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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.


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...


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.


Monday morning update:

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.


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)

Science-based medicine:

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.

More to come...

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