David Longstreet had this to say in response to Andre Blackman's post last week on the the increasing importance of technology in public health. ("Why Technology is No Longer Optional in Public Health."
"the biggest change in software technology is the growing trend of specialization along industry disciplines. The healthcare field is too complex for "generalist" software developers. Those software organizations that specialize in healthcare have productivity and quality rates orders of magnitude higher than generalist firms.
This should not surprise anyone in the healthcare discipline because healthcare has understood the value of specialization for some time now. Unfortunately there are still software firms whose employees work for a bank one week and a hospital the next week…."
Christopher George wrote in reply to Bob Wachter's piece on the implications of comparative effectiveness research. ("Are We Mature Enough to Make Use of Comparative Effectiveness Research?")
"Because the only case which you discuss is one in which supposedly greedy doctors perform ineffective surgery for profit, one might be left with the impression that the principal problem in healthcare is restraining rapacious doctors.
It is well known in certain segments of the medical community that back surgery, and cardiac angioplasty are largely ineffective. It is also well known that regulators with government sponsorship have a limited grasp of statistics and science, and an uncanny tendency to target effective procedures as often as stupid ones. Don't be surprised if you don't like the result once a soviet style Supreme Extra-ordinary Medical Committee makes enforcable decisions about what heathcare is on your treatment menu.
Remember an early target of those who would use government to eliminate medical progress: The CT scan. The assault on the Cat scanner was nearly successful. When you torture the data enough, a CT scanner can seem like a silly thing to use. Why not practice like they did at the dawn of time?"
John Lynn wrote in to address John Haughton MD's prediction that the majority of doctors will pay less than $10K a year for EHR service.
"There already are a number of EHR (sic) in the $10k a year range. The question is how many of the CCHIT certified EHR are in that range. Not very many. If CCHIT becomes the certification criteria that HHS uses, then your prediction will not come to fruition.
Also, don't be at all surprised if many doctors ignore the stimulus altogether. Those that do pay attention will hear about the missing bonus payments from ePrescribing due to some government requirement and shy away from this stimulus as well.
JD had this response to Maggie Mahar's post arguing that tax increases will be needed to pay for the sweeping changes to the healthcare system planned by the Obama administration …
I'm all for realism when it comes to what we can accomplish in the next few years, but to say that we need to pay higher taxes, without saying that this is temporary and only until we are able to reform our system from being the most wasteful in the world, seems to miss the mark and not set us up well for subsequent rounds of reforms that must eventually come. Also, since we are in a deep recession, this is the one time I disagree that we need to pay-as-you-go. I mean, are we not Keynesians here? New taxes need to be few and far between right now, and focused very narrowly so that they don't harm the economy. Better to give more people coverage in 2009 and 2010, deficit spending to do it, then try to bring the hammer down on costs after that, rather than raise taxes.
Randall Oates MD liked what Val Jones MD had to say in this morning's post on improving physician performance. ("How to Win Docs and Influence Patients.")
"Amen! Building on the approaches that show evidence of success will meet far more success than theoretical, centralized planning attempting to force change. In my role promoting physician adoption of EMR’s, I have opportunities to relate to dozens of physicians every week. Most physicians are very interested in better use of information technologies, and most are already demoralized by the controlling entities attempting to force square pegs into round holes. "