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July 21, 2009 News 28 Comments

From Ralph Hinckley: “Re: HIPAA. Looks like we have actual prosecution for HIPAA privacy violations by several individuals.” A doctor and two former employees of St. Vincent Health System (AR) plead guilty to federal charges of snooping into the medical records of murdered local TV anchor Ann Pressly out of curiosity. The misdemeanor charge carries a maximum penalty of a $50,000 fine and a year in prison. Here’s the part that always gripes me: the hospital canned the two employees, but let the doctor off with a two-week suspension.

From Wompa1: “Re: Ayn Rand Center for Individual Rights. I thought you might appreciate this.” The piece has a long quote from Atlas Shrugged about a surgeon who refuses to practice under a system of socialized medicine. Now I’m all hot to read Atlas Shrugged again, so I’ll have to go digging through the bookcases to find it.

From BadNoodle: “Re: [vendor name removed]. They have quietly laid off over 100 people worldwide, with software training and support hit fairly hard.” Inga is trying to confirm and I have suspicions about the anonymous source since the posting appears to have come from a competitor, so I’ll leave the company name out for now.

From Org Insider: “Re: HIMSS. HIMSS produced a Team Training seminar, ‘What is Government Relations’ on June 23, 2009. HIMSS discusses the differences between advocacy, lobbying, and government relations,’What does HIMSS do?’ It is produced by Carla Smith, Executive VP, and Dave Roberts, VP of Government Relations (who is also Mayor of Solana Beach, CA). It appears executive management is trying to sell the staff on the idea that HIMSS is not a lobbyist or vendor organization HIMSS will share IRS and congressional regulations with a ‘sister’ organization to keep under the radar. Is that AHIMA?” Please, sir, may I have some more? I couldn’t get to the link you sent and I didn’t follow the ‘sister organization’ part.

From The PACS Designer: “Re: What Would Google Do? Our fellow blogger Will Weider has read the new book about Google called ‘What Would Google Do" and recommends it for CIOs and other executives. Harper Collins Publishers has a browse version of the book on the Web for HIStalkers to view.” The preview looked good, although some of the Amazon reviews are scathing. I’d read it.


From Dr. Know: “Re: technology. Interesting article in US News about the use of advanced technology in hospitals.” Included: rounding robots with video, RFID, implanted identifiers (they must have missed the Verichip flop), EMRs, and cool rooms. Only in the last paragraph is it mentioned that hospitals have halted almost all of these projects because of economic uncertainty.

From Bob! in accounting: “Re: VA. Ha!” The VA stops (temporarily, it says) 45 IT projects that are over budget or behind schedule until the project managers submit new plans. They’re listed in the article. I see a lot of LIS stuff on the list, so I wonder if the VA is reconsidering its stated intention of replacing some of its own VistA applications with commercial ones from Cerner since it was to start with lab?

Apple’s Q3 numbers: revenue up 12%, EPS $1.35 vs. $1.19. Strong Mac sales and punishing iPhone demand led the estimate-beating numbers. Good timing for me since I had just finished my next guest editorial for Inside Healthcare Computing titled A Harvard Vision of One-Stop Shopping: Why Someday You Might Buy a Michael Jackson Ringtone, a “Pull My Finger” Game, and CPOE from the Same Vendor. It’s a very serious treatise on healthcare IT architecture and the disruptive technology of infrastructure instead of applications. Well, maybe not all that serious.

Here’s an iPhone example: Cannabis, an application that gives directions to medical marijuana suppliers and related services updated from iMedicalCannabis.com. Check the banner ad on the site for Marijuana Medicine Evaluation Centers, which apparently gives exams and certification cards to supposedly legal users (“Come get your medical marijuana card today!!”) There’s even a helpful ICD-9 list of conditions that can be treated with cannabis just in case one is looking for a disease to justify use of its treatment (hypertension? back pain? constipation? You’re in!)

Some folks added new events to the HIStalk Calendar (and why not since it’s free and the events show up on the main page of HIStalk?) You can add your event, too, or check the calendar to see what’s coming.


A reader provided a link to this ACLU video for its Surveillance Campaign, which frets about massive invasions of privacy using “invasive new technologies.” It ties ordering a pizza with having healthcare information immediately available at the call center.

