The KHIT Blog: From the REC Blog, adieu 2012

Sunday, December 30, 2012

From the REC Blog, adieu 2012

I'll be working on New Year's Eve day, just in case I have to assist some 2012 Attestation stragglers who want to close it out (I had four docs attest on Friday). Notwithstanding that EPs have until the end of February 2013 to do their 2012 MU Attestations, ONC is leaning on RECs to get 'em done before CoB 12/31/2012 -- to help make them look good on the Hill.

Like it's gonna matter.

That aside, I've been exhorting my own caseload to get it done the sooner the better. You just cannot know what may fall out of this down-to-the-wire Fiscal Cliff circus in DC.

A BIT OF ANTI-HIT CARPING FUN

Saw this today on a blog:

All patients will suffer as the funds go to pay for HIT devices that have no proof of efficacy or safety, while medicine can not be afforded or covered, and sick patients get sent to pasture at commercial nursing homes and LTACS. What has become of the way this country treats its sick and defenseless?

The commenter was, of course, untraceable (no link in the screen name).

Let me help you out. From Healthcare Informatics:

Report: Health IT Spending to Exceed $69 Billion over Six-Year Period

Providers, payers, and physician groups will be spending over $69 billion on healthcare related IT and telecommunications services over the next six years, according to a market research study released by the Mountain Lakes, N.J.-based Insight Research Corporation. The report says that spending by the US healthcare industry on telecommunications services will grow at a compounded rate of 9.7 percent over the forecast period, increasing from $9.1 billion in 2012 to $14.4 billion in 2017. as the number of healthcare locations expands by 16 percent and the healthcare employment rate increases 2.5 times faster than the total national employment rate...

Big dough, no doubt. Let's round up to an E-Z "$70 billion" and mull over some context.

From CMS, regarding estimates of annual "NHE" (National Health Expenditures, in billions, table on page 6):

2012: $2,809.0

2013: $2,915.5

2014: $3,130.2

2015: $3,307.6

2016: $3,514.4

2017: $3,723.3

~$19.4 trillion. Now, there's some big dough. OK, $70 billion of HIT divided by $19.4 trillion of NHE is...

0.361%

That's not a typo. ~ a third of one percent (if you want to go all "zero degrees of freedom" pedantic, subtract the $70 billion from the denominator to make the two a ratio comparison -- barely moves the needle).

None of this unreflective fellow's lament even begins to consider "netting out," either, i.e., unless you're advocating eliminating medical recordkeeping entirely, the net cost of migrating from paper charts to digital HIT (difficult as the ROI calculations may be in individual scenarios), is vanishingly small.

I took one last shot at this guy on his "safety" and "efficacy" assertions:

As to perfect “proof,” I guess we should all yet be riding around in oxcarts and on donkeys, given the bloody history of incremental alternative transportation safety improvements. We won’t even try to “net out” the relative antecedent safety record of Flintstone Travel.

There is indeed much that is materially lacking in the way we administer health care. Health IT is not a big part of the problem. And, better Health IT will be a significant component of any “solutions.”

Gotta love it.

BACK TO OUR DC DRAMA...

Countdown

Monday morning update:
NO HIPAA OMNIBUS FINAL RULE THIS YEAR

29 Rules issues today. HIPAA is not among them. Oh, well.

At least...

Oh, wait...

I know we're all busy, but I've posted 54 blog posts -- all in my spare time -- in the 193 days since I announced the public "launch" of ARCH-IT.

DR. NOVELLA'S LATEST

Nutrigenomics – Personalized Pseudoscience
Published by Steven Novella under Science and Medicine

I wrote last week about the problem of stem-cell quackery throughout the world, mostly in poorly regulated countries but with the purpose of attracting international customers. Stem cells are real, and the science of developing medical applications of stem cells is both real and promising, but these stem cell clinics are making claims that are years or decades ahead of the science. They are capitalizing on stem cell hype as a marketing ploy to those who are more desperate than scientifically savvy.

I was asked to comment on yet another example of the same phenomenon – nutrigenomics. That’s a very impressive-sounding name, just like a real science, but as always the devil is in the details. The claim is that by analyzing one’s genes a personalized regimen of specific nutrients can be developed to help their gene’s function at optimal efficiency. One website that promises, “Genetics Based Integrative Medicine” contain this statement:

Nutrigenomics seeks to unravel these medical mysteries by providing personalized genetics-based treatment. Even so, it will take decades to confirm what we already understand; that replacing specific nutrients and/or chemicals in existing pathways allows more efficient gene expression, particularly with genetic vulnerabilities and mutations.

The money-quote is the phrase, “it will take decades to confirm what we already understand.” This is the essence of pseudoscience – using science to confirm what one already “knows.” This has it backwards, of course. Science is not use to “confirm” but to determine if a hypothesis is true or not...

(Read on)

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Science-based medicine:
DR. GORSKI'S LAST POST OF THE YEAR

Closing out 2012 with a bit of fun: Do you want some quantum with that pseudoscience?
Published by David Gorski under Basic Science,Health Fraud, Humor

...Among the favorite real science term that quacks love to appropriate is “quantum.” I blame Deepak Chopra. Although I highly doubt he was the first promoter of alternative medicine and various New Age thought to use and abuse the term “quantum” as a seemingly scientific justification of what in reality is nothing more than ancient mystical thinking gussied up with a quantum overcoat to hide its lack of science, Chopra has arguably done the most to popularize the term among the science-challenged set. In Chopra’s world, the word “quantum” functions like a magical talisman that explains™ everything because in the quantum world anything can happen. Actually, I should clarify. While it’s true that many bizarre and wondrous things can be explained through quantum theory (such as quantum entanglement), it is not, as Chopra and his many imitators would have you believe, a “get out of jail free” card for any magical thinking you can imagine, and quantum effects do not work the way people like Chopra (say, Lionel Milgrom, who seems to think that homeopathy works through quantum entanglement between practitioner, remedy, and patient) would like you to think...

Yeah... Read on.
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More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Sunday, December 30, 2012

From the REC Blog, adieu 2012

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