presbyterian hospital: Şubat 2013

24 Şubat 2013 Pazar

You're invited to the Laurie Bass Sklaver Annual Symposium

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Please join us for:

Empower Yourself: Lifestyle and Wellness Choices for Women at High Risk for, or with, Breast Cancer

GET HEALTHY: LIFESTYLE MODIFICATIONS AND DIETARY SUPPLEMENTS FOR CANCER PREVENTION
Heather Greenlee, ND, PhD
Assistant Professor of Epidemiology and Medical Oncology,
Columbia University, Mailman School of Public Health & College of Physicians and Surgeons
Naturopathic Physician and Epidemiologist

SOUL (SEASONAL, ORGANIC, UNPROCESSED, & LOCAL) FOOD TO SUPPORT YOUR HEALTH
Eileen Z. Fuentes
Board Certified Wellness, Lifestyle & Integrative Cancer Coach
Breast Cancer Survivor

MAKING CHOICES: INTEGRATING COMPLEMENTARY THERAPIES AND STANDARD TREATMENTS
Hope Nemiroff
Executive Director, Breast Cancer Options
Breast Cancer Survivor

PATIENT PANEL
A panel of survivors and women at high risk for breast cancer will discuss their experiences.

Moderated by Katherine Crew, MD
Co-Medical Director, Women At Risk
Florence Irving Assistant Professor of Medicine and Epidemiology,
Columbia University College of Physicians and Surgeons

Opening Remarks by Sheldon Feldman, MD
Chief of Breast Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center
MONDAY, NOVEMBER 14th, 2011

Refreshments 5:30-6:00PM * Program 6:00-8:00PM

UJA-Federation of New York * 7th Floor Conference Center * 130 E. 59th St. between Park and Lexington Aves.Reservations Required: Please call (212) 305-5917 or email info@womenatrisknyc.org.

Free admission * Seating is limited

This event is generously supported by the Friends and Family of Laurie Bass Sklaver.

Support Women At Risk this Valentine's Day!

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To help you celebrate this special day of love and affection, Women At Risk has put together the perfect gift for that special someone!

Our limited-edition Pink Package includes:

Women At Risk's beautiful, sterling silver "We Are Resilient" Bracelet, created by renowned designer Catherine M. Zadeh ($100 value alone)
Webkinz Pink Poodle
Avon Anew Reversalist Night Creme
Shiseido Perfect Rouge Parfait Lipstick
Philosophy Melon Daquiri Lip Shine
Pink OPI Nail Lacquer

This assortment of pink-themed beauty products and jewelry is the perfect gift for yourself or the one you love! Proceeds benefit Women At Risk's research, education, and support programs for women at high risk for, and with, breast cancer.

Cost: $100
(Package is valued at $180!)
*$5 shipping for standard delivery, non tax-deductible, box not included.

To order: Contact Eric Dubinsky at erd9025@nyp.org or (212) 305-4486.

You're invited to a Young Professionals Committee outing!

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Join Women At Risk's Young Professionals Committee for a night of socializing and fundraising to fight breast cancer!

All proceeds benefit Women At Risk's Patient Navigation Program.

Where: Mad River Bar & Grille
1442 Third Avenue (at 82nd Street)

When: Thursday, March 15th
6:00-9:00PM
(Come anytime in between!)

Cost: $10 cover (All proceeds go to WAR.)

Plus: $3 domestic drinks, $5 mixed drinks, and half off select appetizers
(10% of sales benefit WAR.)

You're invited: Wine & Cheese Reception at Neiman Marcus

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Neiman Marcus Westchester and Women At Risk invite you to a wine and cheese reception at The Zodiac Restaurant (3rd Floor, Neiman Marcus), followed by a shopping event with "In-Circle" promotions and makeover stations!

With remarks from The Alan & Susan Fuirst Women At Risk Breast Surgery Fellow, Anu Sharma Saigal, M.D., M.P.H., of NewYork-Presbyterian Hospital/Columbia University Medical Center.

Thursday, October 11th
6:00-8:00 p.m.

2 Maple Avenue
White Plains, NY 10601
(Parking tickets will be validated)

Please RSVP to Eric Dubinsky at erd9025@nyp.org or (212) 305-4486.

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23 Şubat 2013 Cumartesi

Congressman Charles Rangel recognizes WAR's commitment to providing, and advocating for, breast cancer screenings

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(Photo Credit: Flickr/RepRangel)

On Friday, October 21st, Representative Charles Rangel issued a statement in honor of Breast Cancer Awareness Month and National Mammography Day urging women across the country to schedule annual mammograms.

"Women are the pillars of our community," Representative Rangel said in the statement. "Again, please make preventative efforts and schedule a mammogram to guarantee you are receiving the care you deserve."

As the Congressman representing NewYork-Presbyterian/Columbia's neighborhood in upper Manhattan, Rangel cited Women At Risk as a "wonderful resource in our community" and encouraged women in his district to contact WAR for more information about the importance of breast cancer screenings.

Women At Risk applauds Representative Rangel's efforts to raise awareness during Breast Cancer Awareness Month and will continue to serve the women in his district through breast cancer research, education, and support programs throughout the year.

