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Berwick, after the fact

The tragedy of Dr. Don Berwick’s short tenure as head of the Centers for Medicare and Medicaid Services has been well-documented, including right here on this blog. Berwick got in by a controversial recess appointment because President Obama didn’t have the political courage to fight for his nominee and allow Berwick to face the Democratic-controlled Senate. Berwick, of course, quit late last year when it became clear Obama would not renominate Berwick for the job he is uniquely qualified for.

There have been a number of postmortems in the press, where Berwick discussed his experience running CMS, including the challenges of implementing both the HITECH Act and the Patient Protection and Affordable Care Act and his. continuing efforts to improve the quality of care in this country. But I haven’t seen one quite as good as what Dan Rather just produced.

The former CBS News anchor has been toiling in relative obscurity at HDNet, a hard-to-find cable network run by billionaire Mark Cuban. Fortunately, Rather took to the far more popular Huffington Post this week to share his thoughts on a recent interview he conducted with Berwick.

“Dr. Don Berwick, a pediatrician by training, came to Washington with a sterling reputation among people who actually know something about health care. He had helped pioneer the Institute for Healthcare Improvement, which may sound like another pointy-headed D.C. think tank, but really is a Cambridge, Massachusetts-based organization lauded the world over for helping make health care systems better. For example, they have worked with hospitals on common sense techniques to reduce hospital infections. These are serious people who are welcomed in hospitals and clinics across the country and around the world,” Rather wrote on HuffPo.

That’s right, Rather understood Berwick’s background, unlike, say Dr. Scott Barbour of a crackpot group called Docs4PatientCare. “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,’” read a pitch I received from that organization last year.

I’ve been over this before. Berwick has probably done more to improve the quality of care and save lives than anybody else on the planet today. Some of the people who publicly opposed his nomination privately knew this, as Rather’s interview with Berwick demonstrates:

Yes, most of the opposition was an elaborate lie perpetrated for political gain. In today’s Washington, is anybody surprised? The losers once again are the American people and anybody who comes to this country for healthcare.

Health Wonk Review, unadorned but chock full of health IT

In the latest edition of Health Wonk Review, hosted by Chris Fleming on the estimable Health Affairs blog, there’s not much in the way of a fun theme, but that’s OK. It’s still full of some good perspectives, including more than the usual share of health IT.

My post that aggregated a bunch of tweets from the Health 2.0 Conference made the biweekly blog carnival, as did a much longer-form way of covering the event, David Harlow’s series of video interviews. Harlow got 18 different people on camera, including HHS gurus Todd Park and Dr. Farzad Mostashari.

Elsewhere, patient advocate Jessie Gruman, president and founder of the Center for Advancing Health, took on mobile apps as a means of changing patient behavior, Tom Lynch of the Workers’ Comp Insider blog discussed predictive modeling in healthcare claims administration and Healthcare Economist blog author Jason Shafrin wonders why patients don’t seem to care much about healthcare quality.

In particular, I invite you to share Shafrin’s short post, if for nothing more than a conversation starter.

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October 13, 2011 I Written By Neil Versel

Filed Under: data mining health 2.0 health IT Health Wonk Review Healthcare IT mobile quality

Tags:Farzad Mostashari Health Affairs healthcare claims patient safety predictive modeling quality smartphone apps Todd Park

Not so elementary, my dear Watson

In just the last few hours, I’ve seen a huge wave of pushback and doubt about Watson, the IBM supercomputer, being used for clinical decision support.

Yesterday, I covered a “healthcare leadership exchange” at IBM’s new Healthcare Innovation Lab in downtown Chicago. I posted some of my observations on the EMR and HIPAA blog, and made the case for diagnostic decision support.

I also wrote a story for InformationWeek, but that hasn’t run. Instead of posting my story, InformationWeek healthcare editor Paul Cerrato wrote a column about Watson already being “beaten in the medical diagnostics race” by Isabel Healthcare, a diagnostic decision support tool that’s been available for years. I have to admit, he’s right. I first interviewed Isabel founder Jason Maude probably in 2002 or so, and I first blogged about the company in 2005. I mentioned Isabel in a 2007 post that, interestingly, also alluded to the work of Don Berwick and Larry Weed.

Cerrato mentioned Jerome Groopman’s 2007 book, “How Doctors Think,” which discussed, in part, how IT could help doctors avoid many types of cognitive errors. “[D]octors tend to lean toward diagnoses that are most available to them in their day-to-day routine,” Cerrato wrote (emphasis in original). That’s exactly what Weed has said for decades, and exactly what Atul Gawande talked about in his groundbreaking book, “Complications.” Computers should not make decisions for physicians, but rather should help them reach the right conclusions, particularly when they see rare cases.

