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Just short of begging

I’m teetering on the brink of attending MedInfo next month, the triennial meeting of the International Medical Informatics Association, which is represented in the United States by the American Medical Informatics Association. I went to the 2004 edition in San Francisco and came out of it with six months of story ideas. This time, the only problem for me is that MedInfo is in Brisbane, Australia, August 20-24.

So, rather than begging for cash (which I’m certainly not above doing), I’m willing to work for it. Therefore, I am publicly offering my services, for a fee, of course, for any publication interested in coverage of MedInfo and other conferences in Australia going on in August. These are:

The types of publications I’d like to find as freelance clients for MedInfo include:

  • Home health
  • Surgical IT
  • Public health
  • Linguistics
  • Open-source software
  • Nursing informatics
  • Dental informatics
  • African health/technology

If you have any information that might help me afford the trip, please e-mail me.

Thanks much for indulging me and for your continued interest in this blog.

July 30, 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.

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 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.

Politics and healthcare

Here are just a couple of links for the politically minded.

First off, the Kaiser Family Foundation has put up a site with health-related news about the many, many candidates for president in 2008.

And the Healthcare Update News Service, mostly a compendium of press releases from various companies that also has weekly updates from Health Affairs, has posted video of a March 28 speech by the always-entertaining Bill “Dr. HIPAA” Braithwaite from the Fourth Health Information Technology Summit on privacy and security issues that may hold back health information exchange. I saw the speech live, and I think it’s worth the 33 minutes. Even if you don’t have that much time, you can skip to the “chapters” most of interest, much like watching a DVD.

Quick links:
KFF 2008 politics site
Braithwaite speech on privacy and security issues

July 16, 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.

My dirty mind

When I first saw a news brief today about a statewide database for medical records in New York, I had to laugh. There was something about the name: Health Information Exchange of New York.

I thought there might be a reason that the state name came at the end, like perhaps to form an acronym. Then I realized that the initials, HIENY, might be pronounced as “hiney.” Talk about setting yourself up to be the butt of jokes (pun strongly intended)!

To my disappointment, I clicked on the link to the actual news story the brief came from and learned that the exchange is known as HIXNY.

Anyhoo …

Yet another health IT bill destined for inaction was introduced in Congress today, but at least this one seems to have some thought behind it. The proposed Independent Health Record Trust Act, from Rep. Dennis Moore (D-Kan.) and Rep. Paul Ryan (R-Wis.), calls for a national network of “trusts” to manage patient-owned health data.

“This forward-looking plan would utilize market forces to drive the creation of a fully interoperable, nationwide HIT network, while also taking additional steps to protect the privacy of sensitive medical information,” Moore said in a press release.

For those of you keeping score at home, Moore and Ryan had sponsored the Independent Health Record Bank Act in the last Congress, a bill that of course went nowhere. Perhaps there is greater political will this year. Perhaps not.

And speaking of National Health Information Network initiatives, there seems to be some opposition among RHIO leaders to the Office of the National Coordinator for Health Information Technology‘s NHIN contracting procedures, as this letter illustrates.

July 11, 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.

Podcast: SureScripts COO Rick Ratliff on proposed Medicare e-Rx rule changes

Right before America effectively shut down for an Independence Day that fell on a Wednesday and surely prompted some very long weekends, the Centers for Medicare and Medicaid Services proposed some modifications to various Medicare payment and provider eligibility rules. Among the proposals is a plan to remove computer-generated faxing from the CMS definition of electronic prescribing.
alter the Medicare Part D electronic prescribing regulations.

This move is bound to make some e-prescribing advocates very happy, particularly on the pharmacy side and among the patient-safety crowd. Case in point is Rick Ratliff, chief operating officer of e-prescribing connectivity network SureScripts, who joins me for this podcast to discuss the CMS proposal and the future of e-prescribing.

Podcast details: Interview with SureScripts COO Rick Ratliff on proposed Medicare Part D e-prescribing regulations. MP3, 64 kbps, 10.2 MB, running time 22:14.

1:00 What SureScripts does
2:08 Fax exemption in existing rule
3:07 What CMS is proposing
4:02 Impact of the proposed change
4:26 What vendors might have to do
5:37 Lack of financial incentives in Medicare e-prescribing rules
6:35 Why it’s a “potentially enormous” change
7:45 Two-way communication in e-prescribing
8:35 Savings from efficiency gains
9:33 Private payers following the lead of CMS
10:00 True electronic prescribing vs. electronic faxing
11:30 Public comment period for the proposal
12:43 What SureScripts might tell CMS
13:22 How to encourage physicians to adopt e-prescribing
15:02 Physician attitudes toward patient suggestions
16:45 The tipping point
17:50 Is this a competitive battleground for pharmacies?
18:37 How retail pharmacies view e-prescribing
19:30 Effect of e-prescribing on patient and physician expectations
20:07 New SureScripts technology to report back to physicians on fill rates
21:25 E-prescribing effect on healthcare quality

July 5, 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.

Say what?

I generally try to stay apolitical on this blog and in my writing, but I got an unbelievably shocking e-mail from the Cato Institute this week: “Join the Anti-Universal Coverage Club!” said the subject line, exclamation point included.

According to the e-mail, and these words are verbatim:

  1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
  2. To achieve “universal coverage” would require either having the government provide health insurance to everyone or forcing everyone to buy it. Government provision is undesirable, because government generally does a poor job of improving quality or affordability. Forcing people to get insurance would lead to a worse health-care system for everyone, because it would necessitate so much more government intervention.
  3. In a free society, people should have the right to refuse health insurance.
  4. If governments must subsidize, they should be free to experiment with cash subsidies, vouchers, insurance coverage, public clinics & hospitals, uncompensated care payments, and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”

The first point certainly is valid. Wide availability of quality certainly is a worthy goal. But does it mean availability to everyone who wants it?

The other points all raise questions, such as, if government intervention in healthcare is so bad, why is Medicare so sacrosanct in U.S. policy-making and why is the Veterans Health Administration held in such high esteem?

Sure, some people may lose the right to refuse health insurance under certain proposals, but that likely will end up varying state-by-state, similar to automobile insurance laws. (Here in Illinois, people have the right to refuse to wear helmets while riding motorcycles, but is that really such a great idea?)

I’m guessing that this Cato e-mail was prompted by two things: the push for universal coverage in key states like Massachusetts and California and the release of the movie “Sicko.” Well, California Gov. Arnold Schwarzenegger gave the closing keynote address to the annual meeting of America’s Health Insurance Plans the week before last, and he was warmly received since private health plans stand to benefit greatly from his flavor of universal coverage.

As for “Sicko,” the rumored appearance of Michael Moore at the AHIP meeting never materialized, but the filmmaker’s presence certainly was felt. The impending release of the movie was on the minds of a lot of attendees, and I heard an AHIP media representative on the phone, giving an impassioned defense of private insurance to an out-of-town reporter. (At the time, the film hadn’t been released, and nobody I know had seen anything more than the trailers.) Further, AHIP CEO Karen Ignani had an op-ed in USA Today last Friday, the day of the movie’s release.

I haven’t seen the movie myself yet, but I have noticed that the debate so far has delivered a deafening silence in the areas of quality and efficiency. How can any discussion of healthcare reform forget such important points?

July 2, 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.