You're invited to the Laurie Bass Sklaver Annual Symposium

Support Women At Risk this Valentine's Day!

To contact us Click HERE

To help you celebrate this special day of love and affection, Women At Risk has put together the perfect gift for that special someone!

Our limited-edition Pink Package includes:

Women At Risk's beautiful, sterling silver "We Are Resilient" Bracelet, created by renowned designer Catherine M. Zadeh ($100 value alone)
Webkinz Pink Poodle
Avon Anew Reversalist Night Creme
Shiseido Perfect Rouge Parfait Lipstick
Philosophy Melon Daquiri Lip Shine
Pink OPI Nail Lacquer

Cost: $100
(Package is valued at $180!)
*$5 shipping for standard delivery, non tax-deductible, box not included.

To order: Contact Eric Dubinsky at erd9025@nyp.org or (212) 305-4486.

You're invited to a Young Professionals Committee outing!

You're invited: Wine & Cheese Reception at Neiman Marcus

To contact us Click HERE

22 Şubat 2013 Cuma

Support Women At Risk this Valentine's Day!

To contact us Click HERE

To help you celebrate this special day of love and affection, Women At Risk has put together the perfect gift for that special someone!

Our limited-edition Pink Package includes:

Women At Risk's beautiful, sterling silver "We Are Resilient" Bracelet, created by renowned designer Catherine M. Zadeh ($100 value alone)
Webkinz Pink Poodle
Avon Anew Reversalist Night Creme
Shiseido Perfect Rouge Parfait Lipstick
Philosophy Melon Daquiri Lip Shine
Pink OPI Nail Lacquer

Cost: $100
(Package is valued at $180!)
*$5 shipping for standard delivery, non tax-deductible, box not included.

To order: Contact Eric Dubinsky at erd9025@nyp.org or (212) 305-4486.

You're invited to a Young Professionals Committee outing!

You're invited: Wine & Cheese Reception at Neiman Marcus

To contact us Click HERE

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21 Şubat 2013 Perşembe

You're invited to the Laurie Bass Sklaver Annual Symposium

Support Women At Risk this Valentine's Day!

To contact us Click HERE

To help you celebrate this special day of love and affection, Women At Risk has put together the perfect gift for that special someone!

Our limited-edition Pink Package includes:

Women At Risk's beautiful, sterling silver "We Are Resilient" Bracelet, created by renowned designer Catherine M. Zadeh ($100 value alone)
Webkinz Pink Poodle
Avon Anew Reversalist Night Creme
Shiseido Perfect Rouge Parfait Lipstick
Philosophy Melon Daquiri Lip Shine
Pink OPI Nail Lacquer

Cost: $100
(Package is valued at $180!)
*$5 shipping for standard delivery, non tax-deductible, box not included.

To order: Contact Eric Dubinsky at erd9025@nyp.org or (212) 305-4486.

You're invited to a Young Professionals Committee outing!

You're invited: Wine & Cheese Reception at Neiman Marcus

To contact us Click HERE

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20 Şubat 2013 Çarşamba

Non-Profit Hospital Executive Salaries Continue to Defy Gravity and Logic

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The old saying is that nothing is certain except death and taxes. In health care, the other near certainty seems to be that compensation for health care leaders is big and always getting bigger.

Over the past few weeks several reports about the compensation of top executives of US non-profit hospitals and hospital systems have appeared. So it is time to do our latest round-up of incessantly buoyant hospital executive compensation, and argumentative hot air that seems to fuel it. I will first summarize the latest cases in alphabetical order by state, and then examine some common justifications for the seemingly anti gravitational nature of executive compensation in this part of health care.

Arizona

On AZCentral.com was an article about the CEO of a single relatively small public hospital system:

The leaders of Maricopa County’s public health-care system agreed to raise chief executive Betsey Bayless’ pay by 33 percent, bringing her salary to $500,000.

That may not seem like a lot of money as executive compensation goes, but consider the context:

The Maricopa Integrated Health System is a public hospital system that provides care for the Valley’s poor and uninsured. It is funded by federal and state health-care dollars and a special county levy paid by all county property-tax payers.

MIHS budgeted $3.5 million for market adjustments and merit raises for its employees in fiscal 2013. Bayless’ salary increase alone will consume one-quarter of the $500,000 the board had allocated this fiscal year to bring all employees’ pay in line with similar positions elsewhere.

The health-care system’s rank-and-file employees have received annual merit-based salary increases of no more than 2.9 percent since fiscal 2008.

Nonetheless, the CEO did not exactly feel rich:

Bayless said she did not request the raise and was not expecting it. She said she believes MIHS employees will understand that her salary has been comparatively low and that her replacement likely will be brought in at an even higher salary.

She justified her pay by comparing it to what she thought the market would bear.

'Any salary information will show you that my salary is always the lowest of any (hospital) CEO currently in the entire state, even the little-bitty hospitals,' Bayless said. 'On any measure, 375 (thousand dollars) is below market. So, do I feel undercompensated? I don’t know. But on any measure, it always comes in below market.'