Wouldn’t you know, “e-Patient” Dave deBronkart commented on my EMR and HIPAA post to say he just finished reading Groopman’s book. He tweeted a link to my post, which a few of his 6,500 other Twitter followers noticed. They also noticed EMR and HIPAA grand poobah John Lynn’s comment that the example in yesterday’s Watson demo, a 29-year-old pregnant woman being prescribed doxycyline was “pretty weak.” (He’s right, by the way.) Aurelia Cotta, who blogs about issues such as infertility and adoption, started this thread that also got South Carolina nurse Sunny Perkins Stokes interested:

[blackbirdpie url=”http://twitter.com/#!/AureliaCotta/status/76775042503028737″]

[blackbirdpie url=”http://twitter.com/#!/AureliaCotta/status/76775279565090816″]

[blackbirdpie url=”http://twitter.com/#!/sunnystill/status/76776486119555072″]

[blackbirdpie url=”http://twitter.com/#!/AureliaCotta/status/76782462893699072″]

[blackbirdpie url=”http://twitter.com/#!/AureliaCotta/status/76782822198743040″]

[blackbirdpie url=”http://twitter.com/#!/AureliaCotta/status/76783250663682048″]

[blackbirdpie url=”http://twitter.com/#!/sunnystill/status/76783933106307072″]

[blackbirdpie url=”http://twitter.com/#!/AureliaCotta/status/76784835267534848″]

[blackbirdpie url=”http://twitter.com/#!/AureliaCotta/status/76785122996789248″]

Well, there’s a reason why I call myself a “healthcare” reporter and not a “medical” reporter. I don’t know the science, and I do occasionally get myself in trouble when I start talking about things like whether doxycycline is contraindicated during pregnancy. (To my credit, I did attribute the statement to IBM’s chief medical scientist, Dr. Marty Kohn.)

As I was reading the above tweets and contemplating this blog post, I came across a link to some tongue-in-cheek pushback against Watson in healthcare. An anonymous radiologist who blogs about PACS as “Dr. Dalai” compared Watson to HAL, the diabolical mainframe in “2001: A Space Odyssey.” Dr. Dalai wrote: “Watch out, boys and girls, Watson is headed to a hospital near you, and he (it?) may challenge you as much as he did Ken Jennings.” Jennings, of course, is the Jeopardy! champion whom Watson beat earlier this year.

At first glance, I thought Dr. Dalai was yet another whiny physician clinging to the status quo. But he hit on the real issue: application of knowledge. Quoting from an interview with one of Watson’s programmers, Dr. Dalai noted that the supercomputer is being loaded with all kinds of medical reference material in preparation for “learning” human physiology and ultimately gathering experience in medicine. “This isn’t fair! If I could just take a text book, stick it up my, ummmm, brain, and have it instantly memorized, I would be whiz, too!” he wrote.

Yeah, isn’t that the whole point of clinical decision support?

ONC opens comments on federal HIT strategic plan

The Office of the National Coordinator for Health Information Technology today opened a four-week comment period on proposed revisions to the Federal Health IT Strategic Plan (pdf). Last updated in 2008, the plan spells out ONC’s strategy for meeting national health IT goals for the five-year period beginning in 2011. The HITECH Act requires this revision.

According to a blog post by national coordinator Dr. David Blumenthal:

Some components of the Plan may already be familiar, including the Medicare and Medicaid Electronic Health Record Incentive Programs and the grant programs created by the HITECH Act, which are creating an infrastructure to support meaningful use. However, the Plan also charts new ground for the federal health IT agenda:

In Goal I, the health information exchange strategy focuses on first fostering business models that create health information exchange, supporting exchange where it is not taking place, and ensuring that information exchange takes place across different business models.

In Goal II, we discuss how integral health IT is to the National Health Care Quality Strategy and Plan that is required by the Affordable Care Act.

In Goal III, we highlight efforts to step up protections to improve privacy and security of health information, and discuss a major investment in an education and outreach strategy to increase the provider community and the public’s understanding of electronic health information, how their information can be used, and their privacy and security rights under the HIPAA Privacy and Security rules.

In Goal IV, we recognize the importance of empowering individuals with access to their electronic health information through useful tools that can be a powerful driver in moving toward more patient-centered care.

In Goal V, we have developed a path forward for building a “learning health system,” that can aggregate, analyze, and leverage health information to improve knowledge about health care across populations.

ONC is accepting comments through April 22 via the blog site.

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March 25, 2011 I Written By Neil Versel

Filed Under: health IT health reform ONC

Tags:ARRA David Blumenthal Federal Health IT Strategic Plan HIPAA Patient Protection and Affordable Care Act population health privacy quality security

Health Wonk Review, summer research edition

I haven’t blogged a lot lately because the real work tends to get in the way. There’s only so long I can spend in front of the computer each day before I start to get a little antsy. OK, a lot antsy.

Fortunately, others are more focused on their blogs than I am, and that brings me to the latest iteration of Health Wonk Review, hosted by Brad Wright at the Health Policy Analysis blog. With summer here, this is the last edition of HWR until July 22, because, let’s face it, everybody needs a break from time to time.