Nasty Parts told you on May 29 that Allscripts would acquire Medfusion and Medem. He’s on track so far: Medfusion announced today that it has bought the health services operations (which I’m guessing is everything but the company name) from Medem. Then, Allscripts announced that it had signed a strategic agreement to make Medfusion’s patient portal available to its customers. Will Allscripts go ahead and buy Medfusion?

Also related: Allscripts posts Q4 numbers, but I’m not smart enough to understand how post-acquisition numbers are derived so I won’t comment. Glen seemed happy with the results, they seemed to beat expectations, and share price is down only a little since then. I think they did well.

The HIMSS Electronic Health Record Association re-elects Justin Barnes (Greenway) as chair and brings on Mark Segal (GE Healthcare) as vice chair and Carl Dvorak (Epic Systems) as executive committee member.

Listening: new from July for Kings, Cincinnati-based alt-rock.

I must be cranky today since I just saw something else that gripes me. A vendor executive lists a big-name business school in the Education section of his LinkedIn profile, right under his only other credential, a bachelor’s degree from a lower-tier state school. I checked out his big-name credential and it was nothing but an expensive, one-week executive seminar, maybe placed there with the hope that it would be confused for a graduate degree. It wasn’t by me, anyway.

Speare Memorial Hospital (NH) names Bob Dullea as director of IS, bringing him over from Dartmouth.

President Obama, making a healthcare speech from what was called Children’s Hospital (I assume it was Children’s National Medical Center in DC) mentions the CIO directly: “We just — I spoke to the chief information officer here at the hospital, and he talked about some wonderful ways in which we could potentially gather up electronic medical records and information for every child not just that comes to this hospital, but in the entire region, and how much money could be saved and how the health of these kids could be improved, but it requires an investment.”

A VA-funded study finds that all the paper records clinicians keep (sticky notes, index cards, and notebooks) can provide insight into how to design an improved human interface to clinical systems. It’s a shamefully small observation study (20 workers in one hospital), but still an interesting concept since everybody keeps paper for mostly good reasons. I’ve used this method: follow a clinician around and write down every piece of information they need, when they need it, where they were at the time, and what they did with it. That’s what an IT system will have to do if you really want to kick out paper.


Also from the VA: it’s testing a BlackBerry application that let cardiologists read EKGs remotely and order treatment to be immediately started in the ED or other location. “The ER pages a cardiologist and sends an electronic EKG to the doc’s mobile device. It also cc’s the electronic health record system, Vista. The cardiologist receives the EKG alert and opens the file by pressing on an icon and logging in. After reading and interpreting the image from a smartphone, the cardiologist clicks a ‘call’ button to contact the ER with a treatment orders. This all happens within 3 minutes.”

Yet another VA item: the Philadelphia VA’s brachytherapy (implanted radiation therapy) program, which was shut down in 2008, gave 92 of its 114 patients the wrong dose of radiation therapy over six years because the dose checking PC had been unplugged from the network.

ACS gets a five-year contract extension worth $10 million to run IT at Rehabilitation Hospital of the Pacific (HI).

A Fox News report says that the universal health plan in Massachusetts is an albatross around the neck of potential Republican presidential candidate Governor Mitt Romney. Costs are out of control, the state is being sued by Boston Medical Center for underpaying it, and legal immigrants who pay taxes are being dumped from the plan to save money. The parties blame each other, apparently, and the only idea anybody’s come up with to cover its costs is to tax smokers even more. They’d better hope those smoking cessation programs don’t work.

Who are some of the big spenders when it comes to healthcare lobbying? Other than the obvious drug companies: GE, AMA, AHA, Blue Cross Blue Shield, American College of Radiology, Siemens, and UnitedHealth Group.

Vanderbilt chooses Omnicell for supply systems.


Hopkins Medicine deploys Cernium video analytics software for security, which ads to the capability of security cameras by not requiring people to sit and watch them. It looks for erratic movements, lurkers, converging groups, and suspicious packages. A bit Big Brotherish, but cool, especially for hospitals.

E-mail me.

HERtalk by Inga

From Heard it thru the grapevine: “Re: rumor control. Hope you are doing well and up to your eyeballs in new shoes. Wouldn’t it be interesting if it were Eric Sellers was the one going to MED3OOO?” Eric Sellers is a former Misys exec, as “Little Birdy” suggested last week. His LinkedIn profile says he has been in real estate for the last five years.