Members of the hospital system's board also justified the pay on the grounds that it was at the market rate:

[Board Members Mary] Harden and [Terence] McMahon said they voted for the pay raise because a national search firm hired to find Bayless’ replacement set $500,000 as a minimum competitive salary for qualified candidates.

Another board member also noted how hard CEO Bayless works:

'The lady works 70-plus hours a week. She’s on call 24/7. So, I think the job warrants it. She works very, very hard,' Dewane said.

I am sure health care professionals who also work long hours, and are frequently on call, but unlike managers, have to make decisions with real life and death consequences would understand, or not.

California

In California a report focused in contrast on the bigger hospitals and hospital systems. California Healthcare News reported on the best compensated hospital executives in the state. In general,

More than one in five non-profit hospital chief executive officers in California received compensation totaling $1 million or more in 2010, according to a new pay survey by Payers & Providers.

Altogether, 32 CEOs of the 154 surveyed received pay packages that ventured into the seven figures. That compares to 19 CEOs who received seven-figure pay packages in the only prior survey Payers & Providers conducted. That survey was published in June 2010, and relied primarily on data from 2007 and 2008.

Some specifics about the best paid executives:

Kaiser Permanente's George Halvorson is the most highly-compensated hospital system executive in California, receiving $7.74 million in 2010. That included more than $6 million in additional compensation. Halvorson is retiring as Kaiser's CEO in June.

Thomas Priselac, the chief executive officer of Cedars-Sinai Medical Center in Los Angeles, was the highest-paid standalone hospital CEO, earning $2.77 million in 2010. That included additional compensation of $1.6 million.

The article provided the justification for Priselac's seven-figure compensation:

According to an email response from Cedars-Sinai spokesperson Duke Helfand, Priselac's compensation 'reflects the top-tier clinical, research and educational performance the medical center consistently has delivered in his 19 years of leadership.'

He did not offer how this performance was measured, how it compared to that of any other hospital, or whether anyone other than the CEO might have been responsible for that performance.

The survey results included the best compensated CEO of a health-district

Michael Covert, the CEO of the two hospital Palomar-Pomerado Health system in San Diego County, was the highest-paid district hospital CEO, earning $1.09 million in 2010. He was among two district hospital CEOs to earn seven-figure compensation.

The survey results also included the best compensated CEO for academic medical centers run by the (state supported) University of California:

David T. Feinberg, M.D., is by far the highest-paid CEO among those who oversee the five research hospitals operated by the University of California. Feinberg, who runs Ronald Reagan UCLA Medical Center, earned $1.33 million in 2010 – the only seven-figure pay package among that cohort of CEOs, and nearly $450,000 more than the second-highest earner in that group, Mark Laret of UC San Francisco Medical Center.

Connecticut

Becker's Hospital Review provided information on the highest paid Connecticut hospital CEOs:

Here are the nine CEOs who earned at least $1 million in 2011.

•   Clarence Silvia, The Hospital of Central Connecticut: $2.76 million
•   Marna Borgstrom, Yale-New Haven Hospital: $2.59 million
•   Brian Grissler, Stamford Hospital: $2.24 million
•   Elliot Joseph, Hartford Hospital: $1.74 million
(*CEO is now Jeff Flaks)
•   Frank Corvino, Greenwich Hospital: $1.71 million
•   Susan Davis, RN, Saint Vincent's Medical Center: $1.48 million
•   Chris Dadlez, Saint Francis Hospital and Medical Center: $1.42 million
•   John Murphy, MD, Danbury Hospital: $1.08 million
•   Christopher O'Connor, Hospital of Saint Raphael: $1.04 million

The report did not provide any justification for the pay levels, and I could find no further news coverage that was relevant.

Massachusetts

The Fitchburg (MA) Sentinel and Enterprise seemed to be the only media outlet which noted the compensation of hospital executives reported to the state attorney general. It listed compensation of some regional hospital leaders,

Patrick Muldoon, president and CEO of HealthAlliance Hospital, a member of the UMass Memorial Health Care system, received a compensation package of $653,868 in 2010, the most recent year for which compensation data is publicly available.

The HealthAlliance system includes a 135-bed community hospital with services on two campuses in Leominster and Fitchburg.

Over that same period, Daniel P. Moen, former president and CEO of the 153-bed Heywood Hospital in Gardner, received a compensation package of $386,126.

Christine Schuster, CEO of Emerson Hospital in Concord, earned a total compensation package of $669,844. Emerson has 179 beds.

Lahey Clinic chief executive Howard Grant, who oversees a facility with 317 beds, was paid a total compensation package of $768,568 in 2010.

The article did not note the justification for the pay of any of these CEOs. I was unable to find any other recent reporting that took advantage of the data supplied to the state Attorney General.
New York
SUNY - Downstate Medical Center

The New York Daily News reported on compensation given to executives at one state supported university medical center:

15 SUNY Downstate Medical Center bigs are raking in $200,000-plus salaries even as plans move forward to shut down its Long Island College Hospital campus.

Downstate president Dr. John Williams who’s leading the drive to close the Cobble Hill hospital gets the fattest pay of all.

