so I really do need to shop for quality and price.

I went to the orthopedist for a knee I injured playing ice hockey and, after some X-rays (on film, not digital) and an exam, he diagnosed a contusion and a sprain. I was to rest the knee when possible, keep the knee wrapped, ice it several times a day and take a double dose of ibuprofen with meals. Simple enough.

Four weeks and a follow-up exam later, I got the OK to test the knee with activities like cycling and skating. It’s certainly not 100 percent, and you won’t see me doing much running or jumping for a while, but it definitely feels better.

The three X-rays set me back $180. I’m still waiting to receive the doctor bill because the practice did submit an insurance claim. Hopefully it won’t be too much out of my pocket.

The physician did not even bother to order an expensive (and often unnecessary) MRI because he could tell by touch that there is no ligament tear, most likely just some cartilage damage. That means no surgery either.

In between the two orthopedic exams, I spent two weeks in Europe, doing a whole lot of walking on old, uneven cobblestone streets and sidewalks, and climbing numerous steep, creaky staircases. It was a little too chilly to rent a bicycle, so I didn’t have to subject my knee to any more work than necessary. The knee mostly held up.

I did, however, have a first-hand encounter with the Dutch health system, thanks to my own stupidity. I left one of my prescription medications back home and didn’t bring enough of another.

Fortunately, a pharmacy near my hotel in Amsterdam was very accommodating, and no, I am not talking about that kind of Amsterdam pharmaceutical vendor. It was about 2:30 p.m. in Amsterdam, which was 7:30 a.m. back in Chicago. My pharmacy at home was not yet open to look up refill information and my doctor was not in his office. No matter, since the local pharmacy would not fill a prescription anyway unless it came from a Dutch physician.

I figured I would have to wait in line at some walk-in clinic and hope for the best. Instead, the pharmacist called a nearby doctor’s office, gave the receptionist my name and told me to head right over there. Less than 30 minutes later, I had my script, and the pharmacy filled it right away. The total doctor’s fee was €13.25 (about $16).

The meds—both generics—actually cost a bit more than I would have paid at home. The lower European prices we hear so much about really only apply to brand-name drugs, but no matter, my vacation was saved.

This system turned out to be amazingly efficient and affordable, and yet I couldn’t get out of my mind the potential for error because the physician’s office did not even ask me for a medical history. All I gave them were my passport for identification, the bottle of the medication I didn’t have enough of and a piece of paper with the name and dosage of my other medication, plus, of course, my small cash payment. They had no proof I even was on the other medication. Neither drug was a narcotic or any sort of controlled substance (at least in the States), but I felt like there was a huge potential to cheat the system if I really wanted to.

I walked out the door with a handwritten script and walked it back over to the pharmacy, the old-fashioned way. The pharmacist did fill the prescription correctly, but she had to explain everything to me because the label, instructions and receipt were printed in Dutch. Fortunately, I was familiar with how to take the medications and potential side effects. If it had been a new prescription, I might have had a problem.

Yeah, I’m aware that the majority of Americans abroad don’t often bother to learn local languages (I studied French, not Dutch), but I could go to just about any pharmacy in the United States—certainly any of the major chains—and get detailed instructions in Spanish, Hindi, Russian or Korean. With the European Union and its open borders now stretching across 25 countries, you would think a Dutch pharmacy would have similar language capabilities. The drug suppliers ought to make sure of it.

Perhaps I’m making a big deal out of nothing, since the system worked and I got what I needed quickly and for not a lot of money, but it’s just another argument in favor of electronic prescribing. Besides, it’s my blog, I can say whatever I like.

I Written By

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