Hayes Management Consulting and Aternity partner to help improve physician adoption of EHRs. The companies will combine the rapid prototype methodology of Hayes with Aternity’s Frontline Performance Intelligence Platform to organizations increase implementation efficiencies.

Hendrick Health System(TX) completes installation of Sentillion’s Tap & Go, which uses passive proximity cards for authentication. Hendricks uses the program in its trauma center to enable caregivers to instantly sign on to any workstation.

ENT and Allergy Associates (NY/NJ) announces it has expanded the use of their NextGen EMR system to 10 of its 30 practice sites. The practice includes about 90 physicians.

UC-San Diego Medical Center selects Dragon Medical for physician documentation.

Former Cisco exec Diane Adams joins to Allscripts as EVP of human resources.

E-mail Inga.

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Currently there are "28 comments" on this Article:

  1. Regarding “big spending lobbyists”, H. Stephen Lieber came from the American Hospital Association (AHA), so no surprises there as to how he runs HIMSS. Regarding your comment on credentials, I looked up Carla Smith under HIMSS executive bios. What does “CNM” stand for, and does it relate to the HIT industry? Like Lieber, she appears to have no technical or clinical background.
    And finally, can you post the link to the HIMSS Team Training seminar mentioned above? Just curious…

    [From Mr. HIStalk] I’m hoping to get the presentation link – the one I have didn’t work. And, after considerable sleuthing, I finally found out what the CNM credential is — Certificate in Nonprofit Management. It’s a non-degree program that takes about a year, 15 graduate credit hours, so it’s fairly substantial (you can’t just test out of it). To Carla and Steve’s credit, both have credentials that relate to their jobs running a member organization (Lieber has CAE, Certified Association Executive, which is similar to CPHIMS and CHCIO – you have to pass a test that was designed to measure typical job knowledge, although you do need to have three years’ of CEO experience, a bachelor’s degree, and professional development hours). All that’s fine for running a membership organization, but neither have worked in healthcare or healthcare IT from what I can tell and have no education in either, so I don’t know how qualified he is to be influencing politicians and making industry pronouncements. But, as long as all of you (us) keep paying dues and attending HIMSS events, we’ve made him our proxy.

  2. Public Radio’s Marketplace talked about EHRs yesterday. Not sure they really understand that the “billions” EHR vendors stand to gain are offset by the cost of developing, maintaining, implementing and supporting these complex applications. Not seeing where they understand what it takes to develop, deploy and support these complex systems and the end-users who must accept them. In this open market model, commercial organizations should be expected to earn a fair profit. http://marketplace.publicradio.org/display/web/2009/07/20/pm_medical/

  3. Thoughts tonight…

    None, other than:

    1. I got my Blue October tickets in the mail today…

    2. I’m still laughing about the new CHCIO certification process:


  4. TPD, thanks for getting the word out regarding What Would Google Do. It really made me think about how we need to reposition healthcare or risk going the way of the newspapers.

    The first half of the book is the best.

    It is also available at audible.com if you want to listen to it rather than read it.

  5. Re: Atlas Shrugged (from a Canadian medical student)

    I’m getting quite tired of the lies spread throughout the US about the Canadian health care system. The nonsense that Canadians don’t have a choice of what doctor they see, what hospital they go to, what treatment they get, etc has got to be recognized as false and misleading. I’m not proposing that the Canadian system is perfect, or that there is a conspiracy afoot to demonize socialized (note: not socialist) medicine in order to keep those with vested interests in for-profit health care happy, but we really must be more careful to consider the source of all the fear-mongering about Obama’s plan.

    I, for one, would love to see a US system that really does provide health care for everyone, regardless of their station in life (or pre-existing conditions). It’s about time that we adopt some of the strategies used by health care systems that spend less per capita and still demonstrate better outcomes than the US’s.

  6. You kind of wonder why Atlas Shrugged didn’t throw in England, Germany, France, and Sweden. Hey everybody, the whole world is doing it wrong. Socialized medicine is crap. We’re all going to die!

    Give me a break. From where I’m sitting, most of my friends are going to die in the USA waiting for healthcare that they can afford. Doctors? You are so out of touch with reality it hurts. Many of the people who need your services can’t even get in your front door because they don’t have insurance. If you could talk to those people…

  7. Thank you, Inga, for your feedback. It is interesting to note just how many HIMSS staff have no credentials, no degree, no education and no experience in the clinical healthcare areas or experience in HIT.