He’s paid $650,000 a year salary and gets an annual housing allowance of up to $80,000 and the use of a car.

It listed the following compensation information for other executives:

Other big hospital administrators’ salaries, 2011
* $552,556.33 — Debra Carey, vice president
* $357,379.26 - Grace Wong, vice president
* $334,072.19 — Ivan Lisnitzer, vice president
* $312,182.24 — Paul Davis, assistant vice president
* $286,954.51 Renee Poncet, vice president

This should be viewed in the context of the medical center's current dire straits:

SUNY Downstate — which has a hospital and medical school in East Flatbush — is in such bad financial shape it could go broke by March, SUNY chairman Carl McCall has said.

Of course, despite these financial threats, a "spokesman" defended these payments again as market-based:

[Robert] Bellafioire defended the brigade of big salaries — though the controller’s audit suggested Downstate should consider cutting the number of high-paid administrators.

'We have to offer competitive compensation, particularly when we’re up against any number of the country’s best hospitals and medical schools just across the bridge and in the metropolitan area,' Bellafiore said.

Rural Hospitals in Upstate New York

On the other hand, the Plattsburgh (NY) Press-Republican reported on the compensation given to hospital executives in rural northern New York state. These included Alice Hyde Medical Center:

John Johnson, president and chief executive officer, was paid $339,539 in 2010. He retired in the fall of 2012.

He was replaced by Douglas DiVello, who is paid $246,682 in salary and benefits.

Then there was CVPH Medical Center in Plattsburgh

Hospital President Stephens Mundy has been at CVPH for 10 years and was paid $749,563 in salary, bonuses and other compensation in 2010.

His base salary for 2013 is $478,421,...

In addition, there was Elizabethtown Community:

Rodney Boula, president and chief executive officer at ECH, was paid $229,902 in 2010.

Note that later the article explained that this hospital has no more than 25 beds.

However, the reporter was unable to find out the compensation of the CEO of the Adirondack Medical Center in Saranac Lake:

Chandler Ralph, president and chief executive officer for 16 years, is not employed by the hospital or its umbrella organization, Adirondack Health.

She is paid through a contract with a management company, Health Tech Management Services, said Joe Riccio, AMC communications director.

Her salary is a confidential employment contract, 'just like any other vendor that does business' with the hospital, he said.

Because of that, her salary was not available through IRS records. The Press-Republican pressed Ralph to release her salary, noting that it was publishing the pay of all other area hospital CEOs, but she refused, citing confidentiality.

Parenthetically, this seems to be an unusual case of the actual outsourcing of top leadership.

This compensation information again should be considered in the context. These are all relatively small hospitals in a rural area with low costs of living. In addition, these hospitals were facing substantial financial challenges:

Numerous jobs were cut in 2012 at the area’s five hospitals, some the first substantial layoffs in decades. One hospital recorded an operating deficit, and at some, programs and services were reduced.

Adirondack Health, parent company of Adirondack Medical Center in Saranac Lake, and CVPH Medical Center in Plattsburgh, each laid off 17 employees last fall and eliminated vacant positions.

Alice Hyde Medical Center in Malone let 12 people go in September and had closed down more than a dozen vacancies.

Nonetheless, the justifications for these compensation levels included the usual suspects.In an introductory discussion not specific to any hospital, we find:

'The responsibilities of a CEO have exploded in the last four years,' said William Van Slyke of the Healthcare Association of New York State, an organization that represents hospitals and health-care systems across the state.

Similarly,

'Being a hospital CEO, you are ‘all in,’ all the time, every hour. It’s a tremendous responsibility.'

This is the familiar argument about how hard seemingly all hospital CEOs work. As noted above, it is particularly incongruous in a health care setting in which numerous health professionals are also "all in," and these professionals bear the responsibility of making decisions and taking actions that can directly affect patients' health, safety, and even survival.

Following this were the equally familiar arguments that the compensation of CEOs is determined by the market, and so to retain CEOs one must pay at this market rate:

'Being a hospital CEO, especially in the state of New York, is complex and demanding job. There is an extraordinarily limited pool of candidates, and that increases their value.'

'I can’t speak for the hospitals in your area,' he told the Press-Republican, 'but a qualified and successful CEO can go anywhere in the country and make equal or higher salaries.'

The Press Republican also elicited very similar articles justifying pay for individual hospital CEOs, for example, regarding the CEO of the Alice Hyde Medical Center, here is the "compensation is determined by the market" argument from "Dean Johnston, president of the Board of Trustees, and member of the hospital's Compensation Committee"

'It’s important that the salary is competitive with other institutions because it’s difficult to attract professional leaders who will improve the quality of care.'

And from the same person, here is the "CEOs work very hard" argument

'It’s difficult being CEO,' Johnston continued, 'because you’re the head of a complex and multi-faceted institution.'

Very similar arguments were made to justify the compensation of the CEO of CVPH Medical Center.

