Now that the legislative language of the HITECH Act — the $20 billion health IT allocation within the economic stimulus package — has been set, it’s time to identify a National Coordinator (NC) for Health IT who can capably lead that office. As many now realize, the language of the Bill can be ambiguous, requiring wise regulatory interpretation and execution to ensure that the money is spent well and that desired outcomes are achieved. Among other tasks, the NC will influence appointments to the new Health Information Technology (HIT) Policy and Standards Committees, refine the Electronic Health Record (EHR) technology certification process, and oversee how information exchange grants and provider incentive payments will be handled.
So I’m in
DC figuring out how the East coast medical policy elite tries to change the world. While the rest of DC is buzzing about Obama’s speech and budget, The Institute of Medicine is having a conference on Integrative Medicine. But most people think it should be called integrative health.
What is integrative health, you ask? Good question.
The majority of the panelists are mainstream health care players like Bill Novelli (AARP), George Halvorson, (Kaiser Permanente), Ralph Snyderman, (Duke). They’re talking about integrating coordinated allopathic health care and information across an individual’s personal health plan. Snyderman, said we need to move from “find it, fix it” to a “personal health plan”. Halvorson said (surprise, surprise) that we need electronic health data on every patient, and to not just replicate the current silos of care in our new data strategy. Novelli went straight at the environmental factors—smoking, fast food et al. And to not ignore them. Mehmet Oz (he of the Oprah show) said that
The report that Mr. Obama’s Surgeon General choice might be neurosurgeon and CNN medical correspondent Dr. Sanjay Gupta produced an upwelling of strong opinion, particularly in the medical community. Some argued that Dr. Gupta has clearly demonstrated his abilities as an able communicator.
But others said that Gupta lacks the experience, seriousness and focus on public health. (I can’t help thinking that anyone who has achieved working neurosurgeon and national TV commentator status is pretty capable and serious, demeanor notwithstanding.)
And so it is that on Facebook, that Dr. Richard Lippin, a longtime Preventive Medicine physician based in Pennsylvania, has posted a letter he sent to President Obama and Secretary Daschle, urging the consideration of Dr. George Lundberg for Surgeon General.
The header reads: “We need a physician with the gravitas and the moral credentials and authority to use this bully pulpit position to speak for science and values based priority public health issues for all Americans. Dr. George Lundberg fits the bill.”
The letter provides a brief bio of Dr. Lundberg, the brilliantly eclectic, progressive, Alabama-born, down-to-earth physician who has been a visible mainstay of American medicine for decades. Dr. Lippin doesn’t mention Dr. Lundberg’s landmark 2002 book on American health care and reform, Severed Trust. (The title alone provides a lot of insight into Dr. Lundberg’s view of the world.)
But Dr. Lippin does believe the Surgeon General choice is about healing both America and American medicine, He writes, “we have a genuine crisis on many levels in US Medicine. Also we need desperately for the medical profession to regain its moral and ethical foundations and furthermore we also need medical leaders who must regain the trust of the American Public which has been dangerously eroded.
I agree with Dr. Lippin that those are the tasks, and I agree that Dr. Lundberg is a terrifically suitable candidate. Over many years, I have developed a warm friendship with him. It is impossible to not be bowled over by his range and grasp of issues, and by his unswerving willingness to stand clearly and openly for approaches that are tied to evidence and reason. The ultimate critical thinker, his judgments are founded most closely to merit, possibility and an unshakable belief in the correctness of the pursuit of excellence in health.
He is also bold and politically savvy. You don’t become the longest running Editor-in-Chief of the Journal of the American Medical Association (until he got politically at odds with them) and then build Medscape into the most widely read Web resource for clinicians worldwide unless you can continuously strike the delicate balances between science, sensibility and moral imperatives among your peers.
I can’t say whether Dr. Lundberg would be the best candidate for the job ahead. He has a huge following in the medical community, nationally and worldwide, the result of many, many years of consistently high performance infused with unassailable integrity. Whether he’s the right person for this moment is another issue, though, fraught with the complexities of political consideration, a vision consistent with the larger plan of the Obama team, fluency with the bewildering array of new technologies that are changing the face of medicine and the patient-physician relationship, and so on.
But Dr. Lippin makes an important point. American medicine is demoralized in the field. Overt, rampant financial conflict has caused many to believe that the profession has lost its compass. With that loss, the trust of patients and the authority that trust conveys have also diminished.
Restoring that trust and authority isn’t simply a matter of leadership or preaching, but will depend on fundamentally changing the business of medicine, a much larger task indeed that will require an orchestrated effort by all of us, not just physicians.
But the new Surgeon General, whoever he or she is, should be grounded first in science, evidence and best practice, in tirelessly advocating and maneuvering for a care delivery system that is as advanced and nuanced as the diagnostic and treatment approaches we’ve developed, and on advancing the health of ALL our people in ways that leverage rather than squander increasingly precious resources.
