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Should Hospitals Install Bar Coding or CPOE First?

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By Bob Wachter

Robert Wachter is widely regarded as a leading figure in the modern
patient safety
movement. Together with Dr. Lee Goldman, he coined the
term "hospitalist" in an influential 1996 essay in The New England
Journal of Medicine. His most recent book, Understanding Patient
Safety, (McGraw-Hill, 2008) examines the factors that have contributed
to what is often described as "an epidemic" facing American hospitals.
His posts appear semi-regularly on THCB and on his own blog "Wachter’s World

This is one of the most commonly asked questions in IT World, and my
answer has always been “CPOE first” – largely because that has always
been David Bates’s (the world’s leading IT/safety researcher) answer. But I’ve changed my mind. Here’s why.

Before I start, I promised
that I’d let you know if I ever blogged on a topic in which I have a
financial conflict of interest. On this, I do: I serve as a paid member
of the Scientific Advisory Board of IntelliDOT, a company that makes a
stand-alone bar coding system. If that freaks you out, stop reading.
But recognize that if you had asked me the “bar coding or computerized
provider order entry?” question last week, I would have answered “CPOE”.

Continue reading…

WSJ analyzes specialist pay

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By Eric Novack

On the front page of Today’s Wall Street Journal is an article entitled, “Medical Specialties Hit by a Growing Pay Gap”.

A few passages worth thinking about:

"Many in health-policy circles have focused on how the current health-care payment system is helping create shortages among primary-care doctors, internists and others on the front lines of medicine. But often lost is how the system is endangering some of the country’s most highly trained specialties as well."

And later…

"… Medicare implemented a new system to set standard fees for physicians’ services and procedures. The system’s aims were to clamp down on prices and, ironically, narrow the disparity between the bread-and-butter office visit and more-expensive specialty procedures. (emphasis mine) Over time, private insurers have taken their cue from Medicare to set their reimbursements, too."

And one more…

"Medicare officials say the government program tries to address cost disparities by continually reviewing its fee schedule but says it relies a lot on medical-specialty societies to raise such issues."

"We want to make sure that payment is appropriate and that includes not underpaying," says Terrence Kay, senior adviser to the director of the Center for Medicare Management.

Marrying for health care

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By Sarah Arnquist

About 7 percent of Americans recently reported in new Kaiser Health Tracking Poll that someone in their household got married so they could get health benefits. While 7 percent may be a bit high, I have no doubt some people consider health benefits when deciding the timing of their marriage.

I gave similar advice to a friend only a few months back. She had recently moved to Denver with her fiancee, and was temporarily unemployed. She wanted health insurance and could afford to buy it, but she couldn’t get it.

Except for seasonal allergies, she’s a healthy 26-year-old woman. Allergies were reason enough, however, for two insurers to deny her coverage. Her fiancee’s policy only covered spouses. My advice: get married quickly at City Hall and then again eight months later at the planned wedding. (She rejected that idea and found a job after about two months of looking that offered health benefits.)

Under John McCain’s proposed health plan, many more people like my friend may be denied coverage. His solution? Create a high-risk insurance pool. But do allergies make my friend high-risk? I don’t think so. Where do individuals like her fit in?

Over at the Health Access blog, Anthony Wright describes California’s high-risk pool, known as the Managed Risk Medical Insurance Board, or MRMIB. It currently has a waiting list of more than 500 people. Another example of people who want insurance but can’t get it.

Waitinglist_3

A Hat Tip to Pediatrician Dr. Benjamin Spock

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By Brian Klepper

Here’s one of today’s entries in The Writers’ Almanac, the wonderful daily newsletter sent out by Garrison Keillor on NPR. Parents of boomers like me were big fans of Dr. Spock, treating him with an almost cult-like reverence for his sensible wisdom about child care. He later parted ways with some of his more conservative followers, when he became an iconic protester against America’s war in Viet Nam. I wonder whether regular THCB readers will read this and, like me, note that this is the same message Jane Sarasohn-Kahn relates in The Wisdom of Patients. We stand on the shoulders of giants.

It’s the birthday of Dr. Benjamin Spock, (books by this author) born in New Haven, Connecticut (1903). His Common Sense Book of Baby and Child Care (1946) was a best seller during the period after World War II, when parents across America were raising the Baby Boom generation. Spock opened his first pediatric practice in 1933. After 10 years of observing children and their health, Spock decided to write a book about taking care of them. Instead of writing it out himself, he dictated the book to his wife, to give it a conversational tone. Previous parenting guidebooks had encouraged parents to be stern with their children, and they were written as a list of commands. Dr. John B. Watson had written in his guidebook, "Never, never kiss your child. Never hold it in your lap. Never rock its carriage." Dr. Spock encouraged parents to be affectionate, and he also encouraged them to follow their own instincts. The first sentence of his book was, "You know more than you think you do."

