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Monday, April 22, 2013

"REBOOT" report, continued

Gotta love this:
For Good Policy Making, Facts Must Matter
By Joseph Goedert
APR 21, 2013 9:15pm ET

“None of the required core or menu objectives in Stage 2 requires communication with other health care providers. This means steps toward interoperability are neither being required nor measured.”

That’s what six United States Senators actually say in a new report from the Republican caucus that is critical of progress made in the electronic health records meaningful use program. The senators, along with six sets of aides and any other “experts” who may have assisted with the report, clearly didn’t do much homework.

They missed these objectives clearly designed to compel provider-to provider data exchange: Provide a summary of care for transitions of care or referrals, generate and transmit electronic prescriptions, and incorporate lab results into EHRs as structured data. There also are multiple other objectives clearly aimed at accelerating interoperability, such as giving patients access to their records, use of secure messaging, submitting syndromic data to public health agencies and reporting cancer cases to registries...
"Facts must matter?" To Senators and Congressmen/women? Really? The author continues.
There is nothing wrong with Congress overseeing the executive branch; that is a constitutionally assigned duty. And the opposition party generally does a better job of oversight. The GOP senators have valid concerns about EHRs accelerating the ordering of unnecessary care, lax data security, and worries of sustainability after incentive payments run out.

If opposition lawmakers had not shown their true colors—that they don’t like the idea of the President having a successful program--then an airing of their concerns could result in improving the meaningful use program. But when the opposition party has a stated top priority of ensuring that the President of their nation fails on all counts, then facts, truth and informed decisions no longer have value.
Well, when I first saw mention of this report, "six Republicans only?" struck me. Last fall, GOP members of the House tried to foment a similar ruckus.

I'm not finished reviewing this "white paper" -- being on vacation in Hawai'i since Thursday, -- but I will.


Above: shot this yesterday from atop Diamond Head. Moments after I took this pic, we got rained on heavily.

Below, apropos of "health care," as I was hiking up to the summit, I saw a fire & rescue helo descend quickly and sharply down into the crater floor parking area. You could see them offloading a patient into an ambulance. The bird then ascended right back up to the tiny pad just off the summit. I waited for them to lift off again.

Pretty dramatic. Hope those being rescued were OK.


I reached out last week to the Hawai'i Health Information Exchange leadership to inquire as to whether I might stop by to do an interview for my KHIT initiative. We settled on noon today (Monday, the 22nd). I showed up with my gear in tow, but the E.D., Christine Mai‘i Sakuda, begged off, saying she was in the process of hiring a marketing/media specialist (pdf), and didn't want to step on a pending unified media message by giving a premature off-the-cuff interview to "some blog."

I was disappointed, but I can see it from her perspective. Who's this dude from the mainland with "some blog". And, they were all very busy and very pleasant. I did not realize, as I learned from Christine, that their HIT service area extends all the way out to far-flung provincial places such as Guam and American Samoa. That's gotta be pretty challenging. Their service area comprises perhaps less than a half percent of U.S. population (~0.44%) but spans a huge pacific geographic area. Nearly 3/4 of Hawaii's population is in the Honolulu County metro area. Hooking that all up with HIE should be a relative cinch. Viably and justly serving the remained of the far-flung jurisdiction is quite another matter.

Unlike my fractious and transient state, they do have some cultural factors running in their favor, but, boots on the ground are very important, and those have to be an expensive proposition for HHIE.

Cheryl and I day-tripped out to the north shore, hoping to see and shoot some of the famous big surf (alas, the ocean was calm). Ran across this clinic along the way. They're up live on GE Centricity "How do you like it? "It's OK."

I'd have like to have probed her in-depth regarding HHIE's successes and barriers to date for KHIT, but, maybe there will be another time -- though I got the sense that they'd soured on me and my entreaty. Notwithstanding that I'm not from "60 Minutes."

Nice of them to see me at all on short notice and such unpreparedness, one supposes.

I just subsequently schlepped over to the piers area by the Aloha Tower and shot a bunch of cool pictures, then hopped the 19 bus back to the hotel after having a bit of lunch.

I'll just have to save this quick little audio setup piece I did in the hotel room this morning (mp3), in case I ever get to use it. Below, KHIT studios, room 611, Hilton Waikiki.


Link to complete article here.

You can bet the EHR audit log analysts will be working overtime with regard to this patient.

U.S. hospitals send hundreds of immigrants back home

By Associated Press
Posted: April 23, 2013 - 8:00 am ET

Days after they were badly hurt in a car accident, Jacinto Cruz and Jose Rodriguez-Saldana lay unconscious in an Iowa hospital while the American health care system weighed what to do with the two immigrants from Mexico.

The men had health insurance from jobs at one of the nation's largest pork producers. But neither had legal permission to live in the U.S., nor was it clear whether their insurance would pay for the long-term rehabilitation they needed.

So Iowa Methodist Medical Center in Des Moines took matters into its own hands: After consulting with the patients' families, it quietly loaded the two comatose men onto a private jet that flew them back to Mexico, effectively deporting them without consulting any court or federal agency.

When the men awoke, they were more than 1,800 miles away in a hospital in Veracruz, on the Mexican Gulf Coast...
The article goes on to say that the PPACA is expected to exacerbate this kind of problem by cutting hospital reimbursements in cases of the indigent uninsured typified by undocumenteds and illegals.

