How to destroy health IT innovation

Tech
September 21, 2012

I have spent a good portion of his career working to come up with ways to make healthcare better, faster and cheaper through the appropriate use of computer and information technologies.  Given the vitriol that I have periodically heaped upon many of the electronic medical record systems commonly deployed and mandated by the government, this enthusiasm for computers and telecommunications may come as a bit of a surprise to some …

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How to destroy health IT innovation

Denying payment for unnecessary emergency room visits

Policy
March 5, 2012

Just when American healthcare system seems so dysfunctional that it seems impossible to imagine how it could be screwed up further, a decision is made that restores one’s faith in the creativity of Man.  But before you run out of guesses as to which particular decision we’re talking about today, we’ll just blurt it out.  We are referring to a recent decision by Washington State Medicaid to deny payment for …

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Denying payment for unnecessary emergency room visits

Human capital makes doctors special

Physician
September 9, 2011

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man.  Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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Human capital makes doctors special

How physicians not adhering to clinical guidelines may be punished

Physician
June 18, 2011

The Justice Department decided to weigh in on the topic of clinical guidelines.

As if to underscore Dr. Rich’s assertion that “guidelines are no longer guidelines,” the Federal government has raised the prospect of fining your doctor and/or sending her to prison for the crime of not strictly following guidelines of care.

As reported by MedPage Today:

“Federal prosecutors are looking into physicians’ prescribing practices relating to implantable cardioverter defibrillators …

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How physicians not adhering to clinical guidelines may be punished

Overhauling America’s Healthcare Machine, an excerpt

Policy
April 8, 2011

An excerpt from Overhauling America’s Healthcare Machine: Stop the Bleeding and Save Trillions, published by Financial Times Press (2011).  Reprinted with permission of FT Press, and imprint of Pearson.

In recent years, more and more of the revenue collected by U.S. healthcare facilities ends up paying for costs that have nothing to do with providing actual healthcare goods and services: things such as administration, billing, documentation, and the cost …

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Overhauling America’s Healthcare Machine, an excerpt

Dangers of strict adherence to clinical guidelines

Physician
April 1, 2011

Medical guidelines are well on their way to becoming the Law of the Land.  Dr. Rich over at The Covert Rationing Blog featured a recent post that highlighted this point.

When a study published in the Journal of the American Medical Association showed that nearly 23% of patients receiving implantable cardioverter-defibrillators (ICDs) received them under circumstances that did not match up with the recommended “guidelines” for doing so, this breach of …

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Dangers of strict adherence to clinical guidelines

FDA regulation and non-approved use of drugs

Meds
January 26, 2011

The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies.  He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate.  He …

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FDA regulation and non-approved use of drugs

Scribes lead to unintended consequences from electronic medical records

Tech
November 29, 2010

Recently, Dr. Scot Silverstein over at Health Care Renewal published this update to the ongoing story of electronic medical records that are so simple, intuitive and easy to use that doctors and hospitals everywhere are being forced to hire “scribes” to run them.

We’d looked at the resurgence of scribes in a previous post, and Dr. Silverstein’s article seems to confirm that the phenomenon is is here to stay for …

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Scribes lead to unintended consequences from electronic medical records

Quality programs have social and medical consequences

Policy
October 9, 2010

Like it or not, “garbage in, garbage out” is the rule rather than the exception for the vast majority of bureaucratically dictated “quality control” programs that we’re ever likely to launch.  There are three primary reasons for this.

First and foremost, there’s Goodhart’s Law:

“Originally, an economic theory stating that if a particular definition of the money supply were to be used as the basis for monetary policy, the stability …

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Quality programs have social and medical consequences

Preparing for gastric bypass surgery by eating more

Conditions
September 2, 2010

Thinking is hard work.  This is why so few people bother.  At least voluntarily.  So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care.

This comes up as a result of a conversation that I had with a patient the other day.  A pleasant, obese gentleman.  He had been struggling with …

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Preparing for gastric bypass surgery by eating more

Doctors hiring scribes because of electronic medical records

Tech
August 2, 2010

I was visiting with my physician colleague Debbie the other day, which is always a pleasure. She is, by far, one of the best dermatologists I know. She had purchased an electronic medical record (EMR or EHR) a year or two ago and I asked her how it was going.

“Pretty well,” she said, “but I’ve had to start using a scribe. It’s just too inefficient any other way. I was …

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Doctors hiring scribes because of electronic medical records