The bizzaro world of McCain’s health care politics

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By Matthew Holt

I sometimes write two different versions of pieces, one for you wonks at THCB and one for the more general crowd at Spot-on. Well to be more accurate I write one version which gets edited heavily over at Spot-on, so today here I’m putting up the THCB version of the one that went up on Spot-on yesterday.

My 6 weeks of traveling the world on an extended honeymoon is over. Thanks very much to Brian Klepper and the cast of thousands who’ve been keeping THCB rolling excellently while with my lovely wife Amanda I’ve been diving on coral reefs, sleeping under the stars with the Bedouin, exploring 3,500 year-old tombs, watching Lions tear apart a buffalo, and tracking chimps hanging out in the rain forest. (Pictures of all this and more to come, I promise)

So what better way to return than to enter the jungle of US Presidential politics? Yesterday I sat in on 2 conference calls. One from the McCain camp on their man’s health care proposal, the other from the Campaign for America’s Future, which is promoting Jacob Hacker’s plan as the theory behind both Clinton and Obama’s policy intentions. It wasn’t pretty.

McCain’s proxies were Douglas Holtz-Eakin, sensible former CBO director, and Carly Fiorina, the fired HP ex-CEO who has been rehabilitating herself by taking credit for her successor’s success, and been hanging out on the McCain campaign as adviser for tech. Apparently she’s on the VP shortlist, and if so, we got a lot of taste of what we can expect. The choice is between free market choice, and the government telling your family which doctor it can go and see. Yes, you’re going to hear “government run heath care care” alot as if we’re all moving to the Gulag.

(Carly also made an amusing slip when she said that McCain favored importing of generic prescription drugs. Generic drugs are of course usually cheaper here—it’s re-importation of branded drugs that McCain supports, which will lose him the odd contribution from PhRMA).

But no matter competition and choice is always cheaper—trust her.  But then again Carly knows all about succeeding in the free market, right?

 

Continue reading…

Seventh Annual Information Therapy Conference

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WIxRED: Next Generation Patient-Centered Care As we engage in a national debate about the directions of health care reform, many experts agree that patient-centered care and health information technology (HIT) are critical elements of our future delivery system. The 2008 Information Therapy (Ix®) Conference at the sensational new Newseum will provide a fabulous venue for a national dialog on the intersection of patient-centered care and HIT. On June 12-13, the 7th annual Ix Conference will challenge health care leaders to seize the opportunity for enhanced patient-centered care and system redesign by integrating Ix initiatives into HIT implementation. Click here to learn more.

Who the Health Cares?

By Matthew Holt

After the hotties from Rocketboom, now politics has a daily quickie from another cutie called Lindsay Campbell (the site Moblogic.tv is run by CBS rather than some indie company), but this episode, Who the Health Cares?, points out very sensibly that the Democrats in Congress aren’t really interested in health reform the way that Clinton and Obama say they are.

Lindsay thinks that all the Dems should sign onto the Conyers single payer bill….

CarePages at BIDMC

By Paul Levy

A suggestion from e-Patient Dave after his treatment at our hospital last year prompted us to start offering Carepages to our patients. The idea is to make it easy for people to create and update a private and personalized web page where they can share their latest news with friends and family and receive messages of support. There is no charge to the patient for this service.
Similar services had been available to patients if they made an effort to find them, but Dave was right to suggest that we offer it directly. For some reason, we were a bit behind the times on this matter, and I am glad he pointed it out to us.
Proving again that patients really have good ideas about how to make life better for patients. Duh!

King of the Serengeti

 

While we’re on the theme of the health care jungle, here’s one more for you. This young lion and his buddy spent the night feasting on this buffalo.

While I was away….

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I met this little baby cheetah….

Meanwhile, over at Spot-on I’m up discussing the McCain health care plan and some of the Democratic reactions to it.

My six weeks of traveling the world on an extended honeymoon is
over. With my lovely wife Amanda I’ve been diving on coral reefs,
sleeping under the stars with the Bedouin, exploring 3,500 year-old
tombs, watching lions tear apart a buffalo, and tracking chimps hanging
out in the rain forest.
What better way to return than to enter the jungle of U.S. Presidential politics? MORE As ever come back here to comment.

assetto corsa mods