Wright focuses quite a bit on research, but does link to one IT post and another about the patient-centered medical home. He also includes some editorial cartoons culled from around the Web, notably this one from Orlando Sentinel cartoonist Dana Summers. The elephant in the room re: health reform is tort reform, Summers suggests. Yeah, we haven’t addressed the liability problem yet, but the fee-for-service payment system is, in my humble opinion, the greatest culprit. There’s that little matter of poor quality, too.

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June 28, 2010 I Written By Neil Versel

Filed Under: health reform Health Wonk Review

Tags:medical liability patient-centered medical home quality

You want solutions for consumer ignorance about health IT? OK

Monday in FierceHealthIT, I wrote a commentary about a new study from the California HealthCare Foundation that found that consumers still equate more care with better care. The study, published in Health Affairs, concluded that evidence-based medicine is a foreign concept among the general public.

In my commentary, I derided the whole premise of the report. I mean, many people in healthcare aren’t completely clear about what evidence-based medicine is. I also criticized mass media for not doing a good job educating the public about quality of care, particularly in the sham of a debate over health reform in the last year or so. It’s not the first time I’ve said something to this effect.

Within three hours of my commentary being posted, one anonymous coward posted the following comment on the FierceHealthIT page: “So Neil, instead of the snark, how about some solutions? You’re a journalist – isn’t the public’s ignorance your failing?”

Well, Mr. or Ms. Coward, no, the public’s ignorance is not my failing. If I had had access to mainstream news outlets, I would have asked the tough questions of the politicians, policymakers and lobbyists, not fueled the red herring of a debate over whether healthcare reform was about government control or not. It’s quality, stupid. I continue to try to pitch mainstream media about freelance gigs, but, alas, everyone’s either cut their freelance budgets to the bone or they won’t give the time of day to someone they don’t know or who doesn’t have some kind of insider connection.

And, to Coward’s other point, I have offered some solutions. If you weren’t so knee-jerk in your anonymous condemnation of my snark, you would know that I recently wrote a piece for journalists about covering EHRs and related health IT topics.
It’s over on the site of the Reporting on Health project at the University of Southern California’s Annenberg School for Communication.

While you’re at it, you might want to check some of my other Fierce columns about how people both in the media and the health IT industry need to do a better job of communicating the issues. They’re not hard to find. In fact, here’s one to get you started.

Next time, don’t be such a coward. And an uninformed one at that.

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June 9, 2010 I Written By Neil Versel

Filed Under: consumerism media

Tags:EMR evidence-based medicine quality

A must-read from Dr. Weed

Kudos to The Health Care Blog for publishing a long, two-part treatise this week from the legendary Dr. Larry Weed and his attorney son, Lincoln Weed, who talk about how “evidence-based medicine” really just represents educated guessing.

Dr. Weed has been arguing for close to half a century in favor of computers in medicine to aid in decision-making because the unaided human mind simply cannot recall all possible permutations of symptoms at the point and time of care. It’s been an uphill battle his whole career because he directly challenges so many elements of the medical establishment, but this is someone whom Don Berwick considers a hero.

It’s a long piece, broken into five installments, and it’s highly academic, even including endnotes, but worth your while.

Part 1: Medicine’s Missing Foundation for Health Care Reform

Part 2: Medicine and the Development of Science.

Part 3: Economy of Knowledge in Decision Making

Part 4: Harvesting Medical Knowledge from Patient Care

Part 5: Patient Autonomy

It’s the quality, stupid.

At the risk of sounding partisan—and I do my best to be unbiased in my actual journalism—I have to call out Sen. John McCain for an ad that he’s been running about healthcare. “The problem with healthcare in America is not the quality of healthcare, it’s the availability and the affordability.”

Say what?

Someone had better brief him on the two Institute of Medicine reports, “To Err Is Human: Building a Safer Health System” (1999) and “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001), not to mention the countless other academic studies that have followed in recent years questioning the adherence of physicians and hospitals to established quality metrics.

Watch for yourself.

This sounds like McCain is trying to play the patriotism card by insinuating that we have the best health system in the world simply because we’re the United States of America. Yes, cost and access are huge issues, but so is quality. Ask anyone who has ever been prescribed the wrong medication or acquired a MRSA infection in a hospital.

For his part, Sen. Barack Obama has not really run any commercials related to healthcare, but he does focus on cost in his discussion of quality on his campaign Web site.

Clearly, this issue is more esoteric and less sexy than, say, Hurricane Ike or the Wall Street crisis, but someone needs to explain to both candidates that quality really is a problem in American healthcare. Perhaps these two senators are part of the reason why Congress has done virtually nothing on health IT?

Berwick, after the fact

Health Wonk Review, unadorned but chock full of health IT

Not so elementary, my dear Watson

ONC opens comments on federal HIT strategic plan

Health Wonk Review, summer research edition

You want solutions for consumer ignorance about health IT? OK

A must-read from Dr. Weed

It’s the quality, stupid.

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