The Usual Talking Points and Logical Fallacies

So, to summarize, hospital executive compensation, at least such compensation that gets noted in the media, seemingly never has been better. CEOs at even the smallest, most rural, non-profit community hospitals can make well into the six figures. CEOs at public hospitals can make over half a million dollars. CEOs at larger hospitals, even those that are state supported, can make even more, up to millions a year for CEOs of moderate to large non-profit hospital systems. Even hospitals that are facing financial challenges, or that are laying off employees still pay substantial amounts.

In previous posts, we noted that whenever anyone bothers to try to justify extravagant executive compensation at hospitals, and for that matter, other health care organizations throughout the US, they seem to repeat the same set of talking points. We first listed the talking points here, and then provided additional examples of their use here, here and here. The talking points are:
- we pay what everyone else pays
- CEOs work hard and are brilliant, and so deserve high pay
- high pay is needed to attract and retain competent, if not brilliant people.

None of the examples of these talking points we have seen so far explain why these apply to CEOs and other top hired managers, but not to other kinds of employees.

So it should be no surprise that the justifications for the largesse to hospital executives found in the cases above follow the talking points yet again.

We Pay What Everyone Else Pays

Another way to put this is that some market determines CEO pay. We saw versions of this to support the compensation of the CEOs of Maricopa Integrated Health System in Arizona, and SUNY - Downstate Medical Center and Alice Hyde Medical Center in New York.

Note that almost never is this argument supported by data about whether comparisons were actually made to a representative peer group. In any case, as we asserted before, this justification may be a logical fallacy, an appeal to common practice.

CEOs Work Hard and Are Brilliant

This is an especially frequently used talking point. I have yet to see an instance in which any hospital official would omit a CEO was anything other than supremely diligent and totally brilliant. We saw versions of this to support the compensation of the CEOs of Maricopa (AZ), Cedars-Sinai Medical Center in California, the Alice Hyde Medical Center and CVPH Medical Center in New York, and generically to support all New York State hospital CEOs.

As we noted above, this justification is almost never accompanied by any evidence that CEOs work harder or are more brilliant than the numerous health care professionals who actually make it possible for the hospital to operate. I would guess it would be very hard to show that CEOs work longer hours, are under more stress, make more consequential decisions, are smarter or better trained than typical doctors, nurses and other health care professionals. This justification thus appears to be another kind of logical fallacy, an appeal to authority.

High Pay is Needed for Retention

We saw versions of this to support the CEOs of Maricopa, SUNY - Downstate, Alice Hyde, CVPH, and generically again to support all NY hospital CEOs. Note that this justification is also almost never supported by any evidence. As we noted here, while this argument, probably like the others, comes from the generic business management literature, there is little data in the larger business world to show that CEOs are very mobile, or likely to succeed when transplanted to a new environment. In fact, a recent report looking at the mobility of CEOs worldwide called this a "self-serving myth." (See this summary for a link to it.) It is too bad that no one ever seems to get the opportunity to challenge these talking points when they are offered as justifications for outlandish executive compensation.

Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy
Read more here: http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html#storylink=cpy
Summary
As we have shown again and again, the pay of top health care leaders seems to endlessly increase, without clear justification, regardless of the vicissitudes affecting the organizations they lead, their employees, their patients and society. This suggests that health care organizations, like many other organizations, seem to be run primarily for the benefit of their executives and their cronies, regardless of what happens to anyone else.

As we have frequently said, current policies about paying hired health care managers leave the managers unaccountable for the effects of their actions on patients' and the public's health, and worse, fail to deter and may even encourage ignorance of the health care mission, frankly mission-hostile behavior, self-interest, conflicts of interest, and outright corruption. Meanwhile, paying nearly all top managers as if they were brilliant, while setting much harsher standards for the employees who actually take care of patients, including health professionals, demoralizes those on whom patients actually depend for care.

As we have said endlessly,.... Health care organizations need leaders that uphold the core values of health care, and focus on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research. On the other hand, those who authorize, direct and implement bad behavior ought to suffer negative consequences sufficient to deter future bad behavior.

If we do not fix the severe problems affecting the leadership and governance of health care, and do not increase accountability, integrity and transparency of health care leadership and governance, we will be as much to blame as the leaders when the system collapses.

Bipartisan Policy Center's Health Innovation Initiative: Health IT Industry Officials Lying to Regulators With Impunity?

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On Wednesday, February 13, 2013, The Bipartisan Policy Center's Health Innovation Initiative held a discussion on its new report: An Oversight Framework for Assuring Patient Safety in Health Information Technology. The announcement is here: https://bipartisanpolicy.org/news/press-releases/2013/02/bipartisan-policy-center-releases-recommendations-oversight-framework-pa

The report is here (PDF): "An Oversight Framework for Assuring Patient Safety in Health Information Technology."

