Ben Goldacre on Blogging and Science in the Media (from a toilet)

Ben Goldacre was recently interviewed in a disabled toilet by Conrad Quilty-Harper:

Scot Silverstein on the Health IT Stimulus

Scot Silverstein had his letter on the Health IT stimulus published on the Wall Street Journal website. This letter is in response to the recent WSJ article on the health IT stimulus package.

Dear Wall Street Journal:

You observe that the true political goal is socialized medicine facilitated by health care information technology. You note that the public is being deceived, as the rules behind this takeover were stealthily inserted in the stimulus bill.

I have a different view on who is deceiving whom. In fact, it is the government that has been deceived by the HIT industry and its pundits. Stated directly, the administration is deluded about the true difficulty of making large-scale health IT work. The beneficiaries will largely be the IT industry and IT management consultants.

For £12.7 billion the U.K., which already has socialized medicine, still does not have a working national HIT system, but instead has a major IT quagmire, some of it caused by U.S. HIT vendors.

HIT (with a few exceptions) is largely a disaster. I’m far more concerned about a mega-expensive IT misadventure than an IT-empowered takeover of medicine.

The stimulus bill, to its credit, recognizes the need for research on improving HIT. However this is a tool to facilitate clinical care, not a cybernetic miracle to revolutionize medicine. The government has bought the IT magic bullet exuberance hook, line and sinker.

I can only hope patients get something worthwhile for the $20 billion.

Scot Silverstein, M.D.
Faculty
Biomedical Informatics
Drexel University Institute for Healthcare Informatics
Philadelphia

For more on Scot, check out his website and his blog.

AMIA on the $20bn Health IT Stimulus

AMIA have published a summary for its members on the Health IT stimulus package:

Highlights of New Funds for the Department of Health and Human Services (HHS)
• $2 billion to the Office of the National Coordinator for Health Information Technology (ONC): of which $300 million is to support regional or sub-national efforts toward health information exchange; $20 million is for technical standards analysis and conformance testing by the National Institute of Standards and Technology (NIST); and $5 million may be used for the administration of funds
• $1.5 billion to the Health Resources and Services Administration (HRSA) for construction, renovation and equipment, and the acquisition of HIT systems for PHS health centers
• $1.3 billion to the NIH National Center for Research Resources (NCRR), of which $1 billion is intended for construction, renovation and repair of non-Federal facilities and $300 million to support shared instrumentation and other capital research equipment
• $8.2 billion to the Office of the Director of NIH, of which $7.4 billion is transferred to the Institutes and Centers of NIH to support research
• $1 billion to the Secretary of HHS for prevention and wellness programs, of which $300 million goes to the CDC for immunization programs, $650 million is to be used to carry out evidence-based clinical and community-based prevention and wellness strategies to address chronic diseases, and $50 million is to be provided to States to carry out activities to reduce healthcare-associated infections
• $1.1 billion for comparative effectiveness research [see the next heading]

Read the full PDF here.

There’s also a slideshow here.

Canadian Economic Stimulus Includes $500m for Health IT

The government of Canada is to spend an additional $500 million on Electronic Health Records to help stimulate the economy:

The federal government confirmed $500 million more in funding Wednesday to support electronic health records, a move announced last month in its budget.

An electronic health record system “will save time and lives by reducing duplication, improving the management of chronic disease, improving access to care and boosting productivity,” Health Minister Leona Aglukkaq said Wednesday.

The technology gives health-care providers a more complete picture of their patient’s health history to improve care, Health Canada said.

It’s hoped that electronic health records will:

  • Reduce wait times by speeding the flow of information through the system.
  • Eliminate duplicate or unnecessary tests.
  • Reduce medication errors and remind health-care providers of necessary tests or vaccinations through automated alerts and reminders.

Link

WSJ Criticizes Health IT Stimulus Package

An editorial in the Wall Street Journal is critical of the new $20 billion Health IT portion of the US stimulus package. In particular, they are against full government control of standards and the bill’s privacy provisions:

Both the House and Senate stimulus bills include about $20 billion in incentive payments (mainly through Medicare and Medicaid) to encourage the digitization of medical records. Fair enough. But one of the reasons only an estimated 17% to 29% of doctors use health IT is because there are still many technical issues to work out. Different systems must be compatible so doctors can communicate with each other, coordinate care and share information — and they don’t want to invest in a platform that could become as obsolete as HD-DVD.

Democrats have decided that the way to jump this gap is for government simply to pick the next Blu-Ray. Instead of building on a voluntary public-private standard-setting body created by the Bush Administration, the stimulus bill codifies it as a federal office and gives it broad new powers if private companies are not “substantially and adequately” meeting the needs of doctors and hospitals. The health IT outfit will soon be deciding which platforms are up to code and shutting down competitors.

This will certainly muffle innovation, given that high-school dropouts have been known to scam U.S. health bureaucrats out of millions of dollars that should be preventable with off-the-shelf auditing software. Anyway, what’s the rush? Democrats give the game away by mandating that most medical providers who aren’t linked into the government-approved health information network after 2016 will start to be penalized. Their real political goal is to make a down payment on national health care.

Read the full article here.

Health Informatics Post Graduate Course at Auckland University

We’ve just put up a student profile on the NIHI (National Institute for Health Innovation) blog:

http://nihi.net.nz/2009/02/01/a-student%e2%80%99s-view-on-postgraduate-health-informatics/

Sandra Oldfield, a recent graduate of the University of Auckland’s postgraduate programme in health informatics, talks about her student experience.

Sandra Oldfield reflects on her time as a student

Sandra Oldfield reflects on her time as a student

She makes the point that clinicians are focused on providing clinical care to individuals within settings that support their work. Health informatics provides a fuller view of healthcare than clinical and this has been demonstrated by her postgraduate study.

Clinicians such as doctors and nurses (like her) mostly care about how the computer and the data it holds can help them provide good clinical care for their patients. “The business courses offered in the postgraduate programme helped me to see why certain decisions are made by DHBs and managers in different departments of a hospital,” says Sandra. They opened up a much wider context for her helping her to see a more comprehensive role for health information management.

The HL7 and Principles of Health Informatics courses gave her a useful foundation for the work she’s currently doing at Orion Healthcare as Document Manager and clinical consultant. Extending her basic IT knowledge to a more detailed and informed understanding of systems development and decision support systems has been invaluable. Sandra says, “It may be coincidence but a lot of what I was learning while doing a particular paper, I saw in the work I was doing at the time.”

Having the Postgraduate Diploma in Health Informatics has broadened the scope of what she can do and the options she has for future career decisions. While working with people who haven’t done postgraduate study in health informatics she’s seen how her learning has added value to what she can do for her customers.

The programme itself was interesting, informative, and at times challenging but worth it. “I still think about how I can continue to extend myself, what else can I learn and how can it make me better at what I do” she says. Sandra hasn’t made a decision yet to continue with her studies and enrol in the Masters of Health Science in Health Informatics, but she says that when the time is right she’ll be back.

For more information about the Postgraduate Diploma in Health Science (Health Informatics) take a look at http://www.fmhs.auckland.ac.nz/faculty/postgrad/programmes/pgdiphsc-healthinfo.aspx