The KHIT Blog: Health IT down the drain

Monday, August 26, 2013

Health IT down the drain

Billions wasted on fruitless bid to create paperless vet health records

By Hannah Winston, News 21

The Department of Veterans Affairs and the Department of Defense spent at least $1.3 billion during the last four years trying unsuccessfully to develop a single electronic health-records system between the two departments — leaving veterans’ disability claims piling up in paper files, a News21 investigation shows.

This does not include billions of dollars wasted during the last three decades, including $2 billion spent on a failed upgrade to the DOD’s existing electronic health-records system.

For a veteran in the disability claims process, these records are critical: They include DOD service and health records needed by the VA to decide veterans’ disability ratings and the compensation they will receive for their injuries.

Although Congress repeatedly has demanded an “integrated” and “interoperable” electronic health-records system, neither the DOD nor the VA is able to completely access the other’s electronic records. Meanwhile, each has spent hundreds of millions of dollars on upgrades to its information technology and on attempts to improve interoperability between their systems.

At a July congressional hearing, Rep. Jeff Miller, R-Fla., said he was disappointed and frustrated. “The only thing interoperable we get are the litany of excuses flying across both departments every year as to why it has taken so long to get this done,” said Miller, the chairman of the Veterans Affairs Committee...

But wait! There's more!

Behemoth breach sounds alarm for 4M
Advocate Health reports second biggest HIPAA breach ever
DOWNERS GROVE, IL | August 26, 2013

Advocate Health System announced that the theft occurred at one of its Advocate Medical Group administrative building in Park Ridge, Ill. on July 15. Patient names, addresses, dates of birth, Social Security numbers and clinical information – including physician, medical diagnoses, medical record numbers and health insurance data — were all contained on the computers, officials say.

Health system officials have contacted local law enforcement to investigate the incident but have been unable to locate the computers.

"We deeply regret that this incident has occurred," wrote Kevin McCune, MD, chief medical officer of Advocate Medical Group, in an Aug. 23 letter mailed to affected patients. "In order to prevent such an incident from reoccurring, we have enhanced our security measures and are conducting a thorough review of our policies and procedures."...

"...we have enhanced our security measures and are conducting a thorough review of our policies and procedures"?

Really? After the fact? Seriously? To determine, say, whether they were HIPAA Omnibus-compliant one month out of the deadline?

How much actual healthcare money has to be foregone in the service of all this incompetence?

HIX UPDATE

Republican hardliners are pushing GOP senators to sign a stunt "pledge" to "defund Obamacare."

Well, I screen-scraped the current status tally off their website and droped it into Excel.

There are 47 GOP Senators. 14 have signed, 9 have stated that they will not, and 24 are tiptoeing past the graveyard.

Boys, you don't have the votes, and are not going to get them. The House is all Sound and Fury, Signifying Nothing. Without a 60 vote Senate supermajority, the "defund" effort is finished before it starts.

While this circus will surely continue until September 30th, you are not going to succeed. "Government shutdown / federal debt default" prospects notwithstanding.

What they're really after is your money. To "sign the petition" you have to give a name and email address. I signed in as "Barack Obama" (I can't believe they don't screen this out).

Which takes you straight to their donation page.

Fleecing the rubes. Talk about money down the drain. My August 20th take on "Defunding ObamaCare" here.
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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
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"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
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"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
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"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
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"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
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"'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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Monday, August 26, 2013

Health IT down the drain

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