The "who's" of the Bipartisan Policy Center's Health Innovation Initiative included these people:

Senator Tom Daschle, Former U.S. Senate Majority Leader; Co-founder, Bipartisan Policy Center (BPC); and Co-leader BPC Health Project Carolyn M. Clancy, M.D., Director, Agency for Healthcare Research and Quality, Department of Health and Human Services
Farzad Mostashari, M.D., ScM, National Coordinator for Health Information Technology, Department of Health and Human Services
Peter Angood, M.D., Chief Executive Officer, American College of Physician Executives
Russ Branzell, Chief Executive Officer, Colorado Health Medical Group, University of Colorado Health
John Glaser, Ph.D., Chief Executive Officer, Siemens Health Services
Douglas E. Henley, M.D., FAAFP, Executive Vice President and Chief Executive Officer, American Academy of Family Physicians
Jeffrey C. Lerner, Ph.D., President and Chief Executive Officer, ECRI Institute
Ed Park, Executive Vice President and Chief Operating Officer, athenahealth
Emad Rizk, M.D., President, McKesson Health Solutions
Janet Marchibroda, Moderator; Director, BPC Health Innovation Initiative

Unfortunately, I was unable to attend. I was at the 2013 Annual Winter Convention of the American Association for Justice (Trial Lawyer's Association) in Florida, as an invited speaker on health IT risk, its use in evidence tampering, and other legal issues.


"United for Justice" - click to enlarge

I found the following statement from the Bipartisan Policy Center's Health Innovation Initiative report remarkable as a "framework for health IT safety":

The Bipartisan Policy Center today proposed an oversight framework for assuring patient safety in health information technology. Among other guiding principles, the framework should be risk-based, flexible and assure patient safety is a shared responsibility, the authors said. “Assuring safety in clinical software in particular is a shared responsibility among developers, implementers, and users across the various stages of the health IT life cycle, which include design and development; implementation and customization; upgrades, maintenance and operations; and risk identification, mitigation and remediation,” the report states. Among other recommendations, the center said clinical software such as electronic health records and software used to inform clinical decision making should be subject to a new oversight framework, rather than traditional regulatory approaches [e.g., FDA - ed.] applied to medical devices given its lower risk profile.

I find it remarkable that the health IT industry and its supporters now feel they can lie to our government and regulatory agencies with impunity. Stating that health IT has a "lower risk profile" is an example.

One cannot know what is acknowledged to be unknown.

From the Institute of Medicine in its 2012 report on health IT safety:

Institute of Medicine. 2012. Health IT and Patient Safety: Building Safer Systems for Better Care . Washington, DC: The National Academies Press.

... While some studies suggest improvements in patient safety can be made, others have found no effect. Instances of health IT–associated harm have been reported. However, little published evidence could be found quantifying the magnitude of the risk.

Several reasons health IT–related safety data are lacking include the absence of measures and a central repository (or linkages among decentralized repositories) to collect, analyze, and act on information related to safety of this technology. Another impediment to gathering safety data is contractual barriers (e.g., nondisclosure, confidentiality clauses) that can prevent users from sharing information about health IT–related adverse events. These barriers limit users’ abilities to share knowledge of risk-prone user interfaces, for instance through screenshots and descriptions of potentially unsafe processes. In addition, some vendors include language in their sales contracts and escape responsibility for errors or defects in their software (i.e., “hold harmless clauses”). The committee believes these types of contractual restrictions limit transparency, which significantly contributes to the gaps in knowledge of health IT–related patient safety risks. These barriers to generating evidence pose unacceptable risks to safety.

... More worrisome, some case reports suggest that poorly designed health IT can create new hazards in the already complex delivery of care. Although the magnitude of the risk associated with health IT is not known, some examples illustrate the concerns. Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human–computer interactions or loss of data have led to serious injury and death.”

Even to those with particularly thick skulls, this statement seems easy to comprehend:

"The magnitude of the risk associated with health IT is not known."

I repeat once again:

One cannot know what is acknowledged to be unknown.

A statement that health IT has a "lower risk profile" compared to other regulated healthcare sectors such as devices or drugs, in order to seek continued and extraordinary regulatory accommodations, is remarkable. It is either reckless regarding something that the statement's makers should know, or should have made it their business to know - or a deliberate prevarication with forethought.

The report did attempt to shroud the declarative "lower risk profile" in a sugar coating through misdirection, citing the need to take into account "several factors" including:

"the level of risk of potential patient harm, the degree of direct clinical action on patients, the opportunity for clinician involvement, the nature and pace of its development, and the number of factors beyond the development stage that impact its level of safety in implementation and use."

These "factors" speak to a higher level of potential risk, not lower, and are a justification for stronger regulatory oversight, not weaker. I would opine that there is a possibility that health IT. through which almost all transactions of care need to pass (e.g., orders, results reporting, recording and review of observations, finding, diagnoses, prognoses, treatment plans, etc.), could have a higher risk profile than one-off devices or drugs. Health IT affects every patient, not just those under a specific therapy or using a specific device or drug.

Partial taxonomies developed from limited data themselves speak to the issue of a potentially huge risk profile of health IT, e.g., the FDA Internal Memo on HIT Risks (link), the AHRQ Hazards Manager taxonomy (link), and the sometimes hair-raising voluntary defects reports (largely from one vendor) in the FDA MAUDE database (link). Further, health IT can and does affect thousands or tens of thousands of patients en masse even due to one simple defect, such as happened in Rhode Island at Lifespan (link), or due to overall design and implementation problems such as at Contra Costa County, CA (link) and San Francisco's Dept. of Public Health (link).

