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Bev MD emailed us in jest in response to "A Shakespearean Approach to Health care reform"           

"Whew, from your post's title I thought you were going to say, "First, let's kill all the doctors."

The thread on David Kibbe's post on "The Health IT chasm" continues to be an interesting discussion. Frog design's Stephen Sutton had this to say.

"As a designer active in developing healthcare solutions (hardware and software), I think it is worthwhile to consider the role of the design process used to develop medical IT, as a key contributor to its evident failure. Driven largely by a nightmarish regulatory environment, medical design projects tend to follow a dysfunctional process where much more attention is given to creating a paper trail than actually discovering and meeting the needs of end-users."

Scott had this comment in response to "The Importance of Being Charles Grassley"

"I like Grassley too, but why the worship of bipartisanship? There are only two structural reasons to seek a lot of Republican consensus: to get around/over a potential filibuster and to entrench the legislation so that a future change in government does not lead to its repeal.

David Kibbe had this to say in response to Bob Wachter's post on Medical Tourism's potential in tough economic times.

"I predict we'll also see US Medical Tourism, that is, states where care is much cheaper will attract patients to their facilities.  Not so exciting as India, perhaps, but Montana's not a bad place to go for your knee replacement, right?"

Grena Porto wrote in with additional background on Alan Rosenstein MD's post "Disruptive Physician Behavior: Fact versus Frenzy."

As a member of the Joint Commission's Sentinel Event Advisory Group and a champion of its efforts in this area, I would like to add a few comments to Alan Rosenstein's excellent posting:  1) the requirements in the JC's standards as well as the guidance in the alert released in July of 2008 clearly state that this applies to everyone, not just physicians.  2)  the work of Alan Rosenstein and ISMP clearly show that the behavior in question is not limited to physicians.  3)  although physicians are not the most frequent disrupters, their behavior tends to have the largest impact because of their relative power in the organization.

Alix Sabin offered this observation in response to Richard Reece's much-discussed "Confessions of a Cultural Anthropologist: The Real Cause of High Health Care Costs."

There is an inherent ticking time bomb in the health care industry’s business model. Health insurance is based on “young and healthies” buying coverage, but not needing care. It reminds me of the business of derivatives and sub-prime mortgages.

Terhilda wrote in response to "Health 2.0 will benefit from Obama's Health IT Stimulus"

"I have been studying the impact of EHRs in KP for 8 years.  The KP Hawaii article reflects early experience with an early attempt at an EHR ('CIS') ultimately  not used by the organization.  Our experience with our EHR,  'KP HealthConnect' is that there are benefits and value generated by the EHR with right leadership for    implementation and the right physician leadership to leverage the tool.  A forthcoming article in Health Affairs elaborates on some of those impacts, in fact, in the region of Hawaii.   There are many ways to do a thing wrong.  No solutions in the complex arena of healthcare are 'bullet-proof'.  We try to keep our eye on the possible and move to that."

Deron was critical of last week's Sam Neill's op-ed on "Small Business and Health Reform."

"This
is not the pulse of the "small business community".  It is the pulse of
the small business community that supports a total government solution.
You want to know what my small business is doing?  We're investing in
wellness programs that actually have the potential to make our
employees healthier.  We're paying for gym memberships, offering free
yoga and free nutritionist consults, among other things.  That's how
you address issues directly."

Goldenstatr had this rather pointed comment on "Tom Daschle on Healthcare Reform."

"The ca micra law is totally unfair. It is a "one size fits all" solution put into play 30 years ago with     absolutely no cost of living adjustment. Hospitals and doctors get an exemption from the law and virtually answer to nobody. A loved one who is killed by a doctors negligence is awarded the same amount of money as a patient who had the wrong "pinky" finger operated on. Lawyers will very seldom take a ca. malpractice case unless there are substancial economic losses by the plaintiff.

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