    Take for example, Jo Ann Klinedinst, VP of Education. I read she has no degree in education and no previous educational experience. She has two credentials. Yet she controls what HIMSS offers as seminars to obtain CEUs, and decides what seminars are offered during HIMSS annual conferences to educate the HIT community. WHY?

    I read that Lisa Gallagher, Senior Director Privacy and Security, began employment at HIMSS in July 2006. Her HIMSS bio states before joining HIMSS, she served as the Certification Development Director for CCHIT. She founded Javelin Technology Group, LLC, an information technology and security consulting firm in 2008:
    I must note that HIStalk stated in its 2.23.09 issue under “More About CCHIT” that it was “Guy Paterson, who was previously CCHIT’s director of certification development according to his LinkedIn profile (although it also lists him as currently employed by CCHIT, so it’s not entirely clear). According to CCHIT meeting minutes, he left in July 2007. Perhaps he’s contracting back to CCHIT at a handsome rate.”

    Perhaps Ms. Gallagher followed in Paterson’s footsteps. I read Ms. Gallagher is still working for CCHIT, perhaps contracting under Javelin Technology consulting group? She is listed under CCHIT staff Pat Wise (who is also HIMSS VP of HIS). Gallagher’s LinkedIn bio states she contracted to work for CCHIT, after she was employed at Javelin? The dates of employment between CCHIT, HIMSS and Javelin just don’t add up.
    There appears to be a revolving door between HIMSS and CCHIT. They are all connected, and they all need to be put out of the industry.

  8. Unlike most talking heads who have an ‘expert opinion’ on healthcare here in the U.S., and what ails it and how to fix it…and have never traveled outside their suburban minivan driving neighborhood… I have been in hospitals in Canada, UK, Belgium, Denmark, Finland, Switzerland, Brazil, Uruguay, Paraguay, Mexico, Puerto Rico, and at times (unfortunately) needed ehem…healthcare.

    If you don’t like our healthcare….find a better one and move there!

    Now that would lower the cost of HC here!

  9. The problem with socialized medicine as found in Canada and the UK isn’t that it’s always terrible (and it certainly isn’t uniformly good), but that it is extremely variable and the patient has little or no control.

    For example, in the UK, if there are a number of family doctors in your area then you have a choice. If you live in an area where there is only one family doctor, you have no choice and you will wait 6 weeks for an appointment.

    Similarly, some parts of the UK allowed Herceptin as a treatment for breast cancer but other parts did not. But the people living in an area where herceptin was not approved could not get it without moving to a new area. Furthermore, they couldn’t just pay for it because the NHS took the view that by paying for any part of treatment you had to pay for the whole lot.

    So overall, the problem is that when/where the socialized system falls down, the individual has little or no power to correct it themselves.

  10. It is rumored Carla Smith is being groomed to replace H. Stephen Lieber when he retires or steps down. It is her face that appears in Washington, so she is known inside the beltway. Dave Garetz, HIMSS Analytics CEO, would make a better replacement. Mr. Garets has 30 years of experience in IT and was Group Vice President, Healthcare Industry Research and Advisory Services at Gartner, Inc.

  11. House: oh right, because the people here in the US without insurance have so much power to make things better for themselves. Or for that matter, people WITH insurance have so much power to appeal denied treatments and claims.

    Please. Nobody’s saying that socialized medicine is perfect, but if you’re going to argue against it at least use examples where the US system is noticeably better. But you can’t – I’ve yet to hear a single argument of why our system is so much better than the one every other industrialized nation in the world uses, aside from vapid generalities about the “free market” (as if!) and inarticulate fear mongering about “socialism”. The bottom line is this: socialized medicine gets better outcomes by every measurable metric (life expectancy for ex) and costs less. What more do you want?

  12. BlueDog, it seems you discovered Lieber’s/Zitowsky’s favorite children, who start off as CCHIT insiders going to work only to create positions for themselves as vendors, pulling the rip cord on golden parachutes to come back and cash in as Javelin enterprirses, ISIS or whatever.

    If HIMSS receives any part of the $32 billion ARRA, we can expect massive expansion of the incubator for producing many more circus performers.