But, you need not have brown skin and a chattery staccato vato foreign language to get dumped. From my 1996 essay "1 in 3"
Sissy Sue

Since high school, my daughter had wanted so intensely to be an actress. Drawn to the glamour of Hollywood, she struggled for years at the periphery of "The Industry" (as she called it), her quest made all the more difficult by her refusal to accept offers involving even "softcore" nudity. Her tenuous existence of spotty sportswear catalog modeling assignments, trade shows, minor syndication TV work, and the occasional music video extra was typical of what I once characterized as "the innumerable, chronically impecunious actress/model wannabees that overpopulate southern California."

Things were finally looking up a bit, however. A few career puzzle pieces were falling into place, helpful contacts established, the doors opening just a crack. A layout for Shape Magazine was in the works, and Sissy was training feverishly at Gold's Gym in Venice Beach to be at her physical peak.

And indeed she was. She reveled in her ability to effect the dramatic entrance, with heads turning in concert upon her arrival. The spectacle of what I called "The Sissy Sue Mafia," a dazzling cohort of shapely, dressed-to-kill "babes" sweeping into a party, nightclub, or restaurant, was a sure-fire attention-getter. I would muse 'enjoy it while it lasts.'

Ruminating, of course, on the implications of aging...

The State Street exit

"LAC," Los Angeles County Hospital/USC Medical Center is a 70-year old earthquake-scarred concrete bunker located in a gritty area just east of the shiny, elegant office towers of downtown. Reeking of urine deposited in the stairwells and elsewhere by impatient visitors and the homeless who inhabit the shrubbery surrounding the four-feet thick walls, it resounds with a cacophony of the myriad tongues of the multicultural quilt of southern California. Polyglot physicians of Oriental, European, and Hindu extraction, of necessity, speak fluent Spanish; glazed-looking patients in flimsy hospital gowns, tethered to IV's hung from mobile stands, panhandle in the hallways for spare change or cigarettes; sullenly menacing, tattooed prisoners in orange jumpsuits and heavy shackles shuffle in and out of service elevators aside heavily armed police escorts. By day a crush of humanity crowds the halls. By night security is everywhere visible and vigilant.

Last year the Los Angeles Times reported there to be an estimated 4.4 million "medically indigent" residents in the L.A. basin, a figure that includes welfare clients and the uninsured "working poor." For many of them, LAC/USC is a familiar-- if less than pleasant-- place, a sprawling, frayed complex where cutting-edge clinical education, expertise, and heroism coexist with intractable socioeconomic and bureaucratic chaos.
Add one previously carefree and clueless young blonde to the 4.4 million aggregation on April 19th, 1996. Welcome to 1200 State Street.
Sissy and some friends had been out the previous evening celebrating her pending good fortune when she suddenly came down violently ill. Suspecting tainted sushi, they took her to Emergency at Cedars Sinai Medical Center in Beverly Hills, where an ultrasound image pointed toward something vastly more ominous. At around 2 a.m., having been heavily sedated, she was transported to LAC-- end of the line for the uninsured acutely ill-- where she awoke and called me in a panic that Friday morning. Unaware that she'd been moved during the night, she had to ask an aide where she was; I could hear "1200 State Street" in an odd dialect in the background...
All dutifully EMTALA compliant.

The irony in all of that was that County (now closed) had one of the top hepatic surgical services in the world. They saved Sissy from imminent demise, and help give me 26 months with her I'd have surely not otherwise have had.


Saw this on TV in the hotel room this morning.


Top Dem sees 'train wreck' for Obama health law
Co-author of Obama health care law sees 'huge train wreck' in implementation

Ricardo Alonso-Zaldivar, Associated Press

WASHINGTON (AP) -- A senior Democratic senator who helped write President Barack Obama's health care law stunned administration officials Wednesday, saying openly he thinks it's headed for a "train wreck" because of bumbling implementation.

"I just see a huge train wreck coming down," Senate Finance Committee Chairman Max Baucus, D-Mont., told Obama's health care chief during a routine budget hearing that suddenly turned tense.
Baucus is the first top Democrat to publicly voice fears about the rollout of the new health care law, designed to bring coverage to some 30 million uninsured Americans through a mix of government programs and tax credits for private insurance that start next year. Polls show the public remains confused by the complexity of the law, and even many uninsured people are skeptical that they will be helped.

A six-term Democrat, Baucus expects to face a tough re-election in 2014. He's still trying to recover from approval ratings that nosedived amid displeasure with the health care law in his home state.
Normally low-key and supportive, Baucus challenged Health and Human Services Secretary Kathleen Sebelius at Wednesday's hearing.

He said he's "very concerned" that new health insurance marketplaces for consumers and small businesses will not open on time in every state, and that if they do, they might just flop because residents don't have the information they need to make choices.

"The administration's public information campaign on the benefits of the Affordable Care Act deserves a failing grade," he told Sebelius. "You need to fix this."

Responding to Baucus, Sebelius pointedly noted that Republicans in Congress last year blocked funding for carrying out the health care law, and she had to resort to raiding other departmental funds that were legally available to her.

The administration is asking for $1.5 billion in next year's budget, and Republicans don't seem willing to grant that, either...
Cut and run, Max.

Not that I'm a particularly big fan of this aspect of PPACA. I followed every word of every draft as it wound its way through The Hill. My dubiety is rather well established via a series of posts on my blog (linked in the upper right links column).

It seems that the GOP, abetted by grandstanding hypocrites such as Baucus, will do their level best to ensure that the HIX aspect of the ACA crashes and burns.

Interesting, timely update. Just arrived in my email inbox (Wed, 224th):


Austin Frakt writes at a great blog known as "The Incidental Economist." One of my routine daily stops, along with SBM and THCB.


HealtHIE Nevada officially launches its website.
Pretty proud that I got to name the HIE (including the tag line). The vendor did a fine job here, site looks great.

More to come...

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