We don't know the true levels of risk and harm - but we need to, and rapidly. Industry self-policing is not the answer; it didn't work in drugs and devices, and even with regulation there are still significant problems in those sectors. (Imagine how it would be if those sectors received the special accommodations that health IT receives, and wishes to continue to receive.)

My other issue is with the "shared responsibility" including "users."

The user's responsibility is patient care, not being a beta tester for bug-laden or grossly defective health IT products. Their responsibility ends at reporting problems without retaliation, and ensuring patient safety.

Their responsibility is to avoid carelessness - as it is when they drive their cars.

In other words, the inclusion of "users" in the statement is superfluous.

It is not a responsibility to be omniscient and be held accountable when bad health IT promotes "use error" (the NIST definition of "use error" I will not repeat again here; search the blog) -- as opposed to and as distinct from "user error" - note the final "r" - i.e., carelessness.

Bad health IT (see here):

Bad Health IT ("BHIT") is defined as IT that is ill-suited topurpose, hard to use, unreliable, loses data or provides incorrect data, causescognitive overload, slows rather than facilitates users, lacks appropriatealerts, creates the need for hypervigilance (i.e.,towards avoiding IT-related mishaps) that increases stress, is lacking insecurity, compromises patient privacy or otherwise demonstrates suboptimaldesign and/or implementation.

One special accommodation that the health IT industry has been afforded for far too long is to be able to "blame the user."

"Blaming the victim" of bad health IT is a more appropriate description.

-- SS

New York Times: "A Digital Shift on Health Data Swells Profits in an Industry"

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The New York Times has published an article today by Julie Creswell entitled "A Digital Shift on Health Data Swells Profits in an Industry." It is available at this link.

... While proponents say new record-keeping technologies will one day reduce costs and improve care [only when today's bad health IT is abolished - see here - ed.], profits and sales are soaring now across the records industry. At Allscripts, annual sales have more than doubled from $548 million in 2009 to an estimated $1.44 billion last year, partly reflecting daring acquisitions made on the bet that the legislation would be a boon for the industry. At the Cerner Corporation of Kansas City, Mo., sales rose 60 percent during that period. With money pouring in, top executives are enjoying Wall Street-style paydays.
None of that would have happened without the health records legislation that was included in the 2009 economic stimulus bill — and the lobbying that helped produce it. Along the way, the records industry made hundreds of thousands of dollars of political contributions to both Democrats and Republicans. In some cases, the ties went deeper. Glen E. Tullman, until recently the chief executive of Allscripts, was health technology adviser to the 2008 Obama campaign. As C.E.O. of Allscripts, he visited the White House no fewer than seven times after President Obama took office in 2009, according to White House records.

The article does not reveal anything that readers of this blog did not know already.

The push for the financial incentives and profits were also written about at the The Huffington Post Investigative Fund by investigative reporter Fred Schulte, now at the Center for Public Integrity ("Stimulus Fuels Gold Rush For Electronic Health Systems"), and in the Washington Post by Robert O'Harrow Jr. (which I wrote about at this post: The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Technology on Unconsented Patients and Clinicians).

Rather than re-hash the issues, I wanted to focus on some of the current NYT reader comments:

... After a visit to a Florida hospital for suspicion of heart attack, I asked for a copy of my records to give my home (IL) physician. I was shocked to read that I had had "anal surgery." When I reviewed these records with my doctor, she told me that I had probably told the admitting ER nurse I had recently had a colonoscopy, so the closest coding information their electronic system allowed was anal surgery. So, how can these inaccuracies which will live on forever electronically be helpful toward patient care? The old acronym GIGO certainly applies here--garbage in; garbage out.

... This article highlights only one aspect of the "Failed Promise of Electronic Health Records". Through lobbying but also supported by a study from the RAND organization, the three final 2008 presidential candidates, Hillary Clinton, John McCain, and Barack Obama outbid each other with promises to spend billions to entice doctors to use electronic record systems. Unfortunately, because of unsolved documentation problems, such systems are often disliked and slow the process. Instead of creating interoperability, electronic medical record systems (EMRs) with limited functionality and benefits were created. In particular, true interoperability has been neglected and attempts to create it through networks in the form of CHINs, RHIOs, and HIEs have failed.

... Mr. Tullman's comment is priceless. “I think it’s very common with every administration that when they want to talk about the automotive industry, they convene automotive executives, and when they want to talk about the Internet, they convene Internet executives." Of course, when "they" want to radically alter the way doctors do their jobs, "they" talk to academics, lawyers, publicly traded insurance CEOs and internet executives. Today's diatribe about quality care being more important than quantity care is laugh out loud funny. Unless you're a physician. Only in America does getting paid less and less, with more clerical data entry record-keeping at every step just to get paid and protect against lawsuit, translate into an incentive to provide quality care. Somebody prescribe a dose of common sense. Oops. Too late.