    [From Mr. HIStalk] I appreciate the HIMSS discussion, but I’m not comfortable allowing comments that put HIMSS employees in an unflattering light since that’s really not fair to them unless the information is relevant, factual, and from identifiable sources. Feel free to discuss HIMSS, its policies, etc. and express whatever opinions you want, but please keep the employees out of it. Thanks.

  13. “If you don’t like our healthcare….find a better one and move there!

    Now that would lower the cost of HC here!”

    Absolute claptrap. It would raise the cost, as any free market economist would tell you. The less people insured the small cohort the risk is shared between translating to higher costs. Even the insurance companies say the best way of reducing costs is to get everybody insured. They don’t want a public option and the drug companies don’t want the V.A to be able to negotiate on drugs, but they are all in favor of having as many people insured as possible.

    People can say what they want about Canada, U.K or France, but the OUTCOMES in those countries are far better than the U.S across the board. From childhood mortality to oncology. And that disparity is getting worse, not better. And so is the cost differential. The U.S pays twice as much per person for care and gets worse results. No amount of isolated scare stories change that.

    The WHO has a nice tool that allows you to compare mortality for any country;


  14. Quite right blah – Jefe is not a good spokesman for the free market. Your link concerning outcomes is worthy of some serious consideration. Most of the WHO reports, as I have posted previously, look at indicators that are biased in favor of a socialized system, but this is something I have not seen before.
    Cassis, your system does seem to bear the brunt of our ire, and perhaps it is not fair. However (I say this with friendship and amity for our neighbors to the North), worry about your own system; we will handle ours. In the same way that I don’t care what teachers’/nurses’ unions have to say on pending legislation, I don’t care that a Canadian med student thinks that Canada’s system is best.
    You single-payer folks seem to work under 3 premises so far as I can see: 1) healthcare (which is a business transaction), is a right, 2) no one should ever have to pay anything out of pocket when they receive health services, and 3) providers of health services (and especially insurers) should not make a profit. Does that sound about right?
    What all of these discussions seem to miss is whether or not these premises are well-founded. 1) is contested by many, so let’s bypass it. 2) why? Why is it wrong to introduce competition between providers (people paying out of pocket shop around, and only competition can reduce costs). 3) Why is it wrong for highly-skilled knowledge workers to profit by that skill? What other motivator will bring the best and brightest to the field?
    HIT Guy – we have no free market in healthcare. Arguments that we do are either: 1) ill informed, or 2) arguing for the (re)introduction of free market principles, which allows for more competition.

  15. Wompa1:

    thank you for your comment! I just want to clarify that I don’t necessarily think the Canadian system is best (I do recognize that it has problems, which I see all the time), but rather that I am frustrated with the constant villification of our system as a nonfunctional, scary, socialist demon. While I do believe health care is a right (just like public education), I am not married to a single-payer system and honestly think that anything that will protect and provide for the uninsured in the US (and prevent those deaths resulting from claims denial by insurance) will be a good thing for my neighbours to the south, both from a humanitarian perspective and a cost perspective. I’m not against competition among insurers (or profit – after all, I’m a Canadian, not a communist). I’m all for any solution you guys come up with, so long as it works.

  16. Wompa, agreed they are biased because of the uninsured in the U.S, that much is for certain. But also biased because when point of care is low cost (there isn’t a single payer system in the world that is entirely free at point of care), preventative care plays a bigger role than it does here. I think that’s one of the best arguments for single payer or socialized medicine.

    As for free markets, how “free” do you want them? As far as I can see the only true free markets are in places like Somalia. Should we remove our own socialized systems like the V.A and Medicare? Should we ban OR deregulate insurance companies in the quest for free markets? When I say ban, do we have an open market where individuals purchase care as needed on an individual basis? For all the knocking down of socialized healthcare I want more specifics about a free market solutions. When I buy consumer goods I look around, use tools like the internet and find the cheapest place to purchase. Insurance just spreads cost over time, nobody purchases goods or service like that in other sectors. Would a co-op be a better option of health savings accounts? The fact is the people against this administrations reforms have not outlined any specifics in decades. There are no other advanced plans for reform. Where have the Republicans been on this?

    I am somewhere in the middle, I am a choice person. Let’s have a public plan, let’s get as many insured as we can (including a removal of pre-existing condition exclusions) and the best system will win. Surely private enterprise would be more competitive than an unsubsidized Government run system anyway?