While there is no question that Dr. Lundberg is worthy, I’d be surprised if the call for his consideration is heard in the din of this transition. Even so, it is deeply gratifying to see an outpouring of support by his peers, the result of successfully dedicating his life to advancing medical knowledge and its best application.
This is a reprint of the letter originally posted to Facebook.
Dear President Obama and Former Senator Tom Daschle:
As a physician leader in the medical specialty Preventive Medicine for 30 plus years, I am writing this open e-letter to you to strongly urge you to consider George D. Lundberg, MD as our nations next U.S. Surgeon General.
My letter relates to the distinctly unique qualifications that Dr Lundberg would bring to this important position and to express my views about the position itself since various previous administrations have held variable views on how to define the activities of the position itself. And the “power of personality” of some of our best US Surgeon Generals has influenced the perception of the role.
This week, Don Berwick will announce the results of the 5 Million Lives Campaign
before thousands of people in Nashville attending the National Forum on Quality Improvement in Health Care.
Twenty years ago, it was almost heretical to question the quality of American health care. The common refrain being that it was unarguably the best in the world.
Decades of work by Berwick and others, however, have dispelled that myth, and the underlying belief that medical errors and hospital acquired infections are simply an artifact of the business. These quality champions deem it unacceptable that as many as 98,000 Americans die annually from preventable medical errors, and that most Americans receive the recommended care only half the time. They’ve spent years building their case, and in turn created a social movement around their cause.
In the book, "The Best Practice," Charles Kenney chronicles this long march toward a culture within American health care that demands continuous quality improvement.
The American Medical Informatics Association will announce today that it has received a $1.2 million grant from the Bill and Melinda Gates Foundation to promote health informatics and biomedical education and training worldwide, particularly in developing countries.
This will be the first project of a new program called 20/20, in which the International Medical Informatics Association
and its regional affiliates, including AMIA, will attempt to train
20,000 informatics professionals globally by 2020. This is an outgrowth
of the AMIA 10×10 program to train 10,000 people in informatics in the U.S. by 2010. IMIA will present details of 20/20 this week at the Wellcome Trust in London.
will use the Gates Foundation money to develop "scalable" approaches
to e-health education, including a replicable blueprint for training
informatics leaders, including physicians, medical records
professionals, computer scientists and medical librarians.
Every 9.5 minutes, someone in the United States is infected with HIV. Every 33 minutes, someone in the U.S. dies from AIDS.
While great gains have been made in the fight against HIV, still more than 53,000 new HIV infections occurred in 2006 and it predominately burdens minority communities. Young, black men and women are at the highest risk of new infection. The HIV incidence rate for black females is nearly 15 times the rate for white females, according to the CDC.
Today is the 20th anniversary of World AIDS Day. Here are some links to excellent summaries of the progress in fighting HIV in the U.S. and around the world.
Taxing cigarettes is the single-most effective way to lower smoking rates, particularly among youth. And if we could lower smoking rates, we’d save hundreds of thousands of lives and billions of dollars each year.
In a related matter, I heard Matt Myers, president of Tobacco Free Kids, recently predict a federal cigarette tax increase to fund SCHIP. He said there’s strong bipartisan support, particularly to fund an expansion of children’s health coverage.
The official campaign ended earlier this year with 1,000 blogs and websites displaying the purple ribbon, but ribbons are still available for creating. For each ribbon created, Caring.com donates $10 to the Alzheimer’s Association for education programs.
Anyone who wants to help
raise awareness for Alzheimer’s disease can create a free web ribbon with just a few clicks. You can personalize the ribbon with a
loved one’s name and it comes in different shades and sizes to
match your website or blog.
Also, if you’re an adult child or caregiver caring for a parent or loved
one with Alzheimer’s, visit the Alzheimer’s and Other Dementias section
of Caring.com for helpful information and resources.
Today is the Great American Smokeout, and while San Franciscans are doing their part to help people battle nicotine addiction, I became aware recently that not all the health insurance plans for our county workers in San Francisco — nor in many other counties around California – were covering all of the smoking cessation benefits recommended by the Center for Disease Control.
The City of San Francisco has embraced a multi-faceted approach to reduce tobacco use, while protecting individuals from insurance coverage barriers as they battle their addiction to nicotine:
- We have endorsed a policy calling on the health plans that provide health insurance coverage for City and County employees to offer comprehensive smoking cessation benefits consistent with Centers for Disease Control and Prevention guidelines.
- The City of San Francisco covers smoking cessation services and treatments for the uninsured.
According to the CDC, the most effective health insurance benefits are those that include patient reimbursements for smoking cessation counseling and FDA-approved pharmacotherapeutic treatments, and reimbursements to clinicians for providing tobacco dependence treatment, just as they are reimbursed for treating other chronic conditions.