... Every person needs a national health ID with up to date health information. To say that the current EMR systems are problematic would be an understatement. They take away face time with patients, the M.D.'s talents and time are wasted doing data entry and worst of all ,they are potentially dangerously flawed. An example is a recent patient I saw who was treated by a number of physicians. His medications had required significant changes which were done by 2 different M.D.'s from his main doctor. Both gave him computer generated lists from the same system. Both had a mixture of unmatching generic and proprietary names, the patient's actual medicines from the pharmacy had a mixture and different doses from the Dr.'s orders. He was trying to set up his week's supply. But didn't know which proprietary name went with which medicine. These systems should have been tried out on a small scale and approved by M.D.'s before this became law. The VA system which is time tested, physician friendly and free only the VA is using. These other systems are set up to maximize profits for the IT companies, cost the physicians huge amounts to install, cost the hospitals huge amounts esp when they are changing from one system to another due to problems when they were advertised to maximize hospital billing. This another example of our distorted legislative process where profits and politics take precedence over people.

... I am a dermatologist in private practice who teaches at a local medical school part time. Electronic records are problematic. Every doctor I know feels they take time away from being a doctor. I literally don't know a single colleague who feels their benefits are worth the extra time involved. In medical school, we learned how to record notes in medical records so that patient care is improved from visit to visit. In short, we use notes from the previous visits to assist in our decisions in subsequent examinations. In today's digital world, most doctors I know are forced to change their notation style to justify payments from insurance companies. The more detailed the note in the medical record, the lower the chance that an insurance company downgrades the fee charged to the patient. Thus, notes are now longer and more detailed than they were ten years ago. The problem with such notes is that they are filled with detritus geared to prevent payment reduction rather than aimed at improving continuity of patient care from visit to visit. The impact of this adoption of electronic medical records is that insurance company computer systems can easily sift through notes to reduce compensation to doctors who spend more time with patients and who write cleaner, more efficient notes.

... I still use pen and paper. One requirement would fix this mess: interoperability No, NOT the "industry supported" standard. Thats a joke. Industry wants NO inter-operability because they want to lock us in to a an individual product, The government has a great EMR (the VA system). All commercial ones should be forced to be able to export data in a way that is 100% compatible with that. As such, they would then be 100% compatible with each other. Some of my colleagues are now on their third EMR product in 7 years. Why? Big company buys company B and then stops supporting it. The doctor is forced to switch to Big Company's new product. Of course the data does not transfer over so the doctor has to go through the crude data-entry mess all over.

... The folly of relying only on digital records. Without constant and costly software and hardware upgrades, your digital medical records will be rendered obsolete. Could be a matter of years or decades, but it will happen. Not only that, digital proprietary systems are at huge risk if the private for-profit company goes bankrupt. Paper records can last 1000 years.

... Another scam. Very expensive and involved for end user:ie doctor. Have had to hire an IT company to assist, have to pay annually for service contract, upgrades and what the article didn't mention was the "meaningful use" criteria that all doctors have to comply with in order to pass government inspection for a rebate. The software vendors, labs, and others are charging doctors extra for software upgrades and abilities to comply with each "meaningful use" component . This is already costing more money and aggravation than the worth of the government rebate. Who will subsidize this? Doctors are starting to lose interest. We know this is another corrupt government sponsored ploy and only the tip of the iceberg. If the government were to have spent the 19 billion with a consortium of vendors such as google apple and microsoft, the goal of free software provision capable of interexchangeable data would likely have been completed with all providers on board.

... Common sense can tell you that the real value of these systems is marginal. Much of medical treatment is "incident specific" where history is not necessary. Most PCP's already have a system that works. In larger systems and for complex diseases, perhaps EMR are beneficial but not for routine care. As has been noted, all sorts of problems arise with EMR's: destruction of MD-pt relationship, incorrect data being entered and never removed, cumbersome and expensive requirements of instituting and maintaining the system, etc. It is awful that physicians and patients are "used" in the service of politicians and EMR execs.

... As a practicing physician I have to struggle everyday with the Citrix and Quickbase electronic records. The Electronics Medical Records industry has been getting the gold promised by the government in exchange of a very poor and deficient product. The EMR industry has been selling to the healthcare providers, in need of electronic records, the equivalent of the Formaldehyde-contaminated trailer homes sold to FEMA for the Katrina homeless.

These are just from the first page of comments. Read the article and the comments at the link above.

My observation is that it seems that as transparency increases, the public "gets it" that these systems are not the panacea the industry wants us to believe, and may impede the clinicians trying to treat them.

Now, when will the government "get it" that they've been had?

-- SS

Addendum: another "anecdote" just caught my eye because it sings an unfortunate familiar tune to me:

So much data, so little knowledge. My best friend's father just died because none of his who-knows-how-many physicians took the time to actually read and anaylze the reams of info they were dutifully inputting. They killed him with an overdose of one drug and not enough of another. Useful data collection and analysis is one thing, but what we seem to have now is just institutionalized hoarding. More data doesn't make anyone safer (except the data companies), just like stacks of old magazines or cans of beans makes one safer. More is NOT better; it is just more. More time and more expense wasted on stuff and less spent on actual health care. You've got to USE anything or it is just more useless and potentially dangerous stuff.

-- SS

Zabar's New York

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Hatsuhana New York

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