  17. Cassis, if I mischaracterized your statement, I apologize. We’ll agree to disagree on “rights,” since Natural Law recognizes no right to healthcare services, or public education. The idea that a childless couple or spinster should pay for my child’s education is just as ludicrous as sending my doctor bill to the taxpayers.
    I’m interested in this idea that socialized systems control costs (relative to freer markets). It flies in the face of everything taught in economics. while I am not well enough read on the cost breakdowns, I think I can logically suggest that:
    1)Mixed systems (like ours, which is NOT a free market) which artificially restrict market forces, and mixed with heavy regulation, produce higher costs than neighboring socialized systems.
    2)The US does not cap drug prices, and other nations benefit from this. If the drug maker could not profit by its work, it would cease to work. Europe and the Commonwealth are beneficiaries of America’s commitment to the free market. In a sense, we subsidize your drugs, because your price caps would (without us), act as a disincentive to new drug development. We pay higher prices and everyone else benefits.
    3) Given the American fetish for litigation, I suspect (do not know) that the medical malpractice industry adds significantly to our costs, relative to those of other nations.
    4) The WHO reported that the US does have far greater (meaning immediate) access than others. Do we pay extra for that? I’m sure we do.
    5) Socialized systems would be MORE expensive than a free market healthcare system, but we have no model for comparison (with the possible exception of cosmetic surgery and medical tourism).
    That competition in a free market will lower price and increase quality is a well accepted principle of economics. Healthcare is not immune. Does anyone argue that a socialized system can produce lower costs than the free market, while delivering the same quality (in whatever market)? I don’t think you can find an example. The humanitarian angle is the motive for moving away from free market healthcare. The question them becomes: do we surrender our property rights and move to a less costly socialized system (relative to our current system), OR move toward free market incentives for the care of the poor, which along with charity, would better provide care to the indigent, while producing greater choice, higher quality, and lower cost for the (vast) majority?

  18. Blah – absolutely right on the Repubs. They do not have a vision for free market HC. They do not support the free market, despite the fact that it works every time it is given a chance (look at China – their prosperity has increased exponentially since they began to adopt freer policies in their markets). the GOP truly is “the party of ‘no'”
    How many hospitals in this country were founded as religious charities? How many children do the Shriners treat at no cost? Charity works. Insurance is not evil, but the less they can exclude high cost patients, the higher all premiums will be. Maybe we’re okay with that. We all pay MORE than we ought for car insurance to cover uninsured drivers, right?
    What if providers received big tax breaks for treatment of the poor/uninsured? that’s a free market incentive (to the extent that paying taxes is compatible with free markets!).
    Why do people believe that faith-based missions to care for the poor will cease to exist? If anything, I think they would expand to fill a void. They don’t do it now, because they cannot compete with “free” gov’t care. Look to other relatively free markets. The tech industry is still largely untouched by Washington. there are solutions out there that don’t involve the “soup kitchen of the welfare state.”

  19. I am also for choice, competition and having a public plan. Many of my friends and family have been laid off. Their health insurance was tied to their former employer, and their only option was a COBRA plan. How can one afford COBRA while receiving unemployment benefits? I like the idea of an individual choosing what company to work for based on what the company has to offer, and not be forced to make an ill-fated career choice simply to obtain health insurance benefits. Too many are scared to make a career move because their health insurance benefits are tied to their employer. If a person is not happy in their job, it slows down productivity and innovation. The U.S. is in a position to learn from other countries: pick and choose what works for us at a reasonable cost. But the public plan should not be free.

  20. Re: HIT Guy: “the people here in the US without insurance have so much power to make things better for themselves. Or for that matter, people WITH insurance have so much power to appeal denied treatments and claims.”

    Surely people in the US have more control over their fate (through choice of insurance provider, plan, and employer) than people under national healthcare systems where there is no choice of system. People in the UK have no more ability to appeal denied treatments and claims, and also cannot switch provider or employer to make a consumer choice.

    The US is better for one key reason: I choose which doctor to see (within the limits of my ability to pay and insurance coverage), and usually that doctor is available to see me in reasonable time. That is exception, not the rule, in national healthcare systems.

    And anyway, most national healthcare systems spawn the creation of the “supplementary insurers”. For example, my sister in the UK found a lump and was given a date 9 months out for an NHS mammogram because she was in a low risk category. Her boyfriend had a job that included supplementary coverage, so she went through that insurance to get a mammo the following week. So wealth dictates healthcare service levels anyway.

    Finally, everyone needs to avoid assuming that correlation means causation. There is a strong correlation between my being asleep and the sky being dark, but neither activity causes the other to occur; the causal linkage is much more complex.

    Specifically, suppose there is a correlation between national healthcare systems and life expectancy. You would be foolish to bet $1 trillion + dollars on the fact that the healthcare system is causing the life expectancy without evidence of that specific causal link. Maybe some other factor (e.g. the lack of malpractice lawyers, lower stress levels in the workplace, eating more fish and less hamburgers, etc) cause longer lives AND a desire for society to provide healthcare to all. If the causation worked in that way, the US would spend a huge amount of money on a new healthcare system and make no impact on the outcomes at all.

  21. House Says: “Specifically, suppose there is a correlation between national healthcare systems and life expectancy. You would be foolish to bet $1 trillion + dollars on the fact that the healthcare system is causing the life expectancy without evidence of that specific causal link.”

    I was told there would be no math or statistics involved in tonight’s debate. – Paraphrase from SNL skit with Chevy Chase playing Gerald Ford. LOL.

  22. “People in the UK have no more ability to appeal denied treatments and claims, and also cannot switch provider or employer to make a consumer choice.”

    There are no denied treatments or claims under socialized medicine. Doctors choose the treatment – not “bureaucrats” as dishonest politicians like to claim. And they can see any provider they want. In fact there’s no concept of ‘switching’ providers. They can go anywhere they want.

    As for the idea that there’s no correlation between care delivery and patient outcomes on a national level, I’m not quite sure what to say to that – that’s asinine. I suppose the tobacco companies are still denying correlation between lung cancer and smoking. And if that were the case, why bother to change it in any way whatsoever?

  23. HIT Guy is categorically wrong in his understanding of the way the national healthcare system works in the UK (and, I understand, Canada although I am less familiar with the details of that system).

    In the UK, a person must (a) go only to the Family doctors serving your zip code — of which there may only be one, and (b) cannot see a specialist unless referred by your family doctor. So people cannot in any sense of the words “go anywhere they want” under the UK NHS.

    Second, although the model is not one of claims and payments, treatments are approved by the NHS management (bureaucrats?) for use. There was a big stink recently because some UK regions did not allow the use of herceptin for breast cancer treatment, whereas others did (see: http://herceptin.dorothygriffiths-bcaf.org.uk/news-archive-apr06.html). This particular issue was resolved in 2006 when the NHS finally agreed to make herceptin available everywhere. This is functionally equivalent to a “denied claim” in the US.

    Finally, my point is not whether the correlation exists. Often, correlation is easy to show statistically. My point is that correlation is not synonymous with causation; the observed correlation can be caused by factors not observed or even known about. For example, malaria is extremely highly correlated to a warm climate. Does malaria cause the climate to be warm? No. Does the warmth cause malaria? No (you can’t sit in a cold room to prevent or cure malaria). It took years of research (and the building of the Panama Canal) to establish that mosquitoes, which thrive in warm climates, transmit the parasites that cause malaria. To eradicate malaria from Panama, the US had to eradicate the specific variety of mosquito that carried it — typically by ensuring there were no standing pools of water for the mosquitoes to breed. So the correlation between warm climates and malaria is interesting, but not useful in isolation for the eradication of the disease.

    Therefore, before taking action on anything you need to establish (a) correlation and (b) that you understand what causes the correlation to exist. Without that, taking any action will be a shot in the dark.

  24. blah:

    Have you checked mortality rates for say….breast cancer in Canada? How about the formulary list for cancer fighting drugs in the UK?

    Nice! Tally another vote for “take two aspirins and call me when your cancer is stage IV…” healthcare.

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  1. Unfortunately, I can't disagree with anything you wrote. It is important that they get this right for so many reasons,…

  2. Going out on a limb here. Wouldn't Oracle's (apparent) interoperability strategy, have a better chance of success, than the VA's?…

  3. Dr Jayne is noticing one of the more egregious but trivial instance of bad behavior by allegedly non-profit organizations. I…

  4. To expand on this a bit. The Vista data are unique to Vista, there are 16(?) different VISN (grouped systems)…

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